Dabrafenib and Trametinib Followed by Ipilimumab and Nivolumab or Ipilimumab and Nivolumab Followed by Dabrafenib and Trametinib in Treating Patients With Stage III-IV BRAFV600 Melanoma
Purpose
This randomized phase III trial studies how well initial treatment with ipilimumab and nivolumab followed by dabrafenib and trametinib works and compares it to initial treatment with dabrafenib and trametinib followed by ipilimumab and nivolumab in treating patients with stage III-IV melanoma that contains a mutation known as BRAFV600 and cannot be removed by surgery (unresectable). Immunotherapy with monoclonal antibodies, such as ipilimumab and nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Dabrafenib and trametinib may block tumor growth by targeting the BRAFV600 gene. It is not yet known whether treating patients with ipilimumab and nivolumab followed by dabrafenib and trametinib is more effective than treatment with dabrafenib and trametinib followed by ipilimumab and nivolumab.
Conditions
- Metastatic Melanoma
- Recurrent Melanoma
- Stage III Cutaneous Melanoma AJCC v7
- Stage IIIA Cutaneous Melanoma AJCC v7
- Stage IIIB Cutaneous Melanoma AJCC v7
- Stage IIIC Cutaneous Melanoma AJCC v7
- Stage IV Cutaneous Melanoma AJCC v6 and v7
- Unresectable Cutaneous Melanoma
Eligibility
- Eligible Ages
- Over 18 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- STEP 1
- Eastern Cooperative Oncology Group (ECOG) performance status: 0 or 1
- The effects of dabrafenib and trametinib or ipilimumab and nivolumab on the developing human fetus are unknown; furthermore, dabrafenib has been reported to interfere with the effect of hormone based oral contraceptives; for this reason and because other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and sexually active males must agree to use at least two other accepted and effective methods of contraception and/or to abstain from sexual intercourse for the duration of their participation in the study, and for at least 4 weeks after treatment with dabrafenib or for 4 months after dabrafenib in combination with trametinib; women of child-bearing potential must use at least two other accepted and effective methods of contraception and/or to abstain from sexual intercourse for at least 5 months after the last dose of nivolumab and/or ipilimumab and sexually active males must use at least two other accepted and effective methods of contraception and/or abstain from sexual intercourse for at least 7 months after the last dose of nivolumab and/or ipilimumab; should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform her treating physician immediately
- Patients must have unresectable stage III or stage IV disease
- Patients must have measurable disease; all sites of disease must be evaluated within 4 weeks prior to randomization
- Patients must have histological or cytological confirmation of melanoma that is metastatic or unresectable and clearly progressive
- NOTE: Any patient with BRAF V600 mutant melanoma (whether cutaneous, acral or mucosal primary) who meets the eligibility criteria is eligible for participation in this trial; patients with uveal melanoma are not eligible for this trial
- Patients must have BRAF V600 mutation, identified by a Food and Drug Administration (FDA)-approved test at a Clinical Laboratory Improvement Act (CLIA)-certified lab; if test at CLIA-certified lab used a non-FDA approved method, information about the assay must be provided (FDA approved tests for BRAF V600 mutations in melanoma include: THxID BRAF Detection Kit and Cobas 4800 BRAF V600 Mutation Test, Foundation Medicine); prompt information on tumor BRAF mutation status can also be obtained via Novartis "knowNow" Program
- Patients may have had prior systemic therapy in the adjuvant setting; however this adjuvant treatment must not have included a CTLA4 or PD1 pathway blocking antibody or a BRAF/MEK inhibitor; also, patients may not have had any prior systemic treatment for advanced (measurable metastatic) disease
- Patients must have discontinued chemotherapy, immunotherapy or other investigational agents used in the adjuvant setting >= 4 weeks prior to entering the study and recovered from adverse events due to those agents; mitomycin and nitrosoureas must have been discontinued at least 6 weeks prior to entering the study; patients must have discontinued radiation therapy >= 1 week prior to entering the study and recovered from any adverse events associated with treatment; prior surgery must be >= 2 weeks from registration and patients must be fully recovered from post-surgical complications
- White blood count >= 3,000/uL (obtained within 4 weeks prior to randomization)
- Absolute neutrophil count (ANC) >= 1,500/uL (obtained within 4 weeks prior to randomization)
- Platelet count >= 100,000/uL (obtained within 4 weeks prior to randomization)
- Hemoglobin > 8 g/dL (obtained within 4 weeks prior to randomization)
- Serum creatinine =< 1.5 x upper limit of normal (ULN) or serum creatinine clearance (CrCl) >= 40 ml/min (obtained within 4 weeks prior to randomization)
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x ULN (=< 5 x ULN for patients with documented liver metastases)
- Alkaline phosphatase =< 2 x ULN (=< 5 x ULN for patients with known liver involvement and =< 7 x ULN for patients with known bone involvement) (obtained within 4 weeks prior to randomization)
- Total bilirubin =< 1.5 x ULN except subjects with normal direct bilirubin or those with known Gilbert's syndrome (obtained within 4 weeks prior to randomization)
- STEP 2 (CROSSOVER ARM FOR PATIENTS WITH PROGRESSIVE DISEASE): The patient must have met all eligibility criteria (except as detailed below) at the time of crossover
- RECIST defined measurable disease is not required
- Only prior systemic therapy as part of step 1 is allowed; patients who received allowed systemic therapy in the adjuvant setting prior to Step 1 and were eligible for Step 1 are not excluded from proceeding to Step 2 if they meet other eligibility criteria
- Malabsorption, swallowing difficulty, or other conditions that would interfere with the ingestion or absorption of dabrafenib or trametinib, or history of retinal vein occlusion are acceptable for patients crossing over to ipilimumab + nivolumab treatment
- History of autoimmune disease, excluding interstitial lung disease or pneumonitis, is allowed in patients crossing over to dabrafenib/trametinib therapy
- Patients crossing over from nivolumab/ipilimumab to dabrafenib/trametinib who underwent surgery or SRS to CNS metastases need not be off of steroids to start treatment
- There is no restriction on serum lactate dehydrogenase (LDH) at crossover
- Patients with a history of cardiovascular risks that developed during step 1 of therapy should be discussed with study principal investigator (PI) at time of crossover
- STEP 2 (CROSSOVER ARM FOR PATIENTS WITH PROGRESSIVE DISEASE): Patients must have melanoma that is metastatic and clearly progressive on prior therapy
- STEP 2 (CROSSOVER ARM FOR PATIENTS WITH PROGRESSIVE DISEASE): Patients must be at least 1 week from documented progressive disease (PD) on Step 1 of current study; all sites of disease must be evaluated within 4 weeks prior to registration
- STEP 2 (CROSSOVER ARM FOR PATIENTS WITH PROGRESSIVE DISEASE): Patients must have recovered from adverse events (toxicities resolved to grade 1 or less) of prior therapy; patients with immune related toxicities from ipilimumab + nivolumab may continue onto Step 2 even if still on steroids to control side effects, so long as toxicity has resolved to grade 1 or less
- STEP 2 (CROSSOVER ARM FOR PATIENTS WITH PROGRESSIVE DISEASE): Patients must have discontinued radiation therapy prior to registering to Step 2 of the study and recovered from any adverse events associated with treatment; prior surgery must be >= 2 weeks from registration to Step 2 and patients must be fully recovered from post-surgical complications
- STEP 2 (CROSSOVER ARM FOR PATIENTS WITH PROGRESSIVE DISEASE): The effects of dabrafenib and trametinib or ipilimumab and nivolumab on the developing human fetus are unknown; furthermore, dabrafenib has been reported to interfere with the effect of hormone based oral contraceptives; for this reason and because other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and sexually active males must agree to continue to use the same contraception requirements as on Step 1 of this study (i.e.: use at least two other accepted and effective methods of contraception and/or to abstain from sexual intercourse for the duration of their participation in the study, and for at least 4 weeks after treatment with dabrafenib or for 4 months after dabrafenib in combination with trametinib; women of child-bearing potential must use at least two other accepted and effective methods of contraception and/or to abstain from sexual intercourse for at least 5 months after the last dose of nivolumab and/or ipilimumab and sexually active males must use at least two other accepted and effective methods of contraception and/or to abstain from sexual intercourse for at least 7 months after the last dose of nivolumab and/or ipilimumab); should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform her treating physician immediately
Exclusion Criteria
- Women must not be pregnant or breast-feeding, as the effects of ipilimumab + nivolumab or dabrafenib + trametinib on the developing human fetus are unknown
- All females of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy
- A female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
- Patients must not receive any other investigational agents while on study or within four weeks prior to registration
- Patients are ineligible if they have any currently active central nervous system (CNS) metastases; patients who have treated brain metastases (with either surgical resection or stereotactic radiosurgery [SRS]) could be eligible; patients must not have taken any steroids =< 10 days prior to randomization for the purpose of managing their brain metastases; repeat imaging after SRS or surgical resection is not required so long as baseline magnetic resonance imaging (MRI) is within 4 weeks of registration; patients with multiple brain metastases treated with SRS (with [w] or without [w/o] whole-brain radiotherapy [WBRT]), are not an exclusion; patients with definitive CNS metastases treated with only WBRT are ineligible; patients with potential CNS metastases that are too small for treatment with either SRS or surgery (e.g. 1-2 mm) and/or are of uncertain etiology are potentially eligible, but need to be discussed with and approved by the study principal investigator (PI)
- Patients must not have other current malignancies, other than basal cell skin cancer, squamous cell skin cancer, in situ cervical cancer, ductal or lobular carcinoma in situ of the breast; patients with other malignancies are eligible if they have been continuously disease-free for > 2 years prior to the time of registration
- Patients must not have any serious or unstable pre-existing medical conditions (aside from malignancy exceptions specified above), including but not limited to, ongoing or active infection requiring parenteral antibiotics on day 1, or psychiatric illness/social situations that would limit compliance with study requirements, interfere with subject's safety, or obtaining informed consent; therapeutic level dosing of warfarin can be used with close monitoring of prothrombin time (PT)/international normalized ratio (INR) by the site; exposure may be decreased due to enzyme induction when on treatment, thus warfarin dosing may need to be adjusted based upon PT/INR; consequently, when discontinuing dabrafenib, warfarin exposure may be increased and thus close monitoring via PT/INR and warfarin dose adjustments must be made as clinically appropriate; prophylactic low dose warfarin may be given to maintain central catheter patency
- Patients must not have a history of or evidence of cardiovascular risks including any of the following:
- QT interval corrected for heart rate using the Bazett's formula (QTcB) >= 480 msec. at baseline
- History of acute coronary syndromes (including myocardial infarction or unstable angina), coronary angioplasty, or stenting within the past 24 weeks prior to registration
- History prior to registration or evidence of current >= class II congestive heart failure as defined by the New York Heart Association (NYHA) functional classification system
- Left ventricular ejection fraction (LVEF) =< 45% on cardiac echocardiogram (echo) or multi gated acquisition scan (MUGA)
- Intra-cardiac defibrillator
- Individuals who are known to be human immunodeficiency virus (HIV) infected are ineligible (note: HIV testing is not required for entry into the study)
- Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids, should be excluded; these include but are not limited to patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue diseases, scleroderma, inflammatory bowel disease (IBD), Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome should be excluded because of the risk of recurrence or exacerbation of disease; patients with vitiligo, endocrine deficiencies including thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible; patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome and psoriasis controlled with topical medication and patients with positive serology, such as antinuclear antibodies (ANA), should be evaluated for the presence of target organ involvement and potential need for systemic treatment; if no systemic immune suppression is deemed necessary they can be eligible
- The following medications or non-drug therapies are also prohibited while on treatment in this study:
- Other anti-cancer therapies
- Other investigational drugs
- Patients taking any medications or substances that are strong inhibitors or inducers of CYP3A or CYP2C8 are ineligible
- Patients must not have history of retinal vein occlusion (RVO)
- Patients must not have evidence of interstitial lung disease or pneumonitis
- Patients must not have malabsorption, swallowing difficulty, or other conditions that would interfere with the ingestion or absorption of dabrafenib or trametinib
- STEP 2 (CROSSOVER ARM FOR PATIENTS WITH PROGRESSIVE DISEASE): Patients are ineligible if they have any currently active CNS metastases; patients who have treated brain metastases (with either surgical resection or stereotactic radiosurgery [SRS]) could be eligible to proceed; patients crossing over from dabrafenib/trametinib to nivolumab (nivo)/ipilimumab (ipi) must not have taken any steroids =< 10 days prior to registration for the purpose of managing their brain metastases; patients with only whole brain irradiation for treatment of CNS metastases are ineligible; patients with definitive CNS metastases treated with only WBRT are ineligible; patients with potential CNS metastases that are too small for treatment with either SRS or surgery (e.g. 1-2 mm) and/or are of uncertain etiology are pote
Study Design
- Phase
- Phase 3
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Crossover Assignment
- Primary Purpose
- Treatment
- Masking
- None (Open Label)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental Arm A (immunotherapy) |
IMMUNOTHERAPY INDUCTION (CYCLES 1-2): Patients receive nivolumab IV over 30-60 minutes and ipilimumab IV over 30-90 minutes on days 1 and 22. Treatment repeats every 6 weeks for 2 cycles in the absence of disease progression or unacceptable toxicity. IMMUNOTHERAPY MAINTENANCE (CYCLES 3-14): Patients receive nivolumab IV over 30-60 minutes on days 1, 15, and 29. Treatment repeats every 6 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Upon disease progression, patients re-register and cross over to Arm C. |
|
|
Experimental Arm B (BRAF inhibitor therapy) |
Patients receive dabrafenib mesylate PO BID and trametinib dimethyl sulfoxide PO daily on days 1-42. Cycles repeat every 6 weeks in the absence of disease progression or unacceptable toxicity. Upon disease progression, patients re-register and cross over to Arm D. |
|
|
Experimental Arm C (BRAF inhibitor therapy) |
Patients receive dabrafenib mesylate PO BID and trametinib dimethyl sulfoxide PO daily on days 1-42. Cycles repeat every 6 weeks in the absence of disease progression or unacceptable toxicity. |
|
|
Experimental Arm D (immunotherapy) |
IMMUNOTHERAPY INDUCTION (CYCLES 1-2): Patients receive nivolumab IV over 30-60 minutes and ipilimumab IV over 30-90 minutes on days 1 and 22. Treatment repeats every 6 weeks for 2 cycles in the absence of disease progression or unacceptable toxicity. IMMUNOTHERAPY MAINTENANCE (CYCLES 3-14): Patients receive nivolumab IV over 30-60 minutes on days 1, 15, and 29. Treatment repeats every 6 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity. |
|
Recruiting Locations
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama 35233
Birmingham, Alabama 35233
Anchorage Associates in Radiation Medicine
Anchorage, Alaska 98508
Anchorage, Alaska 98508
Anchorage Radiation Therapy Center
Anchorage, Alaska 99504
Anchorage, Alaska 99504
Alaska Breast Care and Surgery LLC
Anchorage, Alaska 99508
Anchorage, Alaska 99508
Alaska Oncology and Hematology LLC
Anchorage, Alaska 99508
Anchorage, Alaska 99508
Alaska Women's Cancer Care
Anchorage, Alaska 99508
Anchorage, Alaska 99508
Anchorage Oncology Centre
Anchorage, Alaska 99508
Anchorage, Alaska 99508
Katmai Oncology Group
Anchorage, Alaska 99508
Anchorage, Alaska 99508
Providence Alaska Medical Center
Anchorage, Alaska 99508
Anchorage, Alaska 99508
CTCA at Western Regional Medical Center
Goodyear, Arizona 85338
Goodyear, Arizona 85338
Contact:
Site Public Contact
623-207-3000
Site Public Contact
623-207-3000
Kingman Regional Medical Center
Kingman, Arizona 86401
Kingman, Arizona 86401
CHI Saint Vincent Cancer Center Hot Springs
Hot Springs, Arkansas 71913
Hot Springs, Arkansas 71913
University of Arkansas for Medical Sciences
Little Rock, Arkansas 72205
Little Rock, Arkansas 72205
Contact:
Site Public Contact
501-686-8274
Site Public Contact
501-686-8274
Kaiser Permanente-Anaheim
Anaheim, California 92806
Anaheim, California 92806
Mission Hope Medical Oncology - Arroyo Grande
Arroyo Grande, California 93420
Arroyo Grande, California 93420
PCR Oncology
Arroyo Grande, California 93420
Arroyo Grande, California 93420
Sutter Auburn Faith Hospital
Auburn, California 95602
Auburn, California 95602
Sutter Cancer Centers Radiation Oncology Services-Auburn
Auburn, California 95603
Auburn, California 95603
Kaiser Permanente-Baldwin Park
Baldwin Park, California 91706
Baldwin Park, California 91706
Kaiser Permanente-Bellflower
Bellflower, California 90706
Bellflower, California 90706
Alta Bates Summit Medical Center-Herrick Campus
Berkeley, California 94704
Berkeley, California 94704
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank, California 91505
Burbank, California 91505
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
Cameron Park, California 95682
Cameron Park, California 95682
Eden Hospital Medical Center
Castro Valley, California 94546
Castro Valley, California 94546
Sutter Davis Hospital
Davis, California 95616
Davis, California 95616
City of Hope Comprehensive Cancer Center
Duarte, California 91010
Duarte, California 91010
Kaiser Permanente Dublin
Dublin, California 94568
Dublin, California 94568
Contact:
Site Public Contact
877-642-4691
Site Public Contact
877-642-4691
Kaiser Permanente-Fontana
Fontana, California 92335
Fontana, California 92335
Palo Alto Medical Foundation-Fremont
Fremont, California 94538
Fremont, California 94538
Kaiser Permanente-Fresno
Fresno, California 93720
Fresno, California 93720
Kaiser Permanente - Harbor City
Harbor City, California 90710
Harbor City, California 90710
Kaiser Permanente-Irvine
Irvine, California 92618
Irvine, California 92618
Kaiser Permanente Los Angeles Medical Center
Los Angeles, California 90027
Los Angeles, California 90027
Kaiser Permanente-Cadillac
Los Angeles, California 90034
Los Angeles, California 90034
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California 90095
Los Angeles, California 90095
Contact:
Site Public Contact
888-798-0719
Site Public Contact
888-798-0719
Memorial Medical Center
Modesto, California 95355
Modesto, California 95355
Kaiser Permanente-Modesto
Modesto, California 95356
Modesto, California 95356
Palo Alto Medical Foundation-Camino Division
Mountain View, California 94040
Mountain View, California 94040
Palo Alto Medical Foundation-Gynecologic Oncology
Mountain View, California 94040
Mountain View, California 94040
Kaiser Permanente-Oakland
Oakland, California 94611
Oakland, California 94611
Kaiser Permanente-Ontario
Ontario, California 91761
Ontario, California 91761
Palo Alto Medical Foundation Health Care
Palo Alto, California 94301
Palo Alto, California 94301
Kaiser Permanente - Panorama City
Panorama City, California 91402
Panorama City, California 91402
Eisenhower Medical Center
Rancho Mirage, California 92270
Rancho Mirage, California 92270
Contact:
Site Public Contact
760-834-3798
Site Public Contact
760-834-3798
Kaiser Permanente-Richmond
Richmond, California 94801
Richmond, California 94801
Kaiser Permanente-Riverside
Riverside, California 92505
Riverside, California 92505
Kaiser Permanente-Roseville
Roseville, California 95661
Roseville, California 95661
Sutter Cancer Centers Radiation Oncology Services-Roseville
Roseville, California 95661
Roseville, California 95661
Sutter Roseville Medical Center
Roseville, California 95661
Roseville, California 95661
Kaiser Permanente Downtown Commons
Sacramento, California 95814
Sacramento, California 95814
Sutter Medical Center Sacramento
Sacramento, California 95816
Sacramento, California 95816
Kaiser Permanente-South Sacramento
Sacramento, California 95823
Sacramento, California 95823
Kaiser Permanente - Sacramento
Sacramento, California 95825
Sacramento, California 95825
Kaiser Permanente-San Diego Mission
San Diego, California 92108
San Diego, California 92108
Kaiser Permanente-San Diego Zion
San Diego, California 92120
San Diego, California 92120
California Pacific Medical Center-Pacific Campus
San Francisco, California 94115
San Francisco, California 94115
Kaiser Permanente-Santa Teresa-San Jose
San Jose, California 95119
San Jose, California 95119
Kaiser Permanente San Leandro
San Leandro, California 94577
San Leandro, California 94577
Kaiser Permanente-San Marcos
San Marcos, California 92078
San Marcos, California 92078
Kaiser Permanente-San Rafael
San Rafael, California 94903
San Rafael, California 94903
Kaiser San Rafael-Gallinas
San Rafael, California 94903
San Rafael, California 94903
Kaiser Permanente Medical Center - Santa Clara
Santa Clara, California 95051
Santa Clara, California 95051
Palo Alto Medical Foundation-Santa Cruz
Santa Cruz, California 95065
Santa Cruz, California 95065
Mission Hope Medical Oncology - Santa Maria
Santa Maria, California 93444
Santa Maria, California 93444
Sutter Pacific Medical Foundation
Santa Rosa, California 95403
Santa Rosa, California 95403
Kaiser Permanente-Stockton
Stockton, California 95210
Stockton, California 95210
Palo Alto Medical Foundation-Sunnyvale
Sunnyvale, California 94086
Sunnyvale, California 94086
City of Hope Upland
Upland, California 91786
Upland, California 91786
Sutter Cancer Centers Radiation Oncology Services-Vacaville
Vacaville, California 95687
Vacaville, California 95687
Kaiser Permanente Medical Center-Vacaville
Vacaville, California 95688
Vacaville, California 95688
Kaiser Permanente-Vallejo
Vallejo, California 94589
Vallejo, California 94589
Sutter Solano Medical Center/Cancer Center
Vallejo, California 94589
Vallejo, California 94589
Kaiser Permanente-Walnut Creek
Walnut Creek, California 94596
Walnut Creek, California 94596
Kaiser Permanente-Woodland Hills
Woodland Hills, California 91367
Woodland Hills, California 91367
University of Colorado Hospital
Aurora, Colorado 80045
Aurora, Colorado 80045
Contact:
Site Public Contact
720-848-0650
Site Public Contact
720-848-0650
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado 80907
Colorado Springs, Colorado 80907
Rocky Mountain Cancer Centers-Penrose
Colorado Springs, Colorado 80907
Colorado Springs, Colorado 80907
Porter Adventist Hospital
Denver, Colorado 80210
Denver, Colorado 80210
SCL Health Saint Joseph Hospital
Denver, Colorado 80218
Denver, Colorado 80218
Mercy Medical Center
Durango, Colorado 81301
Durango, Colorado 81301
Southwest Oncology PC
Durango, Colorado 81301
Durango, Colorado 81301
Mountain Blue Cancer Care Center - Swedish
Englewood, Colorado 80113
Englewood, Colorado 80113
Swedish Medical Center
Englewood, Colorado 80113
Englewood, Colorado 80113
Poudre Valley Hospital
Fort Collins, Colorado 80524
Fort Collins, Colorado 80524
Contact:
Site Public Contact
970-297-6150
Site Public Contact
970-297-6150
Grand Valley Oncology
Grand Junction, Colorado 81505
Grand Junction, Colorado 81505
North Colorado Medical Center
Greeley, Colorado 80631
Greeley, Colorado 80631
Saint Anthony Hospital
Lakewood, Colorado 80228
Lakewood, Colorado 80228
Littleton Adventist Hospital
Littleton, Colorado 80122
Littleton, Colorado 80122
Longmont United Hospital
Longmont, Colorado 80501
Longmont, Colorado 80501
Rocky Mountain Cancer Centers-Longmont
Longmont, Colorado 80501
Longmont, Colorado 80501
McKee Medical Center
Loveland, Colorado 80539
Loveland, Colorado 80539
Parker Adventist Hospital
Parker, Colorado 80138
Parker, Colorado 80138
Saint Mary Corwin Medical Center
Pueblo, Colorado 81004
Pueblo, Colorado 81004
Smilow Cancer Hospital Care Center at Saint Francis
Hartford, Connecticut 06105
Hartford, Connecticut 06105
Smilow Cancer Center/Yale-New Haven Hospital
New Haven, Connecticut 06510
New Haven, Connecticut 06510
Yale University
New Haven, Connecticut 06520
New Haven, Connecticut 06520
Eastern Connecticut Hematology and Oncology Associates
Norwich, Connecticut 06360
Norwich, Connecticut 06360
Contact:
Site Public Contact
860-886-8362
Site Public Contact
860-886-8362
MedStar Georgetown University Hospital
Washington, District of Columbia 20007
Washington, District of Columbia 20007
Contact:
Site Public Contact
202-444-2223
Site Public Contact
202-444-2223
MedStar Washington Hospital Center
Washington, District of Columbia 20010
Washington, District of Columbia 20010
Contact:
Site Public Contact
202-877-8839
Site Public Contact
202-877-8839
Holy Cross Hospital
Fort Lauderdale, Florida 33308
Fort Lauderdale, Florida 33308
Contact:
Site Public Contact
954-267-7750
Site Public Contact
954-267-7750
University Cancer and Blood Center LLC
Athens, Georgia 30607
Athens, Georgia 30607
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia 30322
Atlanta, Georgia 30322
Contact:
Site Public Contact
404-778-1868
Site Public Contact
404-778-1868
Emory Saint Joseph's Hospital
Atlanta, Georgia 30342
Atlanta, Georgia 30342
Contact:
Site Public Contact
404-851-7115
Site Public Contact
404-851-7115
Northside Hospital
Atlanta, Georgia 30342
Atlanta, Georgia 30342
Augusta University Medical Center
Augusta, Georgia 30912
Augusta, Georgia 30912
Northside Hospital - Duluth
Duluth, Georgia 30096
Duluth, Georgia 30096
Northside Hospital - Gwinnett
Lawrenceville, Georgia 30046
Lawrenceville, Georgia 30046
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Savannah, Georgia 31405
Savannah, Georgia 31405
Summit Cancer Care-Candler
Savannah, Georgia 31405
Savannah, Georgia 31405
Suburban Hematology Oncology Associates - Snellville
Snellville, Georgia 30078
Snellville, Georgia 30078
Hawaii Cancer Care - Savio
'Aiea, Hawaii 96701
'Aiea, Hawaii 96701
Contact:
Site Public Contact
808-539-2273
Site Public Contact
808-539-2273
Pali Momi Medical Center
'Aiea, Hawaii 96701
'Aiea, Hawaii 96701
Contact:
Site Public Contact
808-486-6000
Site Public Contact
808-486-6000
Queen's Cancer Center - Pearlridge
'Aiea, Hawaii 96701
'Aiea, Hawaii 96701
Contact:
Site Public Contact
808-487-7447
Site Public Contact
808-487-7447
The Cancer Center of Hawaii-Pali Momi
'Aiea, Hawaii 96701
'Aiea, Hawaii 96701
Contact:
Site Public Contact
808-678-9000
Site Public Contact
808-678-9000
Hawaii Cancer Care Inc-POB II
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-524-6115
Site Public Contact
808-524-6115
Island Urology
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Queen's Cancer Cenrer - POB I
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-532-0315
Site Public Contact
808-532-0315
Queen's Medical Center
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-545-8548
Site Public Contact
808-545-8548
Straub Clinic and Hospital
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-522-4333
Site Public Contact
808-522-4333
University of Hawaii Cancer Center
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-586-2979
Site Public Contact
808-586-2979
Hawaii Cancer Care Inc-Liliha
Honolulu, Hawaii 96817
Honolulu, Hawaii 96817
Contact:
Site Public Contact
808-536-4888
Site Public Contact
808-536-4888
Kuakini Medical Center
Honolulu, Hawaii 96817
Honolulu, Hawaii 96817
Contact:
Site Public Contact
808-547-9816
Site Public Contact
808-547-9816
Queen's Cancer Center - Kuakini
Honolulu, Hawaii 96817
Honolulu, Hawaii 96817
Contact:
Site Public Contact
808-531-8521
Site Public Contact
808-531-8521
The Cancer Center of Hawaii-Liliha
Honolulu, Hawaii 96817
Honolulu, Hawaii 96817
Contact:
Site Public Contact
808-547-6881
Site Public Contact
808-547-6881
Kaiser Permanente Moanalua Medical Center
Honolulu, Hawaii 96819
Honolulu, Hawaii 96819
Kapiolani Medical Center for Women and Children
Honolulu, Hawaii 96826
Honolulu, Hawaii 96826
Contact:
Site Public Contact
808-983-6090
Site Public Contact
808-983-6090
Wilcox Memorial Hospital and Kauai Medical Clinic
Lihue, Hawaii 96766
Lihue, Hawaii 96766
Contact:
Site Public Contact
808-535-7960
Site Public Contact
808-535-7960
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho 83706
Boise, Idaho 83706
Saint Luke's Mountain States Tumor Institute
Boise, Idaho 83712
Boise, Idaho 83712
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell, Idaho 83605
Caldwell, Idaho 83605
Kootenai Medical Center
Coeur d'Alene, Idaho 83814
Coeur d'Alene, Idaho 83814
Walter Knox Memorial Hospital
Emmett, Idaho 83617
Emmett, Idaho 83617
Saint Luke's Cancer Institute - Fruitland
Fruitland, Idaho 83619
Fruitland, Idaho 83619
Idaho Urologic Institute-Meridian
Meridian, Idaho 83642
Meridian, Idaho 83642
Saint Luke's Cancer Institute - Meridian
Meridian, Idaho 83642
Meridian, Idaho 83642
Saint Alphonsus Medical Center-Nampa
Nampa, Idaho 83686
Nampa, Idaho 83686
Saint Luke's Cancer Institute - Nampa
Nampa, Idaho 83686
Nampa, Idaho 83686
Kootenai Cancer Center
Post Falls, Idaho 83854
Post Falls, Idaho 83854
Kootenai Cancer Clinic
Sandpoint, Idaho 83864
Sandpoint, Idaho 83864
Saint Luke's Cancer Institute - Twin Falls
Twin Falls, Idaho 83301
Twin Falls, Idaho 83301
Rush - Copley Medical Center
Aurora, Illinois 60504
Aurora, Illinois 60504
Illinois CancerCare-Bloomington
Bloomington, Illinois 61704
Bloomington, Illinois 61704
Illinois CancerCare-Canton
Canton, Illinois 61520
Canton, Illinois 61520
Memorial Hospital of Carbondale
Carbondale, Illinois 62902
Carbondale, Illinois 62902
SIH Cancer Institute
Carterville, Illinois 62918
Carterville, Illinois 62918
Illinois CancerCare-Carthage
Carthage, Illinois 62321
Carthage, Illinois 62321
Centralia Oncology Clinic
Centralia, Illinois 62801
Centralia, Illinois 62801
Northwestern University
Chicago, Illinois 60611
Chicago, Illinois 60611
Rush University Medical Center
Chicago, Illinois 60612
Chicago, Illinois 60612
Carle on Vermilion
Danville, Illinois 61832
Danville, Illinois 61832
Cancer Care Specialists of Illinois - Decatur
Decatur, Illinois 62526
Decatur, Illinois 62526
Decatur Memorial Hospital
Decatur, Illinois 62526
Decatur, Illinois 62526
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois 60115
DeKalb, Illinois 60115
Illinois CancerCare-Dixon
Dixon, Illinois 61021
Dixon, Illinois 61021
Contact:
Site Public Contact
815-285-7800
Site Public Contact
815-285-7800
Carle Physician Group-Effingham
Effingham, Illinois 62401
Effingham, Illinois 62401
Crossroads Cancer Center
Effingham, Illinois 62401
Effingham, Illinois 62401
Illinois CancerCare-Eureka
Eureka, Illinois 61530
Eureka, Illinois 61530
NorthShore University HealthSystem-Evanston Hospital
Evanston, Illinois 60201
Evanston, Illinois 60201
Contact:
Site Public Contact
847-570-2109
Site Public Contact
847-570-2109
Illinois CancerCare-Galesburg
Galesburg, Illinois 61401
Galesburg, Illinois 61401
Western Illinois Cancer Treatment Center
Galesburg, Illinois 61401
Galesburg, Illinois 61401
Contact:
Site Public Contact
309-344-2831
Site Public Contact
309-344-2831
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois 60134
Geneva, Illinois 60134
NorthShore University HealthSystem-Glenbrook Hospital
Glenview, Illinois 60026
Glenview, Illinois 60026
Contact:
Site Public Contact
847-570-2109
Site Public Contact
847-570-2109
NorthShore University HealthSystem-Highland Park Hospital
Highland Park, Illinois 60035
Highland Park, Illinois 60035
Contact:
Site Public Contact
847-570-2109
Site Public Contact
847-570-2109
Joliet Oncology-Hematology Associates Limited
Joliet, Illinois 60435
Joliet, Illinois 60435
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois 61443
Kewanee, Illinois 61443
Northwestern Medicine Lake Forest Hospital
Lake Forest, Illinois 60045
Lake Forest, Illinois 60045
Illinois CancerCare-Macomb
Macomb, Illinois 61455
Macomb, Illinois 61455
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois 61938
Mattoon, Illinois 61938
Loyola University Medical Center
Maywood, Illinois 60153
Maywood, Illinois 60153
Contact:
Site Public Contact
708-226-4357
Site Public Contact
708-226-4357
Cancer Care Center of O'Fallon
O'Fallon, Illinois 62269
O'Fallon, Illinois 62269
Illinois CancerCare-Ottawa Clinic
Ottawa, Illinois 61350
Ottawa, Illinois 61350
Illinois CancerCare-Pekin
Pekin, Illinois 61554
Pekin, Illinois 61554
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
Pekin, Illinois 61554
Pekin, Illinois 61554
Illinois CancerCare-Peoria
Peoria, Illinois 61615
Peoria, Illinois 61615
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
Peoria, Illinois 61615
Peoria, Illinois 61615
Methodist Medical Center of Illinois
Peoria, Illinois 61636
Peoria, Illinois 61636
OSF Saint Francis Medical Center
Peoria, Illinois 61637
Peoria, Illinois 61637
Illinois CancerCare-Peru
Peru, Illinois 61354
Peru, Illinois 61354
Valley Radiation Oncology
Peru, Illinois 61354
Peru, Illinois 61354
Contact:
Site Public Contact
815-664-4141
Site Public Contact
815-664-4141
Illinois CancerCare-Princeton
Princeton, Illinois 61356
Princeton, Illinois 61356
Southern Illinois University School of Medicine
Springfield, Illinois 62702
Springfield, Illinois 62702
Contact:
Site Public Contact
217-545-7929
Site Public Contact
217-545-7929
Springfield Clinic
Springfield, Illinois 62702
Springfield, Illinois 62702
Contact:
Site Public Contact
800-444-7541
Site Public Contact
800-444-7541
Memorial Medical Center
Springfield, Illinois 62781
Springfield, Illinois 62781
Contact:
Site Public Contact
217-788-3528
Site Public Contact
217-788-3528
Southwest Illinois Health Services LLP
Swansea, Illinois 62226
Swansea, Illinois 62226
Carle Cancer Center
Urbana, Illinois 61801
Urbana, Illinois 61801
The Carle Foundation Hospital
Urbana, Illinois 61801
Urbana, Illinois 61801
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois 60555
Warrenville, Illinois 60555
Rush-Copley Healthcare Center
Yorkville, Illinois 60560
Yorkville, Illinois 60560
Deaconess Clinic Downtown
Evansville, Indiana 47713
Evansville, Indiana 47713
Indiana University/Melvin and Bren Simon Cancer Center
Indianapolis, Indiana 46202
Indianapolis, Indiana 46202
Sidney and Lois Eskenazi Hospital
Indianapolis, Indiana 46202
Indianapolis, Indiana 46202
Franciscan Health Indianapolis
Indianapolis, Indiana 46237
Indianapolis, Indiana 46237
Contact:
Site Public Contact
317-528-7060
Site Public Contact
317-528-7060
Woodland Cancer Care Center
Michigan City, Indiana 46360
Michigan City, Indiana 46360
Franciscan Health Mooresville
Mooresville, Indiana 46158
Mooresville, Indiana 46158
Contact:
Site Public Contact
317-834-3603
Site Public Contact
317-834-3603
Chancellor Center for Oncology
Newburgh, Indiana 47630
Newburgh, Indiana 47630
Mary Greeley Medical Center
Ames, Iowa 50010
Ames, Iowa 50010
Contact:
Site Public Contact
515-956-4132
Site Public Contact
515-956-4132
McFarland Clinic PC - Ames
Ames, Iowa 50010
Ames, Iowa 50010
McFarland Clinic PC-Boone
Boone, Iowa 50036
Boone, Iowa 50036
Contact:
Site Public Contact
515-956-4132
Site Public Contact
515-956-4132
Medical Oncology and Hematology Associates-West Des Moines
Clive, Iowa 50325
Clive, Iowa 50325
Mercy Cancer Center-West Lakes
Clive, Iowa 50325
Clive, Iowa 50325
Alegent Health Mercy Hospital
Council Bluffs, Iowa 51503
Council Bluffs, Iowa 51503
Greater Regional Medical Center
Creston, Iowa 50801
Creston, Iowa 50801
Medical Oncology and Hematology Associates-Laurel
Des Moines, Iowa 50314
Des Moines, Iowa 50314
Mercy Medical Center - Des Moines
Des Moines, Iowa 50314
Des Moines, Iowa 50314
McFarland Clinic PC-Trinity Cancer Center
Fort Dodge, Iowa 50501
Fort Dodge, Iowa 50501
Contact:
Site Public Contact
515-956-4132
Site Public Contact
515-956-4132
McFarland Clinic PC-Jefferson
Jefferson, Iowa 50129
Jefferson, Iowa 50129
Contact:
Site Public Contact
515-956-4132
Site Public Contact
515-956-4132
McFarland Clinic PC-Marshalltown
Marshalltown, Iowa 50158
Marshalltown, Iowa 50158
Contact:
Site Public Contact
515-956-4132
Site Public Contact
515-956-4132
Siouxland Regional Cancer Center
Sioux City, Iowa 51101
Sioux City, Iowa 51101
Mercy Medical Center-West Lakes
West Des Moines, Iowa 50266
West Des Moines, Iowa 50266
Cancer Center of Kansas - Chanute
Chanute, Kansas 66720
Chanute, Kansas 66720
Coffeyville Regional Medical Center
Coffeyville, Kansas 67337
Coffeyville, Kansas 67337
Contact:
Site Public Contact
620-252-1606
Site Public Contact
620-252-1606
Cancer Center of Kansas - Dodge City
Dodge City, Kansas 67801
Dodge City, Kansas 67801
Cancer Center of Kansas - El Dorado
El Dorado, Kansas 67042
El Dorado, Kansas 67042
HaysMed University of Kansas Health System
Hays, Kansas 67601
Hays, Kansas 67601
Contact:
Site Public Contact
785-623-5774
Site Public Contact
785-623-5774
Cancer Center of Kansas-Independence
Independence, Kansas 67301
Independence, Kansas 67301
University of Kansas Cancer Center-West
Kansas City, Kansas 66112
Kansas City, Kansas 66112
University of Kansas Cancer Center
Kansas City, Kansas 66160
Kansas City, Kansas 66160
Cancer Center of Kansas-Kingman
Kingman, Kansas 67068
Kingman, Kansas 67068
Lawrence Memorial Hospital
Lawrence, Kansas 66044
Lawrence, Kansas 66044
Cancer Center of Kansas-Liberal
Liberal, Kansas 67905
Liberal, Kansas 67905
Cancer Center of Kansas-Manhattan
Manhattan, Kansas 66502
Manhattan, Kansas 66502
Cancer Center of Kansas - McPherson
McPherson, Kansas 67460
McPherson, Kansas 67460
Cancer Center of Kansas - Newton
Newton, Kansas 67114
Newton, Kansas 67114
Olathe Health Cancer Center
Olathe, Kansas 66061
Olathe, Kansas 66061
University of Kansas Cancer Center-Overland Park
Overland Park, Kansas 66210
Overland Park, Kansas 66210
Cancer Center of Kansas - Parsons
Parsons, Kansas 67357
Parsons, Kansas 67357
Ascension Via Christi - Pittsburg
Pittsburg, Kansas 66762
Pittsburg, Kansas 66762
Cancer Center of Kansas - Pratt
Pratt, Kansas 67124
Pratt, Kansas 67124
Cancer Center of Kansas - Salina
Salina, Kansas 67401
Salina, Kansas 67401
Salina Regional Health Center
Salina, Kansas 67401
Salina, Kansas 67401
University of Kansas Health System Saint Francis Campus
Topeka, Kansas 66606
Topeka, Kansas 66606
Contact:
Site Public Contact
785-295-8000
Site Public Contact
785-295-8000
Cancer Center of Kansas - Wellington
Wellington, Kansas 67152
Wellington, Kansas 67152
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas 66205
Westwood, Kansas 66205
Cancer Center of Kansas-Wichita Medical Arts Tower
Wichita, Kansas 67208
Wichita, Kansas 67208
Ascension Via Christi Hospitals Wichita
Wichita, Kansas 67214
Wichita, Kansas 67214
Cancer Center of Kansas - Wichita
Wichita, Kansas 67214
Wichita, Kansas 67214
Cancer Center of Kansas - Winfield
Winfield, Kansas 67156
Winfield, Kansas 67156
Flaget Memorial Hospital
Bardstown, Kentucky 40004
Bardstown, Kentucky 40004
Commonwealth Cancer Center-Corbin
Corbin, Kentucky 40701
Corbin, Kentucky 40701
Saint Joseph Radiation Oncology Resource Center
Lexington, Kentucky 40504
Lexington, Kentucky 40504
Saint Joseph Hospital East
Lexington, Kentucky 40509
Lexington, Kentucky 40509
Saint Joseph London
London, Kentucky 40741
London, Kentucky 40741
Jewish Hospital
Louisville, Kentucky 40202
Louisville, Kentucky 40202
Saints Mary and Elizabeth Hospital
Louisville, Kentucky 40215
Louisville, Kentucky 40215
Jewish Hospital Medical Center Northeast
Louisville, Kentucky 40245
Louisville, Kentucky 40245
Jewish Hospital Medical Center South
Shepherdsville, Kentucky 40165
Shepherdsville, Kentucky 40165
LSU Health Baton Rouge-North Clinic
Baton Rouge, Louisiana 70805
Baton Rouge, Louisiana 70805
Louisiana Hematology Oncology Associates LLC
Baton Rouge, Louisiana 70809
Baton Rouge, Louisiana 70809
Mary Bird Perkins Cancer Center
Baton Rouge, Louisiana 70809
Baton Rouge, Louisiana 70809
Ochsner Health Center-Summa
Baton Rouge, Louisiana 70809
Baton Rouge, Louisiana 70809
Our Lady of the Lake Physicians Group - Medical Oncology
Baton Rouge, Louisiana 70809
Baton Rouge, Louisiana 70809
Medical Center of Baton Rouge
Baton Rouge, Louisiana 70816
Baton Rouge, Louisiana 70816
Ochsner High Grove
Baton Rouge, Louisiana 70836
Baton Rouge, Louisiana 70836
Northshore Oncology Associates-Covington
Covington, Louisiana 70433
Covington, Louisiana 70433
Ochsner Medical Center Kenner
Kenner, Louisiana 70065
Kenner, Louisiana 70065
Ochsner Medical Center Jefferson
New Orleans, Louisiana 70121
New Orleans, Louisiana 70121
Greater Baltimore Medical Center
Baltimore, Maryland 21204
Baltimore, Maryland 21204
Contact:
Site Public Contact
443-849-3706
Site Public Contact
443-849-3706
Saint Agnes Hospital
Baltimore, Maryland 21229
Baltimore, Maryland 21229
Contact:
Site Public Contact
410-368-2910
Site Public Contact
410-368-2910
MedStar Franklin Square Medical Center/Weinberg Cancer Institute
Baltimore, Maryland 21237
Baltimore, Maryland 21237
Contact:
Site Public Contact
443-777-7364
Site Public Contact
443-777-7364
Baystate Medical Center
Springfield, Massachusetts 01199
Springfield, Massachusetts 01199
Hickman Cancer Center
Adrian, Michigan 49221
Adrian, Michigan 49221
Contact:
Site Public Contact
517-265-0116
Site Public Contact
517-265-0116
Saint Joseph Mercy Hospital
Ann Arbor, Michigan 48106
Ann Arbor, Michigan 48106
Bronson Battle Creek
Battle Creek, Michigan 49017
Battle Creek, Michigan 49017
IHA Hematology Oncology Consultants-Brighton
Brighton, Michigan 48114
Brighton, Michigan 48114
Saint Joseph Mercy Brighton
Brighton, Michigan 48114
Brighton, Michigan 48114
IHA Hematology Oncology Consultants-Canton
Canton, Michigan 48188
Canton, Michigan 48188
Saint Joseph Mercy Canton
Canton, Michigan 48188
Canton, Michigan 48188
Caro Cancer Center
Caro, Michigan 48723
Caro, Michigan 48723
IHA Hematology Oncology Consultants-Chelsea
Chelsea, Michigan 48118
Chelsea, Michigan 48118
Saint Joseph Mercy Chelsea
Chelsea, Michigan 48118
Chelsea, Michigan 48118
Hematology Oncology Consultants-Clarkston
Clarkston, Michigan 48346
Clarkston, Michigan 48346
Newland Medical Associates-Clarkston
Clarkston, Michigan 48346
Clarkston, Michigan 48346
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan 48201
Detroit, Michigan 48201
Ascension Saint John Hospital
Detroit, Michigan 48236
Detroit, Michigan 48236
Great Lakes Cancer Management Specialists-Doctors Park
East China Township, Michigan 48054
East China Township, Michigan 48054
Green Bay Oncology - Escanaba
Escanaba, Michigan 49829
Escanaba, Michigan 49829
Weisberg Cancer Treatment Center
Farmington Hills, Michigan 48334
Farmington Hills, Michigan 48334
Genesee Cancer and Blood Disease Treatment Center
Flint, Michigan 48503
Flint, Michigan 48503
Genesee Hematology Oncology PC
Flint, Michigan 48503
Flint, Michigan 48503
Genesys Hurley Cancer Institute
Flint, Michigan 48503
Flint, Michigan 48503
Hurley Medical Center
Flint, Michigan 48503
Flint, Michigan 48503
Mercy Health Saint Mary's
Grand Rapids, Michigan 49503
Grand Rapids, Michigan 49503
Spectrum Health at Butterworth Campus
Grand Rapids, Michigan 49503
Grand Rapids, Michigan 49503
Academic Hematology Oncology Specialists
Grosse Pointe Woods, Michigan 48236
Grosse Pointe Woods, Michigan 48236
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
Grosse Pointe Woods, Michigan 48236
Grosse Pointe Woods, Michigan 48236
Michigan Breast Specialists-Grosse Pointe Woods
Grosse Pointe Woods, Michigan 48236
Grosse Pointe Woods, Michigan 48236
Bronson Methodist Hospital
Kalamazoo, Michigan 49007
Kalamazoo, Michigan 49007
West Michigan Cancer Center
Kalamazoo, Michigan 49007
Kalamazoo, Michigan 49007
Borgess Medical Center
Kalamazoo, Michigan 49048
Kalamazoo, Michigan 49048
Sparrow Hospital
Lansing, Michigan 48912
Lansing, Michigan 48912
Hope Cancer Clinic
Livonia, Michigan 48154
Livonia, Michigan 48154
Saint Mary Mercy Hospital
Livonia, Michigan 48154
Livonia, Michigan 48154
Great Lakes Cancer Management Specialists-Macomb Medical Campus
Macomb, Michigan 48044
Macomb, Michigan 48044
Michigan Breast Specialists-Macomb Township
Macomb, Michigan 48044
Macomb, Michigan 48044
Saint Mary's Oncology/Hematology Associates of Marlette
Marlette, Michigan 48453
Marlette, Michigan 48453
Toledo Clinic Cancer Centers-Monroe
Monroe, Michigan 48162
Monroe, Michigan 48162
Contact:
Site Public Contact
800-444-3561
Site Public Contact
800-444-3561
Mercy Health Mercy Campus
Muskegon, Michigan 49444
Muskegon, Michigan 49444
Cancer and Hematology Centers of Western Michigan - Norton Shores
Norton Shores, Michigan 49444
Norton Shores, Michigan 49444
21st Century Oncology-Pontiac
Pontiac, Michigan 48341
Pontiac, Michigan 48341
Hope Cancer Center
Pontiac, Michigan 48341
Pontiac, Michigan 48341
Newland Medical Associates-Pontiac
Pontiac, Michigan 48341
Pontiac, Michigan 48341
Saint Joseph Mercy Oakland
Pontiac, Michigan 48341
Pontiac, Michigan 48341
Great Lakes Cancer Management Specialists-Rochester Hills
Rochester Hills, Michigan 48309
Rochester Hills, Michigan 48309
Ascension Saint Mary's Hospital
Saginaw, Michigan 48601
Saginaw, Michigan 48601
Oncology Hematology Associates of Saginaw Valley PC
Saginaw, Michigan 48604
Saginaw, Michigan 48604
Bhadresh Nayak MD PC-Sterling Heights
Sterling Heights, Michigan 48312
Sterling Heights, Michigan 48312
Ascension Saint Joseph Hospital
Tawas City, Michigan 48764
Tawas City, Michigan 48764
Advanced Breast Care Center PLLC
Warren, Michigan 48088
Warren, Michigan 48088
Great Lakes Cancer Management Specialists-Macomb Professional Building
Warren, Michigan 48093
Warren, Michigan 48093
Macomb Hematology Oncology PC
Warren, Michigan 48093
Warren, Michigan 48093
Michigan Breast Specialists-Warren
Warren, Michigan 48093
Warren, Michigan 48093
Saint John Macomb-Oakland Hospital
Warren, Michigan 48093
Warren, Michigan 48093
Saint Mary's Oncology/Hematology Associates of West Branch
West Branch, Michigan 48661
West Branch, Michigan 48661
Metro Health Hospital
Wyoming, Michigan 49519
Wyoming, Michigan 49519
Huron Gastroenterology PC
Ypsilanti, Michigan 48106
Ypsilanti, Michigan 48106
IHA Hematology Oncology Consultants-Ann Arbor
Ypsilanti, Michigan 48197
Ypsilanti, Michigan 48197
Riverwood Healthcare Center
Aitkin, Minnesota 56431
Aitkin, Minnesota 56431
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota 56601
Bemidji, Minnesota 56601
Essentia Health Saint Joseph's Medical Center
Brainerd, Minnesota 56401
Brainerd, Minnesota 56401
Mercy Hospital
Coon Rapids, Minnesota 55433
Coon Rapids, Minnesota 55433
Essentia Health - Deer River Clinic
Deer River, Minnesota 56636
Deer River, Minnesota 56636
Essentia Health Saint Mary's - Detroit Lakes Clinic
Detroit Lakes, Minnesota 56501
Detroit Lakes, Minnesota 56501
Essentia Health Cancer Center
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Essentia Health Saint Mary's Medical Center
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Miller-Dwan Hospital
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Fairview Southdale Hospital
Edina, Minnesota 55435
Edina, Minnesota 55435
Lake Region Healthcare Corporation-Cancer Care
Fergus Falls, Minnesota 56537
Fergus Falls, Minnesota 56537
Essentia Health - Fosston
Fosston, Minnesota 56542
Fosston, Minnesota 56542
Unity Hospital
Fridley, Minnesota 55432
Fridley, Minnesota 55432
Essentia Health Hibbing Clinic
Hibbing, Minnesota 55746
Hibbing, Minnesota 55746
Contact:
Site Public Contact
218-786-3308
Site Public Contact
218-786-3308
Minnesota Oncology Hematology PA-Maplewood
Maplewood, Minnesota 55109
Maplewood, Minnesota 55109
Abbott-Northwestern Hospital
Minneapolis, Minnesota 55407
Minneapolis, Minnesota 55407
Hennepin County Medical Center
Minneapolis, Minnesota 55415
Minneapolis, Minnesota 55415
Health Partners Inc
Minneapolis, Minnesota 55454
Minneapolis, Minnesota 55454
Essentia Health - Park Rapids
Park Rapids, Minnesota 56470
Park Rapids, Minnesota 56470
North Memorial Medical Health Center
Robbinsdale, Minnesota 55422
Robbinsdale, Minnesota 55422
Regions Hospital
Saint Paul, Minnesota 55101
Saint Paul, Minnesota 55101
United Hospital
Saint Paul, Minnesota 55102
Saint Paul, Minnesota 55102
Essentia Health Sandstone
Sandstone, Minnesota 55072
Sandstone, Minnesota 55072
Lakeview Hospital
Stillwater, Minnesota 55082
Stillwater, Minnesota 55082
Sanford Thief River Falls Medical Center
Thief River Falls, Minnesota 56701
Thief River Falls, Minnesota 56701
Contact:
Site Public Contact
605-312-3320
Site Public Contact
605-312-3320
Essentia Health Virginia Clinic
Virginia, Minnesota 55792
Virginia, Minnesota 55792
Minnesota Oncology Hematology PA-Woodbury
Woodbury, Minnesota 55125
Woodbury, Minnesota 55125
Sanford Cancer Center Worthington
Worthington, Minnesota 56187
Worthington, Minnesota 56187
Contact:
Site Public Contact
605-312-3320
Site Public Contact
605-312-3320
Singing River Hospital
Pascagoula, Mississippi 39581
Pascagoula, Mississippi 39581
Contact:
Site Public Contact
228-809-5292
Site Public Contact
228-809-5292
Saint Francis Medical Center
Cape Girardeau, Missouri 63703
Cape Girardeau, Missouri 63703
Southeast Cancer Center
Cape Girardeau, Missouri 63703
Cape Girardeau, Missouri 63703
Contact:
Site Public Contact
573-651-5550
Site Public Contact
573-651-5550
Parkland Health Center - Farmington
Farmington, Missouri 63640
Farmington, Missouri 63640
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Capital Region Southwest Campus
Jefferson City, Missouri 65109
Jefferson City, Missouri 65109
Truman Medical Centers
Kansas City, Missouri 64108
Kansas City, Missouri 64108
Contact:
Site Public Contact
816-404-4375
Site Public Contact
816-404-4375
Kansas City Veterans Affairs Medical Center
Kansas City, Missouri 64128
Kansas City, Missouri 64128
Contact:
Site Public Contact
800-525-1483
Site Public Contact
800-525-1483
University of Kansas Cancer Center - North
Kansas City, Missouri 64154
Kansas City, Missouri 64154
University of Kansas Cancer Center - Lee's Summit
Lee's Summit, Missouri 64064
Lee's Summit, Missouri 64064
Missouri Baptist Medical Center
Saint Louis, Missouri 63131
Saint Louis, Missouri 63131
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Sainte Genevieve County Memorial Hospital
Sainte Genevieve, Missouri 63670
Sainte Genevieve, Missouri 63670
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Mercy Hospital Springfield
Springfield, Missouri 65804
Springfield, Missouri 65804
Contact:
Site Public Contact
417-269-4520
Site Public Contact
417-269-4520
CoxHealth South Hospital
Springfield, Missouri 65807
Springfield, Missouri 65807
Contact:
Site Public Contact
417-269-4520
Site Public Contact
417-269-4520
Missouri Baptist Sullivan Hospital
Sullivan, Missouri 63080
Sullivan, Missouri 63080
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Missouri Baptist Outpatient Center-Sunset Hills
Sunset Hills, Missouri 63127
Sunset Hills, Missouri 63127
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Community Hospital of Anaconda
Anaconda, Montana 59711
Anaconda, Montana 59711
Bozeman Deaconess Hospital
Bozeman, Montana 59715
Bozeman, Montana 59715
Saint James Community Hospital and Cancer Treatment Center
Butte, Montana 59701
Butte, Montana 59701
Contact:
Site Public Contact
406-723-2621
Site Public Contact
406-723-2621
Benefis Healthcare- Sletten Cancer Institute
Great Falls, Montana 59405
Great Falls, Montana 59405
Kalispell Regional Medical Center
Kalispell, Montana 59901
Kalispell, Montana 59901
Saint Patrick Hospital - Community Hospital
Missoula, Montana 59802
Missoula, Montana 59802
Nebraska Medicine-Bellevue
Bellevue, Nebraska 68123
Bellevue, Nebraska 68123
CHI Health Saint Francis
Grand Island, Nebraska 68803
Grand Island, Nebraska 68803
CHI Health Good Samaritan
Kearney, Nebraska 68847
Kearney, Nebraska 68847
Saint Elizabeth Regional Medical Center
Lincoln, Nebraska 68510
Lincoln, Nebraska 68510
Nebraska Methodist Hospital
Omaha, Nebraska 68114
Omaha, Nebraska 68114
Contact:
Site Public Contact
402-354-5144
Site Public Contact
402-354-5144
Nebraska Medicine-Village Pointe
Omaha, Nebraska 68118
Omaha, Nebraska 68118
Contact:
Site Public Contact
402-559-5600
Site Public Contact
402-559-5600
Alegent Health Immanuel Medical Center
Omaha, Nebraska 68122
Omaha, Nebraska 68122
Alegent Health Bergan Mercy Medical Center
Omaha, Nebraska 68124
Omaha, Nebraska 68124
Alegent Health Lakeside Hospital
Omaha, Nebraska 68130
Omaha, Nebraska 68130
Creighton University Medical Center
Omaha, Nebraska 68131
Omaha, Nebraska 68131
University of Nebraska Medical Center
Omaha, Nebraska 68198
Omaha, Nebraska 68198
Midlands Community Hospital
Papillion, Nebraska 68046
Papillion, Nebraska 68046
Carson Tahoe Regional Medical Center
Carson City, Nevada 89703
Carson City, Nevada 89703
Cancer and Blood Specialists-Henderson
Henderson, Nevada 89052
Henderson, Nevada 89052
Comprehensive Cancer Centers of Nevada - Henderson
Henderson, Nevada 89052
Henderson, Nevada 89052
Comprehensive Cancer Centers of Nevada-Horizon Ridge
Henderson, Nevada 89052
Henderson, Nevada 89052
Las Vegas Cancer Center-Henderson
Henderson, Nevada 89052
Henderson, Nevada 89052
OptumCare Cancer Care at Seven Hills
Henderson, Nevada 89052
Henderson, Nevada 89052
21st Century Oncology-Henderson
Henderson, Nevada 89074
Henderson, Nevada 89074
Comprehensive Cancer Centers of Nevada-Southeast Henderson
Henderson, Nevada 89074
Henderson, Nevada 89074
Las Vegas Urology - Green Valley
Henderson, Nevada 89074
Henderson, Nevada 89074
Urology Specialists of Nevada - Green Valley
Henderson, Nevada 89074
Henderson, Nevada 89074
Desert West Surgery
Las Vegas, Nevada 89102
Las Vegas, Nevada 89102
OptumCare Cancer Care at Oakey
Las Vegas, Nevada 89102
Las Vegas, Nevada 89102
University Medical Center of Southern Nevada
Las Vegas, Nevada 89102
Las Vegas, Nevada 89102
Hope Cancer Care of Nevada
Las Vegas, Nevada 89103
Las Vegas, Nevada 89103
Urology Specialists of Nevada - Central
Las Vegas, Nevada 89106
Las Vegas, Nevada 89106
21st Century Oncology
Las Vegas, Nevada 89109
Las Vegas, Nevada 89109
Sunrise Hospital and Medical Center
Las Vegas, Nevada 89109
Las Vegas, Nevada 89109
Las Vegas Prostate Cancer Center
Las Vegas, Nevada 89113
Las Vegas, Nevada 89113
21st Century Oncology-Vegas Tenaya
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Ann M Wierman MD LTD
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Comprehensive Cancer Centers of Nevada - Northwest
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Las Vegas Urology - Cathedral Rock
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Las Vegas Urology - Smoke Ranch
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
OptumCare Cancer Care at MountainView
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Urology Specialists of Nevada - Northwest
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas, Nevada 89135
Las Vegas, Nevada 89135
Comprehensive Cancer Centers of Nevada - Town Center
Las Vegas, Nevada 89144
Las Vegas, Nevada 89144
Comprehensive Cancer Centers of Nevada-Summerlin
Las Vegas, Nevada 89144
Las Vegas, Nevada 89144
Summerlin Hospital Medical Center
Las Vegas, Nevada 89144
Las Vegas, Nevada 89144
Las Vegas Cancer Center-Medical Center
Las Vegas, Nevada 89148-2405
Las Vegas, Nevada 89148-2405
21st Century Oncology-Fort Apache
Las Vegas, Nevada 89148
Las Vegas, Nevada 89148
Comprehensive Cancer Centers of Nevada
Las Vegas, Nevada 89148
Las Vegas, Nevada 89148
OptumCare Cancer Care at Fort Apache
Las Vegas, Nevada 89148
Las Vegas, Nevada 89148
Urology Specialists of Nevada - Southwest
Las Vegas, Nevada 89148
Las Vegas, Nevada 89148
Comprehensive Cancer Centers of Nevada - Central Valley
Las Vegas, Nevada 89169
Las Vegas, Nevada 89169
University Cancer Center
Las Vegas, Nevada 89169
Las Vegas, Nevada 89169
Hope Cancer Care of Nevada-Pahrump
Pahrump, Nevada 89048
Pahrump, Nevada 89048
Renown Regional Medical Center
Reno, Nevada 89502
Reno, Nevada 89502
Saint Mary's Regional Medical Center
Reno, Nevada 89503
Reno, Nevada 89503
Radiation Oncology Associates
Reno, Nevada 89509
Reno, Nevada 89509
Hackensack University Medical Center
Hackensack, New Jersey 07601
Hackensack, New Jersey 07601
Contact:
Site Public Contact
201-996-2879
Site Public Contact
201-996-2879
Lovelace Medical Center-Saint Joseph Square
Albuquerque, New Mexico 87102
Albuquerque, New Mexico 87102
University of New Mexico Cancer Center
Albuquerque, New Mexico 87102
Albuquerque, New Mexico 87102
New Mexico Oncology Hematology Consultants
Albuquerque, New Mexico 87109
Albuquerque, New Mexico 87109
Memorial Medical Center - Las Cruces
Las Cruces, New Mexico 88011
Las Cruces, New Mexico 88011
Presbyterian Rust Medical Center/Jorgensen Cancer Center
Rio Rancho, New Mexico 87124
Rio Rancho, New Mexico 87124
New York Oncology Hematology PC - Albany Medical Center
Albany, New York 12208
Albany, New York 12208
Mary Imogene Bassett Hospital
Cooperstown, New York 13326
Cooperstown, New York 13326
Southeastern Medical Oncology Center-Clinton
Clinton, North Carolina 28328
Clinton, North Carolina 28328
Southeastern Medical Oncology Center-Goldsboro
Goldsboro, North Carolina 27534
Goldsboro, North Carolina 27534
Margaret R Pardee Memorial Hospital
Hendersonville, North Carolina 28791
Hendersonville, North Carolina 28791
Southeastern Medical Oncology Center-Jacksonville
Jacksonville, North Carolina 28546
Jacksonville, North Carolina 28546
Vidant Oncology-Kinston
Kinston, North Carolina 28501
Kinston, North Carolina 28501
Wake Forest University Health Sciences
Winston-Salem, North Carolina 27157
Winston-Salem, North Carolina 27157
Contact:
Site Public Contact
336-713-6771
Site Public Contact
336-713-6771
Sanford Bismarck Medical Center
Bismarck, North Dakota 58501
Bismarck, North Dakota 58501
Essentia Health Cancer Center-South University Clinic
Fargo, North Dakota 58103
Fargo, North Dakota 58103
Sanford South University Medical Center
Fargo, North Dakota 58103
Fargo, North Dakota 58103
Contact:
Site Public Contact
701-234-6161
Site Public Contact
701-234-6161
Sanford Broadway Medical Center
Fargo, North Dakota 58122
Fargo, North Dakota 58122
Sanford Clinic North-Fargo
Fargo, North Dakota 58122
Fargo, North Dakota 58122
Contact:
Preston D. Steen
712-252-0088
Preston D. Steen
712-252-0088
Sanford Roger Maris Cancer Center
Fargo, North Dakota 58122
Fargo, North Dakota 58122
Essentia Health - Jamestown Clinic
Jamestown, North Dakota 58401
Jamestown, North Dakota 58401
UHHS-Chagrin Highlands Medical Center
Beachwood, Ohio 44122
Beachwood, Ohio 44122
Dayton Physicians LLC-Miami Valley South
Centerville, Ohio 45459
Centerville, Ohio 45459
Miami Valley Hospital South
Centerville, Ohio 45459
Centerville, Ohio 45459
Good Samaritan Hospital - Cincinnati
Cincinnati, Ohio 45220
Cincinnati, Ohio 45220
Bethesda North Hospital
Cincinnati, Ohio 45242
Cincinnati, Ohio 45242
TriHealth Cancer Institute-Westside
Cincinnati, Ohio 45247
Cincinnati, Ohio 45247
TriHealth Cancer Institute-Anderson
Cincinnati, Ohio 45255
Cincinnati, Ohio 45255
Case Western Reserve University
Cleveland, Ohio 44106
Cleveland, Ohio 44106
MetroHealth Medical Center
Cleveland, Ohio 44109
Cleveland, Ohio 44109
Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland, Ohio 44111
Cleveland, Ohio 44111
Cleveland Clinic Foundation
Cleveland, Ohio 44195
Cleveland, Ohio 44195
Ohio State University Comprehensive Cancer Center
Columbus, Ohio 43210
Columbus, Ohio 43210
Columbus Oncology and Hematology Associates Inc
Columbus, Ohio 43214
Columbus, Ohio 43214
Riverside Methodist Hospital
Columbus, Ohio 43214
Columbus, Ohio 43214
Grant Medical Center
Columbus, Ohio 43215
Columbus, Ohio 43215
Miami Valley Hospital
Dayton, Ohio 45409
Dayton, Ohio 45409
Dayton Physician LLC-Miami Valley Hospital North
Dayton, Ohio 45415
Dayton, Ohio 45415
Dayton Physicians LLC-Atrium
Franklin, Ohio 45005
Franklin, Ohio 45005
Dayton Physicians LLC-Wayne
Greenville, Ohio 45331
Greenville, Ohio 45331
Wayne Hospital
Greenville, Ohio 45331
Greenville, Ohio 45331
Greater Dayton Cancer Center
Kettering, Ohio 45409
Kettering, Ohio 45409
Kettering Medical Center
Kettering, Ohio 45429
Kettering, Ohio 45429
Cleveland Clinic Cancer Center Mansfield
Mansfield, Ohio 44906
Mansfield, Ohio 44906
Hillcrest Hospital Cancer Center
Mayfield Heights, Ohio 44124
Mayfield Heights, Ohio 44124
Licking Memorial Hospital
Newark, Ohio 43055
Newark, Ohio 43055
Newark Radiation Oncology
Newark, Ohio 43055
Newark, Ohio 43055
Southern Ohio Medical Center
Portsmouth, Ohio 45662
Portsmouth, Ohio 45662
North Coast Cancer Care
Sandusky, Ohio 44870
Sandusky, Ohio 44870
Mercy Saint Anne Hospital
Toledo, Ohio 43623
Toledo, Ohio 43623
Contact:
Site Public Contact
419-407-1160
Site Public Contact
419-407-1160
Toledo Clinic Cancer Centers-Toledo
Toledo, Ohio 43623
Toledo, Ohio 43623
Contact:
Site Public Contact
800-444-3561
Site Public Contact
800-444-3561
Dayton Physicians LLC-Upper Valley
Troy, Ohio 45373
Troy, Ohio 45373
Upper Valley Medical Center
Troy, Ohio 45373
Troy, Ohio 45373
South Pointe Hospital
Warrensville Heights, Ohio 44122
Warrensville Heights, Ohio 44122
UHHS-Westlake Medical Center
Westlake, Ohio 44145
Westlake, Ohio 44145
Cleveland Clinic Wooster Family Health and Surgery Center
Wooster, Ohio 44691
Wooster, Ohio 44691
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma 73104
Oklahoma City, Oklahoma 73104
Integris Southwest Medical Center
Oklahoma City, Oklahoma 73109
Oklahoma City, Oklahoma 73109
Saint Alphonsus Medical Center-Baker City
Baker City, Oregon 97814
Baker City, Oregon 97814
Saint Charles Health System
Bend, Oregon 97701
Bend, Oregon 97701
Clackamas Radiation Oncology Center
Clackamas, Oregon 97015
Clackamas, Oregon 97015
Providence Cancer Institute Clackamas Clinic
Clackamas, Oregon 97015
Clackamas, Oregon 97015
Bay Area Hospital
Coos Bay, Oregon 97420
Coos Bay, Oregon 97420
Providence Newberg Medical Center
Newberg, Oregon 97132
Newberg, Oregon 97132
Saint Alphonsus Medical Center-Ontario
Ontario, Oregon 97914
Ontario, Oregon 97914
Providence Portland Medical Center
Portland, Oregon 97213
Portland, Oregon 97213
Providence Saint Vincent Medical Center
Portland, Oregon 97225
Portland, Oregon 97225
Saint Charles Health System-Redmond
Redmond, Oregon 97756
Redmond, Oregon 97756
Contact:
Site Public Contact
541-706-2909
Site Public Contact
541-706-2909
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania 18103
Allentown, Pennsylvania 18103
Saint Luke's University Hospital-Bethlehem Campus
Bethlehem, Pennsylvania 18015
Bethlehem, Pennsylvania 18015
Contact:
Site Public Contact
484-503-4151
Site Public Contact
484-503-4151
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania 18017
Bethlehem, Pennsylvania 18017
Chambersburg Hospital
Chambersburg, Pennsylvania 17201
Chambersburg, Pennsylvania 17201
Geisinger Medical Center
Danville, Pennsylvania 17822
Danville, Pennsylvania 17822
Pocono Medical Center
East Stroudsburg, Pennsylvania 18301
East Stroudsburg, Pennsylvania 18301
Ephrata Cancer Center
Ephrata, Pennsylvania 17522
Ephrata, Pennsylvania 17522
Contact:
Site Public Contact
717-721-4840
Site Public Contact
717-721-4840
Ephrata Community Hospital
Ephrata, Pennsylvania 17522
Ephrata, Pennsylvania 17522
Adams Cancer Center
Gettysburg, Pennsylvania 17325
Gettysburg, Pennsylvania 17325
Contact:
Site Public Contact
877-441-7957
Site Public Contact
877-441-7957
Cherry Tree Cancer Center
Hanover, Pennsylvania 17331
Hanover, Pennsylvania 17331
Contact:
Site Public Contact
877-441-7957
Site Public Contact
877-441-7957
Geisinger Medical Center-Cancer Center Hazleton
Hazleton, Pennsylvania 18201
Hazleton, Pennsylvania 18201
Lehigh Valley Hospital-Hazleton
Hazleton, Pennsylvania 18201
Hazleton, Pennsylvania 18201
Contact:
Site Public Contact
570-501-1242
Site Public Contact
570-501-1242
Sechler Family Cancer Center
Lebanon, Pennsylvania 17042
Lebanon, Pennsylvania 17042
Geisinger Medical Oncology-Lewisburg
Lewisburg, Pennsylvania 17837
Lewisburg, Pennsylvania 17837
Lewistown Hospital
Lewistown, Pennsylvania 17044
Lewistown, Pennsylvania 17044
Allegheny General Hospital
Pittsburgh, Pennsylvania 15212
Pittsburgh, Pennsylvania 15212
Contact:
Site Public Contact
877-284-2000
Site Public Contact
877-284-2000
West Penn Hospital
Pittsburgh, Pennsylvania 15224
Pittsburgh, Pennsylvania 15224
Contact:
Site Public Contact
412-578-5000
Site Public Contact
412-578-5000
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania 15232
Pittsburgh, Pennsylvania 15232
Contact:
Site Public Contact
412-647-8073
Site Public Contact
412-647-8073
Geisinger Cancer Services-Pottsville
Pottsville, Pennsylvania 17901
Pottsville, Pennsylvania 17901
Guthrie Medical Group PC-Robert Packer Hospital
Sayre, Pennsylvania 18840
Sayre, Pennsylvania 18840
Contact:
Site Public Contact
800-836-0388
Site Public Contact
800-836-0388
Community Medical Center
Scranton, Pennsylvania 18510
Scranton, Pennsylvania 18510
Geisinger Medical Oncology-Selinsgrove
Selinsgrove, Pennsylvania 17870
Selinsgrove, Pennsylvania 17870
Geisinger Medical Group
State College, Pennsylvania 16801
State College, Pennsylvania 16801
Reading Hospital
West Reading, Pennsylvania 19611
West Reading, Pennsylvania 19611
Contact:
Site Public Contact
610-988-9323
Site Public Contact
610-988-9323
Wexford Health and Wellness Pavilion
Wexford, Pennsylvania 15090
Wexford, Pennsylvania 15090
Geisinger Wyoming Valley/Henry Cancer Center
Wilkes-Barre, Pennsylvania 18711
Wilkes-Barre, Pennsylvania 18711
WellSpan Health-York Cancer Center
York, Pennsylvania 17403
York, Pennsylvania 17403
Contact:
Site Public Contact
877-441-7957
Site Public Contact
877-441-7957
WellSpan Health-York Hospital
York, Pennsylvania 17403
York, Pennsylvania 17403
Contact:
Site Public Contact
877-441-7957
Site Public Contact
877-441-7957
Rhode Island Hospital
Providence, Rhode Island 02903
Providence, Rhode Island 02903
Contact:
Site Public Contact
401-444-1488
Site Public Contact
401-444-1488
Medical University of South Carolina
Charleston, South Carolina 29425
Charleston, South Carolina 29425
Prisma Health Cancer Institute - Easley
Easley, South Carolina 29640
Easley, South Carolina 29640
Saint Francis Hospital
Greenville, South Carolina 29601
Greenville, South Carolina 29601
Prisma Health Cancer Institute - Butternut
Greenville, South Carolina 29605
Greenville, South Carolina 29605
Prisma Health Cancer Institute - Faris
Greenville, South Carolina 29605
Greenville, South Carolina 29605
Prisma Health Greenville Memorial Hospital
Greenville, South Carolina 29605
Greenville, South Carolina 29605
Saint Francis Cancer Center
Greenville, South Carolina 29607
Greenville, South Carolina 29607
Prisma Health Cancer Institute - Eastside
Greenville, South Carolina 29615
Greenville, South Carolina 29615
Prisma Health Cancer Institute - Greer
Greer, South Carolina 29650
Greer, South Carolina 29650
South Carolina Cancer Specialists PC
Hilton Head Island, South Carolina 29926-3827
Hilton Head Island, South Carolina 29926-3827
Prisma Health Cancer Institute - Seneca
Seneca, South Carolina 29672
Seneca, South Carolina 29672
Prisma Health Cancer Institute - Spartanburg
Spartanburg, South Carolina 29307
Spartanburg, South Carolina 29307
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota 57104
Sioux Falls, South Dakota 57104
Avera Cancer Institute
Sioux Falls, South Dakota 57105
Sioux Falls, South Dakota 57105
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota 57117-5134
Sioux Falls, South Dakota 57117-5134
Vanderbilt-Ingram Cancer Center Cool Springs
Franklin, Tennessee 37067
Franklin, Tennessee 37067
Contact:
Site Public Contact
800-811-8480
Site Public Contact
800-811-8480
Regional Cancer Center at Indian Path Community Hospital
Kingsport, Tennessee 37660
Kingsport, Tennessee 37660
Wellmont Holston Valley Hospital and Medical Center
Kingsport, Tennessee 37660
Kingsport, Tennessee 37660
Thompson Cancer Survival Center
Knoxville, Tennessee 37916
Knoxville, Tennessee 37916
Contact:
Site Public Contact
865-331-1812
Site Public Contact
865-331-1812
Thompson Cancer Survival Center - West
Knoxville, Tennessee 37932
Knoxville, Tennessee 37932
Contact:
Site Public Contact
865-331-1812
Site Public Contact
865-331-1812
Vanderbilt Breast Center at One Hundred Oaks
Nashville, Tennessee 37204
Nashville, Tennessee 37204
Contact:
Site Public Contact
800-811-8480
Site Public Contact
800-811-8480
Vanderbilt University/Ingram Cancer Center
Nashville, Tennessee 37232
Nashville, Tennessee 37232
Contact:
Site Public Contact
800-811-8480
Site Public Contact
800-811-8480
Thompson Oncology Group-Oak Ridge
Oak Ridge, Tennessee 37830
Oak Ridge, Tennessee 37830
Contact:
Site Public Contact
865-331-1812
Site Public Contact
865-331-1812
Saint Joseph Regional Cancer Center
Bryan, Texas 77802
Bryan, Texas 77802
University of Virginia Cancer Center
Charlottesville, Virginia 22908
Charlottesville, Virginia 22908
Providence Regional Cancer System-Aberdeen
Aberdeen, Washington 98520
Aberdeen, Washington 98520
Overlake Medical Center
Bellevue, Washington 98004
Bellevue, Washington 98004
PeaceHealth Saint Joseph Medical Center
Bellingham, Washington 98225
Bellingham, Washington 98225
Harrison HealthPartners Hematology and Oncology-Bremerton
Bremerton, Washington 98310
Bremerton, Washington 98310
Harrison Medical Center
Bremerton, Washington 98310
Bremerton, Washington 98310
Highline Medical Center-Main Campus
Burien, Washington 98166
Burien, Washington 98166
Providence Regional Cancer System-Centralia
Centralia, Washington 98531
Centralia, Washington 98531
Swedish Cancer Institute-Edmonds
Edmonds, Washington 98026
Edmonds, Washington 98026
Saint Elizabeth Hospital
Enumclaw, Washington 98022
Enumclaw, Washington 98022
Providence Regional Cancer Partnership
Everett, Washington 98201
Everett, Washington 98201
Saint Francis Hospital
Federal Way, Washington 98003
Federal Way, Washington 98003
MultiCare Gig Harbor Medical Park
Gig Harbor, Washington 98335
Gig Harbor, Washington 98335
Swedish Cancer Institute-Issaquah
Issaquah, Washington 98029
Issaquah, Washington 98029
Kadlec Clinic Hematology and Oncology
Kennewick, Washington 99336
Kennewick, Washington 99336
Providence Regional Cancer System-Lacey
Lacey, Washington 98503
Lacey, Washington 98503
Saint Clare Hospital
Lakewood, Washington 98499
Lakewood, Washington 98499
PeaceHealth Saint John Medical Center
Longview, Washington 98632
Longview, Washington 98632
Harrison HealthPartners Hematology and Oncology-Poulsbo
Poulsbo, Washington 98370
Poulsbo, Washington 98370
Valley Medical Center
Renton, Washington 98055
Renton, Washington 98055
Pacific Gynecology Specialists
Seattle, Washington 98104
Seattle, Washington 98104
Swedish Medical Center-Ballard Campus
Seattle, Washington 98107
Seattle, Washington 98107
Swedish Medical Center-First Hill
Seattle, Washington 98122-4307
Seattle, Washington 98122-4307
Swedish Medical Center-Cherry Hill
Seattle, Washington 98122-5711
Seattle, Washington 98122-5711
PeaceHealth United General Medical Center
Sedro-Woolley, Washington 98284
Sedro-Woolley, Washington 98284
Providence Regional Cancer System-Shelton
Shelton, Washington 98584
Shelton, Washington 98584
Franciscan Research Center-Northwest Medical Plaza
Tacoma, Washington 98405
Tacoma, Washington 98405
MultiCare Tacoma General Hospital
Tacoma, Washington 98405
Tacoma, Washington 98405
PeaceHealth Southwest Medical Center
Vancouver, Washington 98664
Vancouver, Washington 98664
Providence Saint Mary Regional Cancer Center
Walla Walla, Washington 99362
Walla Walla, Washington 99362
Providence Regional Cancer System-Yelm
Yelm, Washington 98597
Yelm, Washington 98597
United Hospital Center
Bridgeport, West Virginia 26330
Bridgeport, West Virginia 26330
West Virginia University Charleston Division
Charleston, West Virginia 25304
Charleston, West Virginia 25304
Contact:
Site Public Contact
304-388-9944
Site Public Contact
304-388-9944
WVUH-Berkely Medical Center
Martinsburg, West Virginia 25401
Martinsburg, West Virginia 25401
West Virginia University Healthcare
Morgantown, West Virginia 26506
Morgantown, West Virginia 26506
Camden Clark Medical Center
Parkersburg, West Virginia 26101
Parkersburg, West Virginia 26101
Langlade Hospital and Cancer Center
Antigo, Wisconsin 54409
Antigo, Wisconsin 54409
Duluth Clinic Ashland
Ashland, Wisconsin 54806
Ashland, Wisconsin 54806
Northwest Wisconsin Cancer Center
Ashland, Wisconsin 54806
Ashland, Wisconsin 54806
Marshfield Clinic-Chippewa Center
Chippewa Falls, Wisconsin 54729
Chippewa Falls, Wisconsin 54729
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin 54701
Eau Claire, Wisconsin 54701
Green Bay Oncology at Saint Vincent Hospital
Green Bay, Wisconsin 54301-3526
Green Bay, Wisconsin 54301-3526
Contact:
Brian L. Burnette
920-433-8889
Brian L. Burnette
920-433-8889
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin 54301
Green Bay, Wisconsin 54301
Green Bay Oncology Limited at Saint Mary's Hospital
Green Bay, Wisconsin 54303
Green Bay, Wisconsin 54303
Contact:
Brian L. Burnette
920-433-8889
Brian L. Burnette
920-433-8889
Saint Vincent Hospital Cancer Center at Saint Mary's
Green Bay, Wisconsin 54303
Green Bay, Wisconsin 54303
UW Cancer Center Johnson Creek
Johnson Creek, Wisconsin 53038
Johnson Creek, Wisconsin 53038
Gundersen Lutheran Medical Center
La Crosse, Wisconsin 54601
La Crosse, Wisconsin 54601
Marshfield Clinic - Ladysmith Center
Ladysmith, Wisconsin 54848
Ladysmith, Wisconsin 54848
University of Wisconsin Hospital and Clinics
Madison, Wisconsin 53792
Madison, Wisconsin 53792
Contact:
Site Public Contact
800-622-8922
Site Public Contact
800-622-8922
Holy Family Memorial Hospital
Manitowoc, Wisconsin 54221
Manitowoc, Wisconsin 54221
Contact:
Site Public Contact
920-320-2749
Site Public Contact
920-320-2749
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin 54449
Marshfield, Wisconsin 54449
Aspirus Medford Hospital
Medford, Wisconsin 54451
Medford, Wisconsin 54451
Medical College of Wisconsin
Milwaukee, Wisconsin 53226
Milwaukee, Wisconsin 53226
Contact:
Site Public Contact
414-805-3666
Site Public Contact
414-805-3666
Marshfield Clinic-Minocqua Center
Minocqua, Wisconsin 54548
Minocqua, Wisconsin 54548
Cancer Center of Western Wisconsin
New Richmond, Wisconsin 54017
New Richmond, Wisconsin 54017
Saint Vincent Hospital Cancer Center at Oconto Falls
Oconto Falls, Wisconsin 54154
Oconto Falls, Wisconsin 54154
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin 54868
Rice Lake, Wisconsin 54868
HSHS Saint Nicholas Hospital
Sheboygan, Wisconsin 53081
Sheboygan, Wisconsin 53081
Marshfield Clinic Stevens Point Center
Stevens Point, Wisconsin 54482
Stevens Point, Wisconsin 54482
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Sturgeon Bay, Wisconsin 54235-1495
Sturgeon Bay, Wisconsin 54235-1495
Green Bay Oncology - Sturgeon Bay
Sturgeon Bay, Wisconsin 54235
Sturgeon Bay, Wisconsin 54235
Contact:
Brian L. Burnette
920-433-8889
Brian L. Burnette
920-433-8889
Aspirus Regional Cancer Center
Wausau, Wisconsin 54401
Wausau, Wisconsin 54401
Contact:
Site Public Contact
877-405-6866
Site Public Contact
877-405-6866
Marshfield Clinic-Wausau Center
Wausau, Wisconsin 54401
Wausau, Wisconsin 54401
Marshfield Clinic - Weston Center
Weston, Wisconsin 54476
Weston, Wisconsin 54476
Aspirus UW Cancer Center
Wisconsin Rapids, Wisconsin 54494
Wisconsin Rapids, Wisconsin 54494
Contact:
Site Public Contact
715-422-7718
Site Public Contact
715-422-7718
Marshfield Clinic - Wisconsin Rapids Center
Wisconsin Rapids, Wisconsin 54494
Wisconsin Rapids, Wisconsin 54494
More Details
- NCT ID
- NCT02224781
- Status
- Recruiting
- Sponsor
- National Cancer Institute (NCI)
Detailed Description
PRIMARY OBJECTIVE:
I. To determine whether initial treatment with either combination ipilimumab + nivolumab (with subsequent dabrafenib mesylate [dabrafenib] in combination with trametinib dimethyl sulfoxide [trametinib]) or dabrafenib in combination with trametinib (with subsequent ipilimumab + nivolumab) significantly improves 2 year overall survival (OS) in patients with unresectable stage III or stage IV BRAFV600 mutant melanoma.
SECONDARY CLINICAL OBJECTIVES:
I. To evaluate the impact of initial treatment on median OS and hazard ratio for death.
II. To determine whether initial treatment choice significantly improves 3 year OS.
III. To evaluate the anti-tumor activities (Response Evaluation Criteria in Solid Tumors [RECIST]-defined response rate, median progression-free survival [PFS]) and safety profiles of ipilimumab + nivolumab and dabrafenib-trametinib in a Cooperative Group trial of patients with V600 mutant melanoma.
IV. To evaluate the activity (RECIST-defined response rate, median PFS) and safety of dabrafenib + trametinib in patients who have had disease progression on ipilimumab + nivolumab and in comparison to its activity and safety in ipilimumab + nivolumab naive patients.
V. To evaluate the activity of ipilimumab + nivolumab (RECIST-defined response rate, median PFS) and safety in patients who have had disease progression on dabrafenib + trametinib and in comparison to its activity and safety in dabrafenib + trametinib naive patients.
VI. To assess the feasibility of crossover to the alternative treatment strategy (percentage of patients who are able to crossover from one arm to the other and complete at least an initial course [12 weeks] of treatment after cross-over without intervening symptomatic disease progression or treatment limiting toxicity).
SECONDARY LABORATORY OBJECTIVES:
I. Association of inherited variation with immune mediated adverse events and response to ipilimumab + nivolumab.
Ia. To determine the association of inherited genetic variation and immune-associated adverse events in patients with metastatic melanoma treated with ipilimumab containing regimens by completing candidate-based gene and pathway analyses of genes involved in lymphocyte activation, cytokines, cytokine receptors and within the major histocompatibility complex (MHC) region and an agnostic genome-wide single nucleotide polymorphism (SNP)-based approach.
Ib. To investigate the association between inherited genetics and survival in patients with metastatic melanoma treated with ipilimumab containing regimens by completing candidate-based gene and pathway analyses of genes involved in lymphocyte activation, cytokines profile, cytokine receptors and within the MHC region and an agnostic genome-wide SNP-based approach.
Ic. To replicate genomic markers identified in the above aims in an independent sample set of patients treated with ipilimumab containing regimens and preliminarily characterize their potential functional role by completing replication of variation as associated with immune-related adverse events (irAEs) and survival and bio-informatic assessment of genomic markers.
II. To determine the utility of circulating BRAF levels in determining the response and resistance to either BRAF/MEK directed and/or combination immunotherapy in patients with BRAF mutant melanoma.
IIa. To determine if changes in blood BRAF levels utilizing peripheral blood BRAFV600 mutational testing in patients with stage IV BRAF mutant melanoma correlate with response and resistance to combination BRAF/MEK directed therapy.
IIb. To determine if changes in blood BRAF levels utilizing peripheral blood BRAFV600 mutational testing in patients with stage IV BRAF mutant melanoma correlate with response and resistance to combination immunotherapy.
IIc. To compare the kinetics of peripheral blood BRAFV600 levels during response and resistance in groups of patients receiving BRAF targeted therapy or combination immunotherapy as initial therapy.
IId. To compare the kinetics of peripheral blood BRAFV600 levels during response and resistance to combination BRAF targeted therapy or combination immunotherapy in individual patients (initial treatment vs crossover treatment).
SECONDARY PATIENT REPORTED OUTCOMES OBJECTIVES:
I. To evaluate differences in overall health between initial treatment arms (dabrafenib + trametinib vs. ipilimumab + nivolumab immunotherapy) at 2 years, accounting for toxicities and overall survival. (Primary) II. To assess differences in overall function over 2 years between initial treatment with dabrafenib + trametinib vs. ipilimumab + nivolumab. (Secondary) III. To document the effects of treatment crossover and treatment administration sequence on symptom burden and overall function. (Secondary) IIIa. To compare differences in function and symptoms by treatment sequence for ipilimumab + nivolumab (arm A vs. D), and dabrafenib + trametinib, (arm B vs. C) at baseline, 6 weeks, 12 weeks, and 6 months after the initiation of each treatment.
IIIb. To describe the frequency and severity of treatment toxicities at baseline, 6 weeks, 12 weeks, and 6 months after initiation of each treatment.
EXPLORATORY TOBACCO USE OBJECTIVES:
I. To determine the effects of tobacco, operationalized as combustible tobacco (1a), other forms of tobacco (1b), and environmental tobacco exposure (ETS) (1c) on provider-reported cancer-treatment toxicity (adverse events [both clinical and hematologic] and dose modifications).
II. To determine the effects of tobacco on patient-reported physical symptoms and psychological symptoms.
III. To examine quitting behaviors and behavioral counseling/support and cessation medication utilization.
IV. To explore the effect of tobacco use and exposure on treatment duration, relative dose intensity, and therapeutic benefit.
OUTLINE: Patients are randomized to 1 of 2 treatment arms (Arm A or Arm B).
ARM A:
IMMUNOTHERAPY INDUCTION (CYCLES 1-2): Patients receive nivolumab intravenously (IV) over 30-60 minutes and ipilimumab IV over 30-90 minutes on days 1 and 22. Treatment repeats every 6 weeks for 2 cycles in the absence of disease progression or unacceptable toxicity.
IMMUNOTHERAPY MAINTENANCE (CYCLES 3-14): Patients receive nivolumab IV over 30-60 minutes on days 1, 15, and 29. Treatment repeats every 6 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Upon disease progression, patients re-register and cross over to Arm C.
ARM C: Patients receive dabrafenib mesylate orally (PO) twice daily (BID) and trametinib dimethyl sulfoxide PO daily on days 1-42. Cycles repeat every 6 weeks in the absence of disease progression or unacceptable toxicity.
ARM B: Patients receive dabrafenib mesylate PO BID and trametinib dimethyl sulfoxide PO daily on days 1-42. Cycles repeat every 6 weeks in the absence of disease progression or unacceptable toxicity. Upon disease progression, patients re-register and cross over to Arm D.
ARM D:
IMMUNOTHERAPY INDUCTION (CYCLES 1-2): Patients receive nivolumab IV over 30-60 minutes and ipilimumab IV over 30-90 minutes on days 1 and 22. Treatment repeats every 6 weeks for 2 cycles in the absence of disease progression or unacceptable toxicity.
IMMUNOTHERAPY MAINTENANCE (CYCLES 3-14): Patients receive nivolumab IV over 30-60 minutes on days 1, 15, and 29. Treatment repeats every 6 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.