Активно (без набиране)
Фаза 3
NCT02595944
Nivolumab After Surgery and Chemotherapy in Treating Patients With Stage IB-IIIA Non-small Cell Lung Cancer (An ALCHEMIST Treatment Trial)
Фаза 3 – широко изпитване преди одобрение
Заболявания:
Stage IB Lung Non-Small Cell Carcinoma AJCC v7
Stage II Lung Non-Small Cell Cancer AJCC v7
Stage IIIA Lung Non-Small Cell Cancer AJCC v7
National Cancer Institute (NCI)
Налично на:
This phase III ALCHEMIST treatment trial studies how well nivolumab after surgery and chemotherapy work in treating patients with stage IB-IIIA non-small cell lung cancer. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread.
PRIMARY OBJECTIVES:
I. To evaluate whether adjuvant therapy with nivolumab will result in improved disease-free survival (DFS) over standard observation in patients with stage IB \>= 4 cm, II and IIIA, non-small cell lung cancer (NSCLC) following surgical resection and standard adjuvant therapy.
II. To evaluate whether adjuvant therapy with nivolumab will result in improved disease-free survival (DFS) over standard observation in patients with stage IB \>= 4cm, II and IIIA, NSCLC with high PD-L1 expression (\>= 50% staining) following surgical resection and standard adjuvant therapy.
III. To evaluate whether adjuvant therapy with nivolumab will result in improved overall survival (OS) over standard observation in patients with stage IB \>= 4cm, II and IIIA, NSCLC following surgical resection and standard adjuvant therapy.
SECONDARY OBJECTIVES:
I. To evaluate the safety profile of nivolumab when given as an adjuvant therapy.
II. To evaluate and compare disease free and overall survival in patients with tumors that express PD-L1 in various patterns associated with nivolumab and standard observation.
III. To evaluate and compare disease free and overall survival in patients with tumors that have high mutational load associated with nivolumab and standard observation.
IV. To evaluate OS and DFS by stage. V. To evaluate OS and DFS by each stratification factor.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients receive nivolumab intravenously (IV) over 30 minutes on day 1 of each cycle. Cycles repeat every 4 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity. Patients also undergo computed tomography (CT) and/or positron emission tomography (PET)/CT throughout the trial and blood sample collection during screening and follow-up. Patients may undergo an echocardiography (ECHO) as clinically indicated on study.
ARM II: Patients are followed serially with CT and/or PET/CT imaging for up to 1 year and then during follow-up. Patients also undergo blood sample collection during screening and follow-up. Patients may undergo an ECHO as clinically indicated on study.
After completion of study treatment, patients are followed up at 6 weeks, every 3 months for 2 years, every 6 months for 2 years, and then every 12 months for 6 years.
Inclusion Criteria:
* Age \>= 18 years
* Patients must have undergone complete surgical resection of their stage IB (\>= 4 cm), II or IIIA NSCLC according to the American Joint Committee on Cancer (AJCC) 7th edition and have had negative surgical margins
* Baseline chest CT must be performed within 1 month (30 days) prior to randomization to ensure no evidence of disease; if clinically indicated, additional imaging studies must be performed to rule out metastatic disease
* Eastern Cooperative Oncology Group (ECOG) performance status 0-1
* Patients must be registered to the ALCHEMIST-SCREEN (ALLIANCE A151216) trial prior to randomization
* Non-squamous tumors must not be positive for EGFR exon 19 deletion or exon 21 L858R mutation (centrally as part of the ALCHEMIST-SCREEN protocol) and ALK rearrangement (centrally as part of ALCHEMIST-SCREEN and/or locally)
* NOTE: if the results of the central EGFR testing are negative, but the ALK testing was not able to be completed by the ALCHEMIST central lab, the ALK status will be considered negative (unless locally positive for ALK rearrangement) and the patient may be considered for enrollment onto EA5142, once PD-L1 results are received and all other eligibility requirements are met
* Tumors must have PD-L1 status tested centrally as part of the ALCHEMIST-SCREEN protocol
* Women must not be pregnant or breast-feeding due to unknown and potentially harmful effects of nivolumab on the developing fetus or child
* 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)
* Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception or to abstain from sexual intercourse during the treatment period and for 31 weeks after the last nivolumab infusion
* Patients must NOT have uncontrolled intercurrent illness including, but not limited to, serious ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, or psychiatric illness/social situation that would limit compliance with study requirements
* No prior treatment with an immune checkpoint inhibitor (anti-PD-1, anti-PD-L1, anti-CTLA4 monoclonal antibody)
* Patients must have adequately recovered from thoracic surgery and any administered chemotherapy/radiotherapy at the time of randomization (NOTE: adjuvant chemotherapy and/or radiation is not required)
* Minimum time between date of surgery and randomization is 4 weeks (28 days)
* Maximum time allowed between surgery and randomization:
* 3 months (90 days) if no chemotherapy is administered
* 8 months (240 days) if adjuvant chemotherapy was administered
* 10 months (300 days) if adjuvant chemotherapy and radiation therapy was administered
* Patients must have completed and recovered from any adjuvant chemotherapy 2 or more weeks prior to randomization (6 weeks for mitomycin and nitrosoureas; 4 weeks for post-operative radiation therapy) (NOTE: adjuvant chemotherapy and/or radiation is not required)
* Serum aspartate transaminase (aspartate aminotransferase \[AST\]) and serum alanine transaminase (alanine aminotransferase \[ALT\]) =\< 2.5 x upper limit normal (within 2 weeks prior to randomization)
* Total bilirubin =\< 1.5 x upper limit of normal (ULN) (except in subjects with Gilbert syndrome who must have a total bilirubin \< 3.0 x ULN) (within 2 weeks prior to randomization)
* White blood cell (WBC) \>= 2000/uL (within 2 weeks prior to randomization)
* Neutrophils \>= 1000/uL (within 2 weeks prior to randomization)
* Platelets \>= 100 x 10\^3/uL (within 2 weeks prior to randomization)
* Hemoglobin \>= 8 g/dL (within 2 weeks prior to randomization)
* Serum creatinine =\< 2 x ULN (within 2 weeks prior to randomization)
* Prior to randomization patients with any non-hematologic toxicity from surgery, chemotherapy and radiation therapy must have recovered to grade =\< 1 with the exception of alopecia, ototoxicity and neuropathy
* Patients must not be receiving any other investigational anti-cancer agents while on study
* Patients must not have known or suspected autoimmune disease; subjects with type I diabetes mellitus, hypothyroidism requiring hormone replacement, or skin disorders not requiring systemic treatment are permitted to enroll
* Patients must not have a condition requiring systemic corticosteroids equivalent to \> 10 mg prednisone per day or other immunosuppressive medications within 2 weeks of randomization; inhaled, intra-articular, and epidural steroids are permissible
* Patients must not have known interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected drug-related pulmonary toxicity
* Patients must not have a known history of human immunodeficiency virus (HIV), hepatitis B, or hepatitis C infection that is untreated and/or with a detectable viral load
* Patients must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to nivolumab
Biospecimen Collection
PROCEDURE
Computed Tomography
PROCEDURE
Echocardiography Test
PROCEDURE
Observation Activity
OTHER
Positron Emission Tomography
PROCEDURE
886
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Pali Momi Medical Center
Queen's Cancer Center - Pearlridge
Providence Regional Cancer System-Aberdeen
Hendrick Medical Center
Cleveland Clinic Akron General
Phoebe Putney Memorial Hospital
Lovelace Medical Center-Downtown
Lovelace Medical Center-Saint Joseph Square
University of New Mexico Cancer Center
Presbyterian Kaseman Hospital
Christus Saint Frances Cabrini Hospital
Lehigh Valley Hospital-Cedar Crest
The Don and Sybil Harrington Cancer Center
American Fork Hospital / Huntsman Intermountain Cancer Center
Mary Greeley Medical Center
McFarland Clinic - Ames
Community Hospital of Anaconda
Kaiser Permanente-Anaheim
Katmai Oncology Group
Providence Alaska Medical Center
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
University of Michigan Rogel Cancer Center
Luminis Health Anne Arundel Medical Center
Langlade Hospital and Cancer Center
ThedaCare Regional Cancer Center
Ascension Saint Elizabeth Hospital
PCR Oncology
Randolph Hospital
AdventHealth Infusion Center Asheville
Mission Hospital
King's Daughter's Medical Center
Duluth Clinic Ashland
University Cancer and Blood Center LLC
Emory University Hospital Midtown
Emory University Hospital/Winship Cancer Institute
Emory Saint Joseph's Hospital
Northside Hospital
Sutter Auburn Faith Hospital
Sutter Cancer Centers Radiation Oncology Services-Auburn
Harold Alfond Center for Cancer Care
UCHealth University of Colorado Hospital
Rush-Copley Medical Center
Dell Seton Medical Center at The University of Texas
AIS Cancer Center at San Joaquin Community Hospital
Kaiser Permanente-Baldwin Park
Mercy Oncology and Hematology - Clayton-Clarkson
University of Maryland/Greenebaum Cancer Center
Greater Baltimore Medical Center
Sinai Hospital of Baltimore
MedStar Franklin Square Medical Center/Weinberg Cancer Institute
Johns Hopkins University/Sidney Kimmel Cancer Center
Eastern Maine Medical Center
Flaget Memorial Hospital
Memorial Sloan Kettering Basking Ridge
LSU Health Baton Rouge-North Clinic
Our Lady of the Lake Physician Group
Louisiana Hematology Oncology Associates LLC
Mary Bird Perkins Cancer Center
Ochsner Health Center-Summa
Medical Center of Baton Rouge
Bronson Battle Creek
Northwell Health Imbert Cancer Center
UM Upper Chesapeake Medical Center
MaineHealth Waldo Hospital
Kaiser Permanente-Bellflower
Sanford Joe Lueken Cancer Center
Southwestern Vermont Medical Center
Alta Bates Summit Medical Center-Herrick Campus
Central Vermont Medical Center/National Life Cancer Treatment
Saint Luke's University Hospital-Bethlehem Campus
Lehigh Valley Hospital - Muhlenberg
University of Iowa Healthcare Cancer Services Quad Cities
Beverly Hospital
MaineHealth Maine Medical Center - Biddeford
Billings Clinic Cancer Center
Saint Vincent Healthcare
University of Alabama at Birmingham Cancer Center
Sanford Bismarck Medical Center
Illinois CancerCare-Bloomington
Boca Raton Regional Hospital
Prisma Health Cancer Institute - Spartanburg
Saint Alphonsus Cancer Care Center-Boise
Saint Luke's Cancer Institute - Boise
Parkland Health Center-Bonne Terre
McFarland Clinic - Boone
Massachusetts General Hospital Cancer Center
Boston Medical Center
Beth Israel Deaconess Medical Center
Dana-Farber Cancer Institute
Rocky Mountain Cancer Centers-Boulder
Bozeman Health Deaconess Hospital
Essentia Health Saint Joseph's Medical Center
Lafayette Family Cancer Center-EMMC
United Hospital Center
Dana-Farber Cancer Institute at Boston Medical Center - Brighton
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Trinity Health Medical Center - Brighton
Bristol Regional Medical Center
Ballad Health Cancer Care - Bristol
Ascension Southeast Wisconsin Hospital - Elmbrook Campus
New York-Presbyterian/Brooklyn Methodist Hospital
Maimonides Medical Center
Crozer-Keystone Regional Cancer Center at Broomall
Henry Ford Cancer Institute-Downriver
Bryn Mawr Hospital
Roswell Park Cancer Institute
Mills-Peninsula Medical Center
Cone Health Cancer Center at Alamance Regional
Lahey Hospital and Medical Center
University of Vermont Medical Center
University of Vermont and State Agricultural College
Aurora Cancer Care-Southern Lakes VLCC
Fairview Ridges Hospital
Saint James Community Hospital and Cancer Treatment Center
Saint Alphonsus Cancer Care Center-Caldwell
Cooper Hospital University Medical Center
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
Aultman Health Foundation
Trinity Health IHA Medical Group Hematology Oncology - Canton
Trinity Health Medical Center - Canton
Illinois CancerCare-Canton
Mercy Cancer Center - Cape Girardeau
Saint Francis Medical Center
Mercy San Juan Medical Center
SIH Cancer Institute
Illinois CancerCare-Carthage
Eden Hospital Medical Center
Sandra L Maxwell Cancer Center
Physicians' Clinic of Iowa PC
Mercy Hospital
Oncology Associates at Mercy Medical Center
Dayton Physicians LLC-Miami Valley South
Centralia Oncology Clinic
Providence Regional Cancer System-Centralia
Cancer Center of Kansas - Chanute
UNC Lineberger Comprehensive Cancer Center
Geauga Hospital
Medical University of South Carolina
West Virginia University Charleston Division
Novant Health Presbyterian Medical Center
Oncology Specialists of Charlotte
Southern Oncology Specialists-Charlotte
University of Virginia Cancer Center
Sentara Martha Jefferson Hospital
Chelsea Hospital
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Saint Luke's Hospital
Mount Sinai Hospital Medical Center
Northwestern University
John H Stroger Jr Hospital of Cook County
Rush MD Anderson Cancer Center
University of Chicago Comprehensive Cancer Center
Advocate Illinois Masonic Medical Center
Adena Regional Medical Center
Marshfield Clinic-Chippewa Center
University of Cincinnati Cancer Center-UC Medical Center
Good Samaritan Hospital - Cincinnati
Bethesda North Hospital
TriHealth Cancer Institute-Westside
TriHealth Cancer Institute-Anderson
Siteman Cancer Center at Saint Peters Hospital
Providence Cancer Institute Clackamas Clinic
Newland Medical Associates-Clarkston
Case Western Reserve University
MetroHealth Medical Center
Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland Clinic Foundation
Southeastern Medical Oncology Center-Clinton
Mercy Cancer Center-West Lakes
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
University Oncology Associates
AdventHealth Infusion Center Haywood
Big Horn Basin Cancer Center
Billings Clinic-Cody
Kootenai Health - Coeur d'Alene
Penrose-Saint Francis Healthcare
UCHealth Memorial Hospital Central
MU Health - University Hospital/Ellis Fischel Cancer Center
Ohio State University Comprehensive Cancer Center
Columbus Oncology and Hematology Associates Inc
Grant Medical Center
The Mark H Zangmeister Center
Doctors Hospital
John B Amos Cancer Center
Baptist Memorial Hospital and Cancer Center-Golden Triangle
Memorial Sloan Kettering Commack
New Hampshire Oncology Hematology PA-Concord
John Muir Medical Center-Concord
Cookeville Regional Medical Center
Mercy Hospital
Mary Imogene Bassett Hospital
Bay Area Hospital
UM Sylvester Comprehensive Cancer Center at Coral Gables
Baptist Health Corbin
City of Hope Corona
Good Samaritan Hospital
Northshore Oncology Associates-Covington
Ochsner Hematology Oncology North Shore - Covington (West Region)
Greater Regional Medical Center
Siteman Cancer Center at West County Hospital
UPMC Western Maryland
Parkland Memorial Hospital
UT Southwestern/Simmons Cancer Center-Dallas
Danbury Hospital
Carle at The Riverfront
Geisinger Medical Center
Southern Cancer Center PC-Daphne
MercyOne Genesis Davenport Medical Center
MercyOne Genesis Davenport Cancer Center
Iowa Cancer Specialists
Sutter Davis Hospital
Dayton Veterans Affairs Medical Center
Halifax Health Cancer Center for Hope - Daytona Beach
Henry Ford Medical Center-Fairlane
Atlanta VA Medical Center
Emory Decatur Hospital
Cancer Care Specialists of Illinois - Decatur
Decatur Memorial Hospital
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Northwestern Medicine Cancer Center Kishwaukee
Kaiser Permanente-Franklin
AdventHealth Porter
Smilow Cancer Hospital-Derby Care Center
Iowa Methodist Medical Center
UI Health Care Mission Cancer and Blood - Des Moines Clinic
Mercy Medical Center - Des Moines
UI Health Care Mission Cancer and Blood - Laurel Clinic
Iowa Lutheran Hospital
Henry Ford Hospital
Henry Ford Health Saint John Hospital
Cancer Center of Kansas - Dodge City
Wentworth-Douglass Hospital
Advocate Good Samaritan Hospital
City of Hope Comprehensive Cancer Center
Essentia Health Cancer Center
Saint Luke's Hospital of Duluth
Duke University Medical Center
Prisma Health Cancer Institute - Easley
Marshfield Clinic Cancer Center at Sacred Heart
Marshfield Medical Center-EC Cancer Center
Saint Elizabeth Healthcare Edgewood
Fairview Southdale Hospital
Swedish Cancer Institute-Edmonds
Carle Physician Group-Effingham
Crossroads Cancer Center
Cancer Center of Kansas - El Dorado
Baptist Health Hardin
Mercy Cancer Center - Elk Grove
Christiana Care - Union Hospital
Elmhurst Memorial Hospital
Mercy Cancer Center-Elyria
Mountain Blue Cancer Care Center - Swedish
Ephrata Cancer Center
Ephrata Community Hospital
UPMC Hillman Cancer Center Erie
OSF Saint Francis Hospital and Medical Group
Illinois CancerCare-Eureka
NorthShore University HealthSystem-Evanston Hospital
Exeter Hospital
Inova Schar Cancer Institute
Inova Fair Oaks Hospital
Smilow Cancer Hospital Care Center-Fairfield
Inova Fairfax Hospital
Sanford Broadway Medical Center
Sanford Roger Maris Cancer Center
Corewell Health Farmington Hills Hospital
Armes Family Cancer Center
Blanchard Valley Hospital
Augusta Health Center for Cancer and Blood Disorders
Simonds-Sinon Regional Cancer Center
Genesys Hurley Cancer Institute
McLeod Regional Medical Center
Aurora Health Center-Fond du Lac
Kaiser Permanente-Fontana
Poudre Valley Hospital
McFarland Clinic - Trinity Cancer Center
Cancer Center of Kansas - Fort Scott
Saint Elizabeth Healthcare Fort Thomas
Parkview Regional Medical Center
UT Southwestern/Simmons Cancer Center-Fort Worth
Ascension Saint Francis - Reiman Cancer Center
Mary Washington Hospital
Hematology Oncology Associates of Fredericksburg Inc
Palo Alto Medical Foundation-Fremont
Unity Hospital
Saint Luke's Cancer Institute - Fruitland
Saint Jude Medical Center
Gibbs Cancer Center-Gaffney
Northeast Georgia Medical Center-Gainesville
Illinois CancerCare-Galesburg
Saint Catherine Hospital
CaroMont Regional Medical Center
Gaston Hematology and Oncology Associates
Northwestern Medicine Cancer Center Delnor
Aurora Health Care Germantown Health Center
Adams Cancer Center
UM Baltimore Washington Medical Center/Tate Cancer Center
Glens Falls Hospital
NorthShore University HealthSystem-Glenbrook Hospital
Addison Gilbert Hospital
National Jewish Health-Western Hematology Oncology
Southeastern Medical Oncology Center-Goldsboro
Wayne Memorial Hospital
Goshen Center for Cancer Care
Aurora Cancer Care-Grafton
Altru Cancer Center
Nebraska Cancer Specialists/Oncology Hematology West PC
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Trinity Health Grand Rapids Hospital
Three Rivers Community Hospital
Central Care Cancer Center - Great Bend
Benefis Sletten Cancer Institute
Great Falls Clinic
Banner North Colorado Medical Center
Saint Vincent Hospital Cancer Center Green Bay
Saint Vincent Hospital Cancer Center at Saint Mary's
Aurora BayCare Medical Center
Cone Health Cancer Center
East Carolina University
Saint Francis Hospital
Prisma Health Cancer Institute - Butternut
Prisma Health Cancer Institute - Faris
Saint Francis Cancer Center
Prisma Health Cancer Institute - Eastside
Greenwich Hospital
Self Regional Healthcare
Prisma Health Cancer Institute - Greer
Gibbs Cancer Center-Pelham
Baptist Cancer Center-Grenada
Smilow Cancer Hospital Care Center - Guilford
The Cancer Institute of New Jersey Hamilton
Kaiser Permanente South Bay
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
Memorial Sloan Kettering Westchester
Hartford Hospital
Smilow Cancer Hospital Care Center at Saint Francis
Ingalls Memorial Hospital
Hattiesburg Clinic - Hematology/Oncology Clinic
Forrest General Hospital / Cancer Center
Geisinger Medical Center-Cancer Center Hazleton
Saint Peter's Community Hospital
Maria Parham Hospital
Cancer and Blood Specialists-Henderson
Comprehensive Cancer Centers of Nevada - Henderson
Las Vegas Cancer Center-Henderson
OptumCare Cancer Care at Seven Hills
Comprehensive Cancer Centers of Nevada-Southeast Henderson
Oncology Las Vegas - Henderson
Margaret R Pardee Memorial Hospital
AdventHealth Hendersonville
Penn State Milton S Hershey Medical Center
Essentia Health Hibbing Clinic
NorthShore University HealthSystem-Highland Park Hospital
South Carolina Cancer Specialists PC
Edward Hines Jr VA Hospital
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
UM Sylvester Comprehensive Cancer Center at Hollywood
Hawaii Cancer Care Inc - Waterfront Plaza
Queen's Cancer Cenrer - POB I
Queen's Medical Center
Straub Clinic and Hospital
University of Hawaii Cancer Center
Hawaii Cancer Care Inc-Liliha
Kuakini Medical Center
Queen's Cancer Center - Kuakini
Kapiolani Medical Center for Women and Children
Oncology Center of The South Incorporated
Houston Methodist Hospital
M D Anderson Cancer Center
Memorial Hermann Texas Medical Center
Novant Health Cancer Institute - Huntersville
Southern Oncology Specialists-Huntersville
Edwards Comprehensive Cancer Center
Cleveland Clinic Cancer Center Independence
Cancer Center of Kansas-Independence
Indiana University/Melvin and Bren Simon Cancer Center
Richard L. Roudebush Veterans Affairs Medical Center
Sidney and Lois Eskenazi Hospital
Community Cancer Center East
Community Cancer Center South
Franciscan Health Indianapolis
Community Cancer Center North
University of Iowa/Holden Comprehensive Cancer Center
Iowa City VA Healthcare System
Kaiser Permanente-Irvine
Swedish Cancer Institute-Issaquah
Allegiance Health
University of Mississippi Medical Center
Southeastern Medical Oncology Center-Jacksonville
Baptist MD Anderson Cancer Center
McFarland Clinic - Jefferson
MU Health Care Goldschmidt Cancer Center
Wellmont Medical Associates Oncology and Hematology-Johnson City
University of Wisconsin Carbone Cancer Center - Johnson Creek
Duly Health and Care Joliet
NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
Mercy Hospital Joplin
West Michigan Cancer Center
Logan Health Medical Center
University Health Truman Medical Center
Saint Luke's Hospital of Kansas City
The University of Kansas Cancer Center-South
Research Medical Center
University of Kansas Cancer Center - North
University of Kansas Cancer Center-West
University of Kansas Cancer Center
CHI Health Good Samaritan
ECU Health Oncology Kenansville
New England Cancer Specialists - Kennebunk
Ochsner Medical Center Kenner
Aurora Cancer Care-Kenosha South
Greater Dayton Cancer Center
Kettering Medical Center
Illinois CancerCare-Kewanee Clinic
Cancer Center of Kansas-Kingman
Ballad Health Cancer Care - Kingsport
Wellmont Holston Valley Hospital and Medical Center
ECU Health Oncology Kinston
FHCC at EvergreenHealth
Community Howard Regional Health
Gundersen Lutheran Medical Center
UC San Diego Moores Cancer Center
Providence Regional Cancer System-Lacey
Marshfield Medical Center - Ladysmith
Kaiser Permanente-Rock Creek
CHRISTUS Saint Patrick Hospital
Northwell Health/Center for Advanced Medicine
The Watson Clinic
Rocky Mountain Cancer Centers-Lakewood
University of Michigan Health - Sparrow Lansing
Memorial Medical Center-Las Cruces
OptumCare Cancer Care at Charleston
Cancer and Blood Specialists-Shadow
Radiation Oncology Centers of Nevada Central
HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
HealthCare Partners Medical Group Oncology/Hematology-San Martin
Radiation Oncology Centers of Nevada Southeast
Cancer Therapy and Integrative Medicine
Cancer and Blood Specialists-Tenaya
Comprehensive Cancer Centers of Nevada - Northwest
HealthCare Partners Medical Group Oncology/Hematology-Tenaya
Oncology Las Vegas - Tenaya
OptumCare Cancer Care at MountainView
Comprehensive Cancer Centers of Nevada-Summerlin
Summerlin Hospital Medical Center
Las Vegas Cancer Center-Medical Center
Comprehensive Cancer Centers of Nevada
OptumCare Cancer Care at Fort Apache
HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
Comprehensive Cancer Centers of Nevada - Central Valley
Scotland Memorial Hospital-Laurinburg Cancer Center
Lawrence Memorial Hospital
Northside Hospital - Gwinnett
Cancer Centers of Southwest Oklahoma Research
MD Anderson League City
Sechler Family Cancer Center
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
University of Kansas Cancer Center - Lee's Summit
Saint Luke's East - Lee's Summit
Beebe Medical Center
Geisinger Medical Oncology-Lewisburg
Lewistown Hospital
Baptist Health Lexington
Saint Joseph Hospital East
University of Kentucky/Markey Cancer Center
Cancer Center of Kansas-Liberal
Saint Rita's Medical Center
Cancer Partners of Nebraska
John L McClellan Memorial Veterans Hospital
Trinity Health Saint Mary Mercy Livonia Hospital
Loma Linda University Medical Center
Saint Joseph London
The Dana-Farber Cancer Institute at Londonderry
Kaiser Permanente-Lone Tree
Monmouth Medical Center
Kaiser Permanente Los Angeles Medical Center
Los Angeles General Medical Center
USC / Norris Comprehensive Cancer Center
Kaiser Permanente West Los Angeles
Jewish Hospital
The James Graham Brown Cancer Center at University of Louisville
Baptist Health Louisville
Saints Mary and Elizabeth Hospital
UofL Health Medical Center Northeast
Banner North Colorado Medical Center - Loveland Campus
Covenant Medical Center-Lakeside
Southeastern Regional Medical Center
Centra Alan B Pearson Regional Cancer Center
Illinois CancerCare-Macomb
William S Middleton VA Medical Center
University of Wisconsin Carbone Cancer Center - University Hospital
Baptist Health Madisonville/Merle Mahr Cancer Center
Manchester Memorial Hospital
Solinsky Center for Cancer Care
Dartmouth Cancer Center - Manchester/ DCC Manchester
Holy Family Memorial Hospital
Cleveland Clinic Cancer Center Mansfield
Minnesota Oncology Hematology PA-Maplewood
Saint John's Hospital - Healtheast
Marietta Memorial Hospital
Aurora Bay Area Medical Group-Marinette
Saint Vincent Hospital Cancer Center at Marinette
OhioHealth Marion General Hospital
UP Health System Hematology Oncology Marquette
UP Health System Marquette
McFarland Clinic - Marshalltown
Marshfield Medical Center-Marshfield
Sovah Health Martinsville
Fremont - Rideout Cancer Center
Matthews Radiation Oncology Center
Novant Health Cancer Institute - Matthews
Carle Physician Group-Mattoon/Charleston
Toledo Clinic Cancer Centers-Maumee
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
Hillcrest Hospital Cancer Center
Loyola University Medical Center
Cancer Center of Kansas - McPherson
Bon Secours Memorial Regional Medical Center
Asante Rogue Regional Medical Center
Providence Medford Medical Center
Riddle Memorial Hospital
Baptist Memorial Hospital and Cancer Center-Memphis
Baptist Memorial Hospital for Women
Family Cancer Center-Memphis
UH Seidman Cancer Center at Lake Health Mentor Campus
Ascension Columbia Saint Mary's Hospital Ozaukee
Saint Luke's Cancer Institute - Meridian
University of Miami Miller School of Medicine-Sylvester Cancer Center
UM Sylvester Comprehensive Cancer Center at Kendall
Mount Sinai Medical Center
UH Seidman Cancer Center at Southwest General Hospital
Middlesex Hospital
Memorial Sloan Kettering Monmouth
MyMichigan Medical Center Midland
Bon Secours Saint Francis Medical Center
Dana-Farber/Brigham and Women's Cancer Center at Milford Regional
Aurora Cancer Care-Milwaukee
Ascension Columbia Saint Mary's Hospital - Milwaukee
Aurora Saint Luke's Medical Center
Medical College of Wisconsin
Aurora Sinai Medical Center
Abbott-Northwestern Hospital
Hennepin County Medical Center
Minneapolis VA Medical Center
Health Partners Inc
Marshfield Medical Center - Minocqua
Memorial Regional Cancer Center Day Road
Saint Patrick Hospital - Community Hospital
Community Medical Center
Southern Cancer Center PC-Mobile
Southern Cancer Center PC-Providence
Southern Cancer Center PC-Springhill
Memorial Medical Center
Trinity Medical Center
Ochsner LSU Health Monroe Medical Center
Memorial Sloan Kettering Bergen
Novant Health Cancer Institute - Mooresville
Franciscan Health Mooresville
West Virginia University Healthcare
Morristown Medical Center
Virtua Memorial
Knox Community Hospital
Palo Alto Medical Foundation-Camino Division
Palo Alto Medical Foundation-Gynecologic Oncology
ProHealth D N Greenwald Center
Inspira Medical Center Mullica Hill
The Community Hospital
Intermountain Medical Center
Trinity Health Muskegon Hospital
Saint Alphonsus Cancer Care Center-Nampa
Saint Luke's Cancer Institute - Nampa
Edward Hospital/Cancer Center
Saint Joseph Hospital
Dartmouth Cancer Center - Nashua
Vanderbilt University/Ingram Cancer Center
Baptist Memorial Hospital and Cancer Center-Union County
The Hospital of Central Connecticut
Rutgers Cancer Institute of New Jersey
Smilow Cancer Center/Yale-New Haven Hospital
Yale University
UC Comprehensive Cancer Center at Silver Cross
University Medical Center New Orleans
Ochsner Medical Center Jefferson
Cancer Center of Western Wisconsin
New Ulm Medical Center
Laura and Isaac Perlmutter Cancer Center at NYU Langone
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
Memorial Sloan Kettering Cancer Center
NYP/Weill Cornell Medical Center
Helen F Graham Cancer Center
Medical Oncology Hematology Consultants PA
Licking Memorial Hospital
Providence Newberg Medical Center
Newton-Wellesley Hospital
Newton Medical Center
Yale-New Haven Hospital North Haven Medical Center
Ballad Health Cancer Care - Norton
Sutter Cancer Research Consortium
Henry Ford Health Providence Novi Hospital
Henry Ford Medical Center-Columbus
Cancer Care Center of O'Fallon
Advocate Christ Medical Center
ProHealth Oconomowoc Memorial Hospital
Saint Vincent Hospital Cancer Center at Oconto Falls
McKay-Dee Hospital Center
University of Oklahoma Health Sciences Center
Mercy Hospital Oklahoma City
The University of Kansas Cancer Center - Olathe
Nebraska Methodist Hospital
Alegent Health Immanuel Medical Center
Alegent Health Bergan Mercy Medical Center
University of Nebraska Medical Center
Saint Alphonsus Cancer Care Center-Ontario
Smilow Cancer Hospital-Orange Care Center
Saint Joseph Hospital - Orange
Saint Charles Hospital
University of Chicago Medicine-Orland Park
Ascension Mercy Hospital
Vince Lombardi Cancer Clinic - Oshkosh
Illinois CancerCare-Ottawa Clinic
University of Kansas Cancer Center-Overland Park
Saint Luke's South Hospital
Baptist Memorial Hospital and Cancer Center-Oxford
Baptist Health Paducah
Desert Regional Medical Center
Palo Alto Medical Foundation Health Care
Stanford Cancer Institute Palo Alto
Kaiser Permanente - Panorama City
Paoli Memorial Hospital
The Valley Hospital - Luckow Pavilion
AdventHealth Parker
University Hospitals Parma Medical Center
Cancer Center of Kansas - Parsons
Singing River Hospital
Illinois CancerCare-Pekin
Memorial Hospital West
Sacred Heart Hospital
Illinois CancerCare-Peoria
Mercy Health - Perrysburg Hospital
Illinois CancerCare-Peru
University of Pennsylvania/Abramson Cancer Center
Thomas Jefferson University Hospital
Fox Chase Cancer Center
Temple University Hospital
Mayo Clinic Hospital in Arizona
FirstHealth of the Carolinas-Moore Regional Hospital
Mercy Hospital Pittsburg
University of Pittsburgh Cancer Institute (UPCI)
Berkshire Medical Center - Cancer Center
Edward Hospital/Cancer Center?Plainfield
UM Sylvester Comprehensive Cancer Center at Plantation
Chilton Medical Center
Trinity Health Saint Joseph Mercy Oakland Hospital
Providence Portland Medical Center
Providence Saint Vincent Medical Center
Kaiser Permanente Northwest
Southern Ohio Medical Center
Portsmouth Regional Hospital
Kootenai Clinic Cancer Services - Post Falls
Geisinger Cancer Services-Pottsville
Vassar Brothers Medical Center
Harrison HealthPartners Hematology and Oncology-Poulsbo
Cancer Center of Kansas - Pratt
Illinois CancerCare-Princeton
Roger Williams Medical Center
Utah Valley Regional Medical Center
Quincy Medical Group-Clinic
Aurora Cancer Care-Racine
Duke Cancer Center Raleigh
Eisenhower Medical Center
Northwest Hospital Center
Penn State Health Saint Joseph Medical Center
Mercy Regional Cancer Center
Mercy Oncology Center
Corewell Health Reed City Hospital
Beebe Health Campus
Renown Regional Medical Center
Saint Mary's Regional Medical Center
Valley Medical Center
Marshfield Medical Center-Rice Lake
ECU Health Oncology Richlands
Reid Health
Bon Secours Saint Mary's Hospital
Virginia Cancer Institute
VCU Massey Comprehensive Cancer Center
Valley Health System Ridgewood Campus
Presbyterian Rust Medical Center/Jorgensen Cancer Center
Kaiser Permanente-Riverside
North Memorial Medical Health Center
Mayo Clinic in Rochester
Rochester General Hospital
University of Rochester
OSF Saint Anthony Medical Center
UW Health Carbone Cancer Center Rockford
Mercy Cancer Center - Rocklin
Penobscot Bay Medical Center
Sutter Cancer Centers Radiation Oncology Services-Roseville
Sutter Roseville Medical Center
Corewell Health William Beaumont University Hospital
Mercy Cancer Center - Sacramento
Sutter Medical Center Sacramento
University of California Davis Comprehensive Cancer Center
MyMichigan Medical Center Saginaw
Coborn Cancer Center at Saint Cloud Hospital
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
Park Nicollet Clinic - Saint Louis Park
Regions Hospital
United Hospital
Sainte Genevieve County Memorial Hospital
Cancer Center of Kansas - Salina
Salina Regional Health Center
TidalHealth Peninsula Regional
Utah Cancer Specialists-Salt Lake City
LDS Hospital
Kaiser Permanente-San Diego Zion
Naval Medical Center -San Diego
California Pacific Medical Center-Pacific Campus
Pacific Central Coast Health Center-San Luis Obispo
Kaiser Permanente-San Marcos
Kootenai Clinic Cancer Services - Sandpoint
North Coast Cancer Care
UH Seidman Cancer Center at Firelands Regional Medical Center
MaineHealth Cancer Care and IV Therapy - Sanford
Dominican Santa Cruz Hospital
Palo Alto Medical Foundation-Santa Cruz
Christus Saint Vincent Regional Cancer Center
Sutter Pacific Medical Foundation
Memorial Health University Medical Center
Summit Cancer Care-Memorial
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Guthrie Medical Group PC-Robert Packer Hospital
Mayo Clinic in Arizona
Community Medical Center
TidalHealth Nanticoke / Allen Cancer Center
Virginia Mason Medical Center
Fred Hutchinson Cancer Center
Swedish Medical Center-First Hill
University of Washington Medical Center - Montlake
Prisma Health Cancer Institute - Seneca
Saint Francis Regional Medical Center
HSHS Saint Nicholas Hospital
Vince Lombardi Cancer Clinic-Sheboygan
Welch Cancer Center
LSU Health Sciences Center at Shreveport
CHRISTUS Highland Medical Center
Saint Michael Cancer Center
MercyOne Genesis Silvis Cancer Center
Siouxland Regional Cancer Center
Sanford Cancer Center Oncology Clinic
Avera Cancer Institute
Sanford USD Medical Center - Sioux Falls
Ochsner Hematology Oncology North Shore - Slidell (East Region)
Johnston Memorial Hospital
Robert Wood Johnson University Hospital Somerset
Memorial Hospital of South Bend
VCU Community Memorial Health Center
MaineHealth Cancer Care and IV Therapy - South Portland
Dana-Farber/Brigham and Women's Cancer Center at South Shore
Henry Ford Health Providence Southfield Hospital
Baptist Memorial Hospital and Cancer Center-Desoto
Spartanburg Medical Center
Baystate Medical Center
Springfield Regional Cancer Center
Springfield Regional Medical Center
CoxHealth South Hospital
Central Illinois Hematology Oncology Center
Southern Illinois University School of Medicine
Springfield Clinic
Springfield Memorial Hospital
Mercy Infusion Center - Chippewa
Washington University School of Medicine
Veteran's Affairs Medical Center - Saint Louis
Siteman Cancer Center-South County
Missouri Baptist Medical Center
Siteman Cancer Center at Christian Hospital
Mercy Hospital Saint Louis
Saint George Regional Medical Center
Saint Helena Hospital
Stamford Hospital/Bennett Cancer Center
Geisinger Medical Group
Mount Nittany Medical Center
Staten Island University Hospital
Aspirus Cancer Care - Stevens Point
Lakeview Hospital
Saint Joseph's Medical Center
Cleveland Clinic Cancer Center Strongsville
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Houston Methodist Sugar Land Hospital
Missouri Baptist Sullivan Hospital
Aurora Medical Center in Summit
Overlook Hospital
Palo Alto Medical Foundation-Sunnyvale
BJC Outpatient Center at Sunset Hills
ProMedica Flower Hospital
State University of New York Upstate Medical University
MultiCare Tacoma General Hospital
Moffitt Cancer Center
Union Hospital
Montefiore Medical Center-Einstein Campus
Montefiore Medical Center - Moses Campus
James J Peters VA Medical Center
University of Toledo
Mercy Health - Saint Anne Hospital
Toledo Clinic Cancer Centers-Toledo
Community Medical Center
Cotton O'Neil Cancer Center / Stormont Vail Health
University of Kansas Health System Saint Francis Campus
New England Cancer Specialists - Topsham
Smilow Cancer Hospital-Torrington Care Center
Corewell Health Beaumont Troy Hospital
Gene Upshaw Memorial Tahoe Forest Cancer Center
Smilow Cancer Hospital Care Center-Trumbull
Banner University Medical Center - Tucson
University of Arizona Cancer Center-North Campus
Saint Luke's Cancer Institute - Twin Falls
Vince Lombardi Cancer Clinic-Two Rivers
Memorial Sloan Kettering Nassau
Carle Cancer Center
The Carle Foundation Hospital
South Georgia Medical Center/Pearlman Cancer Center
Sutter Solano Medical Center/Cancer Center
PeaceHealth Southwest Medical Center
Indian River Medical Center
Inspira Medical Center Vineland
Essentia Health Virginia Clinic
Virtua Voorhees
Ridgeview Medical Center
University Hospitals Sharon Health Center
Providence Saint Mary Regional Cancer Center
John Muir Medical Center-Walnut Creek
Henry Ford Health Warren Hospital
South Pointe Hospital
Northwestern Medicine Cancer Center Warrenville
Marion L Shepard Cancer Center - ECU Health Beaufort Hospital
MedStar Georgetown University Hospital
MedStar Washington Hospital Center
Sibley Memorial Hospital
Smilow Cancer Hospital-Waterbury Care Center
Smilow Cancer Hospital Care Center - Waterford
UW Cancer Center at ProHealth Care
Aspirus Regional Cancer Center
Marshfield Clinic-Wausau Center
Ascension Medical Group Southeast Wisconsin - Mayfair Road
Aurora Cancer Care-Milwaukee West
Cancer Center of Kansas - Wellington
Aurora West Allis Medical Center
Henry Ford West Bloomfield Hospital
Chester County Hospital
Lexington Medical Center
Mercy Medical Center-West Lakes
Veterans Affairs Connecticut Healthcare System-West Haven Campus
Reading Hospital
New England Cancer Specialists
UH Seidman Cancer Center at Saint John Medical Center
Marshfield Medical Center - Weston
Cleveland Clinic-Weston
University of Kansas Hospital-Westwood Cancer Center
Valley Health System-Hematology/Oncology
Intermountain Health Lutheran Hospital
Dickstein Cancer Treatment Center
Cancer Center of Kansas-Wichita Medical Arts Tower
Ascension Via Christi Hospitals Wichita
Cancer Center of Kansas - Wichita
Geisinger Wyoming Valley/Henry Cancer Center
UPMC Susquehanna
Rice Memorial Hospital
Asplundh Cancer Pavilion
Beth Israel Deaconess Medical Center/Winchester Center for Cancer Care
Cancer Center of Kansas - Winfield
Wake Forest University Health Sciences
Aspirus Cancer Care - Wisconsin Rapids
Marshfield Clinic - Wisconsin Rapids Center
Minnesota Oncology Hematology PA-Woodbury
Woodland Memorial Hospital
Kaiser Permanente-Woodland Hills
Cleveland Clinic Wooster Family Health and Surgery Center
UMass Memorial Medical Center - University Campus
Wright-Patterson Medical Center
Lankenau Medical Center
University of Michigan Health - West
WellSpan Health-York Cancer Center
WellSpan Health-York Hospital
Rush-Copley Healthcare Center
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
Genesis Healthcare System Cancer Care Center
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