Radiation Therapy With Durvalumab or Cetuximab in Treating Patients With Locoregionally Advanced Head and Neck Cancer Who Cannot Take Cisplatin

Last updated: March 19, 2025
Sponsor: National Cancer Institute (NCI)
Overall Status: Active - Not Recruiting

Phase

2/3

Condition

Carcinoma

Head And Neck Cancer

Squamous Cell Carcinoma

Treatment

Laboratory Biomarker Analysis

Quality-of-Life Assessment

Intensity-Modulated Radiation Therapy

Clinical Study ID

NCT03258554
NCI-2017-01522
NCI-2017-01522
NRG-HN004
U10CA180868
  • Ages > 18
  • All Genders

Study Summary

This phase II/III trial studies how well radiation therapy works with durvalumab or cetuximab in treating patients with head and neck cancer that has spread to a local and/or regional area of the body who cannot take cisplatin. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Immunotherapy with monoclonal antibodies, such as durvalumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Cetuximab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. It is not known if radiation therapy with durvalumab will work better than the usual therapy of radiation therapy with cetuximab in treating patients with head and neck cancer.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • PRIOR TO STEP 1 REGISTRATION INCLUSION CRITERIA

  • Patients must have pathologically confirmed, previously untreated, unresectedsquamous cell carcinoma of the larynx, hypopharynx, oropharynx, oral cavity, orcarcinoma of unknown head/neck primary prior to step 1 registration; submission ofhematoxylin and eosin (H&E) stained slides and formalin-fixed and paraffin-embedded (FFPE) tissue block (or punch biopsy of FFPE block) to the biospecimen bank atUniversity of California, San Francisco (UCSF) for central review for oropharyngealand unknown primaries and for p16 analysis for all other non-oropharyngeal primariesis mandatory for all patients; investigators should check with their pathologydepartment regarding release of biospecimens before approaching patients aboutparticipation in the trial; for oropharyngeal and unknown primaries, submission ofH&E and p16 stained slides (with the required block for PD-L1) to the biospecimenbank at UCSF for central review is also required prior to step 2 registration

  • Note: fine needle aspirates (FNA) samples are not acceptable since they do notprovide enough material for PD-L1 and p16 testing; however, if a cell blockderived from the FNA is available, it is allowable if there are sufficientcells present in the block for PD-L1 testing; Dr. Jordan will determine thisupon receipt; for sites submitting FNA cell blocks for ALL patients they mustdo so within 7-10 business days from registering the patient; sites mustconfirm with their cytology/pathology labs to make sure they can provide therequired material as the bank must be able to retain these samples for themandatory testing

  • Patients must have locoregionally advanced head and neck squamous cell carcinoma (HNSCC)

  • For p16-positive oropharyngeal/unknown primaries, American Joint Committee onCancer [AJCC] 8th edition stage III and selected stage I-II based on smokingstatus in pack-years

  • For laryngeal, hypopharyngeal, and oral cavity primaries and p16-negativeoropharyngeal/unknown primaries, AJCC 8th edition stage III-IVB

  • Based on the following minimum diagnostic workup within 60 days prior to step 1registration:

  • General history and physical examination by a radiation oncologist ormedical oncologist or ear, nose and throat (ENT) or head & neck surgeon

  • For larynx, hypopharynx, and base of tongue primaries, alaryngopharyngoscopy (mirror and/or fiberoptic and/or direct procedure) isrequired, unless the patient cannot tolerate or refuses

  • Imaging of the head and neck with a neck CT or magnetic resonance imaging (MRI) (with contrast, unless contraindicated) or PET/CT; note that the CT portion ofthe PET/CT must be of diagnostic quality, including contrast administrationunless contraindicated. If the CT portion of the PET/CT study is low-dose (non-diagnostic), then an additional CT or MRI study with contrast (unlesscontraindicated) is required

  • Chest imaging: chest CT with and without contrast (unless contraindicated) orPET/CT

  • Patients must have a contraindication to cisplatin as defined in the followingbullet points; sites must complete the online tool at comogram.org prior to step 1registration to determine if the patient is eligible; the scores must be recorded ona case report form (CRF)

  • Age >= 70 with moderate to severe comorbidity or vulnerability to cisplatin,defined as having one or more of the following conditions within 30 days priorto step 1 registration:

  • Modified Charlson Comorbidity Index >= 1

  • Adult Comorbidity Evaluation (ACE)-27 Index >= 1

  • Generalized Competing Event Model for Cancer Risk (GCE) omega PFS score < 0.80

  • Geriatric screening (G-8) score =< 14

  • Cancer and Aging Research Group (CARG) toxicity score >= 30%

  • Cumulative Illness Rating scale for Geriatrics (CIRS-G) score >= 4 OR

  • Age < 70 with severe comorbidity or vulnerability to cisplatin, defined ashaving two or more of the following conditions within 30 days prior to step 1registration

  • Modified Charlson Comorbidity Index >= 1

  • ACE-27 Index >= 1

  • GCE omega PFS-score < 0.80

  • G-8 score =< 14

  • CARG Toxicity score >= 30%

  • CIRS-G score >= 4 OR

  • Age >= 18 with an absolute or relative contraindication to cisplatin, definedas one or more of the following within 30 days prior to step 1 registration:

  • Creatinine clearance (CC) > 30 and < 60 cc/min; for this calculation, usethe Cockcroft-Gault formula

  • Zubrod performance status 2 prior to step 1 registration

  • Pre-existing peripheral neuropathy grade >= 1

  • History of hearing loss, defined as either:

  • Existing need of a hearing aid OR

  • >= 25 decibel shift over 2 contiguous frequencies on a pretreatmenthearing test as clinically indicated

  • Absolute neutrophil count (ANC) >= 1,000 cells/mm^3 (within 14 days prior to step 1registration)

  • Platelets >= 100,000 cells/mm^3 (within 14 days prior to step 1 registration)

  • Hemoglobin >= 9.0 g/dl (Note: the use of transfusion or other intervention toachieve hemoglobin [Hgb] >= 9.0 g/dl is acceptable) (within 14 days prior to step 1registration)

  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 2.5 timesinstitutional upper limit of normal (within 14 days prior to step 1 registration)

  • Serum bilirubin =< 1.5 x institutional upper limit of normal (within 14 days priorto step 1 registration)

  • Measured creatinine clearance (CL) > 30 mL/min or calculated creatinine CL > 30mL/min by the Cockcroft-Gault formula (Cockcroft and Gault 1976) or by 24-hour urinecollection for determination of creatinine clearance (within 14 days prior to step 1registration)

  • For women of childbearing potential, a negative serum or urine pregnancy test within 14 days prior to step 1 registration; Note: women will be considered post-menopausalif they have been amenorrheic for 12 months without an alternative medical cause;the following age-specific requirements apply:

  • Women < 50 years of age would be considered post-menopausal if they have beenamenorrheic for 12 months or more following cessation of exogenous hormonaltreatments and if they have luteinizing hormone and follicle-stimulatinghormone levels in the post-menopausal range for the institution or underwentsurgical sterilization (bilateral oophorectomy or hysterectomy)

  • Women >= 50 years of age would be considered post-menopausal if they have beenamenorrheic for 12 months or more following cessation of all exogenous hormonaltreatments, had radiation-induced menopause with last menses > 1 year ago, hadchemotherapy-induced menopause with last menses > 1 year ago, or underwentsurgical sterilization (bilateral oophorectomy, bilateral salpingectomy orhysterectomy)

  • The patient or a legally authorized representative must provide study-specificinformed consent prior to step 1 registration

  • PRIOR TO STEP 2 REGISTRATION INCLUSION CRITERIA

  • For patients with oropharyngeal or unknown primaries: p16 determination byimmunohistochemistry (defined as greater than 70% strong nuclear or nuclear andcytoplasmic staining of tumor cells), confirmed by central pathology review

  • Note: for patients with oral cavity, laryngeal, and hypopharyngeal primaries,analysis of p16 status prior to step 2 registration/randomization is notrequired (p16 status will be analyzed centrally post-hoc); step 2 registrationfor these patients can be completed after step 1 registration

Exclusion

Exclusion Criteria:

  • PRIOR TO STEP 1 REGISTRATION EXCLUSION CRITERIA

  • Prior invasive malignancy within the past 3 years (except for non-melanomatous skincancer, and early stage treated prostate cancer); synchronous head and neckprimaries are ineligible

  • Prior radiotherapy to the region of the study cancer that would result in overlap ofradiation therapy fields

  • Note: Prior external beam radiotherapy is excluded, but iodine 131 is allowed

  • Prior immunotherapy

  • Prior systemic therapy, including cytotoxic chemotherapy, biologic/targeted therapy,or immune therapy for the study cancer

  • Major surgery within 28 days prior to step 1 registration

  • Proven evidence of distant metastases

  • If both of the following conditions are present, the patient is ineligible:

  • =< 10 pack-year smoking history

  • p16-positive carcinoma of the oropharynx or unknown primary that are T0-3, N0-1 (AJCC 8th Edition)

  • Note: in the event that a registered patient with =< 10 pack-years has ap16-positive result on central review with the tumor and nodal stage T0-3,N0-1 (AJCC 8th Edition), then the site will be notified that the patientis ineligible

  • Zubrod performance status >= 3

  • Body weight =< 30 kg

  • Patients with oral cavity cancer are excluded from participation if the patient ismedically operable and resection of the primary tumor is considered technicallyfeasible by an oral or head and neck cancers surgical subspecialist;(please consultthe surgical oncology co-principal investigator [PI], Steven Chang, Doctor ofMedicine [MD], if clarification is needed on an individual case)

  • Sodium < 130 mmol/L or > 155 mmol/L (within 14 days of step 1 registration, unlesscorrected prior to step 1 registration)

  • Potassium < 3.5 mmol/L or > 6 mmol/L (within 14 days of step 1 registration, unlesscorrected prior to step 1 registration)

  • Fasting glucose < 40 mg/dl or > 400 mg/dl (within 14 days of step 1 registration,unless corrected prior to step 1 registration)

  • Serum calcium (ionized or adjusted for albumin) < 7 mg/dl or > 12.5 mg/dl (within 14days of step 1 registration, unless corrected prior to step 1 registration)

  • Magnesium < 0.9 mg/dl or > 3 mg/dl (within 14 days of step 1 registration, unlesscorrected prior to step 1 registration)

  • Unstable angina and/or congestive heart failure requiring hospitalization within 3months prior to step 1 registration

  • Transmural myocardial infarction within 3 months prior to step 1 registration

  • Respiratory illness requiring hospitalization at the time of step 1 registration

  • Note: if the respiratory illness is resolved and the patient meets theeligibility status above, then the patient can be considered for the trial

  • Idiopathic pulmonary fibrosis or other severe interstitial lung disease thatrequires oxygen therapy or is thought to require oxygen therapy within 1 year priorto step 1 registration

  • History of (non-infectious) pneumonitis that required steroids or currentpneumonitis

  • Clinically apparent jaundice and/or known coagulation defects

  • Active or prior documented autoimmune or inflammatory disorders (includinginflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [withthe exception of diverticulosis], systemic lupus erythematosus, Sarcoidosissyndrome, or Wegener syndrome [granulomatosis with polyangiitis], Graves' disease,rheumatoid arthritis, hypophysitis, uveitis, etc.)

  • The following are exceptions to this criterion:

  • Patients with vitiligo or alopecia;

  • Patients with hypothyroidism (e.g., following Hashimoto syndrome) stableon hormone replacement;

  • Any chronic skin condition that does not require systemic therapy;

  • Patients without active disease in the last 5 years may be included butonly after consultation with the medical oncology study chair;

  • Patients with celiac disease controlled by diet alone

  • History of active primary immunodeficiency including, but not limited to acquiredimmune deficiency syndrome (AIDS) based upon current Centers for Disease Control andPrevention (CDC) definition; Note: human immunodeficiency virus (HIV) testing is notrequired for entry into this protocol; the need to exclude patients with AIDS fromthis protocol is necessary because the treatment involved in this protocol may beimmunosuppressive; patients with known HIV, CD4 counts >= 200/uL, and undetectableviral loads who are stable on an antiretroviral regimen may be included

  • Current or prior use of immunosuppressive medication within 14 days before step 1registration, with the exceptions of intranasal and inhaled corticosteroids orsystemic corticosteroids at physiological doses, which are not to exceed 10 mg/dayof prednisone, or an equivalent corticosteroid

  • Receipt of live attenuated vaccination within 30 days prior to step 1 registration

  • Medical or psychiatric illness which would compromise the patient's ability totolerate treatment or limit compliance with study requirements

  • Pregnancy or women of childbearing potential and men who are sexually active and notwilling/able to use medically acceptable forms of contraception during treatment andfor 6 months after the last dose of cetuximab or MEDI14736 (durvalumab); thisexclusion is necessary because the treatment involved in this study may besignificantly teratogenic; women who are breastfeeding are also excluded

  • Prior allergic reaction or hypersensitivity to cetuximab or MEDI4736 (durvalumab) orany of study drug excipients

  • History of allogenic organ transplantation

  • Uncontrolled hypertension

  • Uncontrolled cardiac arrhythmia

  • Uncontrolled serious chronic gastrointestinal condition associated with diarrhea

  • Active infection including tuberculosis (clinical evaluation that includes clinicalhistory, physical examination and radiographic findings, and tuberculosis [TB]testing in line with local practice), hepatitis B (known positive hepatitis B virus [HBV] surface antigen [HBsAg] result), hepatitis C; patients with a past or resolvedHBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] andabsence of HBsAg) are eligible; patients positive for hepatitis C (hepatitis C virus [HCV]) antibody are eligible only if polymerase chain reaction is negative for HCVribonucleic acid (RNA)

Study Design

Total Participants: 196
Treatment Group(s): 6
Primary Treatment: Laboratory Biomarker Analysis
Phase: 2/3
Study Start date:
April 03, 2018
Estimated Completion Date:
September 19, 2025

Study Description

PRIMARY OBJECTIVES:

I. To determine the safety of radiotherapy (RT) with concurrent and adjuvant anti-PD-L1 therapy (MEDI4736 [durvalumab]) is safe in patients with locoregionally advanced head and neck cancer (HNC) who have a contraindication to cisplatin. (Lead-in) II. To test the hypothesis that concurrent RT and anti-PD-L1 therapy improves progression free survival (PFS) compared to standard therapy (RT with concurrent cetuximab) in patients with locoregionally advanced HNC who have a contraindication to cisplatin. (Phase II) III. To test the hypothesis that concurrent RT and anti-PD-L1 therapy improves overall survival compared to standard therapy (RT with concurrent cetuximab) in patients with locoregionally advanced HNC who have a contraindication to cisplatin. (Phase III)

SECONDARY OBJECTIVES:

I. To compare toxicity using Common Terminology Criteria for Adverse Events (CTCAE) and Patient Reported Outcomes (PRO)-CTCAE between patients treated with RT + anti-PD-L1 therapy versus RT/cetuximab.

II. To test the effect of anti-PD-L1 therapy in the subpopulation of patients with tumors that overexpress PD-L1.

III. To compare overall survival, response (at 4-month fludeoxyglucose F-18 [FDG]-positron emission tomography [PET]-computed tomography [CT]), locoregional failure, distant metastasis, and competing mortality in the two arms by known risk factors, including p16 status and omega score.

IV. To test the hypothesis that MEDI4736 (durvalumab) therapy arm will have less decline in the physical function domain of European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30 version 3.0) based on the change in score from baseline to 12 months from end of RT, compared to the cetuximab-RT arm in patients with locoregionally advanced HNC who have a contraindication to cisplatin.

V. To test the hypothesis that MEDI4736 (durvalumab) therapy arm at 1 year (from end of RT) will have less decline in swallowing related quality of life (QOL) using the M. D. Anderson Dysphagia Inventory (MDADI) total composite score, based on the change in score from baseline to 12 months from end of RT, compared to the cetuximab-RT arm in patients who are medically unfit for cisplatin.

VI. To compare swallowing related performance and function short and long term using the Performance Status Scale for Head & Neck Cancer Patients (PSS-HN).

VII. To evaluate gastrostomy tube retention rates between arms.

EXPLORATORY OBJECTIVES:

I. To test the hypothesis that radiation combined with MEDI4736 (durvalumab) enhances the adaptive immune response using three types of immunophenotyping compared to radiation combined with cetuximab.

II. To compare overall QOL short term (end RT-8 months) and long term (12-24 months from end of RT) between arms using the EORTC QLQ-C30 version 3.0/HN35.

III. To evaluate swallowing related QOL short term (end RT-8 months) and long term (12-24 months from end of RT) using the EORTC Head and Neck (HN)35 swallowing domain and MDADI (subscales) between arms in patients with locoregionally advanced HNC who have a contraindication to cisplatin.

IV. To evaluate patient reported fatigue using the fatigue items in the EORTC QLQ and PRO-CTCAE.

V. To compare clinician and patient reported toxicity using CTCAE and PRO CTCAE.

VI. To explore health utilities between cetuximab and MEDI4736 (durvalumab) RT using the European Quality of Life 5 Dimensional-5 Level (EQ5D-5L).

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive cetuximab intravenously (IV) weekly over 60-120 minutes. Treatment repeats every week for up to 8 cycles in the absence of disease progression or unacceptable toxicity. Beginning 5-7 days after first cetuximab dose, patients undergo intensity modulated radiation therapy (IMRT) 5 fractions per week for up to 7 weeks.

ARM II: Patients receive durvalumab IV over 60 minutes every 4 weeks. Treatment repeats every 4 weeks for up to 7 cycles in the absence of disease progression or unacceptable toxicity. Beginning week 2, patients undergo IMRT 5 fractions per week for up to 7 weeks.

After completion of study treatment, patients are followed up at 1 month, every 4 months for 1 year, every 6 months for 2 years, then annually thereafter.

Connect with a study center

  • London Regional Cancer Program

    London, Ontario N6A 4L6
    Canada

    Site Not Available

  • University Health Network-Princess Margaret Hospital

    Toronto, Ontario M5G 2M9
    Canada

    Site Not Available

  • The Research Institute of the McGill University Health Centre (MUHC)

    Montreal, Quebec H3H 2R9
    Canada

    Site Not Available

  • Allan Blair Cancer Centre

    Regina, Saskatchewan S4T 7T1
    Canada

    Site Not Available

  • University of Alabama at Birmingham Cancer Center

    Birmingham, Alabama 35233
    United States

    Site Not Available

  • University of South Alabama Mitchell Cancer Institute

    Mobile, Alabama 36688
    United States

    Site Not Available

  • Banner MD Anderson Cancer Center

    Gilbert, Arizona 85234
    United States

    Site Not Available

  • CTCA at Western Regional Medical Center

    Goodyear, Arizona 85338
    United States

    Site Not Available

  • Banner University Medical Center - Tucson

    Tucson, Arizona 85719
    United States

    Site Not Available

  • University of Arizona Cancer Center-North Campus

    Tucson, Arizona 85719
    United States

    Site Not Available

  • Kaiser Permanente-Deer Valley Medical Center

    Antioch, California 94531
    United States

    Site Not Available

  • Sutter Cancer Centers Radiation Oncology Services-Auburn

    Auburn, California 95603
    United States

    Site Not Available

  • Alta Bates Summit Medical Center-Herrick Campus

    Berkeley, California 94704
    United States

    Site Not Available

  • City of Hope Comprehensive Cancer Center

    Duarte, California 91010
    United States

    Site Not Available

  • Kaiser Permanente Dublin

    Dublin, California 94568
    United States

    Site Not Available

  • Kaiser Permanente-Fremont

    Fremont, California 94538
    United States

    Site Not Available

  • Fresno Cancer Center

    Fresno, California 93720
    United States

    Site Not Available

  • Kaiser Permanente-Fresno

    Fresno, California 93720
    United States

    Site Not Available

  • UC San Diego Moores Cancer Center

    La Jolla, California 92093
    United States

    Site Not Available

  • Cedars Sinai Medical Center

    Los Angeles, California 90048
    United States

    Site Not Available

  • Kaiser Permanente-Modesto

    Modesto, California 95356
    United States

    Site Not Available

  • Kaiser Permanente Oakland-Broadway

    Oakland, California 94611
    United States

    Site Not Available

  • Kaiser Permanente-Oakland

    Oakland, California 94611
    United States

    Site Not Available

  • Stanford Cancer Institute Palo Alto

    Palo Alto, California 94304
    United States

    Site Not Available

  • VA Palo Alto Health Care System

    Palo Alto, California 94304
    United States

    Site Not Available

  • Kaiser Permanente-Rancho Cordova Cancer Center

    Rancho Cordova, California 95670
    United States

    Site Not Available

  • Kaiser Permanente-Richmond

    Richmond, California 94801
    United States

    Site Not Available

  • Rohnert Park Cancer Center

    Rohnert Park, California 94928
    United States

    Site Not Available

  • Kaiser Permanente-Roseville

    Roseville, California 95661
    United States

    Site Not Available

  • Sutter Cancer Centers Radiation Oncology Services-Roseville

    Roseville, California 95661
    United States

    Site Not Available

  • The Permanente Medical Group-Roseville Radiation Oncology

    Roseville, California 95678
    United States

    Site Not Available

  • Kaiser Permanente Downtown Commons

    Sacramento, California 95814
    United States

    Site Not Available

  • Kaiser Permanente-South Sacramento

    Sacramento, California 95823
    United States

    Site Not Available

  • South Sacramento Cancer Center

    Sacramento, California 95823
    United States

    Site Not Available

  • Sutter Medical Center Sacramento

    Sacramento, California 95816
    United States

    Site Not Available

  • University of California Davis Comprehensive Cancer Center

    Sacramento, California 95817
    United States

    Site Not Available

  • Kaiser Permanente-San Francisco

    San Francisco, California 94115
    United States

    Site Not Available

  • UCSF Medical Center-Mission Bay

    San Francisco, California 94158
    United States

    Site Not Available

  • UCSF Medical Center-Mount Zion

    San Francisco, California 94115
    United States

    Site Not Available

  • Kaiser Permanente-Santa Teresa-San Jose

    San Jose, California 95119
    United States

    Site Not Available

  • Kaiser Permanente San Leandro

    San Leandro, California 94577
    United States

    Site Not Available

  • Kaiser San Rafael-Gallinas

    San Rafael, California 94903
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Santa Clara

    Santa Clara, California 95051
    United States

    Site Not Available

  • Kaiser Permanente-Santa Rosa

    Santa Rosa, California 95403
    United States

    Site Not Available

  • City of Hope South Pasadena

    South Pasadena, California 91030
    United States

    Site Not Available

  • Kaiser Permanente Cancer Treatment Center

    South San Francisco, California 94080
    United States

    Site Not Available

  • Kaiser Permanente-South San Francisco

    South San Francisco, California 94080
    United States

    Site Not Available

  • Kaiser Permanente-Stockton

    Stockton, California 95210
    United States

    Site Not Available

  • Torrance Memorial Medical Center

    Torrance, California 90509
    United States

    Site Not Available

  • Torrance Memorial Physician Network - Cancer Care

    Torrance, California 90505
    United States

    Site Not Available

  • Gene Upshaw Memorial Tahoe Forest Cancer Center

    Truckee, California 96161
    United States

    Site Not Available

  • Kaiser Permanente Medical Center-Vacaville

    Vacaville, California 95688
    United States

    Site Not Available

  • Kaiser Permanente-Vallejo

    Vallejo, California 94589
    United States

    Site Not Available

  • Kaiser Permanente-Walnut Creek

    Walnut Creek, California 94596
    United States

    Site Not Available

  • UCHealth University of Colorado Hospital

    Aurora, Colorado 80045
    United States

    Site Not Available

  • University of Colorado Hospital

    Aurora, Colorado 80045
    United States

    Site Not Available

  • Memorial Hospital North

    Colorado Springs, Colorado 80920
    United States

    Site Not Available

  • Penrose-Saint Francis Healthcare

    Colorado Springs, Colorado 80907
    United States

    Site Not Available

  • UCHealth Memorial Hospital Central

    Colorado Springs, Colorado 80909
    United States

    Site Not Available

  • Poudre Valley Hospital

    Fort Collins, Colorado 80524
    United States

    Site Not Available

  • Banner McKee Medical Center

    Loveland, Colorado 80539
    United States

    Site Not Available

  • McKee Medical Center

    Loveland, Colorado 80539
    United States

    Site Not Available

  • Smilow Cancer Hospital-Hamden Care Center

    Hamden, Connecticut 06518
    United States

    Site Not Available

  • Yale University

    New Haven, Connecticut 06520
    United States

    Site Not Available

  • Smilow Cancer Hospital Care Center-Trumbull

    Trumbull, Connecticut 06611
    United States

    Site Not Available

  • Smilow Cancer Hospital Care Center - Waterford

    Waterford, Connecticut 06385
    United States

    Site Not Available

  • Beebe South Coastal Health Campus

    Frankford, Delaware 19945
    United States

    Site Not Available

  • Beebe South Coastal Health Campus

    Millville, Delaware 19967
    United States

    Site Not Available

  • Helen F Graham Cancer Center

    Newark, Delaware 19713
    United States

    Site Not Available

  • Beebe Health Campus

    Rehoboth Beach, Delaware 19971
    United States

    Site Not Available

  • UM Sylvester Comprehensive Cancer Center at Coral Gables

    Coral Gables, Florida 33146
    United States

    Site Not Available

  • UM Sylvester Comprehensive Cancer Center at Deerfield Beach

    Deerfield Beach, Florida 33442
    United States

    Site Not Available

  • Baptist MD Anderson Cancer Center

    Jacksonville, Florida 32207
    United States

    Site Not Available

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

    Miami, Florida 33136
    United States

    Site Not Available

  • Moffitt Cancer Center

    Tampa, Florida 33612
    United States

    Site Not Available

  • Emory University Hospital Midtown

    Atlanta, Georgia 30308
    United States

    Site Not Available

  • Emory University Hospital/Winship Cancer Institute

    Atlanta, Georgia 30322
    United States

    Site Not Available

  • Grady Health System

    Atlanta, Georgia 30303
    United States

    Site Not Available

  • Augusta University Medical Center

    Augusta, Georgia 30912
    United States

    Site Not Available

  • Hawaii Cancer Care Inc - Waterfront Plaza

    Honolulu, Hawaii 96813
    United States

    Site Not Available

  • Queen's Medical Center

    Honolulu, Hawaii 96813
    United States

    Site Not Available

  • The Cancer Center of Hawaii-Liliha

    Honolulu, Hawaii 96817
    United States

    Site Not Available

  • Saint Alphonsus Cancer Care Center-Caldwell

    Caldwell, Idaho 83605
    United States

    Site Not Available

  • Saint Alphonsus Cancer Care Center-Nampa

    Nampa, Idaho 83687
    United States

    Site Not Available

  • John H Stroger Jr Hospital of Cook County

    Chicago, Illinois 60612
    United States

    Site Not Available

  • Northwestern University

    Chicago, Illinois 60611
    United States

    Site Not Available

  • Rush University Medical Center

    Chicago, Illinois 60612
    United States

    Site Not Available

  • University of Illinois

    Chicago, Illinois 60612
    United States

    Site Not Available

  • Decatur Memorial Hospital

    Decatur, Illinois 62526
    United States

    Site Not Available

  • Crossroads Cancer Center

    Effingham, Illinois 62401
    United States

    Site Not Available

  • Western Illinois Cancer Treatment Center

    Galesburg, Illinois 61401
    United States

    Site Not Available

  • Methodist Medical Center of Illinois

    Peoria, Illinois 61636
    United States

    Site Not Available

  • OSF Saint Francis Medical Center

    Peoria, Illinois 61637
    United States

    Site Not Available

  • Memorial Medical Center

    Springfield, Illinois 62781
    United States

    Site Not Available

  • Springfield Memorial Hospital

    Springfield, Illinois 62781
    United States

    Site Not Available

  • Carle Cancer Center

    Urbana, Illinois 61801
    United States

    Site Not Available

  • IU Health North Hospital

    Carmel, Indiana 46032
    United States

    Site Not Available

  • Parkview Hospital Randallia

    Fort Wayne, Indiana 46805
    United States

    Site Not Available

  • Parkview Regional Medical Center

    Fort Wayne, Indiana 46845
    United States

    Site Not Available

  • Community Cancer Center East

    Indianapolis, Indiana 46219
    United States

    Site Not Available

  • Community Cancer Center North

    Indianapolis, Indiana 46256
    United States

    Site Not Available

  • Community Cancer Center South

    Indianapolis, Indiana 46227
    United States

    Site Not Available

  • Indiana University/Melvin and Bren Simon Cancer Center

    Indianapolis, Indiana 46202
    United States

    Site Not Available

  • Sidney and Lois Eskenazi Hospital

    Indianapolis, Indiana 46202
    United States

    Site Not Available

  • Mercy Cancer Center-West Lakes

    Clive, Iowa 50325
    United States

    Site Not Available

  • Iowa Methodist Medical Center

    Des Moines, Iowa 50309
    United States

    Site Not Available

  • Mercy Medical Center - Des Moines

    Des Moines, Iowa 50314
    United States

    Site Not Available

  • University of Kansas Cancer Center

    Kansas City, Kansas 66160
    United States

    Site Not Available

  • University of Kansas Cancer Center-Overland Park

    Overland Park, Kansas 66210
    United States

    Site Not Available

  • Salina Regional Health Center

    Salina, Kansas 67401
    United States

    Site Not Available

  • University of Kansas Hospital-Westwood Cancer Center

    Westwood, Kansas 66205
    United States

    Site Not Available

  • Ascension Via Christi Hospitals Wichita

    Wichita, Kansas 67214
    United States

    Site Not Available

  • University of Kentucky/Markey Cancer Center

    Lexington, Kentucky 40536
    United States

    Site Not Available

  • Norton Brownsboro Hospital and Medical Campus

    Louisville, Kentucky 40241
    United States

    Site Not Available

  • Norton Hospital Pavilion and Medical Campus

    Louisville, Kentucky 40202
    United States

    Site Not Available

  • The James Graham Brown Cancer Center at University of Louisville

    Louisville, Kentucky 40202
    United States

    Site Not Available

  • East Jefferson General Hospital

    Metairie, Louisiana 70006
    United States

    Site Not Available

  • Greater Baltimore Medical Center

    Baltimore, Maryland 21204
    United States

    Site Not Available

  • Boston Medical Center

    Boston, Massachusetts 02118
    United States

    Site Not Available

  • Lahey Hospital and Medical Center

    Burlington, Massachusetts 01805
    United States

    Site Not Available

  • Saint Joseph Mercy Hospital

    Ann Arbor, Michigan 48106
    United States

    Site Not Available

  • Trinity Health Saint Joseph Mercy Hospital Ann Arbor

    Ann Arbor, Michigan 48106
    United States

    Site Not Available

  • University of Michigan Comprehensive Cancer Center

    Ann Arbor, Michigan 48109
    United States

    Site Not Available

  • McLaren Cancer Institute-Bay City

    Bay City, Michigan 48706
    United States

    Site Not Available

  • Saint Joseph Mercy Brighton

    Brighton, Michigan 48114
    United States

    Site Not Available

  • Trinity Health Medical Center - Brighton

    Brighton, Michigan 48114
    United States

    Site Not Available

  • Henry Ford Cancer Institute-Downriver

    Brownstown, Michigan 48183
    United States

    Site Not Available

  • Saint Joseph Mercy Canton

    Canton, Michigan 48188
    United States

    Site Not Available

  • Trinity Health Medical Center - Canton

    Canton, Michigan 48188
    United States

    Site Not Available

  • Chelsea Hospital

    Chelsea, Michigan 48118
    United States

    Site Not Available

  • Saint Joseph Mercy Chelsea

    Chelsea, Michigan 48118
    United States

    Site Not Available

  • McLaren Cancer Institute-Clarkston

    Clarkston, Michigan 48346
    United States

    Site Not Available

  • Henry Ford Macomb Hospital-Clinton Township

    Clinton Township, Michigan 48038
    United States

    Site Not Available

  • Henry Ford Hospital

    Detroit, Michigan 48202
    United States

    Site Not Available

  • Wayne State University/Karmanos Cancer Institute

    Detroit, Michigan 48201
    United States

    Site Not Available

  • Weisberg Cancer Treatment Center

    Farmington Hills, Michigan 48334
    United States

    Site Not Available

  • McLaren Cancer Institute-Flint

    Flint, Michigan 48532
    United States

    Site Not Available

  • Singh and Arora Hematology Oncology PC

    Flint, Michigan 48532
    United States

    Site Not Available

  • Allegiance Health

    Jackson, Michigan 49201
    United States

    Site Not Available

  • Karmanos Cancer Institute at McLaren Greater Lansing

    Lansing, Michigan 48910
    United States

    Site Not Available

  • Mid-Michigan Physicians-Lansing

    Lansing, Michigan 48912
    United States

    Site Not Available

  • Sparrow Hospital

    Lansing, Michigan 48912
    United States

    Site Not Available

  • University of Michigan Health - Sparrow Lansing

    Lansing, Michigan 48912
    United States

    Site Not Available

  • McLaren Cancer Institute-Lapeer Region

    Lapeer, Michigan 48446
    United States

    Site Not Available

  • McLaren Cancer Institute-Macomb

    Mount Clemens, Michigan 48043
    United States

    Site Not Available

  • McLaren Cancer Institute-Northern Michigan

    Petoskey, Michigan 49770
    United States

    Site Not Available

  • McLaren-Port Huron

    Port Huron, Michigan 48060
    United States

    Site Not Available

  • Ascension Saint Mary's Hospital

    Saginaw, Michigan 48601
    United States

    Site Not Available

  • MyMichigan Medical Center Saginaw

    Saginaw, Michigan 48601
    United States

    Site Not Available

  • Henry Ford West Bloomfield Hospital

    West Bloomfield, Michigan 48322
    United States

    Site Not Available

  • Sanford Joe Lueken Cancer Center

    Bemidji, Minnesota 56601
    United States

    Site Not Available

  • Fairview Ridges Hospital

    Burnsville, Minnesota 55337
    United States

    Site Not Available

  • Miller-Dwan Hospital

    Duluth, Minnesota 55805
    United States

    Site Not Available

  • Fairview Southdale Hospital

    Edina, Minnesota 55435
    United States

    Site Not Available

  • Unity Hospital

    Fridley, Minnesota 55432
    United States

    Site Not Available

  • Hennepin County Medical Center

    Minneapolis, Minnesota 55415
    United States

    Site Not Available

  • Mayo Clinic in Rochester

    Rochester, Minnesota 55905
    United States

    Site Not Available

  • Coborn Cancer Center at Saint Cloud Hospital

    Saint Cloud, Minnesota 56303
    United States

    Site Not Available

  • Regions Hospital

    Saint Paul, Minnesota 55101
    United States

    Site Not Available

  • Saint Francis Medical Center

    Cape Girardeau, Missouri 63703
    United States

    Site Not Available

  • Siteman Cancer Center at West County Hospital

    Creve Coeur, Missouri 63141
    United States

    Site Not Available

  • Mercy Hospital Saint Louis

    Saint Louis, Missouri 63141
    United States

    Site Not Available

  • Washington University School of Medicine

    Saint Louis, Missouri 63110
    United States

    Site Not Available

  • Siteman Cancer Center at Saint Peters Hospital

    Saint Peters, Missouri 63376
    United States

    Site Not Available

  • Billings Clinic Cancer Center

    Billings, Montana 59101
    United States

    Site Not Available

  • Kalispell Regional Medical Center

    Kalispell, Montana 59901
    United States

    Site Not Available

  • Logan Health Medical Center

    Kalispell, Montana 59901
    United States

    Site Not Available

  • CHI Health Saint Francis

    Grand Island, Nebraska 68803
    United States

    Site Not Available

  • Nebraska Cancer Specialists/Oncology Hematology West PC

    Grand Island, Nebraska 68803
    United States

    Site Not Available

  • Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center

    Lebanon, New Hampshire 03756
    United States

    Site Not Available

  • Memorial Sloan Kettering Basking Ridge

    Basking Ridge, New Jersey 07920
    United States

    Site Not Available

  • Hackensack University Medical Center

    Hackensack, New Jersey 07601
    United States

    Site Not Available

  • Memorial Sloan Kettering Monmouth

    Middletown, New Jersey 07748
    United States

    Site Not Available

  • Memorial Sloan Kettering Bergen

    Montvale, New Jersey 07645
    United States

    Site Not Available

  • New Mexico Oncology Hematology Consultants

    Albuquerque, New Mexico 87109
    United States

    Site Not Available

  • University of New Mexico Cancer Center

    Albuquerque, New Mexico 87106
    United States

    Site Not Available

  • James J Peters VA Medical Center

    Bronx, New York 10468
    United States

    Site Not Available

  • Montefiore Medical Center - Moses Campus

    Bronx, New York 10467
    United States

    Site Not Available

  • Roswell Park Cancer Institute

    Buffalo, New York 14263
    United States

    Site Not Available

  • Memorial Sloan Kettering Commack

    Commack, New York 11725
    United States

    Site Not Available

  • Memorial Sloan Kettering Westchester

    Harrison, New York 10604
    United States

    Site Not Available

  • Laura and Isaac Perlmutter Cancer Center at NYU Langone

    New York, New York 10016
    United States

    Site Not Available

  • Memorial Sloan Kettering Cancer Center

    New York, New York 10065
    United States

    Site Not Available

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

    New York, New York 10032
    United States

    Site Not Available

  • University of Rochester

    Rochester, New York 14642
    United States

    Site Not Available

  • Stony Brook University Medical Center

    Stony Brook, New York 11794
    United States

    Site Not Available

  • State University of New York Upstate Medical University

    Syracuse, New York 13210
    United States

    Site Not Available

  • Memorial Sloan Kettering Nassau

    Uniondale, New York 11553
    United States

    Site Not Available

  • Atrium Health Stanly/LCI-Albemarle

    Albemarle, North Carolina 28002
    United States

    Site Not Available

  • UNC Lineberger Comprehensive Cancer Center

    Chapel Hill, North Carolina 27599
    United States

    Site Not Available

  • Atrium Health Pineville/LCI-Pineville

    Charlotte, North Carolina 28210
    United States

    Site Not Available

  • Carolinas Medical Center/Levine Cancer Institute

    Charlotte, North Carolina 28203
    United States

    Site Not Available

  • Atrium Health Cabarrus/LCI-Concord

    Concord, North Carolina 28025
    United States

    Site Not Available

  • Margaret R Pardee Memorial Hospital

    Hendersonville, North Carolina 28791
    United States

    Site Not Available

  • Atrium Health Union/LCI-Union

    Monroe, North Carolina 28112
    United States

    Site Not Available

  • Sanford Roger Maris Cancer Center

    Fargo, North Dakota 58122
    United States

    Site Not Available

  • Aultman Health Foundation

    Canton, Ohio 44710
    United States

    Site Not Available

  • Cleveland Clinic Mercy Hospital

    Canton, Ohio 44708
    United States

    Site Not Available

  • Geauga Hospital

    Chardon, Ohio 44024
    United States

    Site Not Available

  • University of Cincinnati Cancer Center-UC Medical Center

    Cincinnati, Ohio 45219
    United States

    Site Not Available

  • Case Western Reserve University

    Cleveland, Ohio 44106
    United States

    Site Not Available

  • Cleveland Clinic Foundation

    Cleveland, Ohio 44195
    United States

    Site Not Available

  • MetroHealth Medical Center

    Cleveland, Ohio 44109
    United States

    Site Not Available

  • Ohio State University Comprehensive Cancer Center

    Columbus, Ohio 43210
    United States

    Site Not Available

  • Cleveland Clinic Cancer Center Mansfield

    Mansfield, Ohio 44906
    United States

    Site Not Available

  • UH Seidman Cancer Center at Lake Health Mentor Campus

    Mentor, Ohio 44060
    United States

    Site Not Available

  • North Coast Cancer Care

    Sandusky, Ohio 44870
    United States

    Site Not Available

  • ProMedica Flower Hospital

    Sylvania, Ohio 43560
    United States

    Site Not Available

  • University of Cincinnati Cancer Center-West Chester

    West Chester, Ohio 45069
    United States

    Site Not Available

  • UHHS-Westlake Medical Center

    Westlake, Ohio 44145
    United States

    Site Not Available

  • Cleveland Clinic Wooster Family Health and Surgery Center

    Wooster, Ohio 44691
    United States

    Site Not Available

  • University of Oklahoma Health Sciences Center

    Oklahoma City, Oklahoma 73104
    United States

    Site Not Available

  • Good Samaritan Hospital

    Corvallis, Oregon 97330
    United States

    Site Not Available

  • Kaiser Permanente Northwest

    Portland, Oregon 97227
    United States

    Site Not Available

  • Providence Portland Medical Center

    Portland, Oregon 97213
    United States

    Site Not Available

  • Providence Saint Vincent Medical Center

    Portland, Oregon 97225
    United States

    Site Not Available

  • Jefferson Abington Hospital

    Abington, Pennsylvania 19001
    United States

    Site Not Available

  • Crozer-Keystone Regional Cancer Center at Broomall

    Broomall, Pennsylvania 19008
    United States

    Site Not Available

  • Christiana Care Health System-Concord Health Center

    Chadds Ford, Pennsylvania 19317
    United States

    Site Not Available

  • Geisinger Medical Center

    Danville, Pennsylvania 17822
    United States

    Site Not Available

  • Penn State Milton S Hershey Medical Center

    Hershey, Pennsylvania 17033-0850
    United States

    Site Not Available

  • Geisinger Medical Oncology-Lewisburg

    Lewisburg, Pennsylvania 17837
    United States

    Site Not Available

  • Lewistown Hospital

    Lewistown, Pennsylvania 17044
    United States

    Site Not Available

  • Forbes Hospital

    Monroeville, Pennsylvania 15146
    United States

    Site Not Available

  • Fox Chase Cancer Center

    Philadelphia, Pennsylvania 19111
    United States

    Site Not Available

  • Temple University Hospital

    Philadelphia, Pennsylvania 19140
    United States

    Site Not Available

  • Allegheny General Hospital

    Pittsburgh, Pennsylvania 15212
    United States

    Site Not Available

  • UPMC-Shadyside Hospital

    Pittsburgh, Pennsylvania 15232
    United States

    Site Not Available

  • Guthrie Medical Group PC-Robert Packer Hospital

    Sayre, Pennsylvania 18840
    United States

    Site Not Available

  • Reading Hospital

    West Reading, Pennsylvania 19611
    United States

    Site Not Available

  • Wexford Health and Wellness Pavilion

    Wexford, Pennsylvania 15090
    United States

    Site Not Available

  • Geisinger Wyoming Valley/Henry Cancer Center

    Wilkes-Barre, Pennsylvania 18711
    United States

    Site Not Available

  • Asplundh Cancer Pavilion

    Willow Grove, Pennsylvania 19090
    United States

    Site Not Available

  • Medical University of South Carolina

    Charleston, South Carolina 29425
    United States

    Site Not Available

  • Gibbs Cancer Center-Pelham

    Greer, South Carolina 29651
    United States

    Site Not Available

  • Rock Hill Radiation Therapy Center

    Rock Hill, South Carolina 29730
    United States

    Site Not Available

  • Spartanburg Medical Center

    Spartanburg, South Carolina 29303
    United States

    Site Not Available

  • Avera Cancer Institute

    Sioux Falls, South Dakota 57105
    United States

    Site Not Available

  • Sanford USD Medical Center - Sioux Falls

    Sioux Falls, South Dakota 57117-5134
    United States

    Site Not Available

  • M D Anderson Cancer Center

    Houston, Texas 77030
    United States

    Site Not Available

  • Dartmouth Cancer Center - North

    Saint Johnsbury, Vermont 05819
    United States

    Site Not Available

  • Norris Cotton Cancer Center-North

    Saint Johnsbury, Vermont 05819
    United States

    Site Not Available

  • University of Virginia Cancer Center

    Charlottesville, Virginia 22908
    United States

    Site Not Available

  • Sentara Norfolk General Hospital

    Norfolk, Virginia 23507
    United States

    Site Not Available

  • VCU Massey Cancer Center at Stony Point

    Richmond, Virginia 23235
    United States

    Site Not Available

  • Virginia Commonwealth University/Massey Cancer Center

    Richmond, Virginia 23298
    United States

    Site Not Available

  • University of Washington Medical Center - Montlake

    Seattle, Washington 98195
    United States

    Site Not Available

  • West Virginia University Healthcare

    Morgantown, West Virginia 26506
    United States

    Site Not Available

  • Langlade Hospital and Cancer Center

    Antigo, Wisconsin 54409
    United States

    Site Not Available

  • Aurora BayCare Medical Center

    Green Bay, Wisconsin 54311
    United States

    Site Not Available

  • Saint Vincent Hospital Cancer Center Green Bay

    Green Bay, Wisconsin 54301
    United States

    Site Not Available

  • Saint Vincent Hospital Cancer Center at Saint Mary's

    Green Bay, Wisconsin 54303
    United States

    Site Not Available

  • UW Cancer Center Johnson Creek

    Johnson Creek, Wisconsin 53038
    United States

    Site Not Available

  • University of Wisconsin Carbone Cancer Center - Johnson Creek

    Johnson Creek, Wisconsin 53038
    United States

    Site Not Available

  • University of Wisconsin Carbone Cancer Center Johnson Creek

    Johnson Creek, Wisconsin 53038
    United States

    Site Not Available

  • Aurora Cancer Care-Kenosha South

    Kenosha, Wisconsin 53142
    United States

    Site Not Available

  • Gundersen Lutheran Medical Center

    La Crosse, Wisconsin 54601
    United States

    Site Not Available

  • University of Wisconsin Carbone Cancer Center

    Madison, Wisconsin 53792
    United States

    Site Not Available

  • University of Wisconsin Carbone Cancer Center - University Hospital

    Madison, Wisconsin 53792
    United States

    Site Not Available

  • Aurora Bay Area Medical Group-Marinette

    Marinette, Wisconsin 54143
    United States

    Site Not Available

  • Froedtert Menomonee Falls Hospital

    Menomonee Falls, Wisconsin 53051
    United States

    Site Not Available

  • Aurora Saint Luke's Medical Center

    Milwaukee, Wisconsin 53215
    United States

    Site Not Available

  • Medical College of Wisconsin

    Milwaukee, Wisconsin 53226
    United States

    Site Not Available

  • Zablocki Veterans Administration Medical Center

    Milwaukee, Wisconsin 53295
    United States

    Site Not Available

  • ProHealth D N Greenwald Center

    Mukwonago, Wisconsin 53149
    United States

    Site Not Available

  • ProHealth Oconomowoc Memorial Hospital

    Oconomowoc, Wisconsin 53066
    United States

    Site Not Available

  • Vince Lombardi Cancer Clinic-Sheboygan

    Sheboygan, Wisconsin 53081
    United States

    Site Not Available

  • Aurora Medical Center in Summit

    Summit, Wisconsin 53066
    United States

    Site Not Available

  • UW Cancer Center at ProHealth Care

    Waukesha, Wisconsin 53188
    United States

    Site Not Available

  • Aspirus Regional Cancer Center

    Wausau, Wisconsin 54401
    United States

    Site Not Available

  • Aurora West Allis Medical Center

    West Allis, Wisconsin 53227
    United States

    Site Not Available

  • Froedtert West Bend Hospital/Kraemer Cancer Center

    West Bend, Wisconsin 53095
    United States

    Site Not Available

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