A Phase 3 Randomized Study Comparing Perioperative Nivolumab vs. Observation in Patients With Renal Cell Carcinoma Undergoing Nephrectomy (PROSPER RCC)


Condition: Metastatic Malignant Neoplasm in Lymph Node, Metastatic Malignant Neoplasm in the Adrenal Gland, Metastatic Malignant Neoplasm in the Lung, Metastatic Malignant Neoplasm in the Pancreas, Metastatic Malignant Neoplasm in the Skin, Metastatic Malignant Neoplasm in the Soft Tissues, Metastatic Renal Cell Carcinoma, Oligometastasis, Sarcomatoid Renal Cell Carcinoma, Stage II Renal Cell Cancer AJCC v7, Stage III Renal Cell Cancer AJCC v7, Unclassified Renal Cell Carcinoma

Intervention:

  • Procedure: Conventional Surgery
  • Biological: Nivolumab
  • Other: Patient Observation
  • Other: Quality-of-Life Assessment
  • Other: Questionnaire Administration

Purpose: This phase III trial compares nephrectomy (surgery to remove a kidney or part of a kidney) with or without nivolumab in treating patients with kidney cancer that is limited to a certain part of the body (localized). 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 before nephrectomy may make the tumor smaller and reduce the amount of normal tissue that needs to be removed, and after nephrectomy to increase survival. It is not yet known whether nivolumab and nephrectomy is more effective than nephrectomy alone in treating patients with kidney cancer.

Study Type: Interventional

Clinical Trials Identifier NCT 8-digits: NCT03055013

Sponsor: National Cancer Institute (NCI)

Primary Outcome Measures:

  • Measure: Recurrence-free survival (RFS)
  • Time Frame: Time from randomization to disease recurrence or death from any cause, assessed up to 10 years
  • Safety Issue:

Secondary Outcome Measures:

  • Measure: Overall survival
  • Time Frame: Time from randomization to death from any cause, assessed up to 10 years
  • Safety Issue:
  • Measure: RFS among patients with clear cell cancer
  • Time Frame: Up to 10 years
  • Safety Issue:
  • Measure: Incidence of toxicity
  • Time Frame: Up to 10 years
  • Safety Issue:

Estimated Enrollment: 805

Study Start Date: February 2, 2017

Phase: Phase 3

Eligibility:

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

Inclusion Criteria:

  • ELIGIBILITY CRITERIA FOR PREREGISTRATION (STEP 0):
  • Patients with a renal mass consistent with a clinical stage >= T2Nx renal cell carcinoma (RCC) or TanyN+ RCC for which radical or partial nephrectomy is planned
  • Patients must have no clinical or radiological evidence of distant metastases (M0) unless the presumed M1 disease can be resected/definitively treated (e.g., thermal ablation, stereotactic radiation) at the same time or within a 12 week window from the date of the initial procedure such that the patient is considered "no evidence of disease" (M1 NED)
  • Permitted sites of oligo-metastases: lung, adrenal, nodes, pancreas, soft tissue or skin; liver or bone metastases are not permitted
  • No more than 3 metastases are permitted and all must be able to be removed or definitively treated within 12 weeks of the primary tumor resection
  • If histological confirmation of RCC has not been done within 12 months prior to pre-registration (Step 0), patient must be willing to undergo a core biopsy for this purpose if randomized to Arm H
  • NOTE: This can be a (1) standard of care diagnostic biopsy or (2) a research biopsy following assignment to Arm H or a planned metastasectomy before or after randomization; if the biopsy performed following pre-registration (Step 0) clearly demonstrates a benign condition, oncocytoma or a different type of cancer that is not RCC, the patient is not eligible for registration (Step 1); a non-diagnostic biopsy is considered a good faith effort and does not need to be repeated unless deemed clinically necessary by the treating investigator
  • NOTE: Patients randomized to Arm O (Observation) are permitted to register to Step 1 (Arm B) immediately following pre-registration assignment to Arm O, regardless of whether or not they have had a standard of care diagnostic biopsy
  • No prior systemic or local anti-cancer therapy for the current RCC is permitted
  • Partial nephrectomy for prior RCC
  • Metastasectomy for the current RCC diagnosis is not allowed unless performed to render patient NED (in addition to the planned nephrectomy) within 6 months of the current diagnosis
  • Radiation therapyto the bilateral kidney or any distant metastatic sites, is not allowed unless administered to render patient NED within 6 months of the current diagnosis
  • Current or past antineoplastic systemic therapies for RCC are not allowed: i.e., chemotherapy, hormonal therapy, immunotherapy, or standard or investigational agents for treatment of RCC
  • Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways
  • Eastern Cooperative Oncology Group (ECOG) performance status: 0 or 1
  • Patient must have no prior history of RCC that was resected with curative intent within the past 5 years
  • Patients with a prior RCC that was treated > 5 years before, are eligible if the current tumor is consistent with a new primary in the opinion of the treating investigator
  • Patients with bilateral synchronous RCCs are eligible if they can be resected or definitively treated at the same time or within a 12 week window from time of initial nephrectomy (partial or radical) or procedure and maintain adequate residual renal function; the patient is not eligible if both kidneys are completely removed and subsequent hemodialysis is required
  • Permitted forms of local therapy for second tumor:
  • Partial or radical nephrectomy
  • If tumor is =< 3cm: thermal ablation (e.g., radiofrequency ablation, cryoablation or stereotactic radiosurgery)
  • Patients cannot have concurrent malignancies, with the following exceptions:
  • Adequately treated basal cell or squamous cell skin cancer
  • In situ cervical cancer
  • A history of superficial Ta urothelial cancer is permitted (as long as not currently undergoing treatment) whereas T1 or greater disease is excluded if < 3 years from diagnosis; concurrent persistent disease is not permitted
  • Adequately treated stage I or II cancer from which the patient is currently in complete remission
  • Any other cancer and stage from which the patient has been disease-free for at least 3 years prior to the time of pre-registration and as long as they are not receiving any current treatment (e.g. adjuvant or maintenance systemic or local therapy)
  • Concurrent low risk prostate cancer on active surveillance
  • No active known or suspected autoimmune disease; the following autoimmune disorders are permitted: patients with vitiligo, type I diabetes mellitus, controlled/stable hypothyroidism due to autoimmune or non-autoimmune conditions (hormone replacement is allowed), psoriasis not requiring systemic treatment, or other conditions not expected to recur
  • No ongoing condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medications with the exceptions outlined below; no treatment with other immunosuppressive agents within 14 days prior to the first dose of study drug with the following exceptions:
  • Topical, ocular, intra-articular, intranasal, inhaled steroids and adrenal replacement steroid doses > 10 mg daily prednisone or the equivalent are permitted in the absence of active autoimmune disease
  • A brief (less than 3 weeks) course of corticosteroids (any amount) for prophylaxis (for example: contrast dye allergy) or for treatment of non-autoimmune conditions (for example: nausea, delayed-type hypersensitivity reaction caused by a contact allergen) is permitted
  • No uncontrolled adrenal insufficiency
  • No known chronic active liver disease or evidence of acute or chronic hepatitis B virus (HBV) or hepatitis C virus (HCV)
  • No serious intercurrent illness, including ongoing or active infection requiring parenteral antibodies
  • No known evidence of human immunodeficiency virus (HIV) infection, since the effects of nivolumab on anti-retroviral therapy have not been studied
  • No known medical condition (e.g. a condition associated with uncontrolled diarrhea such as ulcerative colitis or acute diverticulitis) that, in the investigator's opinion, would increase the risk associated with study participation or interfere with the interpretation of safety results
  • No major surgery within 28 days prior to randomization
  • No patients currently enrolled in other clinical trials testing a therapeutic intervention
  • No history of severe hypersensitivity to a monoclonal antibody
  • Ability to understand and the willingness to sign a written informed consent document
  • ELIGIBILITY CRITERIA FOR RANDOMIZATION (STEP 1):
  • Patients must meet all Step 0

Eligibility Criteria:

  • FOR PREREGISTRATION (STEP 0):
  • Patients with a renal mass consistent with a clinical stage >= T2Nx renal cell carcinoma (RCC) or TanyN+ RCC for which radical or partial nephrectomy is planned
  • Patients must have no clinical or radiological evidence of distant metastases (M0) unless the presumed M1 disease can be resected/definitively treated (e.g., thermal ablation, stereotactic radiation) at the same time or within a 12 week window from the date of the initial procedure such that the patient is considered "no evidence of disease" (M1 NED)
  • Permitted sites of oligo-metastases: lung, adrenal, nodes, pancreas, soft tissue or skin; liver or bone metastases are not permitted
  • No more than 3 metastases are permitted and all must be able to be removed or definitively treated within 12 weeks of the primary tumor resection
  • If histological confirmation of RCC has not been done within 12 months prior to pre-registration (Step 0), patient must be willing to undergo a core biopsy for this purpose if randomized to Arm H
  • NOTE: This can be a (1) standard of care diagnostic biopsy or (2) a research biopsy following assignment to Arm H or a planned metastasectomy before or after randomization; if the biopsy performed following pre-registration (Step 0) clearly demonstrates a benign condition, oncocytoma or a different type of cancer that is not RCC, the patient is not eligible for registration (Step 1); a non-diagnostic biopsy is considered a good faith effort and does not need to be repeated unless deemed clinically necessary by the treating investigator
  • NOTE: Patients randomized to Arm O (Observation) are permitted to register to Step 1 (Arm B) immediately following pre-registration assignment to Arm O, regardless of whether or not they have had a standard of care diagnostic biopsy
  • No prior systemic or local anti-cancer therapy for the current RCC is permitted
  • Partial nephrectomy for prior RCC
  • Metastasectomy for the current RCC diagnosis is not allowed unless performed to render patient NED (in addition to the planned nephrectomy) within 6 months of the current diagnosis
  • Radiation therapyto the bilateral kidney or any distant metastatic sites, is not allowed unless administered to render patient NED within 6 months of the current diagnosis
  • Current or past antineoplastic systemic therapies for RCC are not allowed: i.e., chemotherapy, hormonal therapy, immunotherapy, or standard or investigational agents for treatment of RCC
  • Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways
  • Eastern Cooperative Oncology Group (ECOG) performance status: 0 or 1
  • Patient must have no prior history of RCC that was resected with curative intent within the past 5 years
  • Patients with a prior RCC that was treated > 5 years before, are eligible if the current tumor is consistent with a new primary in the opinion of the treating investigator
  • Patients with bilateral synchronous RCCs are eligible if they can be resected or definitively treated at the same time or within a 12 week window from time of initial nephrectomy (partial or radical) or procedure and maintain adequate residual renal function; the patient is not eligible if both kidneys are completely removed and subsequent hemodialysis is required
  • Permitted forms of local therapy for second tumor:
  • Partial or radical nephrectomy
  • If tumor is =< 3cm: thermal ablation (e.g., radiofrequency ablation, cryoablation or stereotactic radiosurgery)
  • Patients cannot have concurrent malignancies, with the following exceptions:
  • Adequately treated basal cell or squamous cell skin cancer
  • In situ cervical cancer
  • A history of superficial Ta urothelial cancer is permitted (as long as not currently undergoing treatment) whereas T1 or greater disease is excluded if < 3 years from diagnosis; concurrent persistent disease is not permitted
  • Adequately treated stage I or II cancer from which the patient is currently in complete remission
  • Any other cancer and stage from which the patient has been disease-free for at least 3 years prior to the time of pre-registration and as long as they are not receiving any current treatment (e.g. adjuvant or maintenance systemic or local therapy)
  • Concurrent low risk prostate cancer on active surveillance
  • No active known or suspected autoimmune disease; the following autoimmune disorders are permitted: patients with vitiligo, type I diabetes mellitus, controlled/stable hypothyroidism due to autoimmune or non-autoimmune conditions (hormone replacement is allowed), psoriasis not requiring systemic treatment, or other conditions not expected to recur
  • No ongoing condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive medications with the exceptions outlined below; no treatment with other immunosuppressive agents within 14 days prior to the first dose of study drug with the following exceptions:
  • Topical, ocular, intra-articular, intranasal, inhaled steroids and adrenal replacement steroid doses > 10 mg daily prednisone or the equivalent are permitted in the absence of active autoimmune disease
  • A brief (less than 3 weeks) course of corticosteroids (any amount) for prophylaxis (for example: contrast dye allergy) or for treatment of non-autoimmune conditions (for example: nausea, delayed-type hypersensitivity reaction caused by a contact allergen) is permitted
  • No uncontrolled adrenal insufficiency
  • No known chronic active liver disease or evidence of acute or chronic hepatitis B virus (HBV) or hepatitis C virus (HCV)
  • No serious intercurrent illness, including ongoing or active infection requiring parenteral antibodies
  • No known evidence of human immunodeficiency virus (HIV) infection, since the effects of nivolumab on anti-retroviral therapy have not been studied
  • No known medical condition (e.g. a condition associated with uncontrolled diarrhea such as ulcerative colitis or acute diverticulitis) that, in the investigator's opinion, would increase the risk associated with study participation or interfere with the interpretation of safety results
  • No major surgery within 28 days prior to randomization
  • No patients currently enrolled in other clinical trials testing a therapeutic intervention
  • No history of severe hypersensitivity to a monoclonal antibody
  • Ability to understand and the willingness to sign a written informed consent document
  • ELIGIBILITY CRITERIA FOR RANDOMIZATION (STEP 1):
  • Patients must meet all Step 0 eligibility criteria at the time of their registration to Step 1
  • In patients randomized to Arm H, core tumor biopsy must demonstrate RCC of any histology, including sarcomatoid, unclassified, or "unknown histology" (if preoperative biopsy was uninformative)
  • NOTE: A non-diagnostic biopsy is considered a good faith effort and does not need to be repeated unless deemed clinically necessary by the treating investigator
  • Women must not be pregnant or breast-feeding, as the effects of nivolumab on the developing human fetus or in the nursing infant are unknown; all females of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy; a female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point 2) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
  • Women of childbearing potential (WOCBP) and males who are sexually active with WOCBP must use accepted and effective method(s) of contraception, or to abstain from sexual intercourse for the duration of their participation in the study; women of childbearing potential must use adequate methods to avoid pregnancy for 23 weeks after the last dose of nivolumab; sexually active males must use adequate methods to avoid pregnancy for 31 weeks after the last dose of nivolumab
  • White blood cells >= 2000/uL (within 8 weeks of registration)
  • Absolute neutrophil count (ANC) >= 1,500/mm^3 (within 8 weeks of registration)
  • Platelet count >= 100,000/mm^3 (within 8 weeks of registration)
  • Hemoglobin >= 9.0 g/dL (within 8 weeks of registration)
  • Serum creatinine =< 1.5 x upper limit of normal (ULN) (except subjects with Gilbert syndrome, who can have total bilirubin < 3.0 x ULN) (within 8 weeks of registration)
  • Total bilirubin =< 1.5 x ULN (except subjects with Gilbert syndrome, who can have total bilirubin < 3.0 x ULN) (within 8 weeks of registration)
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x ULN (within 8 weeks of registration)

Locations:

  • University of Arizona Cancer Center at Saint Joseph's
  • Phoenix Arizona 85004 United States
  • Banner University Medical Center - Tucson
  • Tucson Arizona 85719 United States
  • University of Arizona Cancer Center-North Campus
  • Tucson Arizona 85719 United States
  • Kaiser Permanente-Anaheim
  • Anaheim California 92806 United States
  • Sutter Auburn Faith Hospital
  • Auburn California 95602 United States
  • AIS Cancer Center at San Joaquin Community Hospital
  • Bakersfield California 93301 United States
  • Kaiser Permanente-Baldwin Park
  • Baldwin Park California 91706 United States
  • Kaiser Permanente-Bellflower
  • Bellflower California 90706 United States
  • Alta Bates Summit Medical Center-Herrick Campus
  • Berkeley California 94704 United States
  • Kaiser Permanente-Fontana
  • Fontana California 92335 United States
  • Kaiser Permanente - Harbor City
  • Harbor City California 90710 United States
  • Kaiser Permanente-Irvine
  • Irvine California 92618 United States
  • UC San Diego Moores Cancer Center
  • La Jolla California 92093 United States
  • Kaiser Permanente Los Angeles Medical Center
  • Los Angeles California 90027 United States
  • USC / Norris Comprehensive Cancer Center
  • Los Angeles California 90033 United States
  • Kaiser Permanente-Cadillac
  • Los Angeles California 90034 United States
  • Cedars Sinai Medical Center
  • Los Angeles California 90048 United States
  • UCLA / Jonsson Comprehensive Cancer Center
  • Los Angeles California 90095 United States
  • Fremont - Rideout Cancer Center
  • Marysville California 95901 United States
  • Palo Alto Medical Foundation-Camino Division
  • Mountain View California 94040 United States
  • Kaiser Permanente-Oakland
  • Oakland California 94611 United States
  • Kaiser Permanente-Ontario
  • Ontario California 91761 United States
  • Palo Alto Medical Foundation Health Care
  • Palo Alto California 94301 United States
  • Kaiser Permanente - Panorama City
  • Panorama City California 91402 United States
  • Eisenhower Medical Center
  • Rancho Mirage California 92270 United States
  • Kaiser Permanente-Riverside
  • Riverside California 92505 United States
  • Kaiser Permanente-Roseville
  • Roseville California 95661 United States
  • Sutter Roseville Medical Center
  • Roseville California 95661 United States
  • Kaiser Permanente Downtown Commons
  • Sacramento California 95814 United States
  • Sutter Medical Center Sacramento
  • Sacramento California 95816 United States
  • University of California Davis Comprehensive Cancer Center
  • Sacramento California 95817 United States
  • Kaiser Permanente - Sacramento
  • Sacramento California 95825 United States
  • Kaiser Permanente-San Diego Zion
  • San Diego California 92120 United States
  • California Pacific Medical Center-Pacific Campus
  • San Francisco California 94115 United States
  • Kaiser Permanente-San Francisco
  • San Francisco California 94115 United States
  • Kaiser Permanente-Santa Teresa-San Jose
  • San Jose California 95119 United States
  • Kaiser Permanente San Leandro
  • San Leandro California 94577 United States
  • Pacific Central Coast Health Center-San Luis Obispo
  • San Luis Obispo California 93401 United States
  • Kaiser Permanente-San Marcos
  • San Marcos California 92078 United States
  • Kaiser Permanente Medical Center - Santa Clara
  • Santa Clara California 95051 United States
  • Palo Alto Medical Foundation-Santa Cruz
  • Santa Cruz California 95065 United States
  • Kaiser Permanente-South San Francisco
  • South San Francisco California 94080 United States
  • Palo Alto Medical Foundation-Sunnyvale
  • Sunnyvale California 94086 United States
  • Gene Upshaw Memorial Tahoe Forest Cancer Center
  • Truckee California 96161 United States
  • Kaiser Permanente-Vallejo
  • Vallejo California 94589 United States
  • Sutter Solano Medical Center/Cancer Center
  • Vallejo California 94589 United States
  • Kaiser Permanente-Walnut Creek
  • Walnut Creek California 94596 United States
  • Presbyterian Intercommunity Hospital
  • Whittier California 90602 United States
  • Kaiser Permanente-Woodland Hills
  • Woodland Hills California 91367 United States
  • UCHealth Memorial Hospital Central
  • Colorado Springs Colorado 80909 United States
  • Poudre Valley Hospital
  • Fort Collins Colorado 80524 United States
  • Hartford Hospital
  • Hartford Connecticut 06102 United States
  • Midstate Medical Center
  • Meriden Connecticut 06451 United States
  • The Hospital of Central Connecticut
  • New Britain Connecticut 06050 United States
  • Yale University
  • New Haven Connecticut 06520 United States
  • Eastern Connecticut Hematology and Oncology Associates
  • Norwich Connecticut 06360 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
  • Holy Cross Hospital
  • Fort Lauderdale Florida 33308 United States
  • Baptist MD Anderson Cancer Center
  • Jacksonville Florida 32207 United States
  • The Watson Clinic
  • Lakeland Florida 33805 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
  • Queen's Medical Center
  • Honolulu Hawaii 96813 United States
  • Straub Clinic and Hospital
  • Honolulu Hawaii 96813 United States
  • Hawaii Oncology Inc-Kuakini
  • Honolulu Hawaii 96817 United States
  • Saint Luke's Mountain States Tumor Institute
  • Boise Idaho 83712 United States
  • Saint Luke's Mountain States Tumor Institute - Fruitland
  • Fruitland Idaho 83619 United States
  • Saint Luke's Mountain States Tumor Institute - Meridian
  • Meridian Idaho 83642 United States
  • Saint Luke's Mountain States Tumor Institute - Nampa
  • Nampa Idaho 83686 United States
  • Saint Luke's Mountain States Tumor Institute-Twin Falls
  • Twin Falls Idaho 83301 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
  • Northwestern University
  • Chicago Illinois 60611 United States
  • Rush University Medical Center
  • Chicago Illinois 60612 United States
  • University of Chicago Comprehensive Cancer Center
  • Chicago Illinois 60637 United States
  • Cancer Care Specialists of Illinois - Decatur
  • Decatur Illinois 62526 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
  • Northwestern Medicine Cancer Center Delnor
  • Geneva Illinois 60134 United States
  • Illinois CancerCare-Kewanee Clinic
  • Kewanee Illinois 61443 United States
  • Illinois CancerCare-Macomb
  • Macomb Illinois 61455 United States
  • Loyola University Medical Center
  • Maywood Illinois 60153 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
  • 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
  • Springfield Clinic
  • Springfield Illinois 62702 United States
  • Cancer Care Specialists of Illinois-Swansea
  • Swansea Illinois 62226 United States
  • Northwestern Medicine Cancer Center Warrenville
  • Warrenville Illinois 60555 United States
  • Parkview Regional Medical Center
  • Fort Wayne Indiana 46845 United States
  • Indiana University/Melvin and Bren Simon Cancer Center
  • Indianapolis Indiana 46202 United States
  • Sidney and Lois Eskenazi Hospital
  • Indianapolis Indiana 46202 United States
  • Franciscan Health Indianapolis
  • Indianapolis Indiana 46237 United States
  • Franciscan Health Mooresville
  • Mooresville Indiana 46158 United States
  • Reid Health
  • Richmond Indiana 47374 United States
  • Mary Greeley Medical Center
  • Ames Iowa 50010 United States
  • McFarland Clinic PC - Ames
  • Ames Iowa 50010 United States
  • McFarland Clinic PC-Boone
  • Boone Iowa 50036 United States
  • Medical Oncology and Hematology Associates-West Des Moines
  • Clive Iowa 50325 United States
  • Mercy Cancer Center-West Lakes
  • Clive Iowa 50325 United States
  • Medical Oncology and Hematology Associates-Laurel
  • Des Moines Iowa 50314 United States
  • Mercy Medical Center - Des Moines
  • Des Moines Iowa 50314 United States
  • McFarland Clinic PC-Trinity Cancer Center
  • Fort Dodge Iowa 50501 United States
  • McFarland Clinic PC-Jefferson
  • Jefferson Iowa 50129 United States
  • McFarland Clinic PC-Marshalltown
  • Marshalltown Iowa 50158 United States
  • Mercy Medical Center-West Lakes
  • West Des Moines Iowa 50266 United States
  • Hays Medical Center
  • Hays Kansas 67601 United States
  • University of Kansas Cancer Center
  • Kansas City Kansas 66160 United States
  • Olathe Medical Center
  • Olathe Kansas 66061 United States
  • University of Kansas Cancer Center-Overland Park
  • Overland Park Kansas 66210 United States
  • Via Christi Hospital-Pittsburg
  • Pittsburg Kansas 66762 United States
  • Salina Regional Health Center
  • Salina Kansas 67401 United States
  • Saint Francis Hospital and Medical Center - Topeka
  • Topeka Kansas 66606 United States
  • University of Kansas Hospital-Westwood Cancer Center
  • Westwood Kansas 66205 United States
  • University of Kentucky/Markey Cancer Center
  • Lexington Kentucky 40536 United States
  • LSU Health Baton Rouge-North Clinic
  • Baton Rouge Louisiana 70805 United States
  • Louisiana Hematology Oncology Associates LLC
  • Baton Rouge Louisiana 70809 United States
  • Mary Bird Perkins Cancer Center
  • Baton Rouge Louisiana 70809 United States
  • Our Lady of the Lake Physicians Group - Medical Oncology
  • Baton Rouge Louisiana 70809 United States
  • Northshore Oncology Associates-Covington
  • Covington Louisiana 70433 United States
  • Oncology Center of The South Incorporated
  • Houma Louisiana 70360 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
  • Ochsner Medical Center Jefferson
  • New Orleans Louisiana 70121 United States
  • Louisiana State University Health Sciences Center Shreveport
  • Shreveport Louisiana 71103 United States
  • Harold Alfond Center for Cancer Care
  • Augusta Maine 04330 United States
  • Eastern Maine Medical Center
  • Bangor Maine 04401 United States
  • Waldo County General Hospital
  • Belfast Maine 04915 United States
  • MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford
  • Biddeford Maine 04005 United States
  • Lafayette Family Cancer Center-EMMC
  • Brewer Maine 04412 United States
  • Penobscot Bay Medical Center
  • Rockport Maine 04856 United States
  • MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford
  • Sanford Maine 04073 United States
  • Maine Medical Partners - South Portland
  • South Portland Maine 04106 United States
  • Johns Hopkins University/Sidney Kimmel Cancer Center
  • Baltimore Maryland 21287 United States
  • Beverly Hospital
  • Beverly Massachusetts 01915 United States
  • Massachusetts General Hospital Cancer Center
  • Boston Massachusetts 02114 United States
  • Brigham and Women's Hospital
  • Boston Massachusetts 02115 United States
  • Boston Medical Center
  • Boston Massachusetts 02118 United States
  • Beth Israel Deaconess Medical Center
  • Boston Massachusetts 02215 United States
  • Dana-Farber Cancer Institute
  • Boston Massachusetts 02215 United States
  • Lahey Hospital and Medical Center
  • Burlington Massachusetts 01805 United States
  • Simonds-Sinon Regional Cancer Center
  • Fitchburg Massachusetts 01420 United States
  • Winchester Hospital
  • Winchester Massachusetts 01890 United States
  • University of Massachusetts Medical School
  • Worcester Massachusetts 01655 United States
  • Saint Joseph Mercy Hospital
  • Ann Arbor Michigan 48106 United States
  • University of Michigan Comprehensive Cancer Center
  • Ann Arbor Michigan 48109 United States
  • Saint Joseph Mercy Brighton
  • Brighton Michigan 48114 United States
  • Saint Joseph Mercy Canton
  • Canton Michigan 48188 United States
  • Saint Joseph Mercy Chelsea
  • Chelsea Michigan 48118 United States
  • Wayne State University/Karmanos Cancer Institute
  • Detroit Michigan 48201 United States
  • Henry Ford Hospital
  • Detroit Michigan 48202 United States
  • Weisberg Cancer Treatment Center
  • Farmington Hills Michigan 48334 United States
  • Sparrow Hospital
  • Lansing Michigan 48912 United States
  • William Beaumont Hospital-Royal Oak
  • Royal Oak Michigan 48073 United States
  • William Beaumont Hospital - Troy
  • Troy Michigan 48085 United States
  • Minneapolis VA Medical Center
  • Minneapolis Minnesota 55417 United States
  • Mayo Clinic
  • Rochester Minnesota 55905 United States
  • Gulfport Memorial Hospital
  • Gulfport Mississippi 39502 United States
  • University of Mississippi Medical Center
  • Jackson Mississippi 39216 United States
  • Saint Francis Medical Center
  • Cape Girardeau Missouri 63703 United States
  • University of Missouri - Ellis Fischel
  • Columbia Missouri 65212 United States
  • Siteman Cancer Center at West County Hospital
  • Creve Coeur Missouri 63141 United States
  • Truman Medical Center
  • Kansas City Missouri 64108 United States
  • The University of Kansas Cancer Center-Lee's Summit
  • Lee's Summit Missouri 64064 United States
  • Washington University School of Medicine
  • Saint Louis Missouri 63110 United States
  • Siteman Cancer Center at Saint Peters Hospital
  • Saint Peters Missouri 63376 United States
  • Bozeman Deaconess Hospital
  • Bozeman Montana 59715 United States
  • Benefis Healthcare- Sletten Cancer Institute
  • Great Falls Montana 59405 United States
  • CHI Health Saint Francis
  • Grand Island Nebraska 68803 United States
  • Nebraska Methodist Hospital
  • Omaha Nebraska 68114 United States
  • OptumCare Cancer Care at Seven Hills
  • Henderson Nevada 89052 United States
  • OptumCare Cancer Care at Oakey
  • Las Vegas Nevada 89106 United States
  • Comprehensive Cancer Centers of Nevada - Town Center
  • Las Vegas Nevada 89144 United States
  • OptumCare Cancer Care at Fort Apache
  • Las Vegas Nevada 89148 United States
  • Comprehensive Cancer Centers of Nevada - Central Valley
  • Las Vegas Nevada 89169 United States
  • University Cancer Center
  • Las Vegas Nevada 89169 United States
  • Renown Regional Medical Center
  • Reno Nevada 89502 United States
  • Hackensack University Medical Center
  • Hackensack New Jersey 07601 United States
  • Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
  • New Brunswick New Jersey 08903 United States
  • Rutgers Cancer Institute of New Jersey
  • New Brunswick New Jersey 08903 United States
  • Montefiore Medical Center-Einstein Campus
  • Bronx New York 10461 United States
  • Montefiore Medical Center-Weiler Hospital
  • Bronx New York 10461 United States
  • Montefiore Medical Center - Moses Campus
  • Bronx New York 10467 United States
  • James J Peters VA Medical Center
  • Bronx New York 10468 United States
  • Glens Falls Hospital
  • Glens Falls New York 12801 United States
  • Northwell Health/Center for Advanced Medicine
  • Lake Success New York 11042 United States
  • Long Island Jewish Medical Center
  • New Hyde Park New York 11040 United States
  • NYP/Weill Cornell Medical Center
  • New York New York 10065 United States
  • Dickstein Cancer Treatment Center
  • White Plains New York 10601 United States
  • UNC Lineberger Comprehensive Cancer Center
  • Chapel Hill North Carolina 27599 United States
  • Southeastern Medical Oncology Center-Clinton
  • Clinton North Carolina 28328 United States
  • Duke University Medical Center
  • Durham North Carolina 27710 United States
  • Southeastern Medical Oncology Center-Goldsboro
  • Goldsboro North Carolina 27534 United States
  • Wayne Memorial Hospital
  • Goldsboro North Carolina 27534 United States
  • Onslow Memorial Hospital
  • Jacksonville North Carolina 28546 United States
  • Southeastern Medical Oncology Center-Jacksonville
  • Jacksonville North Carolina 28546 United States
  • Vidant Oncology-Kenansville
  • Kenansville North Carolina 28349 United States
  • Vidant Oncology-Kinston
  • Kinston North Carolina 28501 United States
  • Vidant Oncology-Richlands
  • Richlands North Carolina 28574 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 Physicians LLC-Miami Valley South
  • Centerville Ohio 45459 United States
  • University of Cincinnati/Barrett Cancer Center
  • Cincinnati Ohio 45219 United States
  • Good Samaritan Hospital - Cincinnati
  • Cincinnati Ohio 45220 United States
  • Bethesda North Hospital
  • Cincinnati Ohio 45242 United States
  • Kettering Medical Center
  • Kettering Ohio 45429 United States
  • Toledo Clinic Cancer Centers-Toledo
  • Toledo Ohio 43623 United States
  • University Pointe
  • West Chester Ohio 45069 United States
  • University of Oklahoma Health Sciences Center
  • Oklahoma City Oklahoma 73104 United States
  • Mercy Hospital Oklahoma City
  • Oklahoma City Oklahoma 73120 United States
  • Providence Oncology and Hematology Care Southeast
  • Clackamas Oregon 97015 United States
  • Providence Newberg Medical Center
  • Newberg Oregon 97132 United States
  • Providence Willamette Falls Medical Center
  • Oregon City Oregon 97045 United States
  • Providence Portland Medical Center
  • Portland Oregon 97213 United States
  • Providence Saint Vincent Medical Center
  • Portland Oregon 97225 United States
  • Kaiser Permanente Northwest
  • Portland Oregon 97227 United States
  • Lehigh Valley Hospital-Cedar Crest
  • Allentown Pennsylvania 18103 United States
  • Lehigh Valley Hospital - Muhlenberg
  • Bethlehem Pennsylvania 18017 United States
  • Geisinger Medical Center
  • Danville Pennsylvania 17822 United States
  • Penn State Milton S Hershey Medical Center
  • Hershey Pennsylvania 17033-0850 United States
  • University of Pennsylvania/Abramson Cancer Center
  • Philadelphia Pennsylvania 19104 United States
  • University of Pittsburgh Cancer Institute (UPCI)
  • Pittsburgh Pennsylvania 15232 United States
  • Reading Hospital
  • West Reading Pennsylvania 19611 United States
  • UPMC Susquehanna
  • Williamsport Pennsylvania 17701 United States
  • Rhode Island Hospital
  • Providence Rhode Island 02903 United States
  • Miriam Hospital
  • Providence Rhode Island 02906 United States
  • Medical University of South Carolina
  • Charleston South Carolina 29425 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
  • Saint Francis Hospital
  • Greenville South Carolina 29601 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
  • Saint Francis Cancer Center
  • Greenville South Carolina 29607 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
  • Meharry Medical College
  • Nashville Tennessee 37208 United States
  • Vanderbilt University/Ingram Cancer Center
  • Nashville Tennessee 37232 United States
  • UT Southwestern/Simmons Cancer Center-Dallas
  • Dallas Texas 75390 United States
  • UT Southwestern/Simmons Cancer Center-Fort Worth
  • Fort Worth Texas 76104 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
  • Ben Taub General Hospital
  • Houston Texas 77030 United States
  • UTMB Cancer Center at Victory Lakes
  • League City Texas 77573 United States
  • UT Southwestern Clinical Center at Richardson/Plano
  • Richardson Texas 75080 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
  • Central Vermont Medical Center/National Life Cancer Treatment
  • Berlin Vermont 05602 United States
  • University of Vermont Medical Center
  • Burlington Vermont 05401 United States
  • University of Vermont and State Agricultural College
  • Burlington Vermont 05405 United States
  • Sovah Health Martinsville
  • Martinsville Virginia 24115 United States
  • Langlade Hospital and Cancer Center
  • Antigo Wisconsin 54409 United States
  • Aurora Cancer Care-Southern Lakes VLCC
  • Burlington Wisconsin 53105 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
  • UW Cancer Center Johnson Creek
  • Johnson Creek Wisconsin 53038 United States
  • Aurora Cancer Care-Kenosha South
  • Kenosha Wisconsin 53142 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
  • Froedtert and the Medical College of Wisconsin
  • Milwaukee Wisconsin 53226 United States
  • Aurora Sinai Medical Center
  • Milwaukee Wisconsin 53233 United States
  • Marshfield Clinic-Minocqua Center
  • Minocqua Wisconsin 54548 United States
  • ProHealth D N Greenwald Center
  • Mukwonago Wisconsin 53149 United States
  • ProHealth Oconomowoc Memorial Hospital
  • Oconomowoc Wisconsin 53066 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
  • ProHealth Waukesha Memorial Hospital
  • Waukesha Wisconsin 53188 United States
  • UW Cancer Center at ProHealth Care
  • Waukesha Wisconsin 53188 United States
  • Aspirus Regional Cancer Center
  • Wausau Wisconsin 54401 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
  • Aspirus UW Cancer Center
  • Wisconsin Rapids Wisconsin 54494 United States
  • University Health Network-Princess Margaret Hospital
  • Toronto Ontario M5G 2M9 Canada
  • Rambam Medical Center
  • Haifa 31096 Israel
  • Shaare Zedek Medical Center
  • Jerusalem 91031 Israel

View trial on ClinicalTrials.gov


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