Phase II Trial of Atezolizumab in BCG-Unresponsive Non-Muscle Invasive Bladder Cancer


Condition: Recurrent Bladder Urothelial Carcinoma, Stage 0a Bladder Urothelial Carcinoma AJCC v6 and v7, Stage 0is Bladder Urothelial Carcinoma AJCC v6 and v7, Stage I Bladder Urothelial Carcinoma AJCC v6 and v7

Intervention:

  • Drug: Atezolizumab

Purpose: This phase II trial studies how well atezolizumab works in treating patients with non-muscle invasive bladder cancer that has come back and has not responded to treatment with Bacillus Calmette-Guerin (BCG). Immunotherapy with monoclonal antibodies, such as atezolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread.

Study Type: Interventional

Clinical Trials Identifier NCT 8-digits: NCT02844816

Sponsor: National Cancer Institute (NCI)

Primary Outcome Measures:

  • Measure: Complete response (CR) rate in the subset of patients with carcinoma in situ (CIS) based on biopsy
  • Time Frame: At 25 weeks
  • Safety Issue:
  • Measure: Event-free survival (EFS)
  • Time Frame: From date of registration to first documentation of event, assessed up to 18 months
  • Safety Issue:

Secondary Outcome Measures:

  • Measure: Event-free survival (EFS) in the Ta/T1 subset
  • Time Frame: 18 months
  • Safety Issue:
  • Measure: Progression-free survival (PFS)
  • Time Frame: From time of registration to time of first documentation progression or death due to any cause, assessed up to 5 years
  • Safety Issue:
  • Measure: Cystectomy-free survival
  • Time Frame: Up to 5 years
  • Safety Issue:
  • Measure: Bladder cancer specific survival
  • Time Frame: From date of registration to date of death due to bladder cancer, assessed up to 5 years
  • Safety Issue:
  • Measure: Overall survival
  • Time Frame: From date of registration to date of death due to any cause, assessed up to 5 years
  • Safety Issue:
  • Measure: Incidence of adverse events
  • Time Frame: Up to 18 months
  • Safety Issue:

Estimated Enrollment: 162

Study Start Date: February 7, 2017

Phase: Phase 2

Eligibility:

  • Age: minimum 18 Years maximum N/A
  • Gender: All

Inclusion Criteria:

  • Patients must have histologically proven, recurrent, non-muscle invasive urothelial carcinoma of the bladder within 60 days prior to registration; the carcinoma must be stage T1 high-grade, stage CIS, or stage Ta high-grade
  • Patients with mixed urothelial carcinoma and a glandular and/or squamous component will be eligible for the trial, but the presence of other histologic variants, pure adenocarcinoma, or pure squamous cell carcinoma, or pure squamous carcinoma in situ will make a patient ineligible
  • Patients must have had all visible tumor resected completely within 60 days prior to registration; CIS disease is not expected to be completely excised; all patients must have tumor tissue from the histologic diagnosis of recurrence available for central pathology review submission; failure to submit these materials will make the patient ineligible for this study
  • Patients must have had cystoscopy confirming no visible papillary tumor within 21 days prior to registration; (CIS disease is not expected to have been completely excised); if the transurethral resection of bladder tumor (TURBT) or bladder biopsy falls within 21 days of registration it will fulfill this criterion
  • Patients must have had urine cytology within 21 days prior to registration; cytology for patients with CIS component is not expected to be negative for malignant cells; if the cytology for male patients with only Ta/T1 disease in the absence of CIS is positive for malignant cells, patient must have had a biopsy of the prostatic urethra within the previous six months
  • All patients with T1 urothelial carcinoma at study entry must undergo re-TURBT within 60 days prior to registration, and must have evidence of uninvolved muscularis propria in the pathologic specimen from either the first or the second TURBT; tissue from the re-resection must be submitted for central review in addition to the tissue from the first TURBT; the TURBT that identified the recurrent T1 disease may have taken place more than 60 days prior to registration but not more than 120 days; patients with high grade Ta or CIS do not require a re-TURBT, but if this is performed at the discretion of the treating physician, the second TURBT must be within 60 days of registration; there is no requirement for muscularis propria in the specimen of Ta/CIS patients, but the tissue from the first and second TURBTs must be submitted for central review; if a patient with Ta/T1 disease undergoes repeat TURBT, the patient will be stratified as having CIS if there is CIS on either TURBT
  • Patients must not have had urothelial carcinoma in the prostatic urethra within the previous 24 months or muscle invasive urothelial carcinoma of the bladder at any time; patients with prior urothelial carcinoma in the upper urinary tract within the previous 24 months will only be eligible if they had =< T1 carcinoma and were treated with nephroureterectomy; patients must have a computed tomography (CT) or magnetic resonance imaging (MRI) (including CT-intravenous pyelogram [IVP], CT-urogram or MR-urogram) of the abdomen and pelvis to rule out upper tract malignancy and intra-abdominal metastases within 90 days prior to registration; if a patient cannot tolerate intravenous contrast, a retrograde pyelogram should be performed within 90 days prior to registration
  • Patients must be deemed unfit for radical cystectomy by the treating physician, or the patient must refuse radical cystectomy, which is considered standard of care for these patients; the reason for patients not to undergo cystectomy will be clearly documented
  • Patients must be BCG-unresponsive; a patient is BCG-unresponsive if they meet one or more of the following criteria:
  • Patient has persistent or recurrent high-grade Ta/CIS urothelial carcinoma after completing therapy with at least induction BCG (>= 5 doses) and first round maintenance (>= 2 doses) or second induction BCG (>= 2 doses); both rounds of BCG must have been administered within a 12 month period; these patients must have either had high-grade Ta tumors and did not achieve a disease-free state for more than 6 months following last dose of BCG, or they had CIS and did not achieve a CR; S1605 registration must occur within 9 months of the last dose of BCG.
  • If a patient does not meet these criteria only because the last dose of BCG was more than 9 months ago, the patient may become eligible if he/she shows histologically proven high-grade recurrence after an additional round of induction or maintenance BCG (>= 3 doses) within 9 months prior to registration
  • Patient has persistent or recurrent high grade T1 urothelial carcinoma after completing therapy with at least induction BCG (>= 5 doses); patients with recurrent high grade T1 urothelial carcinoma after additional rounds of BCG will also be eligible, but one round of maintenance therapy or a second induction is not a pre-requisite for these patients. Trial registration must occur within 9 months of the last dose of BCG
  • If a patient does not meet these criteria only because the last dose of BCG was more than 9 months ago, the patient may become eligible if he/she shows histologically proven high grade recurrence after an additional round of induction or maintenance BCG (>= 3 doses) within 9 months prior to registration
  • Patient achieves disease-free state at 6 month time point (i.e., complete response; presence of only low-grade tumor at this timepoint is still considered complete response) after induction and maintenance (or second round of induction) BCG but later experiences a high-grade Ta/T1recurrence (with or without concomitant CIS) within 6 months after the last dose of BCG or recurrent CIS (in absence of concomitant Ta/T1 tumor) within 12 months after the last BCG dose; the time of eligibility is measured from the last dose of BCG to the time of disease recurrence; the patient must be registered on the trial within 60 days of this recurrence, or within 60 days of a re-TURBT if indicated
  • All adverse events associated with any prior surgery and intravesical therapy must have resolved to grade =< 2 prior to registration
  • Patients must not have had prior systemic chemotherapy for bladder cancer or systemic immunotherapy, including, but not limited to interferon alfa-2b, high dose interleukin 2 (IL-2), pegylated interferon (PEG-IFN), PD-1, anti-PD-L1, intra-tumoral; patients must not have had vaccine therapies within 6 weeks prior to registration; patients must not have received or be planning to receive any of the prohibited therapies during protocol treatment; prior intravesical administration of chemotherapy, interferon, Vicinium (VB4-485), BC-819 or Instiladrin (rAd-interferon-alpha/Syn3) is allowed if all other criteria are met and the last administration was >= 30 days before registration
  • Patients must not be planning to receive concomitant other biologic therapy, radiation therapy, intravesical chemotherapy, surgery, or other anti-cancer therapy while on this protocol
  • Patients must not have received any prior radiation to the bladder for bladder cancer
  • Patients must not have received treatment with systemic immunosuppressive medications (including, but not limited to, prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF] agents) within 4 weeks prior to registration; exceptions: (1) patients may have received acute, low dose, systemic immunosuppressant medications (e.g., a one-time dose of dexamethasone for nausea); (2) the use of inhaled corticosteroids and mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension or adrenocortical insufficiency is allowed
  • Patients must not have received a live, attenuated vaccine within 4 weeks before registration or anticipation that such a live, attenuated vaccine will be required during the study and up to 5 months after the last dose of atezolizumab
  • Influenza vaccination should be given during influenza season only (approximately October to March); patients must not receive live, attenuated influenza vaccine within 4 weeks prior to cycle 1, day 1 or at any time during the study
  • Patients must not require treatment with a RANKL inhibitor (e.g. denosumab) who cannot discontinue it before treatment with atezolizumab
  • Absolute neutrophil count (ANC) >= 1,500 microliter (mcL) (within 42 days prior to registration)
  • Platelets >= 100,000/mcL (within 42 days prior to registration)
  • Hemoglobin >= 9 g/dL (within 42 days prior to registration)
  • Total bilirubin =< 1.5 x institutional upper limit of normal (IULN) (except Gilbert's syndrome, who must have a total bilirubin < 3.0 mg/dL) (within 42 days prior to registration)
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 2 x IULN (within 42 days prior to registration)
  • Serum creatinine =< 1.5 ULN OR measured or calculated creatinine clearance >= 30 mL/min (within 42 days prior to registration)
  • Patients must have Zubrod performance status =< 2
  • Patients must have a baseline electrocardiograph (ECG) performed within 42 days prior to registration
  • Patient must not have history of idiopathic pulmonary fibrosis, pneumonitis (including drug induced), organizing pneumonia (i.e., bronchiolitis obliterans, cryptogenic organizing pneumonia, etc.), or evidence of active pneumonitis
  • Patients must not have an active infection requiring oral or IV antibiotics within 14 days prior to registration; patients receiving prophylactic antibiotics (e.g., for prevention of a urinary tract infection or chronic obstructive pulmonary disease) are eligible
  • Patients must not have severe infections within 28 days prior to registration, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia
  • Patients must not have active autoimmune disease that has required systemic treatment in past two years (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs); replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment; autoimmune diseases include, but are not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjogren's syndrome, Bell's palsy, Guillain-Barre syndrome, multiple sclerosis, autoimmune thyroid disease, vasculitis, or glomerulonephritis
  • Patients must not have undergone prior allogeneic bone marrow transplantation or prior solid organ transplantation
  • Patient must not have active tuberculosis
  • Patients must not have active hepatitis B (chronic or acute) or active hepatitis C infection
  • Patients with past or resolved hepatitis B infection (defined as having a negative hepatitis B surface antigen [HBsAg] test and a positive anti-HBc [antibody to hepatitis B core antigen] antibody test) are eligible
  • Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction (PCR) is negative for HCV RNA
  • Patients positive for human immunodeficiency virus (HIV) are eligible only if they have all of the following:
  • A stable regimen of highly active anti-retroviral therapy (HAART)
  • No requirement for concurrent antibiotics or antifungal agents for the prevention of opportunistic infections
  • A CD4 count above 250 cells/mcL and an undetectable HIV viral load on standard PCR-based tests
  • No other prior malignancy is allowed except, for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for five years
  • Patients must not be pregnant or nursing due to the potential teratogenic side effects of the protocol treatment; administration of atezolizumab may have an adverse effect on pregnancy and poses a risk to the human fetus, including embryo-lethality; women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 5 months (150 days) after the last dose of study agent; a woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately
  • Due to the potential drug reaction with atezolizumab, patients must not be known to be allergic to Chinese hamster egg or ovaries
  • Patients must be offered the opportunity to participate in specimen banking for future studies, to include translational medicine studies
  • Patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines
  • As a part of the oncology patient enrollment network (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

Locations:

  • Southern Cancer Center PC-Daphne
  • Daphne Alabama 36526 United States
  • Southern Cancer Center PC-Mobile
  • Mobile Alabama 36607 United States
  • Southern Cancer Center PC-Providence
  • Mobile Alabama 36608 United States
  • Southern Cancer Center PC-Springhill
  • Mobile Alabama 36608 United States
  • Mayo Clinic in Arizona
  • Scottsdale Arizona 85259 United States
  • University of Arizona Cancer Center-Orange Grove Campus
  • Tucson Arizona 85704 United States
  • Banner University Medical Center - Tucson
  • Tucson Arizona 85719 United States
  • University of Arizona Cancer Center-North Campus
  • Tucson Arizona 85719 United States
  • Veteran's Administration Medical Center
  • Little Rock Arkansas 72205 United States
  • UC San Diego Moores Cancer Center
  • La Jolla California 92093 United States
  • Los Angeles County-USC Medical Center
  • Los Angeles California 90033 United States
  • USC / Norris Comprehensive Cancer Center
  • Los Angeles California 90033 United States
  • Stanford Cancer Institute Palo Alto
  • Palo Alto California 94304 United States
  • Eisenhower Medical Center
  • Rancho Mirage California 92270 United States
  • University of California Davis Comprehensive Cancer Center
  • Sacramento California 95817 United States
  • UCSF Medical Center-Mission Bay
  • San Francisco California 94158 United States
  • University of Colorado Hospital
  • Aurora Colorado 80045 United States
  • Kaiser Permanente-Franklin
  • Denver Colorado 80205 United States
  • Kaiser Permanente-Rock Creek
  • Lafayette Colorado 80026 United States
  • Kaiser Permanente-Lone Tree
  • Lone Tree Colorado 80124 United States
  • Greenwich Hospital
  • Greenwich Connecticut 06830 United States
  • Yale University
  • New Haven Connecticut 06520 United States
  • Veterans Affairs Connecticut Healthcare System-West Haven Campus
  • West Haven Connecticut 06516 United States
  • Delaware Clinical and Laboratory Physicians PA
  • Newark Delaware 19713 United States
  • Helen F Graham Cancer Center
  • Newark Delaware 19713 United States
  • Medical Oncology Hematology Consultants PA
  • Newark Delaware 19713 United States
  • Regional Hematology and Oncology PA
  • Newark Delaware 19713 United States
  • Christiana Care Health System-Christiana Hospital
  • Newark Delaware 19718 United States
  • Christiana Care Health System-Wilmington Hospital
  • Wilmington Delaware 19801 United States
  • MedStar Washington Hospital Center
  • Washington District of Columbia 20010 United States
  • George Washington University Medical Center
  • Washington District of Columbia 20037 United States
  • Mount Sinai Comprehensive Cancer Center at Aventura
  • Aventura Florida 33180 United States
  • University of Florida Health Science Center - Gainesville
  • Gainesville Florida 32610 United States
  • Mount Sinai Medical Center
  • Miami Beach Florida 33140 United States
  • Indian River Medical Center
  • Vero Beach Florida 32960 United States
  • Emory University Hospital/Winship Cancer Institute
  • Atlanta Georgia 30322 United States
  • Atlanta VA Medical Center
  • Decatur Georgia 30033 United States
  • Pali Momi Medical Center
  • 'Aiea Hawaii 96701 United States
  • Hawaii Cancer Care Inc-POB II
  • Honolulu Hawaii 96813 United States
  • Hawaii Oncology Inc-POB I
  • Honolulu Hawaii 96813 United States
  • Island Urology
  • Honolulu Hawaii 96813 United States
  • Queen's Medical Center
  • Honolulu Hawaii 96813 United States
  • Straub Clinic and Hospital
  • Honolulu Hawaii 96813 United States
  • University of Hawaii Cancer Center
  • Honolulu Hawaii 96813 United States
  • Hawaii Oncology Inc-Kuakini
  • Honolulu Hawaii 96817 United States
  • Kapiolani Medical Center for Women and Children
  • Honolulu Hawaii 96826 United States
  • Saint Alphonsus Cancer Care Center-Boise
  • Boise Idaho 83706 United States
  • Saint Luke's Mountain States Tumor Institute
  • Boise Idaho 83712 United States
  • Saint Alphonsus Cancer Care Center-Caldwell
  • Caldwell Idaho 83605 United States
  • Walter Knox Memorial Hospital
  • Emmett Idaho 83617 United States
  • Idaho Urologic Institute-Meridian
  • Meridian Idaho 83642 United States
  • Saint Luke's Mountain States Tumor Institute - Meridian
  • Meridian Idaho 83642 United States
  • Saint Alphonsus Medical Center-Nampa
  • Nampa Idaho 83686 United States
  • Saint Luke's Mountain States Tumor Institute-Twin Falls
  • Twin Falls Idaho 83301 United States
  • Rush - Copley Medical Center
  • Aurora Illinois 60504 United States
  • Illinois CancerCare-Bloomington
  • Bloomington Illinois 61704 United States
  • Illinois CancerCare-Canton
  • Canton Illinois 61520 United States
  • Illinois CancerCare-Carthage
  • Carthage Illinois 62321 United States
  • Centralia Oncology Clinic
  • Centralia Illinois 62801 United States
  • Northwestern University
  • Chicago Illinois 60611 United States
  • Carle on Vermilion
  • Danville Illinois 61832 United States
  • Cancer Care Specialists of Illinois - Decatur
  • Decatur Illinois 62526 United States
  • Decatur Memorial Hospital
  • Decatur Illinois 62526 United States
  • Carle Physician Group-Effingham
  • Effingham Illinois 62401 United States
  • Crossroads Cancer Center
  • Effingham Illinois 62401 United States
  • Elmhurst Memorial Hospital
  • Elmhurst Illinois 60126 United States
  • Illinois CancerCare-Eureka
  • Eureka Illinois 61530 United States
  • Illinois CancerCare-Galesburg
  • Galesburg Illinois 61401 United States
  • Edward Hines Jr VA Hospital
  • Hines Illinois 60141 United States
  • Illinois CancerCare-Kewanee Clinic
  • Kewanee Illinois 61443 United States
  • Illinois CancerCare-Macomb
  • Macomb Illinois 61455 United States
  • Carle Physician Group-Mattoon/Charleston
  • Mattoon Illinois 61938 United States
  • Loyola University Medical Center
  • Maywood Illinois 60153 United States
  • Good Samaritan Regional Health Center
  • Mount Vernon Illinois 62864 United States
  • Edward Hospital/Cancer Center
  • Naperville Illinois 60540 United States
  • Illinois CancerCare-Ottawa Clinic
  • Ottawa Illinois 61350 United States
  • Illinois CancerCare-Pekin
  • Pekin Illinois 61554 United States
  • Illinois CancerCare-Peoria
  • Peoria Illinois 61615 United States
  • Methodist Medical Center of Illinois
  • Peoria Illinois 61636 United States
  • OSF Saint Francis Medical Center
  • Peoria Illinois 61637 United States
  • Illinois CancerCare-Peru
  • Peru Illinois 61354 United States
  • Edward Hospital/Cancer Center?Plainfield
  • Plainfield Illinois 60585 United States
  • Illinois CancerCare-Princeton
  • Princeton Illinois 61356 United States
  • Southern Illinois University School of Medicine
  • Springfield Illinois 62702 United States
  • Springfield Clinic
  • Springfield Illinois 62702 United States
  • Memorial Medical Center
  • Springfield Illinois 62781 United States
  • Carle Cancer Center
  • Urbana Illinois 61801 United States
  • The Carle Foundation Hospital
  • Urbana Illinois 61801 United States
  • Rush-Copley Healthcare Center
  • Yorkville Illinois 60560 United States
  • Indiana University/Melvin and Bren Simon Cancer Center
  • Indianapolis Indiana 46202 United States
  • Community Cancer Center East
  • Indianapolis Indiana 46219 United States
  • Community Cancer Center South
  • Indianapolis Indiana 46227 United States
  • Community Cancer Center North
  • Indianapolis Indiana 46256 United States
  • Community Howard Regional Health
  • Kokomo Indiana 46904 United States
  • Reid Health
  • Richmond Indiana 47374 United States
  • Cancer Center of Kansas - Chanute
  • Chanute Kansas 66720 United States
  • Cancer Center of Kansas - Dodge City
  • Dodge City Kansas 67801 United States
  • Cancer Center of Kansas - El Dorado
  • El Dorado Kansas 67042 United States
  • Cancer Center of Kansas - Fort Scott
  • Fort Scott Kansas 66701 United States
  • Hays Medical Center
  • Hays Kansas 67601 United States
  • Cancer Center of Kansas-Independence
  • Independence Kansas 67301 United States
  • University of Kansas Cancer Center
  • Kansas City Kansas 66160 United States
  • Cancer Center of Kansas-Kingman
  • Kingman Kansas 67068 United States
  • Lawrence Memorial Hospital
  • Lawrence Kansas 66044 United States
  • Cancer Center of Kansas-Liberal
  • Liberal Kansas 67905 United States
  • Cancer Center of Kansas-Manhattan
  • Manhattan Kansas 66502 United States
  • Cancer Center of Kansas - McPherson
  • McPherson Kansas 67460 United States
  • Cancer Center of Kansas - Newton
  • Newton Kansas 67114 United States
  • Olathe Medical Center
  • Olathe Kansas 66061 United States
  • Cancer Center of Kansas - Parsons
  • Parsons Kansas 67357 United States
  • Via Christi Hospital-Pittsburg
  • Pittsburg Kansas 66762 United States
  • Cancer Center of Kansas - Pratt
  • Pratt Kansas 67124 United States
  • Cancer Center of Kansas - Salina
  • Salina Kansas 67401 United States
  • Salina Regional Health Center
  • Salina Kansas 67401 United States
  • Saint Francis Hospital and Medical Center - Topeka
  • Topeka Kansas 66606 United States
  • Cancer Center of Kansas - Wellington
  • Wellington Kansas 67152 United States
  • University of Kansas Hospital-Westwood Cancer Center
  • Westwood Kansas 66205 United States
  • Cancer Center of Kansas-Wichita Medical Arts Tower
  • Wichita Kansas 67208 United States
  • Cancer Center of Kansas - Wichita
  • Wichita Kansas 67214 United States
  • Via Christi Regional Medical Center
  • Wichita Kansas 67214 United States
  • Cancer Center of Kansas - Winfield
  • Winfield Kansas 67156 United States
  • University of Kentucky/Markey Cancer Center
  • Lexington Kentucky 40536 United States
  • East Jefferson General Hospital
  • Metairie Louisiana 70006 United States
  • LSU Healthcare Network / Metairie Multi-Specialty Clinic
  • Metairie Louisiana 70006 United States
  • Louisiana State University Health Science Center
  • New Orleans Louisiana 70112 United States
  • Louisiana State University Health Sciences Center Shreveport
  • Shreveport Louisiana 71103 United States
  • Johns Hopkins University/Sidney Kimmel Cancer Center
  • Baltimore Maryland 21287 United States
  • Boston Medical Center
  • Boston Massachusetts 02118 United States
  • Lowell General Hospital
  • Lowell Massachusetts 01854 United States
  • Saint Joseph Mercy Hospital
  • Ann Arbor Michigan 48106 United States
  • IHA Hematology Oncology Consultants-Brighton
  • Brighton Michigan 48114 United States
  • Saint Joseph Mercy Brighton
  • Brighton Michigan 48114 United States
  • IHA Hematology Oncology Consultants-Canton
  • Canton Michigan 48188 United States
  • Saint Joseph Mercy Canton
  • Canton Michigan 48188 United States
  • Caro Cancer Center
  • Caro Michigan 48723 United States
  • IHA Hematology Oncology Consultants-Chelsea
  • Chelsea Michigan 48118 United States
  • Saint Joseph Mercy Chelsea
  • Chelsea Michigan 48118 United States
  • Hematology Oncology Consultants-Clarkston
  • Clarkston Michigan 48346 United States
  • Newland Medical Associates-Clarkston
  • Clarkston Michigan 48346 United States
  • Michigan State University Clinical Center
  • East Lansing Michigan 48824-7016 United States
  • Genesee Cancer and Blood Disease Treatment Center
  • Flint Michigan 48503 United States
  • Genesee Hematology Oncology PC
  • Flint Michigan 48503 United States
  • Genesys Hurley Cancer Institute
  • Flint Michigan 48503 United States
  • Sparrow Hospital
  • Lansing Michigan 48912 United States
  • Saint Mary's Oncology/Hematology Associates of Marlette
  • Marlette Michigan 48453 United States
  • Newland Medical Associates-Pontiac
  • Pontiac Michigan 48341 United States
  • Saint Joseph Mercy Oakland
  • Pontiac Michigan 48341 United States
  • Ascension Saint Mary's Hospital
  • Saginaw Michigan 48601 United States
  • Oncology Hematology Associates of Saginaw Valley PC
  • Saginaw Michigan 48604 United States
  • Saint Mary's Oncology/Hematology Associates of West Branch
  • West Branch Michigan 48661 United States
  • Huron Gastroenterology PC
  • Ypsilanti Michigan 48106 United States
  • IHA Hematology Oncology Consultants-Ann Arbor
  • Ypsilanti Michigan 48197 United States
  • Fairview Ridges Hospital
  • Burnsville Minnesota 55337 United States
  • Essentia Health Cancer Center
  • Duluth Minnesota 55805 United States
  • Essentia Health Saint Mary's Medical Center
  • Duluth Minnesota 55805 United States
  • Miller-Dwan Hospital
  • Duluth Minnesota 55805 United States
  • Saint Luke's Hospital of Duluth
  • Duluth Minnesota 55805 United States
  • Fairview-Southdale Hospital
  • Edina Minnesota 55435 United States
  • Coborn Cancer Center at Saint Cloud Hospital
  • Saint Cloud Minnesota 56303 United States
  • Saint Cloud Hospital
  • Saint Cloud Minnesota 56303 United States
  • Park Nicollet Clinic - Saint Louis Park
  • Saint Louis Park Minnesota 55416 United States
  • Essentia Health Virginia Clinic
  • Virginia Minnesota 55792 United States
  • Fairview Lakes Medical Center
  • Wyoming Minnesota 55092 United States
  • Parkland Health Center-Bonne Terre
  • Bonne Terre Missouri 63628 United States
  • Saint Francis Medical Center
  • Cape Girardeau Missouri 63703 United States
  • Southeast Cancer Center
  • Cape Girardeau Missouri 63703 United States
  • University of Missouri - Ellis Fischel
  • Columbia Missouri 65212 United States
  • Kansas City Veterans Affairs Medical Center
  • Kansas City Missouri 64128 United States
  • Missouri Baptist Medical Center
  • Saint Louis Missouri 63131 United States
  • Sainte Genevieve County Memorial Hospital
  • Sainte Genevieve Missouri 63670 United States
  • Missouri Baptist Sullivan Hospital
  • Sullivan Missouri 63080 United States
  • Missouri Baptist Outpatient Center-Sunset Hills
  • Sunset Hills Missouri 63127 United States
  • Benefis Healthcare- Sletten Cancer Institute
  • Great Falls Montana 59405 United States
  • Saint Patrick Hospital - Community Hospital
  • Missoula Montana 59802 United States
  • Nebraska Medicine-Village Pointe
  • Omaha Nebraska 68118 United States
  • University of Nebraska Medical Center
  • Omaha Nebraska 68198 United States
  • Cancer and Blood Specialists-Henderson
  • Henderson Nevada 89052 United States
  • Ann M Wierman MD LTD
  • Las Vegas Nevada 89128 United States
  • Comprehensive Cancer Centers of Nevada - Northwest
  • Las Vegas Nevada 89128 United States
  • OptumCare Cancer Care at MountainView
  • Las Vegas Nevada 89128 United States
  • Comprehensive Cancer Centers of Nevada - Town Center
  • Las Vegas Nevada 89144 United States
  • Comprehensive Cancer Centers of Nevada
  • Las Vegas Nevada 89148 United States
  • Comprehensive Cancer Centers of Nevada - Central Valley
  • Las Vegas Nevada 89169 United States
  • Renown Regional Medical Center
  • Reno Nevada 89502 United States
  • Roswell Park Cancer Institute
  • Buffalo New York 14263 United States
  • Mount Sinai West
  • New York New York 10019 United States
  • NYP/Weill Cornell Medical Center
  • New York New York 10065 United States
  • University of Rochester
  • Rochester New York 14642 United States
  • State University of New York Upstate Medical University
  • Syracuse New York 13210 United States
  • Southeastern Medical Oncology Center-Clinton
  • Clinton North Carolina 28328 United States
  • Southeastern Medical Oncology Center-Goldsboro
  • Goldsboro North Carolina 27534 United States
  • Wayne Memorial Hospital
  • Goldsboro North Carolina 27534 United States
  • Southeastern Medical Oncology Center-Jacksonville
  • Jacksonville North Carolina 28546 United States
  • Veterans Administration Medical Center
  • Salisbury North Carolina 28144 United States
  • Wake Forest University Health Sciences
  • Winston-Salem North Carolina 27157 United States
  • Sanford Bismarck Medical Center
  • Bismarck North Dakota 58501 United States
  • Sanford Broadway Medical Center
  • Fargo North Dakota 58122 United States
  • Sanford Roger Maris Cancer Center
  • Fargo North Dakota 58122 United States
  • Dayton Physician LLC-Miami Valley Hospital North
  • Dayton Ohio 45415 United States
  • Miami Valley Hospital North
  • Dayton Ohio 45415 United States
  • Kettering Medical Center
  • Kettering Ohio 45429 United States
  • Saint Rita's Medical Center
  • Lima Ohio 45801 United States
  • University of Oklahoma Health Sciences Center
  • Oklahoma City Oklahoma 73104 United States
  • Mercy Hospital Oklahoma City
  • Oklahoma City Oklahoma 73120 United States
  • Oklahoma Cancer Specialists and Research Institute-Tulsa
  • Tulsa Oklahoma 74146 United States
  • Saint Alphonsus Medical Center-Baker City
  • Baker City Oregon 97814 United States
  • Legacy Mount Hood Medical Center
  • Gresham Oregon 97030 United States
  • Saint Alphonsus Medical Center-Ontario
  • Ontario Oregon 97914 United States
  • Legacy Good Samaritan Hospital and Medical Center
  • Portland Oregon 97210 United States
  • Legacy Meridian Park Hospital
  • Tualatin Oregon 97062 United States
  • Christiana Care Health System-Concord Health Center
  • Chadds Ford Pennsylvania 19317 United States
  • Allegheny General Hospital
  • Pittsburgh Pennsylvania 15212 United States
  • Greenville Health System Cancer Institute-Laurens
  • Clinton South Carolina 29325 United States
  • Greenville Health System Cancer Institute-Easley
  • Easley South Carolina 29640 United States
  • Greenville Health System Cancer Institute-Butternut
  • Greenville South Carolina 29605 United States
  • Greenville Health System Cancer Institute-Faris
  • Greenville South Carolina 29605 United States
  • Greenville Memorial Hospital
  • Greenville South Carolina 29605 United States
  • Greenville Health System Cancer Institute-Eastside
  • Greenville South Carolina 29615 United States
  • Greenville Health System Cancer Institute-Greer
  • Greer South Carolina 29650 United States
  • Greenville Health System Cancer Institute-Seneca
  • Seneca South Carolina 29672 United States
  • Greenville Health System Cancer Institute-Spartanburg
  • Spartanburg South Carolina 29307 United States
  • Sanford Cancer Center Oncology Clinic
  • Sioux Falls South Dakota 57104 United States
  • Sanford USD Medical Center - Sioux Falls
  • Sioux Falls South Dakota 57117-5134 United States
  • University of Texas Medical Branch
  • Galveston Texas 77555-0565 United States
  • Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
  • Houston Texas 77030 United States
  • UTMB Cancer Center at Victory Lakes
  • League City Texas 77573 United States
  • Audie L Murphy VA Hospital
  • San Antonio Texas 78229 United States
  • University Hospital
  • San Antonio Texas 78229 United States
  • University of Texas Health Science Center at San Antonio
  • San Antonio Texas 78229 United States
  • Farmington Health Center
  • Farmington Utah 84025 United States
  • Huntsman Cancer Institute/University of Utah
  • Salt Lake City Utah 84112 United States
  • South Jordan Health Center
  • South Jordan Utah 84009 United States
  • Centra Lynchburg Hematology-Oncology Clinic Inc
  • Lynchburg Virginia 24501 United States
  • Virginia Commonwealth University/Massey Cancer Center
  • Richmond Virginia 23298 United States
  • Swedish Medical Center-First Hill
  • Seattle Washington 98122-4307 United States
  • Legacy Salmon Creek Hospital
  • Vancouver Washington 98686 United States
  • West Virginia University Charleston Division
  • Charleston West Virginia 25304 United States
  • Duluth Clinic Ashland
  • Ashland Wisconsin 54806 United States
  • Aurora Cancer Care-Southern Lakes VLCC
  • Burlington Wisconsin 53105 United States
  • Marshfield Clinic-Chippewa Center
  • Chippewa Falls Wisconsin 54729 United States
  • Marshfield Medical Center-EC Cancer Center
  • Eau Claire Wisconsin 54701 United States
  • Aurora Health Center-Fond du Lac
  • Fond Du Lac Wisconsin 54937 United States
  • Aurora Health Care Germantown Health Center
  • Germantown Wisconsin 53022 United States
  • Aurora Cancer Care-Grafton
  • Grafton Wisconsin 53024 United States
  • Aurora BayCare Medical Center
  • Green Bay Wisconsin 54311 United States
  • Aurora Cancer Care-Kenosha South
  • Kenosha Wisconsin 53142 United States
  • Marshfield Clinic - Ladysmith Center
  • Ladysmith Wisconsin 54848 United States
  • University of Wisconsin Hospital and Clinics
  • Madison Wisconsin 53792 United States
  • Aurora Bay Area Medical Group-Marinette
  • Marinette Wisconsin 54143 United States
  • Marshfield Medical Center-Marshfield
  • Marshfield Wisconsin 54449 United States
  • Aurora Cancer Care-Milwaukee
  • Milwaukee Wisconsin 53209 United States
  • Aurora Saint Luke's Medical Center
  • Milwaukee Wisconsin 53215 United States
  • Aurora Sinai Medical Center
  • Milwaukee Wisconsin 53233 United States
  • Marshfield Clinic-Minocqua Center
  • Minocqua Wisconsin 54548 United States
  • Vince Lombardi Cancer Clinic - Oshkosh
  • Oshkosh Wisconsin 54904 United States
  • Aurora Cancer Care-Racine
  • Racine Wisconsin 53406 United States
  • Marshfield Medical Center-Rice Lake
  • Rice Lake Wisconsin 54868 United States
  • Vince Lombardi Cancer Clinic-Sheboygan
  • Sheboygan Wisconsin 53081 United States
  • Marshfield Clinic Stevens Point Center
  • Stevens Point Wisconsin 54482 United States
  • Aurora Medical Center in Summit
  • Summit Wisconsin 53066 United States
  • Vince Lombardi Cancer Clinic-Two Rivers
  • Two Rivers Wisconsin 54241 United States
  • Marshfield Clinic-Wausau Center
  • Wausau Wisconsin 54401 United States
  • Aurora Cancer Care-Milwaukee West
  • Wauwatosa Wisconsin 53226 United States
  • Aurora West Allis Medical Center
  • West Allis Wisconsin 53227 United States
  • Marshfield Clinic - Weston Center
  • Weston Wisconsin 54476 United States
  • Marshfield Clinic - Wisconsin Rapids Center
  • Wisconsin Rapids Wisconsin 54494 United States
  • Cross Cancer Institute
  • Edmonton Alberta T6G 1Z2 Canada
  • The Research Institute of the McGill University Health Centre (MUHC)
  • Montreal Quebec H3H 2R9 Canada
  • Allan Blair Cancer Centre
  • Regina Saskatchewan S4T 7T1 Canada

View trial on ClinicalTrials.gov


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