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NCT04510597PHASE3Recruiting

Comparing the Outcome of Immunotherapy-Based Drug Combination Therapy With or Without Surgery to Remove the Kidney in Metastatic Kidney Cancer, the PROBE Trial

SWOG Cancer Research Network

Start Date

3/8/2021

Completion Date

7/1/2033

Summary

This phase III trial compares the effect of adding surgery to a standard of care immunotherapy-based drug combination versus a standard of care immunotherapy-based drug combination alone in treating patients with kidney cancer that has spread to other places in the body (metastatic). Immunotherapy with monoclonal antibodies, such as nivolumab, ipilimumab, pembrolizumab, and avelumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Axitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Surgery to remove the kidney, called a nephrectomy, is also considered standard of care; however, doctors who treat kidney cancer do not agree on its benefits. It is not yet known if the addition of surgery to an immunotherapy-based drug combination works better than an immunotherapy-based drug combination alone in treating patients with kidney cancer.

Detailed Description

PRIMARY OBJECTIVE: I. To compare overall survival in participants with newly diagnosed metastatic renal cell carcinoma who are randomized to receive immune checkpoint inhibitor-based combination treatment plus cytoreductive nephrectomy versus immune checkpoint inhibitor-based combination treatment alone. SECONDARY OBJECTIVES: I. To compare overall survival between arms in the subset who received their assigned protocol treatment. II. To assess complications of nephrectomy and post-randomization drug toxicities. III. To compare objective response rate in metastatic sites between the arms in participants with measurable metastatic disease. IV. To assess change in diameter of primary tumor at week 12 disease assessment in participants who have received pre-randomization treatment. BANKING OBJECTIVE: I. To bank specimens for future correlative studies. OUTLINE: PRE-RANDOMIZATION TREATMENT: Treatment naive patients are assigned to 1 of 3 treatment regimens per standard of care. REGIMEN I: Patients receive nivolumab intravenously (IV) and ipilimumab IV. Treatment repeats every 3 weeks for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients then receive nivolumab IV on day 1. Cycles repeat every 2-4 weeks in the absence of disease progression or unacceptable toxicity. REGIMEN II: Patients receive pembrolizumab IV on day 1 and axitinib orally (PO) twice daily (BID) on days 1-21. Cycles repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. REGIMEN III: Patients receive avelumab IV on day 1 and axitinib PO BID on days 1-14. Cycles repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. NOTE: Some patients may have already completed the standard of care pre-randomization treatment specified above off-trial. RANDOMIZATION TREATMENT: Between 10-14 weeks from the start of on-trial or off-trial pre-randomization treatment, patients are randomized to 1 of 2 arms. ARM I: Patients receive nivolumab IV, pembrolizumab IV, or avelumab IV on day 1. Patients also receive axitinib PO BID. Cycles with nivolumab repeat every 2 or 4 weeks, cycles with pembrolizumab repeat every 3 weeks, and cycles with avelumab repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. ARM II: Within 42 days following randomization, patients undergo radical or partial nephrectomy in addition to nivolumab, pembrolizumab, avelumab, and axitinib as in Arm I in the absence of disease progression or unacceptable toxicity. Axitinib should be stopped at least 24 hours prior to surgery. After completion of trial treatment, patients are followed up every 3 months for the first year, every 6 months for years 2 and 3, and then annually for up to 7 years from randomization.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: * STEP 1 REGISTRATION: Participants must have a histologically proven diagnosis of clear cell or non-clear cell renal cell carcinoma. Participants with collecting duct carcinoma histology are not eligible. Participants with multifocal or bilateral tumors are eligible * STEP 1 REGISTRATION: Participants must have primary tumor in place * STEP 1 REGISTRATION: Participants must have the following scans performed, showing clinical evidence of measurable or non-measurable metastatic disease: * Computed tomography (CT) scan of the chest (can be performed without contrast if CT contrast cannot be given) * CT of abdomen and pelvis with contrast OR magnetic resonance imaging (MRI) of the abdomen and pelvis with or without contrast Scans must be performed within the following timeframes: * Treatment naive participants must have scans documenting metastatic disease completed within 90 days prior to study registration * Previously treated participants must have scans documenting metastatic disease completed within 90 days prior to first dose of systemic treatment * STEP 1 REGISTRATION: Participants with symptomatic metastases may have received palliative radiotherapy or receive palliative radiotherapy after registration * STEP 1 REGISTRATION: Participants must have no clear contraindications to nephrectomy * STEP 1 REGISTRATION: Participants must be offered the opportunity to participate in specimen bank. With participant consent, specimens must be collected and submitted via the Southwest Oncology Group (SWOG) Specimen Tracking System * STEP 1 REGISTRATION: Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines * STEP 1 REGISTRATION: As part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system * STEP 2 REGISTRATION: Participants must have at least one of the following scans performed 12 weeks (+/- 2 weeks) after starting pre-randomization treatment * CT scan of the chest (can be performed without contrast if CT contrast cannot be given) * CT of abdomen and pelvis with contrast OR MRI of the abdomen and pelvis with or without contrast Scans must be performed within 28 days prior to randomization. Response should be assessed by comparing with a CT or MRI of the chest, abdomen and pelvis obtained prior to starting pre-randomization treatment. Participants with complete response in all metastatic sites are not eligible to randomize to Step 2 • STEP 2 REGISTRATION: Participants must have one of the following objective statuses after 12 weeks of pre-randomization treatment * Stable disease * Partial response * The treating investigator believes the patient is deriving clinical benefit from systemic therapy AND have Zubrod performance status 0-1 * STEP 2 REGISTRATION: Participants must plan to continue the immune-based therapy received during pre-randomization treatment * STEP 2 REGISTRATION: Participants must be randomized on or between the 11th and 14th week of protocol-directed pre-randomization treatment therapy * STEP 2 REGISTRATION: Participants must have received at least one of the minimum amounts of immunotherapy: * 2 infusions of nivolumab + 1 infusion of ipilimumab * 2 infusions of pembrolizumab * 2 infusions of avelumab * STEP 2 REGISTRATION: Participants must have a planned surgery date within 42 days of randomization * STEP 2 REGISTRATION: Participants must be a surgical candidate as determined by study urologist. The urology consult should be done within 42 days prior to randomization * STEP 2 REGISTRATION: Participants must have a complete physical examination and medical history within 28 days prior to randomization * STEP 2 REGISTRATION: Participants must have a Zubrod performance status of 0-1 within 28 days prior to randomization * STEP 2 REGISTRATION: Total bilirubin =\< institutional upper limit of normal (ULN) (within 28 days prior to randomization) * STEP 2 REGISTRATION: Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =\< 3 x institutional upper limit of normal (ULN) (within 28 days prior to randomization) * STEP 2 REGISTRATION: Serum creatinine =\< 1.5 x the institutional upper limit of normal (IULN) OR measured OR calculated creatinine clearance \>= 50 mL/min using the Cockcroft-Gault Formula) (must have been drawn and processed within 28 days prior to randomization) Exclusion Criteria: * STEP 1 REGISTRATION: Participants must not have known active brain metastases. Participants with previously treated brain metastases are eligible if participant has no neurologic signs or symptoms suggestive of brain metastasis. Brain imaging studies are not required. If brain imaging studies are performed, they must be negative for disease * STEP 1 REGISTRATION: Participants must not have received the following prior treatment of metastatic renal cell carcinoma: * Treatment naive participants must not have received any prior lines of systemic therapy for metastatic renal cell carcinoma beyond the line intended as part of protocol therapy * Previously treated participants must not have received any systemic therapy for metastatic renal cell carcinoma beyond the one regimen received off protocol as specified in Step 1 pre-randomization treatment * STEP 1 REGISTRATION: Participants must not have received more than the following amounts protocol-directed pre-randomization treatment: * Treatment naive participants must not have received any pre-randomization treatment. * Previously treated participants must not be planning to receive any additional treatment prior to Step 2 randomization, and must not have received more than the following amounts of pre-randomization treatment: * 4 infusions of nivolumab * 4 infusions of ipilimumab * 4 infusions of pembrolizumab * 7 infusions of avelumab * STEP 1 REGISTRATION: Participants must not have received immunotherapy for any cancer within the following timeframes: * Treatment naive participants must not have received any immunotherapy within a year of registration * Previously treated participants must not have received any other immunotherapy within a year of the start of off protocol specified pre-randomization treatment * STEP 1 REGISTRATION: Participants must not have a solitary kidney and not have a transplanted kidney * STEP 1 REGISTRATION: No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, any in situ or T1 cancer, adequately treated stage I or II cancer from which the participant is currently in complete remission, or any other cancer from which the participant has been disease free for at least two years * STEP 1 REGISTRATION: Participants must not have been previously diagnosed with a medical condition that makes them ineligible for immune based combination therapy or nephrectomy * STEP 2 REGISTRATION: Participants must not show progression in the primary tumor. Participants who are considered to have pseudo progression are allowed * STEP 2 REGISTRATION: Participants must not have known active brain metastases. Participants with previously treated brain metastases are eligible if participant has no neurologic signs or symptoms suggestive of brain metastasis. Brain imaging studies are not required. If brain imaging studies are performed, they must be negative for disease * STEP 2 REGISTRATION: No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the participant is currently in complete remission, or any other cancer from which the participant has been disease free for two years

Interventions

PROCEDURE

Cytoreductive Nephrectomy

DRUG

Active Comparator

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Conditions

Metastatic Clear Cell Renal Cell CarcinomaMetastatic Renal Cell CarcinomaStage IV Renal Cell Cancer AJCC v8

Locations

University of Alabama at Birmingham Cancer Center

Birmingham, Alabama 35233

United States

Banner MD Anderson Cancer Center

Gilbert, Arizona 85234

United States

Kingman Regional Medical Center

Kingman, Arizona 86401

United States

Banner University Medical Center - Tucson

Tucson, Arizona 85719

United States

University of Arizona Cancer Center-North Campus

Tucson, Arizona 85719

United States

Mercy Hospital Fort Smith

Fort Smith, Arkansas 72903

United States

PCR Oncology

Arroyo Grande, California 93420

United States

Sutter Auburn Faith Hospital

Auburn, California 95602

United States

Sutter Cancer Centers Radiation Oncology Services-Auburn

Auburn, California 95603

United States

Alta Bates Summit Medical Center-Herrick Campus

Berkeley, California 94704

United States

Keck Medicine of USC Buena Park

Buena Park, California 90621

United States

Sutter Cancer Centers Radiation Oncology Services-Cameron Park

Cameron Park, California 95682

United States

Eden Hospital Medical Center

Castro Valley, California 94546

United States

Sutter Davis Hospital

Davis, California 95616

United States

City of Hope Comprehensive Cancer Center

Duarte, California 91010

United States

Palo Alto Medical Foundation-Fremont

Fremont, California 94538

United States

Keck Medicine of USC Huntington Beach

Huntington Beach, California 92648

United States

Keck Medicine of USC Koreatown

Los Angeles, California 90020

United States

Los Angeles County-USC Medical Center

Los Angeles, California 90033

United States

USC / Norris Comprehensive Cancer Center

Los Angeles, California 90033

United States

Cedars Sinai Medical Center

Los Angeles, California 90048

United States

UCLA / Jonsson Comprehensive Cancer Center

Los Angeles, California 90095

United States

Memorial Medical Center

Modesto, California 95355

United States

Palo Alto Medical Foundation-Camino Division

Mountain View, California 94040

United States

Palo Alto Medical Foundation-Gynecologic Oncology

Mountain View, California 94040

United States

USC Norris Oncology/Hematology-Newport Beach

Newport Beach, California 92663

United States

Sutter Cancer Research Consortium

Novato, California 94945

United States

Palo Alto Medical Foundation Health Care

Palo Alto, California 94301

United States

Keck Medical Center of USC Pasadena

Pasadena, California 91105

United States

Sutter Cancer Centers Radiation Oncology Services-Roseville

Roseville, California 95661

United States

Sutter Roseville Medical Center

Roseville, California 95661

United States

Sutter Medical Center Sacramento

Sacramento, California 95816

United States

University of California Davis Comprehensive Cancer Center

Sacramento, California 95817

United States

California Pacific Medical Center-Pacific Campus

San Francisco, California 94115

United States

Mills Health Center

San Mateo, California 94401

United States

Palo Alto Medical Foundation-Santa Cruz

Santa Cruz, California 95065

United States

Sutter Pacific Medical Foundation

Santa Rosa, California 95403

United States

City of Hope South Pasadena

South Pasadena, California 91030

United States

Palo Alto Medical Foundation-Sunnyvale

Sunnyvale, California 94086

United States

Cedars-Sinai Cancer - Tarzana

Tarzana, California 91356

United States

City of Hope Upland

Upland, California 91786

United States

Sutter Cancer Centers Radiation Oncology Services-Vacaville

Vacaville, California 95687

United States

Sutter Solano Medical Center/Cancer Center

Vallejo, California 94589

United States

MedStar Washington Hospital Center

Washington D.C., District of Columbia 20010

United States

AdventHealth Altamonte

Altamonte Springs, Florida 32701

United States

AdventHealth Celebration

Celebration, Florida 34747

United States

AdventHealth Kissimmee

Kissimmee, Florida 34744

United States

AdventHealth Medical Group Urology at Orlando

Orlando, Florida 32803

United States

AdventHealth Orlando

Orlando, Florida 32803

United States

Orlando Health Cancer Institute

Orlando, Florida 32806

United States

AdventHealth East Orlando

Orlando, Florida 32822

United States

AdventHealth Winter Park

Winter Park, Florida 32792

United States

Saint Anthony's Health

Alton, Illinois 62002

United States

Rush - Copley Medical Center

Aurora, Illinois 60504

United States

Advocate Good Shepherd Hospital

Barrington, Illinois 60010

United States

Illinois CancerCare-Bloomington

Bloomington, Illinois 61704

United States

Loyola Center for Health at Burr Ridge

Burr Ridge, Illinois 60527

United States

Illinois CancerCare-Canton

Canton, Illinois 61520

United States

Memorial Hospital of Carbondale

Carbondale, Illinois 62902

United States

SIH Cancer Institute

Carterville, Illinois 62918

United States

Illinois CancerCare-Carthage

Carthage, Illinois 62321

United States

Centralia Oncology Clinic

Centralia, Illinois 62801

United States

Saint Mary's Hospital

Centralia, Illinois 62801

United States

Northwestern University

Chicago, Illinois 60611

United States

Rush University Medical Center

Chicago, Illinois 60612

United States

University of Illinois

Chicago, Illinois 60612

United States

University of Chicago Comprehensive Cancer Center

Chicago, Illinois 60637

United States

Advocate Illinois Masonic Medical Center

Chicago, Illinois 60657

United States

AMG Crystal Lake - Oncology

Crystal Lake, Illinois 60014

United States

Carle at The Riverfront

Danville, Illinois 61832

United States

Cancer Care Specialists of Illinois - Decatur

Decatur, Illinois 62526

United States

Decatur Memorial Hospital

Decatur, Illinois 62526

United States

Northwestern Medicine Cancer Center Kishwaukee

DeKalb, Illinois 60115

United States

Illinois CancerCare-Dixon

Dixon, Illinois 61021

United States

Advocate Good Samaritan Hospital

Downers Grove, Illinois 60515

United States

Carle Physician Group-Effingham

Effingham, Illinois 62401

United States

Crossroads Cancer Center

Effingham, Illinois 62401

United States

Advocate Sherman Hospital

Elgin, Illinois 60123

United States

Elmhurst Memorial Hospital

Elmhurst, Illinois 60126

United States

Illinois CancerCare-Eureka

Eureka, Illinois 61530

United States

Illinois CancerCare-Galesburg

Galesburg, Illinois 61401

United States

Western Illinois Cancer Treatment Center

Galesburg, Illinois 61401

United States

Northwestern Medicine Cancer Center Delnor

Geneva, Illinois 60134

United States

Advocate South Suburban Hospital

Hazel Crest, Illinois 60429

United States

Loyola Medicine Homer Glen

Homer Glen, Illinois 60491

United States

Illinois CancerCare-Kewanee Clinic

Kewanee, Illinois 61443

United States

Northwestern Medicine Lake Forest Hospital

Lake Forest, Illinois 60045

United States

AMG Libertyville - Oncology

Libertyville, Illinois 60048

United States

Condell Memorial Hospital

Libertyville, Illinois 60048

United States

Illinois CancerCare-Macomb

Macomb, Illinois 61455

United States

Carle Physician Group-Mattoon/Charleston

Mattoon, Illinois 61938

United States

Loyola University Medical Center

Maywood, Illinois 60153

United States

Marjorie Weinberg Cancer Center at Loyola-Gottlieb

Melrose Park, Illinois 60160

United States

Good Samaritan Regional Health Center

Mount Vernon, Illinois 62864

United States

Edward Hospital/Cancer Center

Naperville, Illinois 60540

United States

UC Comprehensive Cancer Center at Silver Cross

New Lenox, Illinois 60451

United States

Cancer Care Center of O'Fallon

O'Fallon, Illinois 62269

United States

Advocate Christ Medical Center

Oak Lawn, Illinois 60453-2699

United States

University of Chicago Medicine-Orland Park

Orland Park, Illinois 60462

United States

Illinois CancerCare-Ottawa Clinic

Ottawa, Illinois 61350

United States

Advocate Lutheran General Hospital

Park Ridge, Illinois 60068

United States

Illinois CancerCare-Pekin

Pekin, Illinois 61554

United States

Illinois CancerCare-Peoria

Peoria, Illinois 61615

United States

Methodist Medical Center of Illinois

Peoria, Illinois 61636

United States

Illinois CancerCare-Peru

Peru, Illinois 61354

United States

Valley Radiation Oncology

Peru, Illinois 61354

United States

Edward Hospital/Cancer Center?Plainfield

Plainfield, Illinois 60585

United States

Illinois CancerCare-Princeton

Princeton, Illinois 61356

United States

Southern Illinois University School of Medicine

Springfield, Illinois 62702

United States

Springfield Clinic

Springfield, Illinois 62702

United States

Memorial Medical Center

Springfield, Illinois 62781

United States

Carle Cancer Center

Urbana, Illinois 61801

United States

The Carle Foundation Hospital

Urbana, Illinois 61801

United States

Northwestern Medicine Cancer Center Warrenville

Warrenville, Illinois 60555

United States

Illinois CancerCare - Washington

Washington, Illinois 61571

United States

Rush-Copley Healthcare Center

Yorkville, Illinois 60560

United States

Reid Health

Richmond, Indiana 47374

United States

Mary Greeley Medical Center

Ames, Iowa 50010

United States

McFarland Clinic - Ames

Ames, Iowa 50010

United States

McFarland Clinic - Boone

Boone, Iowa 50036

United States

Saint Anthony Regional Hospital

Carroll, Iowa 51401

United States

Iowa Methodist Medical Center

Des Moines, Iowa 50309

United States

Medical Oncology and Hematology Associates-Des Moines

Des Moines, Iowa 50309

United States

Broadlawns Medical Center

Des Moines, Iowa 50314

United States

Iowa Lutheran Hospital

Des Moines, Iowa 50316

United States

McFarland Clinic - Trinity Cancer Center

Fort Dodge, Iowa 50501

United States

Trinity Regional Medical Center

Fort Dodge, Iowa 50501

United States

McFarland Clinic - Jefferson

Jefferson, Iowa 50129

United States

McFarland Clinic - Marshalltown

Marshalltown, Iowa 50158

United States

Methodist West Hospital

West Des Moines, Iowa 50266-7700

United States

Central Care Cancer Center - Garden City

Garden City, Kansas 67846

United States

Central Care Cancer Center - Great Bend

Great Bend, Kansas 67530

United States

University of Kentucky/Markey Cancer Center

Lexington, Kentucky 40536

United States

Hematology/Oncology Clinic PLLC

Baton Rouge, Louisiana 70809

United States

East Jefferson General Hospital

Metairie, Louisiana 70006

United States

LSU Healthcare Network / Metairie Multi-Specialty Clinic

Metairie, Louisiana 70006

United States

Louisiana State University Health Science Center

New Orleans, Louisiana 70112

United States

Tulane University Health Sciences Center

New Orleans, Louisiana 70112

United States

University Medical Center New Orleans

New Orleans, Louisiana 70112

United States

University of Michigan Comprehensive Cancer Center

Ann Arbor, Michigan 48109

United States

Bronson Battle Creek

Battle Creek, Michigan 49017

United States

University of Michigan - Brighton Center for Specialty Care

Brighton, Michigan 48116

United States

Henry Ford Cancer Institute-Downriver

Brownstown, Michigan 48183

United States

Henry Ford Hematology Oncology - Hayes

Clinton Township, Michigan 48038

United States

Henry Ford Macomb Hospital-Clinton Township

Clinton Township, Michigan 48038

United States

Henry Ford Medical Center-Fairlane

Dearborn, Michigan 48126

United States

Henry Ford Hospital

Detroit, Michigan 48202

United States

Helen DeVos Children's Hospital at Spectrum Health

Grand Rapids, Michigan 49503

United States

Spectrum Health at Butterworth Campus

Grand Rapids, Michigan 49503

United States

Trinity Health Grand Rapids Hospital

Grand Rapids, Michigan 49503

United States

Allegiance Health

Jackson, Michigan 49201

United States

Bronson Methodist Hospital

Kalamazoo, Michigan 49007

United States

West Michigan Cancer Center

Kalamazoo, Michigan 49007

United States

Ascension Borgess Cancer Center

Kalamazoo, Michigan 49009

United States

Borgess Medical Center

Kalamazoo, Michigan 49048

United States

Trinity Health Muskegon Hospital

Muskegon, Michigan 49444

United States

Lakeland Hospital Niles

Niles, Michigan 49120

United States

Cancer and Hematology Centers of Western Michigan - Norton Shores

Norton Shores, Michigan 49444

United States

Henry Ford Medical Center-Columbus

Novi, Michigan 48377

United States

Spectrum Health Reed City Hospital

Reed City, Michigan 49677

United States

Lakeland Medical Center Saint Joseph

Saint Joseph, Michigan 49085

United States

Marie Yeager Cancer Center

Saint Joseph, Michigan 49085

United States

Henry Ford Macomb Health Center - Shelby Township

Shelby, Michigan 48315

United States

Munson Medical Center

Traverse City, Michigan 49684

United States

Henry Ford West Bloomfield Hospital

West Bloomfield, Michigan 48322

United States

Henry Ford Wyandotte Hospital

Wyandotte, Michigan 48192

United States

University of Michigan Health - West

Wyoming, Michigan 49519

United States

Fairview Ridges Hospital

Burnsville, Minnesota 55337

United States

Minnesota Oncology - Burnsville

Burnsville, Minnesota 55337

United States

Cambridge Medical Center

Cambridge, Minnesota 55008

United States

Mercy Hospital

Coon Rapids, Minnesota 55433

United States

Fairview Southdale Hospital

Edina, Minnesota 55435

United States

Unity Hospital

Fridley, Minnesota 55432

United States

Fairview Clinics and Surgery Center Maple Grove

Maple Grove, Minnesota 55369

United States

Minnesota Oncology Hematology PA-Maplewood

Maplewood, Minnesota 55109

United States

Saint John's Hospital - Healtheast

Maplewood, Minnesota 55109

United States

Abbott-Northwestern Hospital

Minneapolis, Minnesota 55407

United States

Hennepin County Medical Center

Minneapolis, Minnesota 55415

United States

Health Partners Inc

Minneapolis, Minnesota 55454

United States

Monticello Cancer Center

Monticello, Minnesota 55362

United States

New Ulm Medical Center

New Ulm, Minnesota 56073

United States

Fairview Northland Medical Center

Princeton, Minnesota 55371

United States

North Memorial Medical Health Center

Robbinsdale, Minnesota 55422

United States

Park Nicollet Clinic - Saint Louis Park

Saint Louis Park, Minnesota 55416

United States

Regions Hospital

Saint Paul, Minnesota 55101

United States

United Hospital

Saint Paul, Minnesota 55102

United States

Saint Francis Regional Medical Center

Shakopee, Minnesota 55379

United States

Lakeview Hospital

Stillwater, Minnesota 55082

United States

Ridgeview Medical Center

Waconia, Minnesota 55387

United States

Rice Memorial Hospital

Willmar, Minnesota 56201

United States

Minnesota Oncology Hematology PA-Woodbury

Woodbury, Minnesota 55125

United States

Fairview Lakes Medical Center

Wyoming, Minnesota 55092

United States

Gulfport Memorial Hospital

Gulfport, Mississippi 39502

United States

Saint Louis Cancer and Breast Institute-Ballwin

Ballwin, Missouri 63011

United States

Central Care Cancer Center - Bolivar

Bolivar, Missouri 65613

United States

Cox Cancer Center Branson

Branson, Missouri 65616

United States

Saint Francis Medical Center

Cape Girardeau, Missouri 63703

United States

Southeast Cancer Center

Cape Girardeau, Missouri 63703

United States

Parkland Health Center - Farmington

Farmington, Missouri 63640

United States

Capital Region Southwest Campus

Jefferson City, Missouri 65109

United States

Freeman Health System

Joplin, Missouri 64804

United States

Mercy Hospital Joplin

Joplin, Missouri 64804

United States

Delbert Day Cancer Institute at PCRMC

Rolla, Missouri 65401

United States

Mercy Clinic-Rolla-Cancer and Hematology

Rolla, Missouri 65401

United States

Heartland Regional Medical Center

Saint Joseph, Missouri 64506

United States

Sainte Genevieve County Memorial Hospital

Sainte Genevieve, Missouri 63670

United States

Mercy Hospital Springfield

Springfield, Missouri 65804

United States

CoxHealth South Hospital

Springfield, Missouri 65807

United States

Saint Louis Cancer and Breast Institute-South City

St Louis, Missouri 63109

United States

Mercy Hospital South

St Louis, Missouri 63128

United States

Missouri Baptist Medical Center

St Louis, Missouri 63131

United States

Mercy Hospital Saint Louis

St Louis, Missouri 63141

United States

Missouri Baptist Sullivan Hospital

Sullivan, Missouri 63080

United States

Missouri Baptist Outpatient Center-Sunset Hills

Sunset Hills, Missouri 63127

United States

Mercy Hospital Washington

Washington, Missouri 63090

United States

Nebraska Cancer Specialists/Oncology Hematology West PC - MECC

Omaha, Nebraska 68114

United States

Nebraska Methodist Hospital

Omaha, Nebraska 68114

United States

Oncology Associates PC

Omaha, Nebraska 68114

United States

Carson Tahoe Regional Medical Center

Carson City, Nevada 89703

United States

Cancer and Blood Specialists-Henderson

Henderson, Nevada 89052

United States

Comprehensive Cancer Centers of Nevada - Henderson

Henderson, Nevada 89052

United States

Comprehensive Cancer Centers of Nevada-Horizon Ridge

Henderson, Nevada 89052

United States

Las Vegas Cancer Center-Henderson

Henderson, Nevada 89052

United States

OptumCare Cancer Care at Seven Hills

Henderson, Nevada 89052

United States

Comprehensive Cancer Centers of Nevada-Southeast Henderson

Henderson, Nevada 89074

United States

GenesisCare USA - Henderson

Henderson, Nevada 89074

United States

Las Vegas Urology - Green Valley

Henderson, Nevada 89074

United States

Las Vegas Urology - Pebble

Henderson, Nevada 89074

United States

Urology Specialists of Nevada - Green Valley

Henderson, Nevada 89074

United States

Las Vegas Urology - Pecos

Las Vegas, Nevada 89074

United States

Desert West Surgery

Las Vegas, Nevada 89102

United States

OptumCare Cancer Care at Charleston

Las Vegas, Nevada 89102

United States

University Medical Center of Southern Nevada

Las Vegas, Nevada 89102

United States

Hope Cancer Care of Nevada

Las Vegas, Nevada 89103

United States

Radiation Oncology Centers of Nevada Central

Las Vegas, Nevada 89106

United States

Urology Specialists of Nevada - Central

Las Vegas, Nevada 89106

United States

GenesisCare USA - Las Vegas

Las Vegas, Nevada 89109

United States

Sunrise Hospital and Medical Center

Las Vegas, Nevada 89109

United States

Las Vegas Prostate Cancer Center

Las Vegas, Nevada 89113

United States

Las Vegas Urology - Sunset

Las Vegas, Nevada 89113

United States

Urology Specialists of Nevada - Southwest

Las Vegas, Nevada 89113

United States

Radiation Oncology Centers of Nevada Southeast

Las Vegas, Nevada 89119

United States

Ann M Wierman MD LTD

Las Vegas, Nevada 89128

United States

Comprehensive Cancer Centers of Nevada - Northwest

Las Vegas, Nevada 89128

United States

GenesisCare USA - Vegas Tenaya

Las Vegas, Nevada 89128

United States

Las Vegas Urology - Cathedral Rock

Las Vegas, Nevada 89128

United States

Las Vegas Urology - Smoke Ranch

Las Vegas, Nevada 89128

United States

OptumCare Cancer Care at MountainView

Las Vegas, Nevada 89128

United States

Urology Specialists of Nevada - Northwest

Las Vegas, Nevada 89128

United States

Alliance for Childhood Diseases/Cure 4 the Kids Foundation

Las Vegas, Nevada 89135

United States

Comprehensive Cancer Centers of Nevada - Town Center

Las Vegas, Nevada 89144

United States

Comprehensive Cancer Centers of Nevada-Summerlin

Las Vegas, Nevada 89144

United States

Summerlin Hospital Medical Center

Las Vegas, Nevada 89144

United States

Las Vegas Cancer Center-Medical Center

Las Vegas, Nevada 89148-2405

United States

Comprehensive Cancer Centers of Nevada

Las Vegas, Nevada 89148

United States

GenesisCare USA - Fort Apache

Las Vegas, Nevada 89148

United States

OptumCare Cancer Care at Fort Apache

Las Vegas, Nevada 89148

United States

Comprehensive Cancer Centers of Nevada - Central Valley

Las Vegas, Nevada 89169

United States

University Cancer Center

Las Vegas, Nevada 89169

United States

Hope Cancer Care of Nevada-Pahrump

Pahrump, Nevada 89048

United States

Renown Regional Medical Center

Reno, Nevada 89502

United States

Saint Mary's Regional Medical Center

Reno, Nevada 89503

United States

Radiation Oncology Associates

Reno, Nevada 89509

United States

Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center

Lebanon, New Hampshire 03756

United States

Hackensack University Medical Center

Hackensack, New Jersey 07601

United States

University of New Mexico Cancer Center

Albuquerque, New Mexico 87102

United States

Roswell Park Cancer Institute

Buffalo, New York 14263

United States

Northwell Health/Center for Advanced Medicine

Lake Success, New York 11042

United States

University of Rochester

Rochester, New York 14642

United States

Phelps Memorial Hospital Center

Sleepy Hollow, New York 10591

United States

Southeastern Medical Oncology Center-Clinton

Clinton, North Carolina 28328

United States

Southeastern Medical Oncology Center-Goldsboro

Goldsboro, North Carolina 27534

United States

Southeastern Medical Oncology Center-Jacksonville

Jacksonville, North Carolina 28546

United States

UH Seidman Cancer Center at UH Avon Health Center

Avon, Ohio 44011

United States

UHHS-Chagrin Highlands Medical Center

Beachwood, Ohio 44122

United States

Indu and Raj Soin Medical Center

Beavercreek, Ohio 45431

United States

Saint Elizabeth Boardman Hospital

Boardman, Ohio 44512

United States

Dayton Physicians LLC-Miami Valley South

Centerville, Ohio 45459

United States

Miami Valley Hospital South

Centerville, Ohio 45459

United States

University of Cincinnati Cancer Center-UC Medical Center

Cincinnati, Ohio 45219

United States

Oncology Hematology Care Inc-Kenwood

Cincinnati, Ohio 45236

United States

Case Western Reserve University

Cleveland, Ohio 44106

United States

Ohio State University Comprehensive Cancer Center

Columbus, Ohio 43210

United States

Miami Valley Hospital

Dayton, Ohio 45409

United States

Dayton Physician LLC-Miami Valley Hospital North

Dayton, Ohio 45415

United States

Miami Valley Hospital North

Dayton, Ohio 45415

United States

Armes Family Cancer Center

Findlay, Ohio 45840

United States

Blanchard Valley Hospital

Findlay, Ohio 45840

United States

Orion Cancer Care

Findlay, Ohio 45840

United States

Atrium Medical Center-Middletown Regional Hospital

Franklin, Ohio 45005-1066

United States

Dayton Physicians LLC-Atrium

Franklin, Ohio 45005

United States

Dayton Physicians LLC-Wayne

Greenville, Ohio 45331

United States

Wayne Hospital

Greenville, Ohio 45331

United States

Greater Dayton Cancer Center

Kettering, Ohio 45409

United States

Kettering Medical Center

Kettering, Ohio 45429

United States

UH Seidman Cancer Center at Lake Health Mentor Campus

Mentor, Ohio 44060

United States

Springfield Regional Cancer Center

Springfield, Ohio 45504

United States

Springfield Regional Medical Center

Springfield, Ohio 45505

United States

University of Toledo

Toledo, Ohio 43614

United States

Dayton Physicians LLC - Troy

Troy, Ohio 45373

United States

Upper Valley Medical Center

Troy, Ohio 45373

United States

Saint Joseph Warren Hospital

Warren, Ohio 44484

United States

University of Cincinnati Cancer Center-West Chester

West Chester, Ohio 45069

United States

Saint Elizabeth Youngstown Hospital

Youngstown, Ohio 44501

United States

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma 73104

United States

Mercy Hospital Oklahoma City

Oklahoma City, Oklahoma 73120

United States

Kaiser Sunnyside Medical Center

Clackamas, Oregon 97015

United States

Rogue Valley Medical Center

Medford, Oregon 97504

United States

Kaiser Permanente Northwest

Portland, Oregon 97227

United States

Oregon Health and Science University

Portland, Oregon 97239

United States

UPMC Altoona

Altoona, Pennsylvania 16601

United States

UPMC-Heritage Valley Health System Beaver

Beaver, Pennsylvania 15009

United States

UPMC Hillman Cancer Center at Butler Health System

Butler, Pennsylvania 16001

United States

UPMC Hillman Cancer Center Erie

Erie, Pennsylvania 16505

United States

UPMC Cancer Center at UPMC Horizon

Farrell, Pennsylvania 16121

United States

UPMC Cancer Centers - Arnold Palmer Pavilion

Greensburg, Pennsylvania 15601

United States

IRMC Cancer Center

Indiana, Pennsylvania 15701

United States

UPMC-Johnstown/John P. Murtha Regional Cancer Center

Johnstown, Pennsylvania 15901

United States

UPMC Cancer Center at UPMC McKeesport

McKeesport, Pennsylvania 15132

United States

UPMC Hillman Cancer Center - Monroeville

Monroeville, Pennsylvania 15146

United States

UPMC Hillman Cancer Center - Part of Frick Hospital

Mount Pleasant, Pennsylvania 15666

United States

Arnold Palmer Cancer Center Medical Oncology Norwin

N. Huntingdon, Pennsylvania 15642

United States

UPMC Cancer Center-Natrona Heights

Natrona Heights, Pennsylvania 15065

United States

UPMC Hillman Cancer Center - New Castle

New Castle, Pennsylvania 16105

United States

UPMC-Saint Margaret

Pittsburgh, Pennsylvania 15215

United States

University of Pittsburgh Cancer Institute (UPCI)

Pittsburgh, Pennsylvania 15232

United States

UPMC-Shadyside Hospital

Pittsburgh, Pennsylvania 15232

United States

UPMC-Passavant Hospital

Pittsburgh, Pennsylvania 15237

United States

UPMC-Saint Clair Hospital Cancer Center

Pittsburgh, Pennsylvania 15243

United States

UPMC Cancer Center at UPMC Northwest

Seneca, Pennsylvania 16346

United States

UPMC Cancer Center-Uniontown

Uniontown, Pennsylvania 15401

United States

UPMC Cancer Center-Washington

Washington, Pennsylvania 15301

United States

UPMC West Mifflin-Cancer Center Jefferson

West Mifflin, Pennsylvania 15122

United States

Prisma Health Cancer Institute - Spartanburg

Boiling Springs, South Carolina 29316

United States

Medical University of South Carolina

Charleston, South Carolina 29425

United States

Prisma Health Cancer Institute - Easley

Easley, South Carolina 29640

United States

Prisma Health Cancer Institute - Butternut

Greenville, South Carolina 29605

United States

Prisma Health Cancer Institute - Faris

Greenville, South Carolina 29605

United States

Prisma Health Greenville Memorial Hospital

Greenville, South Carolina 29605

United States

Prisma Health Cancer Institute - Eastside

Greenville, South Carolina 29615

United States

Prisma Health Cancer Institute - Greer

Greer, South Carolina 29650

United States

Prisma Health Cancer Institute - Seneca

Seneca, South Carolina 29672

United States

UT Southwestern Simmons Cancer Center - RedBird

Dallas, Texas 75237

United States

UT Southwestern/Simmons Cancer Center-Dallas

Dallas, Texas 75390

United States

UT Southwestern/Simmons Cancer Center-Fort Worth

Fort Worth, Texas 76104

United States

Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center

Houston, Texas 77030

United States

Ben Taub General Hospital

Houston, Texas 77030

United States

UT Southwestern Clinical Center at Richardson/Plano

Richardson, Texas 75080

United States

University of Texas Health Science Center at San Antonio

San Antonio, Texas 78229

United States

University of Utah Sugarhouse Health Center

Salt Lake City, Utah 84106

United States

Huntsman Cancer Institute/University of Utah

Salt Lake City, Utah 84112

United States

George E Wahlen Department of Veterans Affairs Medical Center

Salt Lake City, Utah 84148

United States

Norris Cotton Cancer Center-North

Saint Johnsbury, Vermont 05819

United States

Overlake Medical Center

Bellevue, Washington 98004

United States

Valley Medical Center

Renton, Washington 98055

United States

North Star Lodge Cancer Center at Yakima Valley Memorial Hospital

Yakima, Washington 98902

United States

Aurora Cancer Care-Southern Lakes VLCC

Burlington, Wisconsin 53105

United States

Marshfield Clinic-Chippewa Center

Chippewa Falls, Wisconsin 54729

United States

Marshfield Medical Center-EC Cancer Center

Eau Claire, Wisconsin 54701

United States

Aurora Health Care Germantown Health Center

Germantown, Wisconsin 53022

United States

Aurora Cancer Care-Grafton

Grafton, Wisconsin 53024

United States

Aurora BayCare Medical Center

Green Bay, Wisconsin 54311

United States

Aurora Cancer Care-Kenosha South

Kenosha, Wisconsin 53142

United States

Marshfield Clinic - Ladysmith Center

Ladysmith, Wisconsin 54848

United States

Aurora Bay Area Medical Group-Marinette

Marinette, Wisconsin 54143

United States

Marshfield Medical Center-Marshfield

Marshfield, Wisconsin 54449

United States

Froedtert Menomonee Falls Hospital

Menomonee Falls, Wisconsin 53051

United States

Aurora Cancer Care-Milwaukee

Milwaukee, Wisconsin 53209

United States

Aurora Saint Luke's Medical Center

Milwaukee, Wisconsin 53215

United States

Medical College of Wisconsin

Milwaukee, Wisconsin 53226

United States

Aurora Sinai Medical Center

Milwaukee, Wisconsin 53233

United States

Marshfield Clinic-Minocqua Center

Minocqua, Wisconsin 54548

United States

Cancer Center of Western Wisconsin

New Richmond, Wisconsin 54017

United States

Drexel Town Square Health Center

Oak Creek, Wisconsin 53154

United States

Vince Lombardi Cancer Clinic - Oshkosh

Oshkosh, Wisconsin 54904

United States

Aurora Cancer Care-Racine

Racine, Wisconsin 53406

United States

Marshfield Medical Center-Rice Lake

Rice Lake, Wisconsin 54868

United States

Vince Lombardi Cancer Clinic-Sheboygan

Sheboygan, Wisconsin 53081

United States

Marshfield Medical Center-River Region at Stevens Point

Stevens Point, Wisconsin 54482

United States

Aurora Medical Center in Summit

Summit, Wisconsin 53066

United States

Vince Lombardi Cancer Clinic-Two Rivers

Two Rivers, Wisconsin 54241

United States

Marshfield Clinic-Wausau Center

Wausau, Wisconsin 54401

United States

Aurora Cancer Care-Milwaukee West

Wauwatosa, Wisconsin 53226

United States

Aurora West Allis Medical Center

West Allis, Wisconsin 53227

United States

Froedtert West Bend Hospital/Kraemer Cancer Center

West Bend, Wisconsin 53095

United States

Marshfield Medical Center - Weston

Weston, Wisconsin 54476

United States

Marshfield Clinic - Wisconsin Rapids Center

Wisconsin Rapids, Wisconsin 54494

United States