A Study of Lower Radiotherapy Dose to Treat Children With CNS Germinoma

Last updated: February 20, 2026
Sponsor: Children's Oncology Group
Overall Status: Active - Recruiting

Phase

2

Condition

Hormone Deficiencies

Testicular Cancer

Germ Cell Tumors

Treatment

Intensity-Modulated Radiation Therapy

Questionnaire Administration

Magnetic Resonance Imaging

Clinical Study ID

NCT06368817
ACNS2321
ACNS2321
U10CA180886
NCI-2024-03518
  • Ages 3-29
  • All Genders

Study Summary

This phase II trial studies how well lower dose radiotherapy after chemotherapy (Carboplatin & Etoposide) works in treating children with central nervous system (CNS) germinomas. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors. Carboplatin is in a class of medications known as platinum-containing compounds. It works in a way similar to the anticancer drug cisplatin, but may be better tolerated than cisplatin. Carboplatin works by killing, stopping or slowing the growth of tumor cells. Etoposide is in a class of medications known as podophyllotoxin derivatives. It blocks a certain enzyme needed for cell division and DNA repair and may kill cancer cells. Researchers want to see if lowering the dose of standard radiotherapy (RT) after chemotherapy can help get rid of CNS germinomas with fewer long-term side effects.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patients must be ≥ 3 years and < 30 years at the time of study enrollment

  • Patients must be newly-diagnosed primary localized germinoma of the suprasellarand/or pineal region by pathology and/or serum and/or CSF hCGbeta 5-50 mIU/mL ANDinstitutional normal AFP (or ≤ 10 ng/mL if no institutional normal exists),including tumors with contiguous ventricular or unifocal parenchymal extension. Nohistologic confirmation required

  • Patients with EITHER (A) bifocal (pineal + suprasellar) involvement OR (B) pineallesion with diabetes insipidus (DI) AND hCGbeta ≤ 100 mIU/mL in serum and/or CSF ANDinstitutional normal AFP (or ≤ 10 ng/mL if no institutional normal exists) in bothserum and CSF. No histologic confirmation required

  • Patients with hCGbeta 51-100 mIU/mL in serum and/or CSF and institutional normal AFP (or ≤ 10 ng/mL if no institutional normal exists) in both serum and CSF. Histologicconfirmation of germinoma IS required

  • Patients with germinoma of the basal ganglia and or/thalamic primary sites areeligible

  • Patients with metastatic germinoma including non-contiguous disease or distantdisease in the brain, ventricles, or spine are eligible

  • Patients with germinoma admixed with mature teratoma are eligible

  • Patients must have a performance status corresponding to Eastern CooperativeOncology Group (ECOG) scores of 0, 1 or 2. Use Karnofsky for patients > 16 years ofage and Lansky for patients ≤ 16 years of age

  • Patients must have eligibility confirmed by Rapid Central Imaging Review performedon APEC14B1-CNS

  • Imaging studies must be obtained within 31 days prior to study enrollment and startof protocol therapy. (Note: for patients that have had surgery and post-operativeimaging performed, it is the post-operative MRI that must be obtained within 31 daysprior to enrollment.)

  • Patients must have a cranial magnetic resonance imaging (MRI) with and withoutgadolinium at diagnosis/prior to enrollment. If surgical resection is performed,patients must have pre-operative and post-operative brain MRI with and withoutgadolinium. The post-operative brain MRI should be obtained within 72 hours ofsurgery. If patient has a biopsy only, post-operative brain MRI is recommended butnot required

  • Patients must have a spine MRI with gadolinium obtained at diagnosis/prior toenrollment

  • Patients must be enrolled, and protocol therapy must begin, no later than 31 daysafter definitive surgery or clinical diagnosis, whichever is later

  • Patients must have eligibility confirmed by Rapid Central Tumor Marker Reviewperformed on APEC14B1-CNS

  • Lumbar CSF must be obtained prior to study enrollment unless medicallycontraindicated. If a patient undergoes surgery and lumbar CSF cytology cannot beobtained at the time of surgery, then it should be performed at least 10 daysfollowing surgery and prior to study enrollment. False positive cytology can occurwithin 10 days of surgery. Of note, lumbar CSF should not be performed prior toobtaining spine MRI, as this can make interpretation of the spine MRI less clear

  • Patients must have CSF tumor markers obtained prior to study enrollment unlessmedically contraindicated. Ventricular CSF obtained at the time of CSF diversionprocedure (if performed) is acceptable for tumor markers but lumbar CSF ispreferred. In case CSF diversion and biopsy/surgery are combined, CSF tumor markersshould be collected first. Ideally serum and CSF tumor markers should be collectedat the same time and processed without delay

  • For patients with solid tumors: Peripheral absolute neutrophil count (ANC) >= 1000/uL (Must be performed within 7 days prior to enrollment unless otherwiseindicated)

  • For patients with solid tumors: Platelet count >= 100,000/uL (transfusionindependent) (Must be performed within 7 days prior to enrollment unless otherwiseindicated)

  • For patients with solid tumors: Hemoglobin >= 8.0 g/dL (may receive red blood cell [RBC] transfusions) (Must be performed within 7 days prior to enrollment unlessotherwise indicated)

  • For pediatric patients (age 3-17 years): A serum creatinine based on age/gender asfollows (Must be performed within 7 days prior to enrollment unless otherwiseindicated):

  • Age: 3 to < 6 years; maximum serum creatinine (mg/dL): 0.8 (male); 0.8 (female)

  • Age: 6 to < 10 years; maximum serum creatinine (mg/dL): 1 (male); 1 (female)

  • Age: 10 to < 13 years; maximum serum creatinine (mg/dL): 1.2 (male); 1.2 (female)

  • Age: 13 to < 16 years; maximum serum creatinine (mg/dL): 1.5 (male); 1.4 (female)

  • Age: ≥ 17 years; maximum serum creatinine (mg/dL): 1.7 (male); 1.4 (female) ORa 24-hour urine creatinine clearance ≥ 70 mL/min/1.73 m^2 OR a glomerularfiltration rate (GFR) ≥ 50 mL/min/1.73 m^2. GFR must be performed using directmeasurement with a nuclear blood sampling method OR direct small moleculeclearance method (iothalamate or other molecule per institutional standard).

  • Note: Estimated GFR (eGFR) from serum or plasma creatinine, cystatin C or otherestimates are not acceptable for determining eligibility.

  • For adult patients (age 18 years or older) (Must be performed within 7 daysprior to enrollment unless otherwise indicated):

  • Creatinine clearance ≥ 70 mL/min, as estimated by the Cockcroft and Gaultformula or a 24-hour urine collection. The creatinine value used in thecalculation must have been obtained within 28 days prior to registration.Estimated creatinine clearance is based on actual body weight

  • Total bilirubin ≤ 1.5 x upper limit of normal (ULN) for age (Must be performedwithin 7 days prior to enrollment unless otherwise indicated)

  • Serum glutamic-pyruvic transaminase (SGPT) (alanine transaminase [ALT]) ≤ 135 U/L (Must be performed within 7 days prior to enrollment unless otherwise indicated)

  • Note: For the purpose of this study, the ULN for SGPT (ALT) has been set to thevalue of 45 U/L

  • No evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry > 94%if there is clinical indication for determination

  • Patients with seizure disorder may be enrolled if on anticonvulsants and wellcontrolled

  • CNS toxicity =< grade 2

  • Patients must not be in status epilepticus, coma or assisted ventilation prior tostudy enrollment

  • HIV-infected patients on effective anti-retroviral therapy with undetectable viralload are eligible for this study

Exclusion

Exclusion Criteria:

  • Patients with any of the following malignant pathological elements are not eligible:

  • Endodermal sinus (yolk sac)

  • Embryonal carcinoma, choriocarcinoma

  • Malignant/immature teratoma and mixed germ cell tumor (GCT) (i.e., may includesome germinoma)

  • Patients with only mature teratoma upon tumor sampling at diagnosis and negativetumor markers are not eligible

  • Patients who have received any prior tumor-directed therapy for their diagnosis ofgerminoma other than surgical intervention and corticosteroids are not eligible

  • Female patients who are pregnant since fetal toxicities and teratogenic effects havebeen noted for several of the study drugs. A pregnancy test is required for femalepatients of childbearing potential.

  • Note: Serum and urine pregnancy tests may be falsely positive due toHCGbeta-secreting germ cell tumors. Ensure the patient is not pregnant byinstitutional standards

  • Lactating females who plan to breastfeed their infants

  • Sexually active patients of reproductive potential who have not agreed to use aneffective contraceptive method for the duration of their study participation

  • All patients and/or their parents or legal guardians must sign a written informedconsent

  • All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met

Study Design

Total Participants: 240
Treatment Group(s): 9
Primary Treatment: Intensity-Modulated Radiation Therapy
Phase: 2
Study Start date:
October 22, 2024
Estimated Completion Date:
November 04, 2033

Study Description

PRIMARY OBJECTIVE:

I. To determine whether 12 Gy whole ventricular irradiation (WVI) and 12 Gy tumor boost would maintain similar efficacy compared to ACNS1123 stratum 2 as measured by event-free survival (EFS) in eligible patients with localized primary central nervous system (CNS) germinoma who present with serum and/or cerebrospinal fluid (CSF) human chorionic gonadotropin-beta (hCGbeta) ≤ 100 IU/L and normal alpha-fetoprotein (AFP), and meet complete response (CR) or continued complete response (CCR) criteria following chemotherapy/second-look surgery (Stratum 1).

SECONDARY OBJECTIVES:

I. To estimate the EFS distribution for patients with localized midline - including bifocal - CNS germinoma with partial response (PR) after chemotherapy, followed by 18 Gy WVI and 12 Gy tumor boost (Stratum 2).

II. To estimate the EFS distribution for patients with localized midline - including bifocal - CNS germinoma with less than a PR after chemotherapy, followed by 24 Gy WVI and 12 Gy tumor boost (Stratum 3).

III. To estimate the overall survival (OS), response rates to chemotherapy and radiotherapy (RT), as well as the patterns of failure of the various cohorts based on tumor characteristics, treatment regimen, and treatment modality.

IV. To determine the impact of tumor characteristics, treatment regimen and treatment modalities on the long-term neuroendocrine function for patients with CNS germinomas.

V. To prospectively evaluate processing speed of children and young adults with CNS germinoma through the Children's Oncology Group (COG) Standardized assessment battery.

EXPLORATORY OBJECTIVES:

I. To estimate the EFS distribution for patients with metastatic germinomas treated with chemotherapy followed by craniospinal irradiation (CSI) [18 Gy for CR/CCR (Stratum 4)] or [24 Gy for less than CR (Stratum 5)] with a 12 Gy tumor boost to the pre-treatment volume, including metastatic sites.

II. To estimate the EFS distribution for patients with basal ganglia and thalamic germinomas (BGTG) treated with chemotherapy followed by whole brain irradiation (WBI) [18 Gy for CR/CCR (Stratum 6)] or [24 Gy for less than CR (Stratum 7)] with a 12 Gy tumor boost to the pre-treatment volume.

III. To prospectively collect blood, cerebrospinal fluid, and tumor tissue at diagnosis and second-look surgery (if feasible) for future biology studies.

IV. To prospectively measure the incidence of cerebral vascular events (stroke or transient ischemic attacks) in the follow-up period and longitudinally evaluate and model the cognitive, social and behavioral functioning of children and young adults with CNS germinoma through the COG Standardized assessment battery, and compare these outcomes based on tumor characteristics, treatment regimen, and treatment modality.

OUTLINE:

INDUCTION PHASE: All patients receive carboplatin intravenously (IV) over 15-60 minutes on day 1 and etoposide IV over 90-120 minutes on days 1-3 of each cycle. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

Patients are then assigned to 1 of 7 strata.

STRATUM I: Patients with localized germinoma achieving CR with normalization of markers undergo 3-dimensional conformal radiation therapy (3DCRT) or intensity-modulated radiation therapy (IMRT) once daily (QD) 5 days a week for 16 days. Patients achieving PR with normalization of markers may undergo second-look surgery. Patients found to have mature teratoma or non-viable tumor undergo 3DRT or IMRT QD 5 days a week for 16 days. Patients with normalization of markers who fail to achieve CR or PR may undergo second-look surgery. Patients found to have mature teratoma or non-viable tumor undergo 3DRT or IMRT QD 5 days a week for 16 days. Patients with bifocal germinoma undergo 3DRT or IMRT QD 5 days a week for 16 days.

STRATUM II: Patients with localized germinoma achieving PR with normalization of markers who do not undergo second-look surgery undergo 3DRT or IMRT QD 5 days a week for 20 days.

STRATUM III: Patients with localized germinoma with normalization of markers who fail to achieve CR or PR who do not undergo second-look surgery undergo 3DRT or IMRT QD 5 days a week for 24 days.

STRATUM IV: Patients with metastatic germinoma achieving CR undergo 3DRT or IMRT QD 5 days a week for 20 days. Patients with metastatic germinoma and normalization of markers who fail to achieve CR may undergo second-look surgery. Patients found to have mature teratoma or non-viable tumor undergo 3DRT or IMRT QD 5 days a week for 20 days.

STRATUM V: Patients with metastatic germinoma with normalization of markers who fail to achieve CR who do not undergo second-look surgery undergo 3DRT or IMRT QD 5 days a week for 24 days.

STRATUM VI: Patients with basal ganglia and thalamic germinoma achieving CR undergo 3DRT or IMRT QD 5 days a week for 20 days. Patients with basal ganglia and thalamic germinoma and normalization of markers who fail to achieve CR may undergo second-look surgery. Patients found to have mature teratoma or non-viable tumor undergo 3DRT or IMRT QD 5 days a week for 20 days.

STRATUM VII: Patients with basal ganglia and thalamic germinoma with normalization of germinoma through the Children's Oncology Group (COG) Standardized assessment battery.&#xd; &#xd; EXPLORATORY OBJECTIVES:&#xd; &#xd; I. To estimate the EFS distribution for patients with metastatic germinomas treated with&#xd; chemotherapy followed by craniospinal irradiation (CSI) [18 Gy for CR/CCR (Stratum 4)] or&#xd; [24 Gy for less than CR (Stratum 5)] with a 12 Gy tumor boost to the pre-treatment&#xd; volume, including metastatic sites.&#xd; &#xd; II. To estimate the EFS distribution for patients with basal ganglia and thalamic&#xd; germinomas (BGTG) treated with chemotherapy followed by whole brain irradiation (WBI) [18&#xd; Gy for CR/CCR (Stratum 6)] or [24 Gy for less than CR (Stratum 7)] with a 12 Gy tumor&#xd; boost to the pre-treatment volume.&#xd; &#xd; III. To prospectively collect blood, cerebrospinal fluid, and tumor tissue at diagnosis&#xd; and second-look surgery (if feasible) for future biology studies.&#xd; &#xd; IV. To prospectively measure the incidence of cerebral vascular events (stroke or&#xd; transient ischemic attacks) in the follow-up period and longitudinally evaluate and model&#xd; the cognitive, social and behavioral functioning of children and young adults with CNS&#xd; germinoma through the COG Standardized assessment battery, and compare these outcomes&#xd; based on tumor characteristics, treatment regimen, and treatment modality.&#xd; &#xd; OUTLINE:&#xd; &#xd; INDUCTION PHASE: All patients receive carboplatin intravenously (IV) over 15-60 minutes&#xd; on day 1 and etoposide IV over 90-120 minutes on days 1-3 of each cycle. Treatment&#xd; repeats every 21 days for up to 4 cycles in the absence of disease progression or&#xd; unacceptable toxicity.&#xd; &#xd; Patients are then assigned to 1 of 7 strata.&#xd; &#xd; STRATUM I: Patients with localized germinoma achieving CR with normalization of markers&#xd; undergo 3-dimensional conformal radiation therapy (3DCRT) or intensity-modulated&#xd; radiation therapy (IMRT) once daily (QD) 5 days a week for 16 days. Patients achieving PR&#xd; with normalization of markers may undergo second-look surgery. Patients found to have&#xd; mature teratoma or non-viable tumor undergo 3DRT or IMRT QD 5 days a week for 16 days.&#xd; Patients with normalization of markers who fail to achieve CR or PR may undergo&#xd; second-look surgery. Patients found to have mature teratoma or non-viable tumor undergo&#xd; 3DRT or IMRT QD 5 days a week for 16 days. Patients with bifocal germinoma undergo 3DRT&#xd; or IMRT QD 5 days a week for 16 days.&#xd; &#xd; STRATUM II: Patients with localized germinoma achieving PR with normalization of markers&#xd; who do not undergo second-look surgery undergo 3DRT or IMRT QD 5 days a week for 20 days.&#xd; &#xd; STRATUM III: Patients with localized germinoma with normalization of markers who fail to&#xd; achieve CR or PR who do not undergo second-look surgery undergo 3DRT or IMRT QD 5 days a&#xd; week for 24 days.&#xd; &#xd; STRATUM IV: Patients with metastatic germinoma achieving CR undergo 3DRT or IMRT QD 5&#xd; days a week for 20 days. Patients with metastatic germinoma and normalization of markers&#xd; who fail to achieve CR may undergo second-look surgery. Patients found to have mature&#xd; teratoma or non-viable tumor undergo 3DRT or IMRT QD 5 days a week for 20 days.&#xd; &#xd; STRATUM V: Patients with metastatic germinoma with normalization of markers who fail to&#xd; achieve CR who do not undergo second-look surgery undergo 3DRT or IMRT QD 5 days a week&#xd; for 24 days.&#xd; &#xd; STRATUM VI: Patients with basal ganglia and thalamic germinoma achieving CR undergo 3DRT&#xd; or IMRT QD 5 days a week for 20 days. Patients with basal ganglia and thalamic germinoma&#xd; and normalization of markers who fail to achieve CR may undergo second-look surgery.&#xd; Patients found to have mature teratoma or non-viable tumor undergo 3DRT or IMRT QD 5 days&#xd; a week for 20 days.&#xd; &#xd; STRATUM VII: Patients with basal ganglia and thalamic germinoma with normalization of&#xd; markers who fail to achieve CR who do not undergo second-look surgery undergo 3DRT or IMRT QD 5 days a week for 24 days.

Patients with non-normalized tumor markers or PD and no second-look surgery or viable tumor during second-look surgery discontinue protocol therapy.

All patients undergo magnetic resonance imaging (MRI) and optional blood and tissue sample collection throughout the study. Patients may undergo lumbar puncture (LP) for CSF sample collection during screening and follow up.

After completion of study treatment, patients are followed up every 3 months for 12 months, every 4 months for 24 months, and then annually for up to 120 months.

Connect with a study center

  • Sydney Children's Hospital

    Randwick, New South Wales 2031
    Australia

    Site Not Available

  • The Children's Hospital at Westmead

    Westmead, New South Wales 2145
    Australia

    Site Not Available

  • John Hunter Children's Hospital

    Hunter Regional Mail Centre, New South Wales 2155400 2310
    Australia

    Active - Recruiting

  • Sydney Children's Hospital

    Randwick 2208285, New South Wales 2155400 2031
    Australia

    Active - Recruiting

  • The Children's Hospital at Westmead

    Westmead 2143973, New South Wales 2155400 2145
    Australia

    Active - Recruiting

  • Queensland Children's Hospital

    South Brisbane 2207259, Queensland 2152274 4101
    Australia

    Active - Recruiting

  • Royal Children's Hospital

    Parkville, Victoria 3052
    Australia

    Site Not Available

  • Royal Children's Hospital

    Parkville 2153770, Victoria 2145234 3052
    Australia

    Active - Recruiting

  • Perth Children's Hospital

    Perth 2063523, Western Australia 2058645 6009
    Australia

    Active - Recruiting

  • University of Alberta Hospital

    Edmonton, Alberta T6G 2B7
    Canada

    Site Not Available

  • University of Alberta Hospital

    Edmonton 5946768, Alberta 5883102 T6G 2B7
    Canada

    Active - Recruiting

  • British Columbia Children's Hospital

    Vancouver 6173331, British Columbia 5909050 V6H 3V4
    Canada

    Active - Recruiting

  • IWK Health Centre

    Halifax, Nova Scotia B3K 6R8
    Canada

    Site Not Available

  • IWK Health Centre

    Halifax 6324729, Nova Scotia 6091530 B3K 6R8
    Canada

    Active - Recruiting

  • McMaster Children's Hospital at Hamilton Health Sciences

    Hamilton, Ontario L8N 3Z5
    Canada

    Site Not Available

  • Children's Hospital

    London, Ontario N6A 5W9
    Canada

    Site Not Available

  • Hospital for Sick Children

    Toronto, Ontario M5G 1X8
    Canada

    Site Not Available

  • McMaster Children's Hospital at Hamilton Health Sciences

    Hamilton 5969782, Ontario 6093943 L8N 3Z5
    Canada

    Active - Recruiting

  • Children's Hospital

    London 6058560, Ontario 6093943 N6A 5W9
    Canada

    Active - Recruiting

  • Hospital for Sick Children

    Toronto 6167865, Ontario 6093943 M5G 1X8
    Canada

    Active - Recruiting

  • Centre Hospitalier Universitaire Sainte-Justine

    Montreal, Quebec H3T 1C5
    Canada

    Active - Recruiting

  • The Montreal Children's Hospital of the MUHC

    Montreal, Quebec H3H 1P3
    Canada

    Site Not Available

  • Centre Hospitalier Universitaire de Sherbrooke-Fleurimont

    Sherbrooke, Quebec J1H 5N4
    Canada

    Site Not Available

  • Centre Hospitalier Universitaire Sainte-Justine

    Montreal 6077243, Quebec 6115047 H3T 1C5
    Canada

    Active - Recruiting

  • The Montreal Children's Hospital of the MUHC

    Montreal 6077243, Quebec 6115047 H3H 1P3
    Canada

    Active - Recruiting

  • Centre Hospitalier Universitaire de Sherbrooke-Fleurimont

    Sherbrooke 6146143, Quebec 6115047 J1H 5N4
    Canada

    Active - Recruiting

  • CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)

    Quebec, G1V 4G2
    Canada

    Site Not Available

  • CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)

    Québec 6325494, G1V 4G2
    Canada

    Active - Recruiting

  • USA Health Strada Patient Care Center

    Mobile, Alabama 36604
    United States

    Site Not Available

  • USA Health Strada Patient Care Center

    Mobile 4076598, Alabama 4829764 36604
    United States

    Active - Recruiting

  • Phoenix Childrens Hospital

    Phoenix, Arizona 85016
    United States

    Site Not Available

  • Phoenix Childrens Hospital

    Phoenix 5308655, Arizona 5551752 85016
    United States

    Active - Recruiting

  • Arkansas Children's Hospital

    Little Rock, Arkansas 72202-3591
    United States

    Site Not Available

  • Arkansas Children's Hospital

    Little Rock 4119403, Arkansas 4099753 72202-3591
    United States

    Active - Recruiting

  • Loma Linda University Medical Center

    Loma Linda, California 92354
    United States

    Site Not Available

  • Children's Hospital Los Angeles

    Los Angeles, California 90027
    United States

    Site Not Available

  • UCSF Benioff Children's Hospital Oakland

    Oakland, California 94609
    United States

    Site Not Available

  • Children's Hospital of Orange County

    Orange, California 92868
    United States

    Site Not Available

  • Lucile Packard Children's Hospital Stanford University

    Palo Alto, California 94304
    United States

    Site Not Available

  • Rady Children's Hospital - San Diego

    San Diego, California 92123
    United States

    Site Not Available

  • UCSF Medical Center-Mission Bay

    San Francisco, California 94158
    United States

    Site Not Available

  • Loma Linda University Medical Center

    Loma Linda 5367696, California 5332921 92354
    United States

    Active - Recruiting

  • Children's Hospital Los Angeles

    Los Angeles 5368361, California 5332921 90027
    United States

    Active - Recruiting

  • UCSF Benioff Children's Hospital Oakland

    Oakland 5378538, California 5332921 94609
    United States

    Active - Recruiting

  • Children's Hospital of Orange County

    Orange 5379513, California 5332921 92868
    United States

    Active - Recruiting

  • Lucile Packard Children's Hospital Stanford University

    Palo Alto 5380748, California 5332921 94304
    United States

    Active - Recruiting

  • Rady Children's Hospital - San Diego

    San Diego 5391811, California 5332921 92123
    United States

    Active - Recruiting

  • UCSF Medical Center-Mission Bay

    San Francisco 5391959, California 5332921 94158
    United States

    Active - Recruiting

  • Children's Hospital Colorado

    Aurora, Colorado 80045
    United States

    Site Not Available

  • Children's Hospital Colorado

    Aurora 5412347, Colorado 5417618 80045
    United States

    Active - Recruiting

  • Connecticut Children's Medical Center

    Hartford 4835797, Connecticut 4831725 06106
    United States

    Active - Recruiting

  • Alfred I duPont Hospital for Children

    Wilmington, Delaware 19803
    United States

    Site Not Available

  • Alfred I duPont Hospital for Children

    Wilmington 4145381, Delaware 4142224 19803
    United States

    Active - Recruiting

  • Children's National Medical Center

    Washington, District of Columbia 20010
    United States

    Site Not Available

  • Children's National Medical Center

    Washington D.C. 4140963, District of Columbia 4138106 20010
    United States

    Active - Recruiting

  • Memorial Regional Hospital/Joe DiMaggio Children's Hospital

    Hollywood, Florida 33021
    United States

    Site Not Available

  • Nemours Children's Clinic-Jacksonville

    Jacksonville, Florida 32207
    United States

    Site Not Available

  • Nicklaus Children's Hospital

    Miami, Florida 33155
    United States

    Active - Recruiting

  • University of Miami Miller School of Medicine-Sylvester Cancer Center

    Miami, Florida 33136
    United States

    Site Not Available

  • Arnold Palmer Hospital for Children

    Orlando, Florida 32806
    United States

    Site Not Available

  • Nemours Children's Hospital

    Orlando, Florida 32827
    United States

    Active - Recruiting

  • Nemours Children's Clinic - Pensacola

    Pensacola, Florida 32504
    United States

    Site Not Available

  • Sacred Heart Hospital

    Pensacola, Florida 32504
    United States

    Suspended

  • Johns Hopkins All Children's Hospital

    Saint Petersburg, Florida 33701
    United States

    Site Not Available

  • Memorial Regional Hospital/Joe DiMaggio Children's Hospital

    Hollywood 4158928, Florida 4155751 33021
    United States

    Active - Recruiting

  • Nemours Children's Clinic-Jacksonville

    Jacksonville 4160021, Florida 4155751 32207
    United States

    Active - Recruiting

  • Nicklaus Children's Hospital

    Miami 4164138, Florida 4155751 33155
    United States

    Active - Recruiting

  • University of Miami Miller School of Medicine-Sylvester Cancer Center

    Miami 4164138, Florida 4155751 33136
    United States

    Active - Recruiting

  • Arnold Palmer Hospital for Children

    Orlando 4167147, Florida 4155751 32806
    United States

    Active - Recruiting

  • Nemours Children's Hospital

    Orlando 4167147, Florida 4155751 32827
    United States

    Active - Recruiting

  • Nemours Children's Clinic - Pensacola

    Pensacola 4168228, Florida 4155751 32504
    United States

    Active - Recruiting

  • Sacred Heart Hospital

    Pensacola 4168228, Florida 4155751 32504
    United States

    Site Not Available

  • Johns Hopkins All Children's Hospital

    St. Petersburg 4171563, Florida 4155751 33701
    United States

    Active - Recruiting

  • Saint Joseph's Hospital/Children's Hospital-Tampa

    Tampa 4174757, Florida 4155751 33607
    United States

    Active - Recruiting

  • Children's Healthcare of Atlanta - Arthur M Blank Hospital

    Atlanta, Georgia 30329
    United States

    Site Not Available

  • Children's Healthcare of Atlanta - Arthur M Blank Hospital

    Atlanta 4180439, Georgia 4197000 30329
    United States

    Active - Recruiting

  • Kapiolani Medical Center for Women and Children

    Honolulu 5856195, Hawaii 5855797 96826
    United States

    Active - Recruiting

  • Saint Luke's Cancer Institute - Boise

    Boise, Idaho 83712
    United States

    Site Not Available

  • Saint Luke's Cancer Institute - Boise

    Boise 5586437, Idaho 5596512 83712
    United States

    Active - Recruiting

  • University of Chicago Comprehensive Cancer Center

    Chicago, Illinois 60637
    United States

    Site Not Available

  • Loyola University Medical Center

    Maywood, Illinois 60153
    United States

    Site Not Available

  • Lurie Children's Hospital-Chicago

    Chicago 4887398, Illinois 4896861 60611
    United States

    Active - Recruiting

  • University of Chicago Comprehensive Cancer Center

    Chicago 4887398, Illinois 4896861 60637
    United States

    Active - Recruiting

  • University of Illinois

    Chicago 4887398, Illinois 4896861 60612
    United States

    Active - Recruiting

  • Loyola University Medical Center

    Maywood 4901514, Illinois 4896861 60153
    United States

    Active - Recruiting

  • University of Iowa/Holden Comprehensive Cancer Center

    Iowa City, Iowa 52242
    United States

    Site Not Available

  • University of Iowa/Holden Comprehensive Cancer Center

    Iowa City 4862034, Iowa 4862182 52242
    United States

    Active - Recruiting

  • Norton Children's Hospital

    Louisville, Kentucky 40202
    United States

    Site Not Available

  • Norton Children's Hospital

    Louisville 4299276, Kentucky 6254925 40202
    United States

    Active - Recruiting

  • Johns Hopkins University/Sidney Kimmel Cancer Center

    Baltimore, Maryland 21287
    United States

    Site Not Available

  • Johns Hopkins University/Sidney Kimmel Cancer Center

    Baltimore 4347778, Maryland 4361885 21287
    United States

    Active - Recruiting

  • Dana-Farber Cancer Institute

    Boston, Massachusetts 02215
    United States

    Site Not Available

  • Dana-Farber Cancer Institute

    Boston 4930956, Massachusetts 6254926 02215
    United States

    Active - Recruiting

  • C S Mott Children's Hospital

    Ann Arbor, Michigan 48109
    United States

    Site Not Available

  • Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital

    Grand Rapids, Michigan 49503
    United States

    Site Not Available

  • C S Mott Children's Hospital

    Ann Arbor 4984247, Michigan 5001836 48109
    United States

    Active - Recruiting

  • Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital

    Grand Rapids 4994358, Michigan 5001836 49503
    United States

    Active - Recruiting

  • University of Minnesota/Masonic Cancer Center

    Minneapolis, Minnesota 55455
    United States

    Site Not Available

  • Mayo Clinic in Rochester

    Rochester, Minnesota 55905
    United States

    Site Not Available

  • Children's Hospitals and Clinics of Minnesota - Minneapolis

    Minneapolis 5037649, Minnesota 5037779 55404
    United States

    Active - Recruiting

  • University of Minnesota/Masonic Cancer Center

    Minneapolis 5037649, Minnesota 5037779 55455
    United States

    Active - Recruiting

  • Mayo Clinic in Rochester

    Rochester 5043473, Minnesota 5037779 55905
    United States

    Active - Recruiting

  • University of Mississippi Medical Center

    Jackson, Mississippi 39216
    United States

    Site Not Available

  • University of Mississippi Medical Center

    Jackson 4431410, Mississippi 4436296 39216
    United States

    Active - Recruiting

  • Children's Mercy Hospitals and Clinics

    Kansas City, Missouri 64108
    United States

    Site Not Available

  • Cardinal Glennon Children's Medical Center

    Saint Louis, Missouri 63104
    United States

    Site Not Available

  • Washington University School of Medicine

    Saint Louis, Missouri 63110
    United States

    Active - Recruiting

  • Children's Mercy Hospitals and Clinics

    Kansas City 4393217, Missouri 4398678 64108
    United States

    Active - Recruiting

  • Cardinal Glennon Children's Medical Center

    St Louis 4407066, Missouri 4398678 63104
    United States

    Active - Recruiting

  • Washington University School of Medicine

    St Louis 4407066, Missouri 4398678 63110
    United States

    Active - Recruiting

  • Children's Hospital and Medical Center of Omaha

    Omaha, Nebraska 68114
    United States

    Site Not Available

  • University of Nebraska Medical Center

    Omaha, Nebraska 68198
    United States

    Active - Recruiting

  • Children's Hospital and Medical Center of Omaha

    Omaha 5074472, Nebraska 5073708 68114
    United States

    Active - Recruiting

  • University of Nebraska Medical Center

    Omaha 5074472, Nebraska 5073708 68198
    United States

    Active - Recruiting

  • Alliance for Childhood Diseases/Cure 4 the Kids Foundation

    Las Vegas 5506956, Nevada 5509151 89135
    United States

    Active - Recruiting

  • Summerlin Hospital Medical Center

    Las Vegas 5506956, Nevada 5509151 89144
    United States

    Active - Recruiting

  • Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center

    Lebanon, New Hampshire 03756
    United States

    Site Not Available

  • Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center

    Lebanon 5088597, New Hampshire 5090174 03756
    United States

    Active - Recruiting

  • Hackensack University Medical Center

    Hackensack, New Jersey 07601
    United States

    Site Not Available

  • Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital

    New Brunswick, New Jersey 08903
    United States

    Site Not Available

  • Newark Beth Israel Medical Center

    Newark, New Jersey 07112
    United States

    Site Not Available

  • Saint Joseph's Regional Medical Center

    Paterson, New Jersey 07503
    United States

    Site Not Available

  • Hackensack University Medical Center

    Hackensack 5098706, New Jersey 5101760 07601
    United States

    Active - Recruiting

  • Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital

    New Brunswick 5101717, New Jersey 5101760 08903
    United States

    Active - Recruiting

  • Saint Peter's University Hospital

    New Brunswick 5101717, New Jersey 5101760 08901
    United States

    Active - Recruiting

  • Newark Beth Israel Medical Center

    Newark 5101798, New Jersey 5101760 07112
    United States

    Active - Recruiting

  • Saint Joseph's Regional Medical Center

    Paterson 5102466, New Jersey 5101760 07503
    United States

    Active - Recruiting

  • Albany Medical Center

    Albany, New York 12208
    United States

    Site Not Available

  • Montefiore Medical Center - Moses Campus

    Bronx, New York 10467
    United States

    Site Not Available

  • Laura and Isaac Perlmutter Cancer Center at NYU Langone

    New York, New York 10016
    United States

    Active - Recruiting

  • Memorial Sloan Kettering Cancer Center

    New York, New York 10065
    United States

    Site Not Available

  • Mount Sinai Hospital

    New York, New York 10029
    United States

    Active - Recruiting

  • NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

    New York, New York 10032
    United States

    Active - Recruiting

  • State University of New York Upstate Medical University

    Syracuse, New York 13210
    United States

    Site Not Available

  • Albany Medical Center

    Albany 5106834, New York 5128638 12208
    United States

    Active - Recruiting

  • Laura and Isaac Perlmutter Cancer Center at NYU Langone

    New York 5128581, New York 5128638 10016
    United States

    Active - Recruiting

  • Memorial Sloan Kettering Cancer Center

    New York 5128581, New York 5128638 10065
    United States

    Active - Recruiting

  • Mount Sinai Hospital

    New York 5128581, New York 5128638 10029
    United States

    Active - Recruiting

  • NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

    New York 5128581, New York 5128638 10032
    United States

    Active - Recruiting

  • State University of New York Upstate Medical University

    Syracuse 5140405, New York 5128638 13210
    United States

    Active - Recruiting

  • Montefiore Medical Center - Moses Campus

    The Bronx 5110266, New York 5128638 10467
    United States

    Active - Recruiting

  • UNC Lineberger Comprehensive Cancer Center

    Chapel Hill, North Carolina 27599
    United States

    Site Not Available

  • Wake Forest University Health Sciences

    Winston-Salem, North Carolina 27157
    United States

    Site Not Available

  • UNC Lineberger Comprehensive Cancer Center

    Chapel Hill 4460162, North Carolina 4482348 27599
    United States

    Active - Recruiting

  • Wake Forest University Health Sciences

    Winston-Salem 4499612, North Carolina 4482348 27157
    United States

    Active - Recruiting

  • Sanford Broadway Medical Center

    Fargo, North Dakota 58122
    United States

    Site Not Available

  • Sanford Broadway Medical Center

    Fargo 5059163, North Dakota 5690763 58122
    United States

    Active - Recruiting

  • Rainbow Babies and Childrens Hospital

    Cleveland, Ohio 44106
    United States

    Site Not Available

  • Nationwide Children's Hospital

    Columbus, Ohio 43205
    United States

    Site Not Available

  • Rainbow Babies and Childrens Hospital

    Cleveland 5150529, Ohio 5165418 44106
    United States

    Active - Recruiting

  • Nationwide Children's Hospital

    Columbus 4509177, Ohio 5165418 43205
    United States

    Active - Recruiting

  • University of Oklahoma Health Sciences Center

    Oklahoma City 4544349, Oklahoma 4544379 73104
    United States

    Active - Recruiting

  • Oregon Health and Science University

    Portland, Oregon 97239
    United States

    Site Not Available

  • Oregon Health and Science University

    Portland 5746545, Oregon 5744337 97239
    United States

    Active - Recruiting

  • Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania 19104
    United States

    Active - Recruiting

  • Saint Christopher's Hospital for Children

    Philadelphia, Pennsylvania 19134
    United States

    Site Not Available

  • Children's Hospital of Pittsburgh of UPMC

    Pittsburgh, Pennsylvania 15224
    United States

    Site Not Available

  • Children's Hospital of Philadelphia

    Philadelphia 4560349, Pennsylvania 6254927 19104
    United States

    Active - Recruiting

  • Saint Christopher's Hospital for Children

    Philadelphia 4560349, Pennsylvania 6254927 19134
    United States

    Active - Recruiting

  • Children's Hospital of Pittsburgh of UPMC

    Pittsburgh 5206379, Pennsylvania 6254927 15224
    United States

    Active - Recruiting

  • Rhode Island Hospital

    Providence, Rhode Island 02903
    United States

    Site Not Available

  • Rhode Island Hospital

    Providence 5224151, Rhode Island 5224323 02903
    United States

    Active - Recruiting

  • Prisma Health Richland Hospital

    Columbia 4575352, South Carolina 4597040 29203
    United States

    Active - Recruiting

  • BI-LO Charities Children's Cancer Center

    Greenville 4580543, South Carolina 4597040 29605
    United States

    Active - Recruiting

  • Sanford USD Medical Center - Sioux Falls

    Sioux Falls, South Dakota 57117-5134
    United States

    Site Not Available

  • Sanford USD Medical Center - Sioux Falls

    Sioux Falls 5231851, South Dakota 5769223 57117-5134
    United States

    Active - Recruiting

  • Saint Jude Children's Research Hospital

    Memphis, Tennessee 38105
    United States

    Site Not Available

  • Saint Jude Children's Research Hospital

    Memphis 4641239, Tennessee 4662168 38105
    United States

    Active - Recruiting

  • Dell Children's Medical Center of Central Texas

    Austin, Texas 78723
    United States

    Site Not Available

  • Driscoll Children's Hospital

    Corpus Christi, Texas 78411
    United States

    Site Not Available

  • Medical City Dallas Hospital

    Dallas, Texas 75230
    United States

    Site Not Available

  • Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center

    Houston, Texas 77030
    United States

    Active - Recruiting

  • M D Anderson Cancer Center

    Houston, Texas 77030
    United States

    Site Not Available

  • Children's Hospital of San Antonio

    San Antonio, Texas 78207
    United States

    Active - Recruiting

  • University of Texas Health Science Center at San Antonio

    San Antonio, Texas 78229
    United States

    Site Not Available

  • Dell Children's Medical Center of Central Texas

    Austin 4671654, Texas 4736286 78723
    United States

    Active - Recruiting

  • Driscoll Children's Hospital

    Corpus Christi 4683416, Texas 4736286 78411
    United States

    Active - Recruiting

  • Medical City Dallas Hospital

    Dallas 4684888, Texas 4736286 75230
    United States

    Active - Recruiting

  • UT Southwestern/Simmons Cancer Center-Dallas

    Dallas 4684888, Texas 4736286 75390
    United States

    Active - Recruiting

  • Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center

    Houston 4699066, Texas 4736286 77030
    United States

    Active - Recruiting

  • M D Anderson Cancer Center

    Houston 4699066, Texas 4736286 77030
    United States

    Active - Recruiting

  • Children's Hospital of San Antonio

    San Antonio 4726206, Texas 4736286 78207
    United States

    Active - Recruiting

  • University of Texas Health Science Center at San Antonio

    San Antonio 4726206, Texas 4736286 78229
    United States

    Active - Recruiting

  • Primary Children's Hospital

    Salt Lake City, Utah 84113
    United States

    Site Not Available

  • Primary Children's Hospital

    Salt Lake City 5780993, Utah 5549030 84113
    United States

    Active - Recruiting

  • University of Virginia Cancer Center

    Charlottesville, Virginia 22908
    United States

    Site Not Available

  • Children's Hospital of The King's Daughters

    Norfolk, Virginia 23507
    United States

    Site Not Available

  • University of Virginia Cancer Center

    Charlottesville 4752031, Virginia 6254928 22908
    United States

    Active - Recruiting

  • Children's Hospital of The King's Daughters

    Norfolk 4776222, Virginia 6254928 23507
    United States

    Active - Recruiting

  • Seattle Children's Hospital

    Seattle, Washington 98105
    United States

    Site Not Available

  • Providence Sacred Heart Medical Center and Children's Hospital

    Spokane, Washington 99204
    United States

    Site Not Available

  • Seattle Children's Hospital

    Seattle 5809844, Washington 5815135 98105
    United States

    Active - Recruiting

  • Providence Sacred Heart Medical Center and Children's Hospital

    Spokane 5811696, Washington 5815135 99204
    United States

    Active - Recruiting

  • University of Wisconsin Carbone Cancer Center - University Hospital

    Madison, Wisconsin 53792
    United States

    Site Not Available

  • University of Wisconsin Carbone Cancer Center - University Hospital

    Madison 5261457, Wisconsin 5279468 53792
    United States

    Active - Recruiting

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