Testing the Use of the Immunotherapy Drugs Ipilimumab and Nivolumab Plus Radiation Therapy Compared to the Usual Treatment (Temozolomide and Radiation Therapy) for Newly Diagnosed MGMT Unmethylated Glioblastoma
Study Purpose
This phase II/III trial compares the usual treatment with radiation therapy and temozolomide to radiation therapy in combination with immunotherapy with ipilimumab and nivolumab in treating patients with newly diagnosed MGMT unmethylated glioblastoma. Radiation therapy uses high energy photons to kill tumor and shrink tumors. Chemotherapy drugs, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Temozolomide, may not work as well for the treatment of tumors that have the unmethylated MGMT. Immunotherapy with monoclonal antibodies called immune checkpoint inhibitors, such as ipilimumab and nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. It is possible that immune checkpoint inhibitors may work better at time of first diagnosis as opposed to when tumor comes back. Giving radiation therapy with ipilimumab and nivolumab may lengthen the time without brain tumor returning or growing and may extend patients' life compared to usual treatment with radiation therapy and temozolomide.
Recruitment Criteria
|
Accepts Healthy Volunteers
Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms |
No |
|
Study Type
An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes. An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes. Searching Both is inclusive of interventional and observational studies. |
Interventional |
| Eligible Ages | 18 Years and Over |
| Gender | All |
Inclusion Criteria:
- - PRIOR TO STEP 1 REGISTRATION: - No known IDH mutation.
- - Availability of formalin-fixed paraffin-embedded (FFPE) tumor tissue block and hematoxylin & eosin (H&E) stained slide to be sent for central pathology review for confirmation of histology and MGMT promoter methylation status.
- - Note: The central pathology review and central MGMT results determine eligibility.
- - Contrast-enhanced brain MRI within 3 days after surgery.
- - MRI with Axial T2 weighted FLAIR {preferred} or T2 turbo spin echo (TSE)/fast spin echo (FSE) and 3-dimensional (3D) contrast-enhanced T1 sequences are required.
- - 3D pre contrast-enhanced T1 sequences are strongly suggested.
- - Women of childbearing potential (WOCBP) and men who are sexually active with WOCBP must be willing to use an adequate method of contraception hormonal or barrier method of birth control; or abstinence during and after treatment.
- - The patient or a legally authorized representative must provide study-specific informed consent prior to study entry.
- - PRIOR TO STEP 2 REGISTRATION: - Histopathologically proven diagnosis of glioblastoma (or gliosarcoma as a subtype of glioblastoma) confirmed by central pathology review.
- - Note: diagnoses of "Molecular glioblastoma" per the Consortium to Inform Molecular and Practical Approaches to Central Nervous System (CNS) Tumor Taxonomy (c-IMPACT-NOW) criteria or "CNS grade 4" per the World Health Organization (WHO) 2021 criteria are NOT relevant.
- - MGMT promoter without methylation confirmed by central pathology review.
- - Note: central pathology review and central MGMT results determine eligibility; local pathology or MGMT results cannot be used for eligibility/randomization.
- - Note: patients with methylated MGMT may be considered for enrollment on NRG-BN011.
- - IDH mutation testing by at least one method (such as immunohistochemistry for IDH1 R132H) must be performed as part of standard of care and no mutation must be found (i.
- - Note: this test is not being performed in real time as part of central review and will not be provided to sites from a centrally performed test.
- - History/physical examination within 28 days prior to step 2 registration.
- - Karnofsky Performance Status (KPS) >= 70 within 28 days prior to step 2 registration.
- - Neurologic function assessment within 28 days prior to step 2 registration.
- - Age >= 18 years.
- - Hemoglobin >= 10 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 10.0 g/dl is acceptable) (within 7 days prior to step 2 registration) - Leukocytes >= 2,000/mm^3 (within 7 days prior to step 2 registration) - Absolute neutrophil count >= 1,500/mm^3 (within 7 days prior to step 2 registration) - Platelets >= 100,000/mm^3 (within 7 days prior to step 2 registration) - Total bilirubin =< 1.5 x institutional/lab upper limit of normal (ULN) (within 7 days prior to step 2 registration) - Aspartate transaminase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) =< 2.5 x ULN (within 7 days prior to step 2 registration) - Alanine transferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x ULN (within 7 days prior to step 2 registration) - Serum creatinine =< 1.5 x ULN OR creatinine clearance (CrCl) >= 50 mL/min (if using the Cockcroft-Gault formula) (within 7 days prior to step 2 registration) - For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.
- - For women of childbearing potential (WOCBP), negative serum or urine pregnancy test within 7 days prior to step 2 registration.
- - Women of childbearing potential (WOCBP) is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal.
Exclusion Criteria:
- - Prior therapy for tumor except for resection.
- - Note that 5-aminolevulinic acid (ALA)-mediated fluorescent guided resection (FGR) photodynamic therapy (PDT) or fluorescein administered prior to/during surgery to aid resection is not exclusionary and is not considered a chemotherapy or intracerebral agent.
- - Current or planned treatment with any other investigational agents for the study cancer.
- - Definitive clinical or radiologic evidence of metastatic disease outside the brain.
- - Prior invasive malignancy (except non-melanomatous skin cancer, cervical cancer in situ and melanoma in situ) unless disease free for a minimum of 2 years.
- - Prior radiotherapy to the head or neck that would result in overlap of radiation therapy fields.
- - Pregnancy and nursing females due to the potential teratogenic effects and potential risk for adverse events in nursing infants.
- - History of severe hypersensitivity reaction to any monoclonal antibody.
- - History of allergic reactions attributed to compounds of similar chemical or biologic composition to ipilimumab, nivolumab, or temozolomide.
- - On any dose of any systemically administered (oral, rectal, intravenous) corticosteroid within 3 days prior to step 2 registration.
- - Patients with known immune impairment who may be unable to respond to anti-CTLA 4 antibody.
- - History of interstitial lung disease including but not limited to sarcoidosis or pneumonitis.
- - Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, defined as New York Heart Association functional classification III/IV (Note: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association functional classification), unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
- - Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) - Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids, are excluded, as are patients on active immunosuppressive therapy.
- - Exceptions: patients with a history of the following conditions are not excluded, unless receiving active immunosuppressive therapy: - Vitiligo.
- - Type I diabetes.
- - Rheumatoid arthritis and other arthropathies.
- - Sjogren's syndrome and psoriasis controlled with topical medication and patients with positive serology, such as antinuclear antibodies (ANA) - Anti-thyroid antibodies should be evaluated for the presence of target organ involvement and potential need for systemic treatment but should otherwise be eligible.
- - Patients who have evidence of active or acute diverticulitis, intra-abdominal abscess, gastrointestinal (GI) obstruction and abdominal carcinomatosis which are known risk factors for bowel perforation are also excluded.
Trial Details
|
Trial ID:
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries. |
NCT04396860 |
|
Phase
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans. Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data. Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs. Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use. |
Phase 2/Phase 3 |
|
Lead Sponsor
The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data. |
National Cancer Institute (NCI) |
|
Principal Investigator
The person who is responsible for the scientific and technical direction of the entire clinical study. |
Andrew B Lassman |
| Principal Investigator Affiliation | NRG Oncology |
|
Agency Class
Category of organization(s) involved as sponsor (and collaborator) supporting the trial. |
NIH, Other |
| Overall Status | Active, not recruiting |
| Countries | United States |
|
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied. |
Gliosarcoma, MGMT-Unmethylated Glioblastoma |
PRIMARY OBJECTIVES:
- I. To determine if adding ipilimumab and nivolumab to radiotherapy significantly prolongs progression-free survival (PFS) versus adding temozolomide to radiotherapy in patients with newly diagnosed glioblastoma (GBM) without MGMT promoter methylation.
- II. To determine if adding ipilimumab and nivolumab to radiotherapy significantly prolongs overall survival (OS) versus adding temozolomide to radiotherapy in patients with newly diagnosed GBM without MGMT promoter methylation.
- I. To determine if adding ipilimumab and nivolumab to radiotherapy significantly prolongs PFS versus adding temozolomide to radiotherapy in patients with newly diagnosed GBM without MGMT promoter methylation for the phase III part of the study.
- II. To determine if adding ipilimumab and nivolumab to radiotherapy significantly increases the 2-year OS rate versus adding temozolomide to radiotherapy in patients with newly diagnosed GBM without MGMT promoter methylation.
- III. To evaluate the safety of adding ipilimumab and nivolumab to radiotherapy via comparative frequency between arms of specific adverse events of interest and frequency summaries for all adverse event types.
- IV. To evaluate the effect of adding ipilimumab and nivolumab to radiotherapy versus adding temozolomide to radiotherapy on patient reported outcomes (PROs), as measured by the MD Anderson Symptom Inventory - Brain Tumor (MDASI-BT) in patients with newly diagnosed GBM without MGMT promoter methylation.
- V. To evaluate the effect of adding ipilimumab and nivolumab to radiotherapy versus adding temozolomide to radiotherapy on selected Patient Reported Outcomes-Common Terminology Criteria for Adverse Events (PRO-CTCAE) items in patients with newly diagnosed GBM without MGMT promoter methylation.
- VI. To evaluate the impact of adding ipilimumab and nivolumab to radiotherapy versus adding temozolomide to radiotherapy on neurocognitive function (NCF) in patients with newly diagnosed GBM without MGMT promoter methylation.
- I. To explore biomarkers in pre-treatment archival tumor tissue that may predict efficacy of ipilimumab and nivolumab as measured by OS, PFS, and 2-year OS rate, such as but not limited to: Ia.
- II. To explore (in the two treatment separately) whether the MGMT protein expression correlates with clinical outcomes including OS, PFS, and 2-year OS rate.
- III. To evaluate if MGMT protein expression may be predictive of differential treatment effects between the two treatment arms.
Arms
Active Comparator: Arm I (radiation therapy, temozolomide)
Patients undergo radiation therapy for 5 days per week (Monday-Friday) for a total of 30 fractions over 6 weeks and simultaneously receive temozolomide PO daily for 6 weeks. After radiation, patients may wear the Optune device at the discretion of the patient and their treating physician. Beginning 1 month after radiation therapy, patients receive temozolomide on days 1-5. Treatment repeats every 28 days for up to 12 cycles at the discretion of the treating investigator in the absence of disease progression or unacceptable toxicity. Patients also undergo contrast-enhanced brain MRI throughout the trial.
Experimental: Arm II (radiation therapy, ipilimumab, nivolumab)
Patients undergo radiation therapy for 5 days per week (Monday-Friday) for a total of 30 fractions over 6 weeks. Starting on the first day of radiation, patients also receive ipilimumab IV over 90 minutes Q4W for 4 doses and nivolumab IV over 30 minutes every 2 weeks until disease progression. Patients also undergo contrast-enhanced brain MRI throughout the trial.
Interventions
Procedure: - Contrast-enhanced Magnetic Resonance Imaging
Undergo contrast-enhanced brain MRI
Biological: - Ipilimumab
Given IV
Biological: - Nivolumab
Given IV
Device: - NovoTTF-100A Device
Wear Optune device
Other: - Quality-of-Life Assessment
Ancillary studies
Other: - Questionnaire Administration
Ancillary studies
Radiation: - Radiation Therapy
Undergo radiation therapy
Drug: - Temozolomide
Given PO
Contact a Trial Team
If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.
Status
Address
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, 35233
Status
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University of Arkansas for Medical Sciences
Little Rock, Arkansas, 72205
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Kaiser Permanente-Anaheim
Anaheim, California, 92806
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Address
Sutter Auburn Faith Hospital
Auburn, California, 95602
Status
Address
Sutter Cancer Centers Radiation Oncology Services-Auburn
Auburn, California, 95603
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Address
John Muir Medical Center-Concord
Concord, California, 94520
Status
Address
UC San Diego Moores Cancer Center
La Jolla, California, 92093
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Address
Loma Linda University Medical Center
Loma Linda, California, 92354
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Address
Kaiser Permanente Los Angeles Medical Center
Los Angeles, California, 90027
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Address
Cedars Sinai Medical Center
Los Angeles, California, 90048
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Address
Kaiser Permanente-Ontario
Ontario, California, 91761
Status
Address
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange, California, 92868
Status
Address
Sutter Cancer Centers Radiation Oncology Services-Roseville
Roseville, California, 95661
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Address
Sutter Roseville Medical Center
Roseville, California, 95661
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Address
Sutter Medical Center Sacramento
Sacramento, California, 95816
Status
Address
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
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Address
Torrance Memorial Physician Network - Cancer Care
Torrance, California, 90505
Status
Address
Torrance Memorial Medical Center
Torrance, California, 90509
Status
Address
John Muir Medical Center-Walnut Creek
Walnut Creek, California, 94598
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Address
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado, 80907
Status
Address
AdventHealth Porter
Denver, Colorado, 80210
Status
Address
Littleton Adventist Hospital
Littleton, Colorado, 80122
Status
Address
Parker Adventist Hospital
Parker, Colorado, 80138
Status
Address
Hartford Hospital
Hartford, Connecticut, 06102
Status
Address
The Hospital of Central Connecticut
New Britain, Connecticut, 06050
Status
Address
Beebe Medical Center
Lewes, Delaware, 19958
Status
Address
Beebe South Coastal Health Campus
Millville, Delaware, 19967
Status
Address
Delaware Clinical and Laboratory Physicians PA
Newark, Delaware, 19713
Status
Address
Helen F Graham Cancer Center
Newark, Delaware, 19713
Status
Address
Medical Oncology Hematology Consultants PA
Newark, Delaware, 19713
Status
Address
Christiana Care Health System-Christiana Hospital
Newark, Delaware, 19718
Status
Address
Beebe Health Campus
Rehoboth Beach, Delaware, 19971
Status
Address
Baptist MD Anderson Cancer Center
Jacksonville, Florida, 32207
Status
Address
AdventHealth Orlando
Orlando, Florida, 32803
Status
Address
Augusta University Medical Center
Augusta, Georgia, 30912
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Address
Memorial Health University Medical Center
Savannah, Georgia, 31404
Status
Address
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Savannah, Georgia, 31405
Status
Address
Lewis Hall Singletary Oncology Center
Thomasville, Georgia, 31792
Status
Address
Hawaii Cancer Care - Westridge
'Aiea, Hawaii, 96701
Status
Address
Pali Momi Medical Center
'Aiea, Hawaii, 96701
Status
Address
Queen's Cancer Center - Pearlridge
'Aiea, Hawaii, 96701
Status
Address
The Cancer Center of Hawaii-Pali Momi
'Aiea, Hawaii, 96701
Status
Address
Hawaii Cancer Care Inc - Waterfront Plaza
Honolulu, Hawaii, 96813
Status
Address
Island Urology
Honolulu, Hawaii, 96813
Status
Address
Queen's Cancer Cenrer - POB I
Honolulu, Hawaii, 96813
Status
Address
Queen's Medical Center
Honolulu, Hawaii, 96813
Status
Address
Straub Clinic and Hospital
Honolulu, Hawaii, 96813
Status
Address
University of Hawaii Cancer Center
Honolulu, Hawaii, 96813
Status
Address
Hawaii Cancer Care Inc-Liliha
Honolulu, Hawaii, 96817
Status
Address
Queen's Cancer Center - Kuakini
Honolulu, Hawaii, 96817
Status
Address
The Cancer Center of Hawaii-Liliha
Honolulu, Hawaii, 96817
Status
Address
Kapiolani Medical Center for Women and Children
Honolulu, Hawaii, 96826
Status
Address
Castle Medical Center
Kailua, Hawaii, 96734
Status
Address
Wilcox Memorial Hospital and Kauai Medical Clinic
Lihue, Hawaii, 96766
Status
Address
Saint Luke's Cancer Institute - Boise
Boise, Idaho, 83712
Status
Address
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell, Idaho, 83605
Status
Address
Saint Luke's Cancer Institute - Fruitland
Fruitland, Idaho, 83619
Status
Address
Saint Luke's Cancer Institute - Meridian
Meridian, Idaho, 83642
Status
Address
Saint Alphonsus Cancer Care Center-Nampa
Nampa, Idaho, 83687
Status
Address
Saint Luke's Cancer Institute - Nampa
Nampa, Idaho, 83687
Status
Address
Saint Luke's Cancer Institute - Twin Falls
Twin Falls, Idaho, 83301
Status
Address
Illinois CancerCare-Bloomington
Bloomington, Illinois, 61704
Status
Address
Illinois CancerCare-Canton
Canton, Illinois, 61520
Status
Address
Illinois CancerCare-Carthage
Carthage, Illinois, 62321
Status
Address
Centralia Oncology Clinic
Centralia, Illinois, 62801
Status
Address
Northwestern University
Chicago, Illinois, 60611
Status
Address
University of Illinois
Chicago, Illinois, 60612
Status
Address
Carle at The Riverfront
Danville, Illinois, 61832
Status
Address
Cancer Care Specialists of Illinois - Decatur
Decatur, Illinois, 62526
Status
Address
Decatur Memorial Hospital
Decatur, Illinois, 62526
Status
Address
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois, 60115
Status
Address
Carle Physician Group-Effingham
Effingham, Illinois, 62401
Status
Address
Crossroads Cancer Center
Effingham, Illinois, 62401
Status
Address
Elmhurst Memorial Hospital
Elmhurst, Illinois, 60126
Status
Address
Illinois CancerCare-Eureka
Eureka, Illinois, 61530
Status
Address
NorthShore University HealthSystem-Evanston Hospital
Evanston, Illinois, 60201
Status
Address
Illinois CancerCare-Galesburg
Galesburg, Illinois, 61401
Status
Address
Western Illinois Cancer Treatment Center
Galesburg, Illinois, 61401
Status
Address
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois, 60134
Status
Address
NorthShore University HealthSystem-Glenbrook Hospital
Glenview, Illinois, 60026
Status
Address
NorthShore University HealthSystem-Highland Park Hospital
Highland Park, Illinois, 60035
Status
Address
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois, 61443
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Address
Illinois CancerCare-Macomb
Macomb, Illinois, 61455
Status
Address
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
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Address
Edward Hospital/Cancer Center
Naperville, Illinois, 60540
Status
Address
Cancer Care Center of O'Fallon
O'Fallon, Illinois, 62269
Status
Address
Illinois CancerCare-Ottawa Clinic
Ottawa, Illinois, 61350
Status
Address
Advocate Lutheran General Hospital
Park Ridge, Illinois, 60068
Status
Address
Illinois CancerCare-Pekin
Pekin, Illinois, 61554
Status
Address
Illinois CancerCare-Peoria
Peoria, Illinois, 61615
Status
Address
Methodist Medical Center of Illinois
Peoria, Illinois, 61636
Status
Address
OSF Saint Francis Medical Center
Peoria, Illinois, 61637
Status
Address
Illinois CancerCare-Peru
Peru, Illinois, 61354
Status
Address
Illinois CancerCare-Princeton
Princeton, Illinois, 61356
Status
Address
UW Health Carbone Cancer Center Rockford
Rockford, Illinois, 61114
Status
Address
Southern Illinois University School of Medicine
Springfield, Illinois, 62702
Status
Address
Springfield Clinic
Springfield, Illinois, 62702
Status
Address
Springfield Memorial Hospital
Springfield, Illinois, 62781
Status
Address
Carle Cancer Center
Urbana, Illinois, 61801
Status
Address
The Carle Foundation Hospital
Urbana, Illinois, 61801
Status
Address
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois, 60555
Status
Address
Illinois CancerCare - Washington
Washington, Illinois, 61571
Status
Address
Indiana University/Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, 46202
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Address
IU Health Methodist Hospital
Indianapolis, Indiana, 46202
Status
Address
Mary Greeley Medical Center
Ames, Iowa, 50010
Status
Address
McFarland Clinic - Ames
Ames, Iowa, 50010
Status
Address
Mercy Cancer Center-West Lakes
Clive, Iowa, 50325
Status
Address
Mission Cancer and Blood - West Des Moines
Clive, Iowa, 50325
Status
Address
Heartland Oncology and Hematology LLP
Council Bluffs, Iowa, 51503
Status
Address
Methodist Jennie Edmundson Hospital
Council Bluffs, Iowa, 51503
Status
Address
Greater Regional Medical Center
Creston, Iowa, 50801
Status
Address
Iowa Methodist Medical Center
Des Moines, Iowa, 50309
Status
Address
Mission Cancer and Blood - Des Moines
Des Moines, Iowa, 50309
Status
Address
Broadlawns Medical Center
Des Moines, Iowa, 50314
Status
Address
Mercy Medical Center - Des Moines
Des Moines, Iowa, 50314
Status
Address
Mission Cancer and Blood - Laurel
Des Moines, Iowa, 50314
Status
Address
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, 52242
Status
Address
Mercy Medical Center-West Lakes
West Des Moines, Iowa, 50266
Status
Address
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
Status
Address
Tulane University School of Medicine
New Orleans, Louisiana, 70112
Status
Address
Ochsner Medical Center Jefferson
New Orleans, Louisiana, 70121
Status
Address
Eastern Maine Medical Center
Bangor, Maine, 04401
Status
Address
MaineHealth Coastal Cancer Treatment Center
Bath, Maine, 04530
Status
Address
Waldo County General Hospital
Belfast, Maine, 04915
Status
Address
Lafayette Family Cancer Center-EMMC
Brewer, Maine, 04412
Status
Address
Maine Medical Center-Bramhall Campus
Portland, Maine, 04102
Status
Address
Penobscot Bay Medical Center
Rockport, Maine, 04856
Status
Address
MaineHealth Cancer Care Center of York County
Sanford, Maine, 04073
Status
Address
Maine Medical Center- Scarborough Campus
Scarborough, Maine, 04074
Status
Address
Maine Medical Partners Neurology
Scarborough, Maine, 04074
Status
Address
Maine Medical Partners - South Portland
South Portland, Maine, 04106
Status
Address
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
Status
Address
UM Upper Chesapeake Medical Center
Bel Air, Maryland, 21014
Status
Address
Central Maryland Radiation Oncology in Howard County
Columbia, Maryland, 21044
Status
Address
UM Baltimore Washington Medical Center/Tate Cancer Center
Glen Burnie, Maryland, 21061
Status
Address
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor, Michigan, 48106
Status
Address
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton, Michigan, 48114
Status
Address
Trinity Health Medical Center - Brighton
Brighton, Michigan, 48114
Status
Address
Trinity Health IHA Medical Group Hematology Oncology - Canton
Canton, Michigan, 48188
Status
Address
Trinity Health Medical Center - Canton
Canton, Michigan, 48188
Status
Address
Chelsea Hospital
Chelsea, Michigan, 48118
Status
Address
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Chelsea, Michigan, 48118
Status
Address
Corewell Health Dearborn Hospital
Dearborn, Michigan, 48124
Status
Address
Henry Ford Health Saint John Hospital
Detroit, Michigan, 48236
Status
Address
Genesys Hurley Cancer Institute
Flint, Michigan, 48503
Status
Address
Hurley Medical Center
Flint, Michigan, 48503
Status
Address
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids, Michigan, 49503
Status
Address
Bronson Methodist Hospital
Kalamazoo, Michigan, 49007
Status
Address
West Michigan Cancer Center
Kalamazoo, Michigan, 49007
Status
Address
Ascension Borgess Hospital
Kalamazoo, Michigan, 49048
Status
Address
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan, 48154
Status
Address
Michigan Healthcare Professionals Pontiac
Pontiac, Michigan, 48341
Status
Address
Corewell Health William Beaumont University Hospital
Royal Oak, Michigan, 48073
Status
Address
MyMichigan Medical Center Saginaw
Saginaw, Michigan, 48601
Status
Address
Oncology Hematology Associates of Saginaw Valley PC
Saginaw, Michigan, 48604
Status
Address
MyMichigan Medical Center Tawas
Tawas City, Michigan, 48764
Status
Address
Corewell Health Beaumont Troy Hospital
Troy, Michigan, 48085
Status
Address
Henry Ford Health Warren Hospital
Warren, Michigan, 48093
Status
Address
Saint Mary's Oncology/Hematology Associates of West Branch
West Branch, Michigan, 48661
Status
Address
University of Michigan Health - West
Wyoming, Michigan, 49519
Status
Address
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
Ypsilanti, Michigan, 48197
Status
Address
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota, 56601
Status
Address
Fairview Ridges Hospital
Burnsville, Minnesota, 55337
Status
Address
Minnesota Oncology - Burnsville
Burnsville, Minnesota, 55337
Status
Address
Mercy Hospital
Coon Rapids, Minnesota, 55433
Status
Address
Fairview Southdale Hospital
Edina, Minnesota, 55435
Status
Address
Unity Hospital
Fridley, Minnesota, 55432
Status
Address
Fairview Clinics and Surgery Center Maple Grove
Maple Grove, Minnesota, 55369
Status
Address
Minnesota Oncology Hematology PA-Maplewood
Maplewood, Minnesota, 55109
Status
Address
Hennepin County Medical Center
Minneapolis, Minnesota, 55415
Status
Address
Health Partners Inc
Minneapolis, Minnesota, 55454
Status
Address
Park Nicollet Clinic - Saint Louis Park
Saint Louis Park, Minnesota, 55416
Status
Address
Regions Hospital
Saint Paul, Minnesota, 55101
Status
Address
United Hospital
Saint Paul, Minnesota, 55102
Status
Address
Lakeview Hospital
Stillwater, Minnesota, 55082
Status
Address
University of Mississippi Medical Center
Jackson, Mississippi, 39216
Status
Address
Baptist Memorial Hospital and Cancer Center-Desoto
Southhaven, Mississippi, 38671
Status
Address
Saint Francis Medical Center
Cape Girardeau, Missouri, 63703
Status
Address
Billings Clinic Cancer Center
Billings, Montana, 59101
Status
Address
Bozeman Health Deaconess Hospital
Bozeman, Montana, 59715
Status
Address
Saint James Community Hospital and Cancer Treatment Center
Butte, Montana, 59701
Status
Address
Benefis Sletten Cancer Institute
Great Falls, Montana, 59405
Status
Address
Logan Health Medical Center
Kalispell, Montana, 59901
Status
Address
Nebraska Medicine-Bellevue
Bellevue, Nebraska, 68123
Status
Address
Cancer Partners of Nebraska
Lincoln, Nebraska, 68516
Status
Address
Nebraska Methodist Hospital
Omaha, Nebraska, 68114
Status
Address
Nebraska Medicine-Village Pointe
Omaha, Nebraska, 68118
Status
Address
University of Nebraska Medical Center
Omaha, Nebraska, 68198
Status
Address
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
Status
Address
Hackensack University Medical Center
Hackensack, New Jersey, 07601
Status
Address
Saint Barnabas Medical Center
Livingston, New Jersey, 07039
Status
Address
Morristown Medical Center
Morristown, New Jersey, 07960
Status
Address
Jersey Shore Medical Center
Neptune, New Jersey, 07753
Status
Address
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, 08903
Status
Address
Capital Health Medical Center-Hopewell
Pennington, New Jersey, 08534
Status
Address
Overlook Hospital
Summit, New Jersey, 07902
Status
Address
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, 10016
Status
Address
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, 10032
Status
Address
NYP/Weill Cornell Medical Center
New York, New York, 10065
Status
Address
University of Rochester
Rochester, New York, 14642
Status
Address
State University of New York Upstate Medical University
Syracuse, New York, 13210
Status
Address
Good Samaritan University Hospital
West Islip, New York, 11795
Status
Address
Carolinas Medical Center/Levine Cancer Institute
Charlotte, North Carolina, 28203
Status
Address
Atrium Health Pineville/LCI-Pineville
Charlotte, North Carolina, 28210
Status
Address
Atrium Health Cabarrus/LCI-Concord
Concord, North Carolina, 28025
Status
Address
Sanford Bismarck Medical Center
Bismarck, North Dakota, 58501
Status
Address
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
Status
Address
Sanford Roger Maris Cancer Center
Fargo, North Dakota, 58122
Status
Address
Summa Health System - Akron Campus
Akron, Ohio, 44304
Status
Address
Case Western Reserve University
Cleveland, Ohio, 44106
Status
Address
Cleveland Clinic Foundation
Cleveland, Ohio, 44195
Status
Address
Riverside Methodist Hospital
Columbus, Ohio, 43214
Status
Address
Dublin Methodist Hospital
Dublin, Ohio, 43016
Status
Address
Cancer Centers of Southwest Oklahoma Research
Lawton, Oklahoma, 73505
Status
Address
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Status
Address
Clackamas Radiation Oncology Center
Clackamas, Oregon, 97015
Status
Address
Providence Cancer Institute Clackamas Clinic
Clackamas, Oregon, 97015
Status
Address
Legacy Mount Hood Medical Center
Gresham, Oregon, 97030
Status
Address
Providence Newberg Medical Center
Newberg, Oregon, 97132
Status
Address
Legacy Good Samaritan Hospital and Medical Center
Portland, Oregon, 97210
Status
Address
Providence Portland Medical Center
Portland, Oregon, 97213
Status
Address
Providence Saint Vincent Medical Center
Portland, Oregon, 97225
Status
Address
Kaiser Permanente Northwest
Portland, Oregon, 97227
Status
Address
Legacy Meridian Park Hospital
Tualatin, Oregon, 97062
Status
Address
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania, 18103
Status
Address
Crozer-Keystone Regional Cancer Center at Broomall
Broomall, Pennsylvania, 19008
Status
Address
Christiana Care Health System-Concord Health Center
Chadds Ford, Pennsylvania, 19317
Status
Address
Lancaster General Ann B Barshinger Cancer Institute
Lancaster, Pennsylvania, 17601
Status
Address
Lancaster General Hospital
Lancaster, Pennsylvania, 17602
Status
Address
Forbes Hospital
Monroeville, Pennsylvania, 15146
Status
Address
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, 19107
Status
Address
Allegheny General Hospital
Pittsburgh, Pennsylvania, 15212
Status
Address
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, 15232
Status
Address
UPMC-Shadyside Hospital
Pittsburgh, Pennsylvania, 15232
Status
Address
Reading Hospital
West Reading, Pennsylvania, 19611
Status
Address
Wexford Health and Wellness Pavilion
Wexford, Pennsylvania, 15090
Status
Address
Rock Hill Radiation Therapy Center
Rock Hill, South Carolina, 29730
Status
Address
Avera Cancer Institute at Pierre
Pierre, South Dakota, 57501
Status
Address
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota, 57104
Status
Address
Avera Cancer Institute
Sioux Falls, South Dakota, 57105
Status
Address
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Status
Address
Baptist Memorial Hospital and Cancer Center-Collierville
Collierville, Tennessee, 38017
Status
Address
Baptist Memorial Hospital and Cancer Center-Memphis
Memphis, Tennessee, 38120
Status
Address
Memorial Hermann Texas Medical Center
Houston, Texas, 77030
Status
Address
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
Status
Address
American Fork Hospital / Huntsman Intermountain Cancer Center
American Fork, Utah, 84003
Status
Address
Sandra L Maxwell Cancer Center
Cedar City, Utah, 84720
Status
Address
Logan Regional Hospital
Logan, Utah, 84321
Status
Address
Intermountain Medical Center
Murray, Utah, 84107
Status
Address
McKay-Dee Hospital Center
Ogden, Utah, 84403
Status
Address
Utah Valley Regional Medical Center
Provo, Utah, 84604
Status
Address
Riverton Hospital
Riverton, Utah, 84065
Status
Address
Saint George Regional Medical Center
Saint George, Utah, 84770
Status
Address
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, 84112
Status
Address
LDS Hospital
Salt Lake City, Utah, 84143
Status
Address
Central Vermont Medical Center/National Life Cancer Treatment
Berlin, Vermont, 05602
Status
Address
University of Vermont Medical Center
Burlington, Vermont, 05401
Status
Address
University of Vermont and State Agricultural College
Burlington, Vermont, 05405
Status
Address
Inova Schar Cancer Institute
Fairfax, Virginia, 22031
Status
Address
Virginia Commonwealth University/Massey Cancer Center
Richmond, Virginia, 23298
Status
Address
VCU Community Memorial Health Center
South Hill, Virginia, 23970
Status
Address
Virginia Mason Medical Center
Seattle, Washington, 98101
Status
Address
Legacy Cancer Institute Medical Oncology and Day Treatment
Vancouver, Washington, 98684
Status
Address
Legacy Salmon Creek Hospital
Vancouver, Washington, 98686
Status
Address
Wheeling Hospital/Schiffler Cancer Center
Wheeling, West Virginia, 26003
Status
Address
Aurora Cancer Care-Southern Lakes VLCC
Burlington, Wisconsin, 53105
Status
Address
Aurora Health Care Germantown Health Center
Germantown, Wisconsin, 53022
Status
Address
Aurora Cancer Care-Grafton
Grafton, Wisconsin, 53024
Status
Address
Aurora BayCare Medical Center
Green Bay, Wisconsin, 54311
Status
Address
University of Wisconsin Carbone Cancer Center - Johnson Creek
Johnson Creek, Wisconsin, 53038
Status
Address
Aurora Cancer Care-Kenosha South
Kenosha, Wisconsin, 53142
Status
Address
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792
Status
Address
Aurora Bay Area Medical Group-Marinette
Marinette, Wisconsin, 54143
Status
Address
Aurora Cancer Care-Milwaukee
Milwaukee, Wisconsin, 53209
Status
Address
Aurora Saint Luke's Medical Center
Milwaukee, Wisconsin, 53215
Status
Address
Aurora Sinai Medical Center
Milwaukee, Wisconsin, 53233
Status
Address
Marshfield Medical Center - Minocqua
Minocqua, Wisconsin, 54548
Status
Address
Cancer Center of Western Wisconsin
New Richmond, Wisconsin, 54017
Status
Address
Vince Lombardi Cancer Clinic - Oshkosh
Oshkosh, Wisconsin, 54904
Status
Address
Aurora Cancer Care-Racine
Racine, Wisconsin, 53406
Status
Address
Vince Lombardi Cancer Clinic-Sheboygan
Sheboygan, Wisconsin, 53081
Status
Address
Aurora Medical Center in Summit
Summit, Wisconsin, 53066
Status
Address
Vince Lombardi Cancer Clinic-Two Rivers
Two Rivers, Wisconsin, 54241
Status
Address
Aurora Cancer Care-Milwaukee West
Wauwatosa, Wisconsin, 53226
Status
Address
Aurora West Allis Medical Center
West Allis, Wisconsin, 53227
