Testing the Addition of Nivolumab to Standard Treatment for Patients With Metastatic or Unresectable Colorectal Cancer That Have a BRAF Mutation
Phase 2 – studying effectiveness and dosage
Conditions:
Metastatic Colon Adenocarcinoma
Metastatic Rectal Adenocarcinoma
Stage III Colon Cancer AJCC v8
Stage III Rectal Cancer AJCC v8
Stage IV Colon Cancer AJCC v8
Stage IV Rectal Cancer AJCC v8
Unresectable Colon Adenocarcinoma
Unresectable Rectal Adenocarcinoma
Sponsor: National Cancer Institute (NCI)
trial.available_in:
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Overview
This phase II trial tests whether adding nivolumab to the usual treatment (encorafenib and cetuximab) works better than the usual treatment alone to shrink tumors in patients with colorectal cancer that has spread to other places in the body (metastatic) or that cannot be removed by surgery (unresectable) and whose tumor has a mutation in a gene called BRAF. Encorafenib is in a class of medications called kinase inhibitors. It is used in patients whose cancer has a certain mutation (change) in the BRAF gene. It works by blocking the action of mutated BRAF that signals cancer cells to multiply. This helps to stop or slow the spread of cancer cells. Cetuximab is in a class of medications called monoclonal antibodies. It binds to a protein called EGFR, which is found on some types of cancer cells. This may help keep cancer cells from growing. 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. Giving nivolumab in combination with encorafenib and cetuximab may be more effective than encorafenib and cetuximab alone at stopping tumor growth and spreading in patients with metastatic or unresectable BRAF-mutant colorectal cancer.
Description
PRIMARY OBJECTIVE:
I. To compare progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 in patients with microsatellite stable (MSS), BRAF\^V600E metastatic and/or unresectable colorectal cancer (CRC) randomized to treatment with nivolumab + encorafenib + cetuximab compared to encorafenib + cetuximab.
SECONDARY OBJECTIVES:
I. To compare overall response rate (ORR), including confirmed and unconfirmed, complete and partial response, according to RECIST 1.1 criteria between the two arms.
II. To compare overall survival (OS) between the two arms. III. To compare duration of response between the two arms. IV. To compare safety and tolerability between the two arms. V. To assess immune-related PFS using modified response criteria adapted for immunotherapy (irRC-PFS) in patients treated with nivolumab + encorafenib + cetuximab.
BANKING OBJECTIVE:
I. To bank tissue and blood specimens for future correlative studies.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients receive encorafenib orally (PO) once daily (QD) on days 1-28, cetuximab intravenously (IV) on days 1 and 15, and nivolumab IV on day 1. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive encorafenib PO QD on days 1-28 and cetuximab IV on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed until death or 3 years after registration, whichever occurs first.
Who can participate
Inclusion Criteria:
* Participants must have a histologically or cytologically confirmed diagnosis of adenocarcinoma of the colon or rectum. The date of diagnosis will be determined according to the pathologic date of diagnosis
* Participants must have measurable disease according to RECIST1.1 criteria. Computed tomography (CT) scans or magnetic resonance imaging (MRIs) used to assess measurable disease must have been completed within 28 days prior to registration. CT scans or MRIs used to assess non-measurable disease must have been completed within 42 days prior to registration. All disease must be assessed and documented on the Baseline Tumor Assessment Form
* Participants must have documented unresectable and/or metastatic disease on CT or MRI imaging. All disease must be assessed and documented on the Baseline Tumor Assessment Form
* Participants must have BRAF\^V600E mutated colorectal cancer as tested in a Clinical Laboratory Improvement Act (CLIA)-certified laboratory
* Participants must have proficient mismatch repair (pMMR) or microsatellite stable (MSS) status as tested in a CLIA-certified laboratory and documented by the treating clinician. Proficient mismatch repair status can be determined by intact expression by immunohistochemistry of all 4 mismatch repair proteins (MLH1, MSH2, MSH6, and PMS2). Microsatellite instability can be determined by polymerase chain reaction (PCR)
* Participants with brain metastases must have completed surgery or radiation therapy \>= 28 days prior to registration. These participants must have a CT or MRI of the brain showing no new or enlarging lesions within 42 days prior to registration. These participants must also be neurologically asymptomatic and without corticosteroid treatment for at least 7 days prior to registration. Metastatic brain parenchymal disease must have been treated and participant must be off steroids for 7 days prior to registration. The presence of leptomeningeal disease (LMD) is not considered stable disease, and participants with LMD are not eligible for this study
* Participants with known evidence of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load on suppressive therapy within 28 days prior to registration
* Participants with a history of hepatitis C virus (HCV) infection must have been treated and cured. Participants with HCV infection who are currently on treatment must have an undetectable HCV viral load within 28 days prior to registration
* Participants must have had one or two prior regimens of systemic chemotherapy for metastatic or locally advanced, unresectable disease. (A maintenance regimen of 5-fluorouracil or capecitabine, with or without bevacizumab, should not be counted as a separate line of treatment. The re-introduction of an initially successful induction regimen will not be counted as one additional line of treatment). Prior treatment for metastatic disease is not required for patients who experienced disease recurrence during or within 6 months of completion of adjuvant chemotherapy
* Participants must be of age \>= 18 years at the time of informed consent
* Participants must have a Zubrod performance status of 0 or 1
* Participants must have a complete medical history and physical exam within 28 days prior to registration
* Absolute neutrophil count \>= 1.0 x 10\^3/uL (within 28 days prior to registration)
* Hemoglobin \>= 9 g/dL (within 28 days prior to registration)
* Platelets \>= 75 x 10\^3/uL (within 28 days prior to registration)
* Total bilirubin =\< 1.5 x institutional upper limit of normal (ULN) (within 28 days prior to registration)
* Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =\< 3 x institutional ULN (within 28 days prior to registration)
* If liver metastases are present, then it is acceptable for AST level =\< 5.0 x ULN, and/or an ALT level =\< 5.0 x ULN (within 28 days prior to registration)
* Participants must have serum creatinine =\< the IULN OR measured OR calculated creatinine clearance \>= 50 mL/min using the Cockroft-Gault Formula. This specimen must have been drawn and processed within 28 days prior to registration
* Participants must be able to swallow and retain pills
* Participants must have adequate cardiac function. Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, must have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, participants must be class 2 or better
* Participants with a known significant risk of corrected QT interval (QTc) prolongation must have an electrocardiogram (ECG) performed within 28 days prior to prior to registration
* Note: Per package insert for encorafenib, participants already at risk for development of QTc prolongation include those who "already have or who are at significant risk of developing QTc prolongation, including participants with known long QT syndromes, clinically significant bradyarrhythmias, severe or uncontrolled heart failure and those taking other medicinal products associated with QT prolongation."
* Participants must be offered the opportunity to participate in specimen banking. With participant consent, specimens must be collected and submitted via the Southwest Oncology Group (SWOG) Specimen Tracking System
* Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines.
* Note: As a part of the OPEN registration process, the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system
Exclusion Criteria:
* Participants must not have a known positive serology for human immunodeficiency virus (HIV). Encorafenib is contraindicated with concomitant use of non-nucleoside analog reverse transcriptase inhibitors like efavirenz and etravirine. In addition, it is recommended in the investigator brochure of encorafenib to avoid using encorafenib with protease inhibitors. Therefore, because all participants on this study would receive encorafenib for either randomized arm of treatment, participants with HIV who receive these components of highly active antiretroviral therapy (HAART) would be at high risk for complications of drug-drug interaction
* Participants must not have had prior treatment with a BRAF inhibitor (including, but not limited to, encorafenib, dabrafenib, or vemurafenib), MEK inhibitor (including, but not limited to, trametinib, selumetinib, or binimetinib), or ERK inhibitor (of note, regorafenib is not considered a BRAF inhibitor for the context of eligibility criteria)
* Participants must not have had prior treatment with anti-EGFR therapies
* Participants must not have had prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways
* Participants must not have a condition requiring systemic treatment with either corticosteroids (\> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of registration. Inhaled or topical steroids and adrenal replacement doses \< 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease. Patients are permitted to use topical, ocular, intra-articular, intranasal, and inhalational corticosteroids (with minimal systemic absorption). Physiologic replacement doses of systemic corticosteroids are permitted, even if \< 10 mg/day prednisone equivalents. A brief course of corticosteroids for prophylaxis (e.g., contrast dye allergy) or for treatment of non-autoimmune conditions (e.g., delayed-type hypersensitivity reaction caused by contact allergen) is permitted, as long as there has been a washout period for corticosteroids of \>= 7 days prior to registration
* Participants must not have received a live vaccine within 30 days prior to study registration. Seasonal flu and COVID vaccines that do not contain a live virus are permitted
* Participants must not be receiving any other investigational agents
* Participants must not have impaired gastrointestinal function or disease that may significantly alter the absorption of study drug (e.g., ulcerative diseases, uncontrolled vomiting, malabsorption syndrome, small bowel resection with decreased intestinal absorption)
* Participants must not have a history of inflammatory bowel disease, (including ulcerative colitis and Crohn's disease), symptomatic autoimmune disease (e.g., rheumatoid arthritis, systemic progressive sclerosis \[scleroderma\], systemic lupus erythematosus, autoimmune vasculitis \[e.g., Wegener's Granulomatosis\]); central nervous system (CNS) or motor neuropathy considered of autoimmune origin (e.g., Guillain-Barre Syndrome and myasthenia gravis, multiple sclerosis).
* Note: Participants with Graves' disease will be allowed
* Participants must not have a history of pneumonitis that has required oral or intravenous (IV) steroids within the last 12 months
* Participants must not have a history of a grade 3 or 4 allergic reaction attributed to humanized or human monoclonal antibody therapy
* Participants must not have a history of a prior allogeneic tissue or solid organ transplant
* Participants must not have a history of acute coronary syndromes (including myocardial infarction, unstable angina, coronary artery bypass grafting, coronary angioplasty, or stenting) within 6 months prior to study registration
* Participants must not have uncontrolled blood pressure and hypertension within 28 days prior to registration.
* Uncontrolled blood pressure and hypertension is defined as systolic blood pressure (SBP) \>= 160 mmHg or diastolic blood pressure (DBP) \> 100 mmHg within 28 days prior to registration. Participants are permitted to be receiving multiple anti-hypertensive medications (unless otherwise indicated in the study). All blood pressure measurements within the 28 days prior to registration must be SBP \< 160 and DBP =\< 100. An exception can be made by a healthcare provider for a participant with a single blood pressure elevation who upon rechecking has a normal blood pressure
* Participants must not have a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) has the potential to interfere with the safety or efficacy assessment of the investigational regimen or requires concurrent therapy
* Participants must not be pregnant or nursing. Individuals who are of reproductive potential must have agreed to use an effective contraceptive method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion and vasectomy with testing showing no sperm in the semen
* Participants must not be planning treatment with other systemic anti-cancer agents (e.g., chemotherapy, hormonal therapy, immunotherapy) or other treatments not part of protocol-specified anti-cancer therapy including concurrent investigational agents of any type
Interventions
Cetuximab
BIOLOGICAL
Encorafenib
DRUG
Nivolumab
BIOLOGICAL
Locations
286
Puerto Rico (4)
Puerto Rico Hematology Oncology Group
Bayamón
Centro Comprensivo de Cancer de UPR
San Juan
PROncology
San Juan
San Juan City Hospital
San Juan
United States (282)
Lehigh Valley Hospital-Cedar Crest
Allentown , Pennsylvania
The Don and Sybil Harrington Cancer Center
Amarillo , Texas
Mary Greeley Medical Center
Ames , Iowa
McFarland Clinic - Ames
Ames , Iowa
Community Hospital of Anaconda
Anaconda , Montana
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor , Michigan
ThedaCare Regional Cancer Center
Appleton , Wisconsin
Duluth Clinic Ashland
Ashland , Wisconsin
UCHealth University of Colorado Hospital
Aurora , Colorado
Rush-Copley Medical Center
Aurora , Illinois
Advocate Good Shepherd Hospital
Barrington , Illinois
LSU Health Baton Rouge-North Clinic
Baton Rouge , Louisiana
Our Lady of the Lake Physician Group
Baton Rouge , Louisiana
Bronson Battle Creek
Battle Creek , Michigan
Strecker Cancer Center-Belpre
Belpre , Ohio
Lehigh Valley Hospital - Muhlenberg
Bethlehem , Pennsylvania
Billings Clinic Cancer Center
Billings , Montana
Illinois CancerCare-Bloomington
Bloomington , Illinois
Prisma Health Cancer Institute - Spartanburg
Boiling Springs , South Carolina
Saint Alphonsus Cancer Care Center-Boise
Boise , Idaho
Saint Luke's Cancer Institute - Boise
Boise , Idaho
McFarland Clinic - Boone
Boone , Iowa
Bozeman Health Deaconess Hospital
Bozeman , Montana
United Hospital Center
Bridgeport , West Virginia
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton , Michigan
Trinity Health Medical Center - Brighton
Brighton , Michigan
Roswell Park Cancer Institute
Buffalo , New York
Aurora Cancer Care-Southern Lakes VLCC
Burlington , Wisconsin
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell , Idaho
Illinois CancerCare-Canton
Canton , Illinois
Trinity Health IHA Medical Group Hematology Oncology - Canton
Canton , Michigan
Trinity Health Medical Center - Canton
Canton , Michigan
Saint Francis Medical Center
Cape Girardeau , Missouri
Mercy Cancer Center - Carmichael
Carmichael , California
Mercy San Juan Medical Center
Carmichael , California
Illinois CancerCare-Carthage
Carthage , Illinois
Miami Valley Hospital South
Centerville , Ohio
Centralia Oncology Clinic
Centralia , Illinois
Medical University of South Carolina
Charleston , South Carolina
Chelsea Hospital
Chelsea , Michigan
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Chelsea , Michigan
University of Illinois
Chicago , Illinois
Advocate Illinois Masonic Medical Center
Chicago , Illinois
Adena Regional Medical Center
Chillicothe , Ohio
Clackamas Radiation Oncology Center
Clackamas , Oregon
Providence Cancer Institute Clackamas Clinic
Clackamas , Oregon
Southeastern Medical Oncology Center-Clinton
Clinton , North Carolina
Kootenai Health - Coeur d'Alene
Coeur d'Alene , Idaho
Rocky Mountain Cancer Centers-Penrose
Colorado Springs , Colorado
UCHealth Memorial Hospital Central
Colorado Springs , Colorado
Memorial Hospital North
Colorado Springs , Colorado
Mount Carmel East Hospital
Columbus , Ohio
Columbus Oncology and Hematology Associates Inc
Columbus , Ohio
Riverside Methodist Hospital
Columbus , Ohio
Grant Medical Center
Columbus , Ohio
The Mark H Zangmeister Center
Columbus , Ohio
Doctors Hospital
Columbus , Ohio
Mercy Hospital
Coon Rapids , Minnesota
Ochsner Hematology Oncology North Shore - Covington (West Region)
Covington , Louisiana
Northwest Cancer Center - Crown Point
Crown Point , Indiana
AMG Crystal Lake - Oncology
Crystal Lake , Illinois
Aurora Saint Luke's South Shore
Cudahy , Wisconsin
UT Southwestern Simmons Cancer Center - RedBird
Dallas , Texas
UT Southwestern/Simmons Cancer Center-Dallas
Dallas , Texas
Carle at The Riverfront
Danville , Illinois
Miami Valley Hospital
Dayton , Ohio
Premier Blood and Cancer Center
Dayton , Ohio
Dayton Physician LLC - Englewood
Dayton , Ohio
Miami Valley Hospital North
Dayton , Ohio
Cancer Care Specialists of Illinois - Decatur
Decatur , Illinois
Decatur Memorial Hospital
Decatur , Illinois
Essentia Health - Deer River Clinic
Deer River , Minnesota
Delaware Health Center-Grady Cancer Center
Delaware , Ohio
Grady Memorial Hospital
Delaware , Ohio
Mercy Medical Center - Des Moines
Des Moines , Iowa
Henry Ford Hospital
Detroit , Michigan
Henry Ford Health Saint John Hospital
Detroit , Michigan
Illinois CancerCare-Dixon
Dixon , Illinois
Advocate Good Samaritan Hospital
Downers Grove , Illinois
Kaiser Permanente Dublin
Dublin , California
Columbus Oncology and Hematology Associates
Dublin , Ohio
Essentia Health Cancer Center
Duluth , Minnesota
Northwest Oncology LLC
Dyer , Indiana
Prisma Health Cancer Institute - Easley
Easley , South Carolina
Henry Ford River District Hospital
East China Township , Michigan
Marshfield Medical Center-EC Cancer Center
Eau Claire , Wisconsin
Fairview Southdale Hospital
Edina , Minnesota
Swedish Cancer Institute-Edmonds
Edmonds , Washington
Carle Physician Group-Effingham
Effingham , Illinois
Crossroads Cancer Center
Effingham , Illinois
Advocate Sherman Hospital
Elgin , Illinois
Mercy Cancer Center - Elk Grove
Elk Grove , California
Illinois CancerCare-Eureka
Eureka , Illinois
Hunterdon Medical Center
Flemington , New Jersey
Cancer Hematology Centers - Flint
Flint , Michigan
Genesee Hematology Oncology PC
Flint , Michigan
Genesys Hurley Cancer Institute
Flint , Michigan
Hurley Medical Center
Flint , Michigan
Poudre Valley Hospital
Fort Collins , Colorado
Cancer Care and Hematology-Fort Collins
Fort Collins , Colorado
McFarland Clinic - Trinity Cancer Center
Fort Dodge , Iowa
UT Southwestern/Simmons Cancer Center-Fort Worth
Fort Worth , Texas
Atrium Medical Center-Middletown Regional Hospital
Franklin , Ohio
Dayton Physicians LLC-Atrium
Franklin , Ohio
Kaiser Permanente-Fremont
Fremont , California
Kaiser Permanente-Fresno
Fresno , California
Saint Luke's Cancer Institute - Fruitland
Fruitland , Idaho
Illinois CancerCare-Galesburg
Galesburg , Illinois
Aurora Health Care Germantown Health Center
Germantown , Wisconsin
Southeastern Medical Oncology Center-Goldsboro
Goldsboro , North Carolina
CTCA at Western Regional Medical Center
Goodyear , Arizona
Aurora Cancer Care-Grafton
Grafton , Wisconsin
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids , Michigan
Trinity Health Grand Rapids Hospital
Grand Rapids , Michigan
Benefis Sletten Cancer Institute
Great Falls , Montana
UCHealth Greeley Hospital
Greeley , Colorado
Aurora BayCare Medical Center
Green Bay , Wisconsin
Prisma Health Cancer Institute - Butternut
Greenville , South Carolina
Prisma Health Cancer Institute - Faris
Greenville , South Carolina
Prisma Health Greenville Memorial Hospital
Greenville , South Carolina
Prisma Health Cancer Institute - Eastside
Greenville , South Carolina
Miami Valley Cancer Care and Infusion
Greenville , Ohio
Prisma Health Cancer Institute - Greer
Greer , South Carolina
Henry Ford Saint John Hospital - Academic
Grosse Pointe Woods , Michigan
Henry Ford Saint John Hospital - Van Elslander
Grosse Pointe Woods , Michigan
Mount Carmel Grove City Hospital
Grove City , Ohio
Advocate South Suburban Hospital
Hazel Crest , Illinois
Essentia Health Hibbing Clinic
Hibbing , Minnesota
UCHealth Highlands Ranch Hospital
Highlands Ranch , Colorado
Northwest Cancer Center - Hobart
Hobart , Indiana
Saint Mary Medical Center
Hobart , Indiana
Kaiser Permanente Moanalua Medical Center
Honolulu , Hawaii
M D Anderson Cancer Center
Houston , Texas
Franciscan Health Indianapolis
Indianapolis , Indiana
Saint Catherine Hospital
Indianapolis , Indiana
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
Irvine , California
Swedish Cancer Institute-Issaquah
Issaquah , Washington
Southeastern Medical Oncology Center-Jacksonville
Jacksonville , North Carolina
McFarland Clinic - Jefferson
Jefferson , Iowa
Bronson Methodist Hospital
Kalamazoo , Michigan
West Michigan Cancer Center
Kalamazoo , Michigan
Beacon Kalamazoo Cancer Center
Kalamazoo , Michigan
Logan Health Medical Center
Kalispell , Montana
Aurora Cancer Care-Kenosha South
Kenosha , Wisconsin
Kettering Medical Center
Kettering , Ohio
Illinois CancerCare-Kewanee Clinic
Kewanee , Illinois
Franciscan Saint Elizabeth Health - Lafayette East
Lafayette , Indiana
Fairfield Medical Center
Lancaster , Ohio
University of Michigan Health - Sparrow Lansing
Lansing , Michigan
Cancer Centers of Southwest Oklahoma Research
Lawton , Oklahoma
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon , New Hampshire
AMG Libertyville - Oncology
Libertyville , Illinois
Condell Memorial Hospital
Libertyville , Illinois
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia , Michigan
Medical Center of the Rockies
Loveland , Colorado
Illinois CancerCare-Macomb
Macomb , Illinois
Henry Ford Saint John Hospital - Macomb Medical
Macomb , Michigan
OhioHealth Mansfield Hospital
Mansfield , Ohio
Aurora Bay Area Medical Group-Marinette
Marinette , Wisconsin
OhioHealth Marion General Hospital
Marion , Ohio
McFarland Clinic - Marshalltown
Marshalltown , Iowa
Marshfield Medical Center-Marshfield
Marshfield , Wisconsin
Memorial Hospital
Marysville , Ohio
Carle Physician Group-Mattoon/Charleston
Mattoon , Illinois
Saint Luke's Cancer Institute - Meridian
Meridian , Idaho
Woodland Cancer Care Center
Michigan City , Indiana
Aurora Cancer Care-Milwaukee
Milwaukee , Wisconsin
Aurora Saint Luke's Medical Center
Milwaukee , Wisconsin
Aurora Sinai Medical Center
Milwaukee , Wisconsin
Abbott-Northwestern Hospital
Minneapolis , Minnesota
Marshfield Medical Center - Minocqua
Minocqua , Wisconsin
Community Medical Center
Missoula , Montana
Kaiser Permanente-Modesto
Modesto , California
Franciscan Health Mooresville
Mooresville , Indiana
West Virginia University Healthcare
Morgantown , West Virginia
Knox Community Hospital
Mount Vernon , Ohio
ProHealth D N Greenwald Center
Mukwonago , Wisconsin
The Community Hospital
Munster , Indiana
Women's Diagnostic Center - Munster
Munster , Indiana
Trinity Health Muskegon Hospital
Muskegon , Michigan
Saint Alphonsus Cancer Care Center-Nampa
Nampa , Idaho
Saint Luke's Cancer Institute - Nampa
Nampa , Idaho
Vanderbilt University/Ingram Cancer Center
Nashville , Tennessee
Ochsner Medical Center Jefferson
New Orleans , Louisiana
Cancer Center of Western Wisconsin
New Richmond , Wisconsin
Licking Memorial Hospital
Newark , Ohio
Providence Newberg Medical Center
Newberg , Oregon
CTCA at Southeastern Regional Medical Center
Newnan , Georgia
Corewell Health Lakeland Hospitals - Niles Hospital
Niles , Michigan
Cancer and Hematology Centers of Western Michigan - Norton Shores
Norton Shores , Michigan
Henry Ford Health Providence Novi Hospital
Novi , Michigan
Henry Ford Medical Center-Columbus
Novi , Michigan
Cancer Care Center of O'Fallon
O'Fallon , Illinois
Advocate Christ Medical Center
Oak Lawn , Illinois
Kaiser Permanente-Oakland
Oakland , California
ProHealth Oconomowoc Memorial Hospital
Oconomowoc , Wisconsin
University of Oklahoma Health Sciences Center
Oklahoma City , Oklahoma
Mercy Hospital Oklahoma City
Oklahoma City , Oklahoma
Saint Alphonsus Cancer Care Center-Ontario
Ontario , Oregon
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange , California
Providence Willamette Falls Medical Center
Oregon City , Oregon
Vince Lombardi Cancer Clinic - Oshkosh
Oshkosh , Wisconsin
Illinois CancerCare-Ottawa Clinic
Ottawa , Illinois
Advocate Lutheran General Hospital
Park Ridge , Illinois
Illinois CancerCare-Pekin
Pekin , Illinois
Illinois CancerCare-Peoria
Peoria , Illinois
Illinois CancerCare-Peru
Peru , Illinois
University of Pennsylvania/Abramson Cancer Center
Philadelphia , Pennsylvania
FirstHealth of the Carolinas-Moore Regional Hospital
Pinehurst , North Carolina
Providence Portland Medical Center
Portland , Oregon
Providence Saint Vincent Medical Center
Portland , Oregon
Southern Ohio Medical Center
Portsmouth , Ohio
Kootenai Clinic Cancer Services - Post Falls
Post Falls , Idaho
Illinois CancerCare-Princeton
Princeton , Illinois
Rhode Island Hospital
Providence , Rhode Island
Aurora Cancer Care-Racine
Racine , Wisconsin
Corewell Health Reed City Hospital
Reed City , Michigan
Marshfield Medical Center-Rice Lake
Rice Lake , Wisconsin
UT Southwestern Clinical Center at Richardson/Plano
Richardson , Texas
North Memorial Medical Health Center
Robbinsdale , Minnesota
Mercy Cancer Center - Rocklin
Rocklin , California
Kaiser Permanente-Roseville
Roseville , California
Kaiser Permanente Downtown Commons
Sacramento , California
Mercy Cancer Center - Sacramento
Sacramento , California
Kaiser Permanente-South Sacramento
Sacramento , California
MyMichigan Medical Center Saginaw
Saginaw , Michigan
Oncology Hematology Associates of Saginaw Valley PC
Saginaw , Michigan
Dartmouth Cancer Center - North
Saint Johnsbury , Vermont
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
Saint Joseph , Michigan
Park Nicollet Clinic - Saint Louis Park
Saint Louis Park , Minnesota
Regions Hospital
Saint Paul , Minnesota
United Hospital
Saint Paul , Minnesota
Huntsman Cancer Institute/University of Utah
Salt Lake City , Utah
Kaiser Permanente-San Francisco
San Francisco , California
Kaiser Permanente-Santa Teresa-San Jose
San Jose , California
Kaiser Permanente San Leandro
San Leandro , California
Kootenai Clinic Cancer Services - Sandpoint
Sandpoint , Idaho
Essentia Health Sandstone
Sandstone , Minnesota
Kaiser Permanente Medical Center - Santa Clara
Santa Clara , California
Kaiser Permanente-Santa Rosa
Santa Rosa , California
Swedish Medical Center-First Hill
Seattle , Washington
Prisma Health Cancer Institute - Seneca
Seneca , South Carolina
Vince Lombardi Cancer Clinic-Sheboygan
Sheboygan , Wisconsin
Kaiser Permanente-South San Francisco
South San Francisco , California
Henry Ford Health Providence Southfield Hospital
Southfield , Michigan
Southern Illinois University School of Medicine
Springfield , Illinois
Springfield Clinic
Springfield , Illinois
Springfield Memorial Hospital
Springfield , Illinois
Springfield Regional Cancer Center
Springfield , Ohio
Springfield Regional Medical Center
Springfield , Ohio
Bhadresh Nayak MD PC-Sterling Heights
Sterling Heights , Michigan
Marshfield Medical Center-River Region at Stevens Point
Stevens Point , Wisconsin
Aurora Medical Center in Summit
Summit , Wisconsin
MyMichigan Medical Center Tawas
Tawas City , Michigan
Toledo Clinic Cancer Centers-Toledo
Toledo , Ohio
Munson Medical Center
Traverse City , Michigan
Upper Valley Medical Center
Troy , Ohio
Saint Luke's Cancer Institute - Twin Falls
Twin Falls , Idaho
Vince Lombardi Cancer Clinic-Two Rivers
Two Rivers , Wisconsin
Carle Cancer Center
Urbana , Illinois
Kaiser Permanente-Vallejo
Vallejo , California
Northwest Cancer Center - Valparaiso
Valparaiso , Indiana
Essentia Health Virginia Clinic
Virginia , Minnesota
Kaiser Permanente-Walnut Creek
Walnut Creek , California
Henry Ford Health Warren Hospital
Warren , Michigan
Henry Ford Warren Hospital - GLCMS
Warren , Michigan
Macomb Hematology Oncology PC
Warren , Michigan
Illinois CancerCare - Washington
Washington , Illinois
UW Cancer Center at ProHealth Care
Waukesha , Wisconsin
Aurora Cancer Care-Milwaukee West
Wauwatosa , Wisconsin
Aurora West Allis Medical Center
West Allis , Wisconsin
Henry Ford West Bloomfield Hospital
West Bloomfield , Michigan
Saint Mary's Oncology/Hematology Associates of West Branch
West Branch , Michigan
Reading Hospital
West Reading , Pennsylvania
Saint Ann's Hospital
Westerville , Ohio
Marshfield Medical Center - Weston
Weston , Wisconsin
Woodland Memorial Hospital
Woodland , California
University of Michigan Health - West
Wyoming , Michigan
Rush-Copley Healthcare Center
Yorkville , Illinois
Huron Gastroenterology PC
Ypsilanti , Michigan
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus