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NCT04511013PHASE2Recruiting

A Study to Compare the Administration of Encorafenib + Binimetinib + Nivolumab Versus Ipilimumab + Nivolumab in BRAF-V600 Mutant Melanoma With Brain Metastases

SWOG Cancer Research Network

Start Date

1/6/2021

Completion Date

6/30/2027

Summary

This phase II trial compares the effect of encorafenib, binimetinib, and nivolumab versus ipilimumab and nivolumab in treating patients with BRAF- V600 mutant melanoma that has spread to the brain (brain metastases). Encorafenib and binimetinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Ipilimumab and nivolumab are monoclonal antibodies that may interfere with the ability of tumor cells to grow and spread. This trial aims to find out which approach is more effective in shrinking and controlling brain metastases from melanoma.

Detailed Description

PRIMARY OBJECTIVE: I. To compare progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 between participants randomized to the triplet combination of encorafenib + binimetinib + nivolumab versus the doublet combination of ipilimumab + nivolumab among participants with BRAF-V600 mutant melanoma that has metastasized to the brain. SECONDARY OBJECTIVES: I. To estimate the overall survival (OS) of participants in each treatment arm. II. To estimate the objective response rate (ORR) (confirmed and unconfirmed, complete and partial responses) per RECIST 1.1 in each treatment arm. III. To estimate the intracranial response rate (ICRR), defined as confirmed and unconfirmed complete and partial response per modified RECIST for brain metastases (mRECIST). IV. To evaluate the duration of response, per RECIST 1.1 and the duration of ICRR per mRECIST, and per Response Assessment in Neuro-Oncology (RANO)-Brain Metastases (BM) (and immunotherapy \[i\]RANO) in each treatment arm. V. To evaluate the toxicity profile of each treatment arm. VI. To evaluate current and emerging radiographic response criteria (modified RECIST 1.1, modified RANO-BM and iRANO) by a retrospective blinded independent centralized review (BICR) of banked images. BANKING OBJECTIVE: I. To bank tumor tissue, cerebral spinal fluid (CSF), stool and blood samples for future correlative studies. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive encorafenib orally (PO) once daily (QD) on days 1-28, binimetinib PO twice daily (BID) on days 1-28, and nivolumab intravenously (IV) on day 1. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive nivolumab IV on day 1 of all cycles and ipilimumab IV over 30 minutes on day 1 of cycles 1-4. Cycles repeat every 21 days for 4 cycles and then every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6 months for 2 years, and then annually until 3 years after randomization.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: * Participants must have histologically and pathologically confirmed melanoma that has metastasized to the brain * Any primary (cutaneous, acral/mucosal, etc) or unknown origin are permitted, except that participants with uveal primary are not eligible * Participants must have BRAF-V600 mutant melanoma documented by a Clinical Laboratory Improvement Act (CLIA)-certified laboratory * All participants must have an magnetic resonance imaging (MRI) of the brain within 28 days prior to registration and must have central nervous system metastases with at least one measurable brain metastasis \>= 0.5 cm in size (per modified RECIST 1.1) that has not been irradiated, or progressed (in the opinion of the treating physician) after prior radiation therapy. Participating sites MUST use MRI slice thickness of =\< 1.5 mm and are recommended to adhere to the 'minimum' Brain Tumor Imaging Protocol for Clinical Trials in Brain Metastases (BTIP-BM) compliant MRI acquisition protocol. Computed tomography (CT) of the head cannot substitute for brain MRI. (NOTE: All central nervous system \[CNS\] disease must be documented on BOTH the Brain Metastases Baseline Tumor Assessment Form, using modified RECIST, and the Baseline Tumor Assessment Form \[RECIST 1.1\] using RECIST 1.1.) * Participants may have measurable or non-measurable extracranial disease. All measurable disease must be assessed within 28 days prior to randomization; all non-measurable disease must be assessed within 42 days prior to randomization. Please note, while any extracranial disease will also be assessed and followed, participants are NOT required to have extracranial disease for randomization. NOTE: All disease must be assessed and documented on the Baseline Tumor Assessment Form (RECIST 1.1). CNS disease must be documented on BOTH the Brain Metastases Baseline Tumor Assessment Form, using modified RECIST, and the Baseline Tumor Assessment Form (RECIST 1.1) using RECIST 1.1 * Participants may have leptomeningeal disease * Participants may be receiving corticosteroids for brain metastases at a dose of up to 8 mg of dexamethasone per day. The dose must not have exceeded 8 mg per day for at least 7 days prior to randomization * Participants must have Zubrod performance status =\< 2 * Participants must have complete history and physical examination within 28 days prior to randomization * Participants must be able to swallow and retain pills * Hemoglobin \>= 8.0 g/dL (within 28 days prior to randomization) * Absolute neutrophil count \>= 1,500/mcL (within 28 days prior to randomization) * Platelets \>= 75,000/mcL (within 28 days prior to randomization) * Total bilirubin =\< 1.5 institutional upper limit of normal (ULN) (within 28 days prior to randomization) * Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 2.5 x institutional ULN (in participants with liver metastases =\< 5 x ULN) (within 28 days prior to randomization) * Creatinine =\< 2.0 institutional ULN (within 28 days prior to randomization) * Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, must have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, participants must be class 2B or better * Participants with a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial * Participants with known human immunodeficiency virus (HIV)-infection are eligible providing they are on effective anti-retroviral therapy and have undetectable viral load at their most recent viral load test and within 90 days prior to randomization * Participants with a known history of hepatitis C virus (HCV) infection must have been treated and cured. Participants with HCV infection who are currently on treatment must have an undetectable HCV viral load prior to randomization * Participants must agree to participate in image banking. Images must be submitted via the Triad System * Participants must be offered the opportunity to participate in specimen and blood collections * 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 * As a part of the 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 Exclusion Criteria: * Participants must not have received prior systemic therapy for metastatic disease. Prior systemic therapy received only in the neoadjuvant and/or adjuvant setting (e.g., BRAF/MEK inhibitor therapy, anti-PD-1 therapy or anti-CTLA4 therapy, alfa-interferon, etc.) is permitted. If patients received prior neoadjuvant/adjuvant therapy, they must have had eventual disease relapse prior to randomization * Participants must not have had prior radiation therapy within 7 days prior to randomization * Participants must not be planning to require any additional form of systemic anti-tumor therapy for melanoma while on protocol treatment * Participants must not be planning to use hormonal contraceptives * Participants must not have a serious active infection requiring systemic therapy at time of randomization in the opinion of the treating physician * Participants must not have active autoimmune disease that has required treatment in the past 6 months with use of biologic disease modifying agents (.e.g. infliximab, adalimumab). Patients on non-biologic disease modifying agents (e.g. methotrexate) or patients on corticosteroids =\< 10 mg prednisone daily or equivalent (to treat auto-immune disease), or on replacement therapy (e.g., thyroxine, insulin) are eligible if deemed in the best interest of the patient by treating physician * Participants must not have had grade 3 or 4 immune-related adverse events on ipilimumab or nivolumab that required more than 12 weeks of immune suppression with corticosteroids * Participants must not have had adverse events related to encorafenib and/or binimetinib specifically, that required discontinuation of one or both drugs. (Please note this does not apply to other BRAF/MEK inhibitor drugs.) * Participants must not be pregnant or nursing. Women/men of reproductive potential must have agreed to use an effective method of contraception. (NOTE: Patients must agree to not use hormonal contraceptives, as encorafenib can result in decreased concentration and loss of efficacy.) A woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months. In addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation. However, if at any point a previously celibate participant chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures

Interventions

DRUG

Binimetinib

DRUG

Encorafenib

BIOLOGICAL

Ipilimumab

BIOLOGICAL

Nivolumab

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Conditions

Acral Lentiginous MelanomaClinical Stage IV Cutaneous Melanoma AJCC v8Metastatic Cutaneous MelanomaMetastatic Malignant Neoplasm in the BrainMetastatic MelanomaMetastatic Mucosal MelanomaPathologic Stage IV Cutaneous Melanoma AJCC v8

Locations

University of Alabama at Birmingham Cancer Center

Birmingham, Alabama 35233

United States

Thomas Hospital

Fairhope, Alabama 36532

United States

Mobile Infirmary Medical Center

Mobile, Alabama 36607

United States

Anchorage Associates in Radiation Medicine

Anchorage, Alaska 98508

United States

Anchorage Radiation Therapy Center

Anchorage, Alaska 99504

United States

Alaska Breast Care and Surgery LLC

Anchorage, Alaska 99508

United States

Alaska Oncology and Hematology LLC

Anchorage, Alaska 99508

United States

Alaska Women's Cancer Care

Anchorage, Alaska 99508

United States

Anchorage Oncology Centre

Anchorage, Alaska 99508

United States

Katmai Oncology Group

Anchorage, Alaska 99508

United States

Providence Alaska Medical Center

Anchorage, Alaska 99508

United States

Fairbanks Memorial Hospital

Fairbanks, Alaska 99701

United States

Mercy Hospital Fort Smith

Fort Smith, Arkansas 72903

United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center

Burbank, California 91505

United States

Epic Care-Dublin

Dublin, California 94568

United States

Bay Area Breast Surgeons Inc

Emeryville, California 94608

United States

Epic Care Partners in Cancer Care

Emeryville, California 94608

United States

UCLA / Jonsson Comprehensive Cancer Center

Los Angeles, California 90095

United States

Contra Costa Regional Medical Center

Martinez, California 94553-3156

United States

Providence Queen of The Valley

Napa, California 94558

United States

Alta Bates Summit Medical Center - Summit Campus

Oakland, California 94609

United States

Bay Area Tumor Institute

Oakland, California 94609

United States

Sharp Memorial Hospital

San Diego, California 92123

United States

Providence Medical Foundation - Santa Rosa

Santa Rosa, California 95403

United States

Providence Santa Rosa Memorial Hospital

Santa Rosa, California 95405

United States

Epic Care Cyberknife Center

Walnut Creek, California 94597

United States

Rocky Mountain Cancer Centers-Aurora

Aurora, Colorado 80012

United States

The Medical Center of Aurora

Aurora, Colorado 80012

United States

University of Colorado Hospital

Aurora, Colorado 80045

United States

Boulder Community Foothills Hospital

Boulder, Colorado 80303

United States

Rocky Mountain Cancer Centers-Boulder

Boulder, Colorado 80304

United States

Rocky Mountain Cancer Centers - Centennial

Centennial, Colorado 80112

United States

The Women's Imaging Center

Denver, Colorado 80209

United States

Colorado Blood Cancer Institute

Denver, Colorado 80218

United States

Presbyterian - Saint Lukes Medical Center - Health One

Denver, Colorado 80218

United States

Rocky Mountain Cancer Centers-Midtown

Denver, Colorado 80218

United States

Rocky Mountain Cancer Centers-Rose

Denver, Colorado 80220

United States

Rose Medical Center

Denver, Colorado 80220

United States

Western Surgical Care

Denver, Colorado 80220

United States

Mountain Blue Cancer Care Center - Swedish

Englewood, Colorado 80113

United States

Rocky Mountain Cancer Centers - Swedish

Englewood, Colorado 80113

United States

Swedish Medical Center

Englewood, Colorado 80113

United States

The Melanoma and Skin Cancer Institute

Englewood, Colorado 80113

United States

North Colorado Medical Center

Greeley, Colorado 80631

United States

Rocky Mountain Cancer Centers-Lakewood

Lakewood, Colorado 80228

United States

Rocky Mountain Cancer Centers-Littleton

Littleton, Colorado 80120

United States

Rocky Mountain Cancer Centers-Sky Ridge

Lone Tree, Colorado 80124

United States

Sky Ridge Medical Center

Lone Tree, Colorado 80124

United States

McKee Medical Center

Loveland, Colorado 80539

United States

Rocky Mountain Cancer Centers-Thornton

Thornton, Colorado 80260

United States

UM Sylvester Comprehensive Cancer Center at Aventura

Aventura, Florida 33180

United States

UM Sylvester Comprehensive Cancer Center at Coral Gables

Coral Gables, Florida 33146

United States

UM Sylvester Comprehensive Cancer Center at Deerfield Beach

Deerfield Beach, Florida 33442

United States

University of Miami Miller School of Medicine-Sylvester Cancer Center

Miami, Florida 33136

United States

UM Sylvester Comprehensive Cancer Center at Kendall

Miami, Florida 33176

United States

Orlando Health Cancer Institute

Orlando, Florida 32806

United States

UM Sylvester Comprehensive Cancer Center at Plantation

Plantation, Florida 33324

United States

Moffitt Cancer Center-International Plaza

Tampa, Florida 33607

United States

Moffitt Cancer Center - McKinley Campus

Tampa, Florida 33612

United States

Moffitt Cancer Center

Tampa, Florida 33612

United States

Lewis Cancer and Research Pavilion at Saint Joseph's/Candler

Savannah, Georgia 31405

United States

Saint Alphonsus Cancer Care Center-Boise

Boise, Idaho 83706

United States

Saint Luke's Cancer Institute - Boise

Boise, Idaho 83712

United States

Saint Alphonsus Cancer Care Center-Caldwell

Caldwell, Idaho 83605

United States

Kootenai Health - Coeur d'Alene

Coeur d'Alene, Idaho 83814

United States

Walter Knox Memorial Hospital

Emmett, Idaho 83617

United States

Saint Luke's Cancer Institute - Fruitland

Fruitland, Idaho 83619

United States

Idaho Urologic Institute-Meridian

Meridian, Idaho 83642

United States

Saint Luke's Cancer Institute - Meridian

Meridian, Idaho 83642

United States

Saint Luke's Cancer Institute - Nampa

Nampa, Idaho 83686

United States

Saint Alphonsus Cancer Care Center-Nampa

Nampa, Idaho 83687

United States

Kootenai Clinic Cancer Services - Post Falls

Post Falls, Idaho 83854

United States

Kootenai Cancer Clinic

Sandpoint, Idaho 83864

United States

Saint Luke's Cancer Institute - Twin Falls

Twin Falls, Idaho 83301

United States

Saint Anthony's Health

Alton, Illinois 62002

United States

Rush - Copley Medical Center

Aurora, Illinois 60504

United States

Illinois CancerCare-Bloomington

Bloomington, Illinois 61704

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

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

Illinois CancerCare-Dixon

Dixon, Illinois 61021

United States

Carle Physician Group-Effingham

Effingham, Illinois 62401

United States

Crossroads Cancer Center

Effingham, Illinois 62401

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

Illinois CancerCare-Kewanee Clinic

Kewanee, Illinois 61443

United States

Northwestern Medicine Lake Forest Hospital

Lake Forest, Illinois 60045

United States

Illinois CancerCare-Macomb

Macomb, Illinois 61455

United States

Good Samaritan Regional Health Center

Mount Vernon, Illinois 62864

United States

Cancer Care Center of O'Fallon

O'Fallon, Illinois 62269

United States

Illinois CancerCare-Ottawa Clinic

Ottawa, Illinois 61350

United States

Illinois CancerCare-Pekin

Pekin, Illinois 61554

United States

Illinois CancerCare-Peoria

Peoria, Illinois 61615

United States

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

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

Southwest Illinois Health Services LLP

Swansea, Illinois 62226

United States

Carle Cancer Center

Urbana, Illinois 61801

United States

The Carle Foundation Hospital

Urbana, Illinois 61801

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

Mercy Health - Paducah Medical Oncology and Hematology

Paducah, Kentucky 42003

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

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

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

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

Munson Medical Center

Traverse City, Michigan 49684

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

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

Community Hospital of Anaconda

Anaconda, Montana 59711

United States

Billings Clinic Cancer Center

Billings, Montana 59101

United States

Bozeman Deaconess Hospital

Bozeman, Montana 59715

United States

Benefis Healthcare- Sletten Cancer Institute

Great Falls, Montana 59405

United States

Great Falls Clinic

Great Falls, Montana 59405

United States

Kalispell Regional Medical Center

Kalispell, Montana 59901

United States

Saint Patrick Hospital - Community Hospital

Missoula, Montana 59802

United States

Community Medical Hospital

Missoula, Montana 59804

United States

Cancer Partners of Nebraska - Pine Lake

Lincoln, Nebraska 68516

United States

Southeast Nebraska Cancer Center - 68th Street Place

Lincoln, Nebraska 68516

United States

Roswell Park Cancer Institute

Buffalo, New York 14263

United States

Wake Forest University at Clemmons

Clemmons, North Carolina 27012

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

Wake Forest Baptist Health - Hematology Oncology - Statesville

Statesville, North Carolina 28677

United States

Wake Forest Baptist Health - Wilkes Medical Center

Wilkesboro, North Carolina 28659

United States

Wake Forest University Health Sciences

Winston-Salem, North Carolina 27157

United States

UHHS-Chagrin Highlands Medical Center

Beachwood, Ohio 44122

United States

Indu and Raj Soin Medical Center

Beavercreek, Ohio 45431

United States

Strecker Cancer Center-Belpre

Belpre, Ohio 45714

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

Geauga Hospital

Chardon, Ohio 44024

United States

Adena Regional Medical Center

Chillicothe, Ohio 45601

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

Mount Carmel East Hospital

Columbus, Ohio 43213

United States

Columbus Oncology and Hematology Associates Inc

Columbus, Ohio 43214

United States

Riverside Methodist Hospital

Columbus, Ohio 43214

United States

Grant Medical Center

Columbus, Ohio 43215

United States

The Mark H Zangmeister Center

Columbus, Ohio 43219

United States

Mount Carmel Health Center West

Columbus, Ohio 43222

United States

Doctors Hospital

Columbus, Ohio 43228

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

Delaware Health Center-Grady Cancer Center

Delaware, Ohio 43015

United States

Grady Memorial Hospital

Delaware, Ohio 43015

United States

Columbus Oncology and Hematology Associates

Dublin, Ohio 43016

United States

Dublin Methodist Hospital

Dublin, Ohio 43016

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

Central Ohio Breast and Endocrine Surgery

Gahanna, Ohio 43230

United States

Dayton Physicians LLC-Wayne

Greenville, Ohio 45331

United States

Wayne Hospital

Greenville, Ohio 45331

United States

Mount Carmel Grove City Hospital

Grove City, Ohio 43123

United States

Zangmeister Center Grove City

Grove City, Ohio 43123

United States

Greater Dayton Cancer Center

Kettering, Ohio 45409

United States

Kettering Medical Center

Kettering, Ohio 45429

United States

Fairfield Medical Center

Lancaster, Ohio 43130

United States

Saint Rita's Medical Center

Lima, Ohio 45801

United States

OhioHealth Mansfield Hospital

Mansfield, Ohio 44903

United States

Marietta Memorial Hospital

Marietta, Ohio 45750

United States

OhioHealth Marion General Hospital

Marion, Ohio 43302

United States

UH Seidman Cancer Center at Southwest General Hospital

Middleburg Heights, Ohio 44130

United States

Knox Community Hospital

Mount Vernon, Ohio 43050

United States

Mount Carmel New Albany Surgical Hospital

New Albany, Ohio 43054

United States

Licking Memorial Hospital

Newark, Ohio 43055

United States

Newark Radiation Oncology

Newark, Ohio 43055

United States

University Hospitals Parma Medical Center

Parma, Ohio 44129

United States

Mercy Health Perrysburg Cancer Center

Perrysburg, Ohio 43551

United States

Southern Ohio Medical Center

Portsmouth, Ohio 45662

United States

University Hospitals Portage Medical Center

Ravenna, Ohio 44266

United States

UH Seidman Cancer Center at Firelands Regional Medical Center

Sandusky, Ohio 44870

United States

Springfield Regional Cancer Center

Springfield, Ohio 45504

United States

Springfield Regional Medical Center

Springfield, Ohio 45505

United States

Saint Vincent Mercy Medical Center

Toledo, Ohio 43608

United States

Mercy Health - Saint Anne Hospital

Toledo, Ohio 43623

United States

Dayton Physicians LLC - Troy

Troy, Ohio 45373

United States

Upper Valley Medical Center

Troy, Ohio 45373

United States

University Hospitals Sharon Health Center

Wadsworth, Ohio 44281

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 Ann's Hospital

Westerville, Ohio 43081

United States

UH Seidman Cancer Center at Saint John Medical Center

Westlake, Ohio 44145

United States

Saint Elizabeth Youngstown Hospital

Youngstown, Ohio 44501

United States

Genesis Healthcare System Cancer Care Center

Zanesville, Ohio 43701

United States

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma 73104

United States

Mercy Hospital Oklahoma City

Oklahoma City, Oklahoma 73120

United States

Saint Alphonsus Medical Center-Baker City

Baker City, Oregon 97814

United States

Saint Charles Health System

Bend, Oregon 97701

United States

Clackamas Radiation Oncology Center

Clackamas, Oregon 97015

United States

Providence Cancer Institute Clackamas Clinic

Clackamas, Oregon 97015

United States

Bay Area Hospital

Coos Bay, Oregon 97420

United States

Providence Newberg Medical Center

Newberg, Oregon 97132

United States

Saint Alphonsus Medical Center-Ontario

Ontario, Oregon 97914

United States

Providence Willamette Falls Medical Center

Oregon City, Oregon 97045

United States

Providence Portland Medical Center

Portland, Oregon 97213

United States

Providence Saint Vincent Medical Center

Portland, Oregon 97225

United States

Saint Charles Health System-Redmond

Redmond, Oregon 97756

United States

University of Pittsburgh Cancer Institute (UPCI)

Pittsburgh, Pennsylvania 15232

United States

Avera Cancer Institute

Sioux Falls, South Dakota 57105

United States

Huntsman Cancer Institute/University of Utah

Salt Lake City, Utah 84112

United States

Providence Regional Cancer System-Aberdeen

Aberdeen, Washington 98520

United States

PeaceHealth Saint Joseph Medical Center

Bellingham, Washington 98225

United States

Providence Regional Cancer System-Centralia

Centralia, Washington 98531

United States

Swedish Cancer Institute-Edmonds

Edmonds, Washington 98026

United States

Providence Regional Cancer Partnership

Everett, Washington 98201

United States

Swedish Cancer Institute-Issaquah

Issaquah, Washington 98029

United States

Kadlec Clinic Hematology and Oncology

Kennewick, Washington 99336

United States

Providence Regional Cancer System-Lacey

Lacey, Washington 98503

United States

PeaceHealth Saint John Medical Center

Longview, Washington 98632

United States

Jefferson Healthcare

Port Townsend, Washington 98368

United States

Pacific Gynecology Specialists

Seattle, Washington 98104

United States

Swedish Medical Center-Ballard Campus

Seattle, Washington 98107

United States

Swedish Medical Center-Cherry Hill

Seattle, Washington 98122-5711

United States

Swedish Medical Center-First Hill

Seattle, Washington 98122

United States

PeaceHealth United General Medical Center

Sedro-Woolley, Washington 98284

United States

Providence Regional Cancer System-Shelton

Shelton, Washington 98584

United States

PeaceHealth Southwest Medical Center

Vancouver, Washington 98664

United States

Providence Saint Mary Regional Cancer Center

Walla Walla, Washington 99362

United States

Providence Regional Cancer System-Yelm

Yelm, Washington 98597

United States

Langlade Hospital and Cancer Center

Antigo, Wisconsin 54409

United States

Marshfield Medical Center-EC Cancer Center

Eau Claire, Wisconsin 54701

United States

Gundersen Lutheran Medical Center

La Crosse, Wisconsin 54601

United States

University of Wisconsin Carbone Cancer Center

Madison, Wisconsin 53792

United States

Marshfield Medical Center-Marshfield

Marshfield, Wisconsin 54449

United States

Aspirus Medford Hospital

Medford, Wisconsin 54451

United States

Marshfield Clinic-Minocqua Center

Minocqua, Wisconsin 54548

United States

Cancer Center of Western Wisconsin

New Richmond, Wisconsin 54017

United States

Marshfield Medical Center-Rice Lake

Rice Lake, Wisconsin 54868

United States

Ascension Saint Michael's Hospital

Stevens Point, Wisconsin 54481

United States

Marshfield Medical Center-River Region at Stevens Point

Stevens Point, Wisconsin 54482

United States

Aspirus Regional Cancer Center

Wausau, Wisconsin 54401

United States

Marshfield Medical Center - Weston

Weston, Wisconsin 54476

United States

Aspirus Cancer Care - Wisconsin Rapids

Wisconsin Rapids, Wisconsin 54494

United States

Cheyenne Regional Medical Center-West

Cheyenne, Wyoming 82001

United States

Billings Clinic-Cody

Cody, Wyoming 82414

United States

Welch Cancer Center

Sheridan, Wyoming 82801

United States