Testing the Addition of the Immunotherapy Drug Pembrolizumab to the Usual Chemotherapy Treatment (Paclitaxel and Carboplatin) in Stage III-IV or Recurrent Endometrial Cancer
This phase III trial studies how well the combination of pembrolizumab, paclitaxel and carboplatin works compared with paclitaxel and carboplatin alone in treating patients with endometrial cancer that is stage III or IV, or has come back after a period of improvement (recurrent). Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Paclitaxel and carboplatin are chemotherapy drugs used as part of the usual treatment approach for this type of cancer. This study aims to assess if adding immunotherapy to these drugs is better or worse than the usual approach for treatment of this cancer.
Description
PRIMARY OBJECTIVE:
I. To evaluate the efficacy of pembrolizumab (MK-3475) in combination with paclitaxel and carboplatin in patients with advanced stage (measurable stage III or IVA), stage IVB and recurrent endometrial cancer.
SECONDARY OBJECTIVES:
I. To determine the nature, frequency and degree of toxicity as assessed by Common Terminology Criteria for Adverse Events (CTCAE) for each treatment arm.
II. To evaluate blinded independent central review (BICR) assessed or investigator assessed objective response rate (ORR) as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 by treatment arm and by mismatch repair (MMR) immunohistochemistry (IHC) status in patients who enter the study with measurable disease.
III. To evaluate BICR assessed or investigator assessed duration of response (DOR) by treatment arm and by MMR IHC status in patients who enter the study with measurable disease.
IV. To evaluate the effect of pembrolizumab (MK-3475) on overall survival (OS) in patients with mismatch repair protein proficient (pMMR) or mismatch repair deficiency (dMMR).
V. To determine whether the addition of pembrolizumab (MK-3475) to standard combination chemotherapy is associated with improved patient reported physical function as measured with the Patient-Reported Outcomes Measurement Information System (PROMIS)-physical function scale (short form), quality of life as measured with the Functional Assessment of Cancer Therapy (FACT) - Endometrial Trial Outcome Index (En TOI) and worsened fatigue as measured with the PROMIS-Fatigue scale (short form) in the pMMR patients.
VI. To determine concordance between institutional MMR IHC testing and centralized MMR IHC.
EXPLORATORY OBJECTIVES:
I. To explore the correlation between patient-reported physical function as measured with the PROMIS-physical function scale (short form) and quality of life as measure with the FACT-En TOI.
II. To explore whether the addition of pembrolizumab (MK-3475) to standard combination chemotherapy is associated with self-reported neurotoxicity as measured with the FACT/Gynecologic Oncology Group Neurotoxicity (GOG-Ntx) subscale (short) and the extent to which patients differ on their self-reported bother from side effects of cancer therapy in the pMMR patients.
III. To evaluate the efficacy of pembrolizumab (MK-3475) in combination with paclitaxel and carboplatin in patients with advanced stage (measurable stage III or IVA), stage IVB and recurrent endometrial cancer by Programmed Death Ligand 1 (PD-L1) IHC (positive versus \[vs\] negative).
IV. To assess the association between PD-L1 IHC (positive vs negative) and mismatch repair status (pMMR and dMMR).
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I:
COMBINATION PHASE: Patients receive placebo intravenously (IV) over 30 minutes on day 1 of each cycle, paclitaxel IV over 3 hours on day 1 of each cycle, and carboplatin IV over 30-60 minutes on day 1 of each cycle. Treatment repeats every 3 wee
Who can participate
Inclusion Criteria:
* Measurable stage III, measurable stage IVA, stage IVB (with or without measurable disease) or recurrent (with or without measurable disease) endometrial cancer.
* Pathology report showing results of institutional MMR IHC testing.
* Histologic confirmation of the original primary tumor is required (submission of pathology report(s) is required). Patients with the following histologic types are eligible: Endometrioid adenocarcinoma, serous adenocarcinoma, dedifferentiated/undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma, adenocarcinoma not otherwise specified (N.O.S.).
* Submission of tumor specimens for centralized MMR IHC testing is required after Step 1 and before Step 2 registration.
* In patients with measurable disease, lesions will be defined and monitored by RECIST version (v) 1.1. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded). Each lesion must be \>= 10 mm when measured by CT or magnetic resonance imaging (MRI). Lymph nodes must be \>= 15 mm in short axis when measured by CT or MRI.
* Patients may have received
* NO prior chemotherapy for treatment of endometrial cancer OR
* Prior adjuvant chemotherapy (e.g., paclitaxel/carboplatin alone or as a component of concurrent chemotherapy and radiation therapy \[with or without cisplatin\]) provided adjuvant chemotherapy was completed \>= 12 months prior to STEP 2 registration.
* Patients may have received prior radiation therapy for treatment of endometrial cancer. Prior radiation therapy may have included pelvic radiation therapy, extended field pelvic/para aortic radiation therapy, intravaginal brachytherapy, and/or palliative radiation therapy. All radiation therapy must be completed at least 4 weeks prior to STEP 2 registration.
* Patients may have received prior hormonal therapy for treatment of endometrial cancer. All hormonal therapy must be discontinued at least three weeks prior to STEP 2 registration.
* Interval or cytoreductive surgery, after start of treatment on this trial, and prior to documentation of disease progression, is NOT permitted.
* Age \>= 18.
* Performance status of 0, 1 or 2.
* Platelets \>= 100,000/mcl.
* Absolute neutrophil count (ANC) \>= 1,500/mcl.
* Creatinine =\< 1.5 x institutional/laboratory upper limit of normal (ULN).
* Total serum bilirubin level =\< 1.5 x ULN (patients with known Gilbert's disease who have bilirubin level =\< 3 x ULN may be enrolled).
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 3 x ULN.
* Thyroid stimulating hormone (TSH) within normal limits. If TSH is not within normal range despite no symptoms of thyroid dysfunction, normal Free T4 level is required.
* Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of Step 2 registration are eligible for this trial.
* For patients of child bearing potential: negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test is required.
* Administration of study drugs (pembrolizumab \[MK-3475\], paclitaxel, carboplatin) may have an adverse effect on pregnancy and poses a risk to the human fetus, including embryo-lethality. Women of childbearing potential (WOCBP) must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) from at least 14 days prior to Step 2 registration (for oral contraceptives), during treatment, and for 120 days after the last dose of study medication. 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 will be considered of nonreproductive potential if they are either:
* Postmenopausal (defined as at least 12 months with no menses without an alternative medical cause; in women \< 45 years of age, a high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a postmenopausal state in women not using hormonal contraception or hormonal replacement therapy. In the absence of 12 months of amenorrhea, a single FSH measurement is insufficient); OR
* Have a hysterectomy and/or bilateral oophorectomy, bilateral salpingectomy or bilateral tubal ligation/occlusion, at least 6 weeks prior to Step 2 registration; OR
* Have a congenital or acquired condition that prevents childbearing.
* Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.
* The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information.
Exclusion Criteria:
* Patients with prior treatment with anti-PD-1, anti-PD-L1 or anti-CTLA-4 therapeutic antibody or other similar agents.
* Patients who have a history of a severe hypersensitivity reaction to monoclonal antibody or pembrolizumab (MK-3475) and/or its excipients; and/or a severe hypersensitivity reaction to paclitaxel and/or carboplatin.
* Patients who are currently participating and receiving cancer-directed study therapy or have participated in a study of an investigational agent and received cancer-directed study therapy within 4 weeks prior to Step 2 registration.
* Patients who have a diagnosis of immunodeficiency or are receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to Step 2 registration.
* Patients who have received steroids as CT scan contrast premedication may be enrolled.
* The use of inhaled or topical corticosteroids is allowed.
* The use of mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension or adrenocortical insufficiency is allowed.
* The use of physiologic doses of corticosteroids may be approved after consultation with the study chair.
* Patients with treated brain metastases are eligible if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression, and they have been off steroids for at least 4 weeks prior to Step 2 registration and remain clinically stable.
* 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. This includes, but is 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 because of the risk of recurrence or exacerbation of disease.
* Patients with vitiligo, endocrine deficiencies including type I diabetes mellitus, 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), anti-thyroid antibodies should be evaluated for the presence of target organ involvement and potential need for systemic treatment but should otherwise be eligible.
* Patients who have a history of (non-infectious) pneumonitis that required steroids, or current pneumonitis.
* Uncontrolled intercurrent illness including, but not limited to: ongoing or active infection (except for uncomplicated urinary tract infection), interstitial lung disease or active, non-infectious pneumonitis, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
* Known clinically significant liver disease, including active viral, alcoholic, or other hepatitis; and cirrhosis.
* For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.
* Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.
* Pregnant or lactating patients.
Interventions
Carboplatin
DRUG
Computed Tomography
PROCEDURE
Paclitaxel
DRUG
Pembrolizumab
BIOLOGICAL
Placebo Administration
OTHER
Quality-of-Life Assessment
OTHER
Questionnaire Administration
OTHER
Locations
397
Canada (14)
Royal Victoria Regional Health Centre
Barrie , Ontario
Health Sciences North
Greater Sudbury , Ontario
Juravinski Cancer Centre at Hamilton Health Sciences
Hamilton , Ontario
Kingston Health Sciences Centre
Kingston , Ontario
Hopital de la Cite-de-la-Sante
Laval , Quebec
London Regional Cancer Program
London , Ontario
The Moncton Hospital
Moncton , New Brunswick
CHUM - Centre Hospitalier de l'Universite de Montreal
Montreal , Quebec
Lakeridge Health Oshawa
Oshawa , Ontario
Allan Blair Cancer Centre
Regina , Saskatchewan
Saskatoon Cancer Centre
Saskatoon , Saskatchewan
Algoma District Cancer Program Sault Area Hospital
Sault Ste. Marie , Ontario
Odette Cancer Centre- Sunnybrook Health Sciences Centre
Toronto , Ontario
University Health Network-Princess Margaret Hospital
Toronto , Ontario
Japan (4)
Kure Medical Center and Chugoku Cancer Center
Kure , Hiroshima
Niigata University Medical and Dental Hospital
Niigata , Niigata
Saitama Medical University International Medical Center
Saitama
Ehime University Hospital
Tōon , Ehime
Puerto Rico (1)
Centro Comprensivo de Cancer de UPR
San Juan
South Korea (8)
Kyungpook National University Chilgok Hospital
Daegu
Keimyung University-Dongsan Medical Center
Dalseo-gu , Daegu
Seoul National University Bundang Hospital
Seongnam , Kyeonggi-do
Samsung Changwon Hospital
Seoul , Gyeongsangnam-do
Asan Medical Center
Seoul
Gangnam Severance Hospital
Seoul
Yonsei University Health System-Severance Hospital
Seoul
Korea Cancer Center Hospital
Seoul
United States (370)
Summa Health System - Akron Campus
Akron , Ohio
Southwest Gynecologic Oncology Associates Inc
Albuquerque , New Mexico
University of New Mexico Cancer Center
Albuquerque , New Mexico
Lehigh Valley Hospital-Cedar Crest
Allentown , Pennsylvania
Community Hospital of Anaconda
Anaconda , Montana
Alaska Women's Cancer Care
Anchorage , Alaska
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor , Michigan
University of Michigan Rogel Cancer Center
Ann Arbor , Michigan
Luminis Health Anne Arundel Medical Center
Annapolis , Maryland
Grady Health System
Atlanta , Georgia
Emory University Hospital Midtown
Atlanta , Georgia
Emory University Hospital/Winship Cancer Institute
Atlanta , Georgia
Emory Saint Joseph's Hospital
Atlanta , Georgia
Northside Hospital
Atlanta , Georgia
Harold Alfond Center for Cancer Care
Augusta , Maine
WellStar Cobb Hospital
Austell , Georgia
Kaiser Permanente-Baldwin Park
Baldwin Park , California
University of Maryland/Greenebaum Cancer Center
Baltimore , Maryland
Greater Baltimore Medical Center
Baltimore , Maryland
Sinai Hospital of Baltimore
Baltimore , Maryland
Saint Agnes Hospital
Baltimore , Maryland
MedStar Franklin Square Medical Center/Weinberg Cancer Institute
Baltimore , Maryland
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore , Maryland
Memorial Sloan Kettering Basking Ridge
Basking Ridge , New Jersey
LSU Health Baton Rouge-North Clinic
Baton Rouge , Louisiana
Our Lady of the Lake Physician Group
Baton Rouge , Louisiana
Our Lady of The Lake
Baton Rouge , Louisiana
Our Lady of the Lake Medical Oncology
Baton Rouge , Louisiana
Woman's Hospital
Baton Rouge , Louisiana
Northwell Health Imbert Cancer Center
Bay Shore , New York
UHHS-Chagrin Highlands Medical Center
Beachwood , Ohio
UM Upper Chesapeake Medical Center
Bel Air , Maryland
MaineHealth Waldo Hospital
Belfast , Maine
Kaiser Permanente-Bellflower
Bellflower , California
Sanford Joe Lueken Cancer Center
Bemidji , Minnesota
Saint Charles Health System
Bend , Oregon
Alta Bates Summit Medical Center-Herrick Campus
Berkeley , California
Walter Reed National Military Medical Center
Bethesda , Maryland
Lehigh Valley Hospital - Muhlenberg
Bethlehem , Pennsylvania
MaineHealth Maine Medical Center - Biddeford
Biddeford , Maine
Billings Clinic Cancer Center
Billings , Montana
University of Alabama at Birmingham Cancer Center
Birmingham , Alabama
Sanford Bismarck Medical Center
Bismarck , North Dakota
Saint Alphonsus Cancer Care Center-Boise
Boise , Idaho
Saint Luke's Cancer Institute - Boise
Boise , Idaho
Florida Cancer Specialists - Bradenton Cancer Center
Bradenton , Florida
Lafayette Family Cancer Center-EMMC
Brewer , Maine
Island Gynecologic Oncology
Brightwaters , New York
New York-Presbyterian/Brooklyn Methodist Hospital
Brooklyn , New York
Roswell Park Cancer Institute
Buffalo , New York
Lahey Hospital and Medical Center
Burlington , Massachusetts
University of Vermont Medical Center
Burlington , Vermont
Aurora Cancer Care-Southern Lakes VLCC
Burlington , Wisconsin
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell , Idaho
Cooper Hospital University Medical Center
Camden , New Jersey
Aultman Health Foundation
Canton , Ohio
Miami Valley Hospital South
Centerville , Ohio
UNC Lineberger Comprehensive Cancer Center
Chapel Hill , North Carolina
Geauga Hospital
Chardon , Ohio
Medical University of South Carolina
Charleston , South Carolina
West Virginia University Charleston Division
Charleston , West Virginia
Carolinas Medical Center/Levine Cancer Institute
Charlotte , North Carolina
University of Virginia Cancer Center
Charlottesville , Virginia
Northwestern University
Chicago , Illinois
Rush MD Anderson Cancer Center
Chicago , Illinois
University of Illinois
Chicago , Illinois
University of Chicago Comprehensive Cancer Center
Chicago , Illinois
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati , Ohio
Good Samaritan Hospital - Cincinnati
Cincinnati , Ohio
Case Western Reserve University
Cleveland , Ohio
MetroHealth Medical Center
Cleveland , Ohio
Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland , Ohio
Cleveland Clinic Foundation
Cleveland , Ohio
Southeastern Medical Oncology Center-Clinton
Clinton , North Carolina
Community Cancer Institute
Clovis , California
Penrose-Saint Francis Healthcare
Colorado Springs , Colorado
UCHealth Memorial Hospital Central
Colorado Springs , Colorado
Memorial Hospital North
Colorado Springs , Colorado
Ohio State University Comprehensive Cancer Center
Columbus , Ohio
Riverside Methodist Hospital
Columbus , Ohio
The Mark H Zangmeister Center
Columbus , Ohio
Memorial Sloan Kettering Commack
Commack , New York
Atrium Health Cabarrus/LCI-Concord
Concord , North Carolina
Northwest Cancer Center - Crown Point
Crown Point , Indiana
Parkland Memorial Hospital
Dallas , Texas
UT Southwestern/Simmons Cancer Center-Dallas
Dallas , Texas
Danbury Hospital
Danbury , Connecticut
Carle at The Riverfront
Danville , Illinois
Geisinger Medical Center
Danville , Pennsylvania
Cancer Care Specialists of Illinois - Decatur
Decatur , Illinois
City of Hope Comprehensive Cancer Center
Duarte , California
Essentia Health Cancer Center
Duluth , Minnesota
Northwest Oncology LLC
Dyer , Indiana
University of Maryland Shore Medical Center at Easton
Easton , Maryland
Marshfield Medical Center-EC Cancer Center
Eau Claire , Wisconsin
Saint Elizabeth Healthcare Edgewood
Edgewood , Kentucky
Crossroads Cancer Center
Effingham , Illinois
Ephrata Cancer Center
Ephrata , Pennsylvania
NorthShore University HealthSystem-Evanston Hospital
Evanston , Illinois
University of Kansas Clinical Research Center
Fairway , Kansas
Sanford Broadway Medical Center
Fargo , North Dakota
Sanford Roger Maris Cancer Center
Fargo , North Dakota
Piedmont Fayette Hospital
Fayetteville , Georgia
Cancer Hematology Centers - Flint
Flint , Michigan
Genesee Hematology Oncology PC
Flint , Michigan
Genesys Hurley Cancer Institute
Flint , Michigan
The New York Hospital Medical Center of Queens
Flushing , New York
Poudre Valley Hospital
Fort Collins , Colorado
Cancer Care and Hematology-Fort Collins
Fort Collins , Colorado
Saint Luke's Cancer Institute - Fruitland
Fruitland , Idaho
Northeast Georgia Medical Center-Gainesville
Gainesville , Georgia
Northwestern Medicine Cancer Center Delnor
Geneva , Illinois
Aurora Health Care Germantown Health Center
Germantown , Wisconsin
Adams Cancer Center
Gettysburg , Pennsylvania
MultiCare Gig Harbor Medical Park
Gig Harbor , Washington
NorthShore University HealthSystem-Glenbrook Hospital
Glenview , Illinois
Southeastern Medical Oncology Center-Goldsboro
Goldsboro , North Carolina
CTCA at Western Regional Medical Center
Goodyear , Arizona
Aurora Cancer Care-Grafton
Grafton , Wisconsin
Nebraska Cancer Specialists/Oncology Hematology West PC
Grand Island , Nebraska
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids , Michigan
Banner North Colorado Medical Center
Greeley , Colorado
UCHealth Greeley Hospital
Greeley , Colorado
Aurora BayCare Medical Center
Green Bay , Wisconsin
Saint Francis Hospital
Greenville , South Carolina
Prisma Health Cancer Institute - Faris
Greenville , South Carolina
Saint Francis Cancer Center
Greenville , South Carolina
Smilow Cancer Hospital Care Center - Guilford
Guilford , Connecticut
WellSpan Medical Oncology and Hematology
Hanover , Pennsylvania
Kaiser Permanente South Bay
Harbor City , California
Memorial Sloan Kettering Westchester
Harrison , New York
Hartford Hospital
Hartford , Connecticut
Smilow Cancer Hospital Care Center at Saint Francis
Hartford , Connecticut
Ingalls Memorial Hospital
Harvey , Illinois
Geisinger Medical Center-Cancer Center Hazleton
Hazleton , Pennsylvania
Margaret R Pardee Memorial Hospital
Hendersonville , North Carolina
NorthShore University HealthSystem-Highland Park Hospital
Highland Park , Illinois
Northwest Cancer Center - Hobart
Hobart , Indiana
Saint Mary Medical Center
Hobart , Indiana
Queen's Medical Center
Honolulu , Hawaii
Kapiolani Medical Center for Women and Children
Honolulu , Hawaii
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston , Texas
Ben Taub General Hospital
Houston , Texas
Houston Methodist Hospital
Houston , Texas
Methodist Willowbrook Hospital
Houston , Texas
Indiana University/Melvin and Bren Simon Cancer Center
Indianapolis , Indiana
Community Cancer Center East
Indianapolis , Indiana
Community Cancer Center South
Indianapolis , Indiana
Franciscan Health Indianapolis
Indianapolis , Indiana
Community Cancer Center North
Indianapolis , Indiana
Ascension Saint Vincent Indianapolis Hospital
Indianapolis , Indiana
Saint Catherine Hospital
Indianapolis , Indiana
University of Iowa/Holden Comprehensive Cancer Center
Iowa City , Iowa
Kaiser Permanente-Irvine
Irvine , California
Mississippi Baptist Medical Center
Jackson , Mississippi
University of Mississippi Medical Center
Jackson , Mississippi
Southeastern Medical Oncology Center-Jacksonville
Jacksonville , North Carolina
Jefferson Hospital
Jefferson Hills , Pennsylvania
UPMC-Johnstown/John P. Murtha Regional Cancer Center
Johnstown , Pennsylvania
NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
Jonesboro , Arkansas
Bronson Methodist Hospital
Kalamazoo , Michigan
West Michigan Cancer Center
Kalamazoo , Michigan
University of Kansas Cancer Center
Kansas City , Kansas
Saint Luke's Hospital of Kansas City
Kansas City , Missouri
Kadlec Clinic Hematology and Oncology
Kennewick , Washington
Aurora Cancer Care-Kenosha South
Kenosha , Wisconsin
UC San Diego Moores Cancer Center
La Jolla , California
Northwell Health/Center for Advanced Medicine
Lake Success , New York
Monmouth Medical Center Southern Campus
Lakewood , New Jersey
City of Hope Antelope Valley
Lancaster , California
Lancaster General Ann B Barshinger Cancer Institute
Lancaster , Pennsylvania
Lancaster General Hospital
Lancaster , Pennsylvania
University of Michigan Health - Sparrow Lansing
Lansing , Michigan
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon , New Hampshire
Sechler Family Cancer Center
Lebanon , Pennsylvania
University of Arkansas for Medical Sciences
Little Rock , Arkansas
Saint Barnabas Medical Center
Livingston , New Jersey
Monmouth Medical Center
Long Branch , New Jersey
Kaiser Permanente Los Angeles Medical Center
Los Angeles , California
Los Angeles General Medical Center
Los Angeles , California
USC / Norris Comprehensive Cancer Center
Los Angeles , California
Cedars Sinai Medical Center
Los Angeles , California
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles , California
Medical Center of the Rockies
Loveland , Colorado
Banner North Colorado Medical Center - Loveland Campus
Loveland , Colorado
Lowell General Hospital
Lowell , Massachusetts
University of Wisconsin Carbone Cancer Center - University Hospital
Madison , Wisconsin
WellStar Health System Inc
Marietta , Georgia
Wellstar Kennestone Hospital
Marietta , Georgia
Aurora Bay Area Medical Group-Marinette
Marinette , Wisconsin
Marshfield Medical Center-Marshfield
Marshfield , Wisconsin
Carle Physician Group-Mattoon/Charleston
Mattoon , Illinois
Hillcrest Hospital Cancer Center
Mayfield Heights , Ohio
Loyola University Medical Center
Maywood , Illinois
Baptist Memorial Hospital and Cancer Center-Memphis
Memphis , Tennessee
UH Seidman Cancer Center at Lake Health Mentor Campus
Mentor , Ohio
Saint Luke's Cancer Institute - Meridian
Meridian , Idaho
East Jefferson General Hospital
Metairie , Louisiana
Memorial Sloan Kettering Monmouth
Middletown , New Jersey
Aurora Saint Luke's Medical Center
Milwaukee , Wisconsin
Aurora Sinai Medical Center
Milwaukee , Wisconsin
Aurora Cancer Care-Milwaukee
Milwaukee , Wisconsin
NYU Langone Hospital - Long Island
Mineola , New York
Marshfield Medical Center - Minocqua
Minocqua , Wisconsin
Forbes Hospital
Monroeville , Pennsylvania
UPMC Hillman Cancer Center - Monroeville
Monroeville , Pennsylvania
Memorial Sloan Kettering Bergen
Montvale , New Jersey
Franciscan Health Mooresville
Mooresville , Indiana
Monongalia Hospital
Morgantown , West Virginia
West Virginia University Healthcare
Morgantown , West Virginia
Palo Alto Medical Foundation-Gynecologic Oncology
Mountain View , California
The Community Hospital
Munster , Indiana
Women's Diagnostic Center - Munster
Munster , Indiana
Saint Alphonsus Cancer Care Center-Nampa
Nampa , Idaho
Saint Luke's Cancer Institute - Nampa
Nampa , Idaho
Vanderbilt University/Ingram Cancer Center
Nashville , Tennessee
Jersey Shore Medical Center
Neptune City , New Jersey
The Hospital of Central Connecticut
New Britain , Connecticut
Rutgers Cancer Institute of New Jersey
New Brunswick , New Jersey
Yale University
New Haven , Connecticut
Long Island Jewish Medical Center
New Hyde Park , New York
UC Comprehensive Cancer Center at Silver Cross
New Lenox , Illinois
University Medical Center New Orleans
New Orleans , Louisiana
Ochsner Baptist Medical Center
New Orleans , Louisiana
Ochsner Medical Center Jefferson
New Orleans , Louisiana
Mount Sinai Chelsea
New York , New York
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York , New York
Mount Sinai Hospital
New York , New York
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York , New York
Memorial Sloan Kettering Cancer Center
New York , New York
NYP/Weill Cornell Medical Center
New York , New York
Helen F Graham Cancer Center
Newark , Delaware
CTCA at Southeastern Regional Medical Center
Newnan , Georgia
Yale-New Haven Hospital North Haven Medical Center
North Haven , Connecticut
Norwalk Hospital
Norwalk , Connecticut
Cancer Care Center of O'Fallon
O'Fallon , Illinois
Kaiser Permanente-Oakland
Oakland , California
ProHealth Oconomowoc Memorial Hospital
Oconomowoc , Wisconsin
University of Oklahoma Health Sciences Center
Oklahoma City , Oklahoma
Nebraska Methodist Hospital
Omaha , Nebraska
University of Nebraska Medical Center
Omaha , Nebraska
Saint Alphonsus Cancer Care Center-Ontario
Ontario , Oregon
Saint Joseph Hospital - Orange
Orange , California
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange , California
University of Chicago Medicine-Orland Park
Orland Park , Illinois
Vince Lombardi Cancer Clinic - Oshkosh
Oshkosh , Wisconsin
University of Kansas Hospital-Indian Creek Campus
Overland Park , Kansas
The Valley Hospital - Luckow Pavilion
Paramus , New Jersey
Thomas Jefferson University Hospital
Philadelphia , Pennsylvania
UPMC-Magee Womens Hospital
Pittsburgh , Pennsylvania
West Penn Hospital
Pittsburgh , Pennsylvania
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh , Pennsylvania
Legacy Good Samaritan Hospital and Medical Center
Portland , Oregon
Providence Portland Medical Center
Portland , Oregon
Providence Saint Vincent Medical Center
Portland , Oregon
Geisinger Cancer Services-Pottsville
Pottsville , Pennsylvania
Women and Infants Hospital
Providence , Rhode Island
MultiCare Good Samaritan Hospital
Puyallup , Washington
Aurora Cancer Care-Racine
Racine , Wisconsin
Eisenhower Medical Center
Rancho Mirage , California
Rapid City Regional Hospital
Rapid City , South Dakota
Mercy Regional Cancer Center
Redding , California
Mercy Oncology Center
Redding , California
Valley Medical Center
Renton , Washington
Marshfield Medical Center-Rice Lake
Rice Lake , Wisconsin
VCU Massey Comprehensive Cancer Center
Richmond , Virginia
Neurosurgeons of New Jersey-Ridgewood
Ridgewood , New Jersey
Valley Health System Ridgewood Campus
Ridgewood , New Jersey
Kaiser Permanente-Riverside
Riverside , California
Mayo Clinic in Rochester
Rochester , Minnesota
Highland Hospital
Rochester , New York
University of Rochester
Rochester , New York
Penobscot Bay Medical Center
Rockport , Maine
Kaiser Permanente-Roseville
Roseville , California
WellStar North Fulton Hospital
Roswell , Georgia
Kaiser Permanente Downtown Commons
Sacramento , California
Mercy Cancer Center - Sacramento
Sacramento , California
University of California Davis Comprehensive Cancer Center
Sacramento , California
University of Utah Sugarhouse Health Center
Salt Lake City , Utah
Huntsman Cancer Institute/University of Utah
Salt Lake City , Utah
Kaiser Permanente-San Diego Zion
San Diego , California
Naval Medical Center -San Diego
San Diego , California
Zuckerberg San Francisco General Hospital
San Francisco , California
California Pacific Medical Center-Pacific Campus
San Francisco , California
Kaiser Permanente-San Francisco
San Francisco , California
UCSF Medical Center-Mission Bay
San Francisco , California
Kaiser Permanente-Santa Teresa-San Jose
San Jose , California
Kaiser Permanente San Leandro
San Leandro , California
Kaiser Permanente-San Marcos
San Marcos , California
MaineHealth Cancer Care and IV Therapy - Sanford
Sanford , Maine
Kaiser Permanente Medical Center - Santa Clara
Santa Clara , California
Florida Cancer Specialists - Sarasota
Sarasota , Florida
Florida Cancer Specialists - Sarasota Downtown
Sarasota , Florida
Sarasota Memorial Hospital
Sarasota , Florida
Memorial Health University Medical Center
Savannah , Georgia
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Savannah , Georgia
MaineHealth Maine Medical Center- Scarborough
Scarborough , Maine
Community Medical Center
Scranton , Pennsylvania
Swedish Medical Center-First Hill
Seattle , Washington
Prisma Health Cancer Institute - Seneca
Seneca , South Carolina
Vince Lombardi Cancer Clinic-Sheboygan
Sheboygan , Wisconsin
Sanford Cancer Center Oncology Clinic
Sioux Falls , South Dakota
Avera Cancer Institute
Sioux Falls , South Dakota
WellStar Vinings Health Park
Smyrna , Georgia
Robert Wood Johnson University Hospital Somerset
Somerville , New Jersey
City of Hope South Pasadena
South Pasadena , California
Kaiser Permanente-South San Francisco
South San Francisco , California
Springfield Clinic
Springfield , Illinois
Baystate Medical Center
Springfield , Massachusetts
Mercy Hospital Springfield
Springfield , Missouri
Washington University School of Medicine
St Louis , Missouri
Mercy Hospital Saint Louis
St Louis , Missouri
Stamford Hospital/Bennett Cancer Center
Stamford , Connecticut
Staten Island University Hospital
Staten Island , New York
Marshfield Medical Center-River Region at Stevens Point
Stevens Point , Wisconsin
Stony Brook University Medical Center
Stony Brook , New York
Houston Methodist Sugar Land Hospital
Sugar Land , Texas
Aurora Medical Center in Summit
Summit , Wisconsin
Palo Alto Medical Foundation-Sunnyvale
Sunnyvale , California
ProMedica Flower Hospital
Sylvania , Ohio
State University of New York Upstate Medical University
Syracuse , New York
MultiCare Tacoma General Hospital
Tacoma , Washington
Montefiore Medical Center-Einstein Campus
The Bronx , New York
Montefiore Medical Center - Moses Campus
The Bronx , New York
Houston Methodist The Woodlands Hospital
The Woodlands , Texas
Community Medical Center
Toms River , New Jersey
Smilow Cancer Hospital-Torrington Care Center
Torrington , Connecticut
Munson Medical Center
Traverse City , Michigan
Smilow Cancer Hospital Care Center-Trumbull
Trumbull , Connecticut
Legacy Meridian Park Hospital
Tualatin , Oregon
Oklahoma Cancer Specialists and Research Institute-Tulsa
Tulsa , Oklahoma
Saint Luke's Cancer Institute - Twin Falls
Twin Falls , Idaho
Vince Lombardi Cancer Clinic-Two Rivers
Two Rivers , Wisconsin
Memorial Sloan Kettering Nassau
Uniondale , New York
City of Hope Upland
Upland , California
Carle Cancer Center
Urbana , Illinois
Westchester Medical Center
Valhalla , New York
Kaiser Permanente-Vallejo
Vallejo , California
Northwest Cancer Center - Valparaiso
Valparaiso , Indiana
Legacy Salmon Creek Hospital
Vancouver , Washington
Florida Cancer Specialists - Venice Pinebrook
Venice , Florida
Florida Cancer Specialists - Venice Island
Venice , Florida
MD Anderson Cancer Center at Cooper-Voorhees
Voorhees Township , New Jersey
Kaiser Permanente-Walnut Creek
Walnut Creek , California
John Muir Medical Center-Walnut Creek
Walnut Creek , California
Northwestern Medicine Cancer Center Warrenville
Warrenville , Illinois
MedStar Washington Hospital Center
Washington D.C. , District of Columbia
Sibley Memorial Hospital
Washington D.C. , District of Columbia
Smilow Cancer Hospital-Waterbury Care Center
Waterbury , Connecticut
Smilow Cancer Hospital Care Center - Waterford
Waterford , Connecticut
UW Cancer Center at ProHealth Care
Waukesha , Wisconsin
Aurora Cancer Care-Milwaukee West
Wauwatosa , Wisconsin
Valley Medical Group - Wayne Multispecialty Practice
Wayne , New Jersey
Aurora West Allis Medical Center
West Allis , Wisconsin
University of Cincinnati Cancer Center-West Chester
West Chester , Ohio
Reading Hospital
West Reading , Pennsylvania
UH Seidman Cancer Center at Saint John Medical Center
Westlake , Ohio
Marshfield Medical Center - Weston
Weston , Wisconsin
University of Kansas Hospital-Westwood Cancer Center
Westwood , Kansas
Valley Health System-Hematology/Oncology
Westwood , New Jersey
Wexford Health and Wellness Pavilion
Wexford , Pennsylvania
Geisinger Wyoming Valley/Henry Cancer Center
Wilkes-Barre , Pennsylvania
Asplundh Cancer Pavilion
Willow Grove , Pennsylvania
Novant Health New Hanover Regional Medical Center
Wilmington , North Carolina
Beth Israel Deaconess Medical Center/Winchester Center for Cancer Care
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