Testing the Addition of Stereotactic Radiation Therapy With Immune Therapy for the Treatment of Patients With Unresectable or Metastatic Renal Cell Cancer, SAMURAI Trial
Start Date
2/1/2023
Completion Date
6/15/2028
Summary
This phase II trial tests whether the addition of radiation to the primary tumor, typically given with stereotactic ablative radiation therapy (SABR), in combination with standard of care immunotherapy improves outcomes in patients with renal cell cancer that is not recommended for surgery and has spread from where it first started (primary site) to other places in the body (metastatic). Radiation therapy uses high energy photons to kill tumor cells and shrink tumors. Stereotactic body radiation therapy uses special equipment to position a patient and deliver radiation to tumors with high precision. This method may kill tumor cells with fewer doses of radiation over a shorter period and cause less damage to normal tissue. Immunotherapy with monoclonal antibodies, such as nivolumab, ipilimumab, avelumab, and pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Axitinib, cabozantinib, and lenvatinib are in a class of medications called antiangiogenic agents. They work by stopping the formation of blood vessels that bring oxygen and nutrients to tumor. This may slow the growth and spread of tumor. Giving SABR in combination with standard of care immunotherapy may help shrink or stabilize the cancer in patients with renal cell cancer.
Detailed Description
PRIMARY OBJECTIVE: I. To determine whether the addition of stereotactic ablative radiotherapy (SABR) to the primary tumor in combination with immunotherapy improves outcomes compared to immunotherapy alone in patients with metastatic, unresected, renal cell carcinoma (RCC). The primary endpoint is nephrectomy and radiographic progression-free survival (nrPFS) with progression determined as per iRECIST criteria. SECONDARY OBJECTIVES: I. To assess the safety, toxicity and tolerability of the two treatment strategies as defined by Common Terminology Criteria for Adverse Events (CTCAE) version 5 in each treatment arm. II. To assess the objective response rate (ORR) by Immune-related Response Evaluation Criteria in Solid Tumors (iRECIST) in each treatment arm. III. Nephrectomy and radiographic progression-free survival excluding nephrectomies that were performed for non-protocol specified indications (nephrectomy and radiographic progression-free survival \[nrPFS\]2). IV. Radiographic progression-free survival (rPFS). V. To assess overall survival (OS) in each treatment arm. VI. To assess the time to subsequent second-line therapy or death in each treatment arm. VII. To assess the rate of cytoreductive nephrectomy in each treatment arm. VIII. To assess treatment-free survival in patients who discontinue therapy for reason other than radiographic disease progression. IX. To assess the ORR by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and iRECIST in the primary renal mass. EXPLORATORY OBJECTIVES: I. To assess composite nrPFS in the predefined histological subgroups below: Ia. Clear cell versus non-clear cell histology; Ib. International Metastatic RCC database consortium (IMDC) intermediate versus poor risk group; Ic. Systemic treatment with immunotherapy-immunotherapy combination versus immunotherapy-vascular endothelial growth factor (VEGF) targeted therapy combination; Id. Sarcomatoid versus non sarcomatoid variant. II. To identify prognostic and predictive biomarkers of response to SABR in the context of immunotherapy based treatment via assessment of tissue and blood based biomarkers. III. To evaluate the abscopal effect of SABR with systemic therapy. IIIa. Compare ORR in non-irradiated target lesions in the control arm patients undergoing immunotherapy alone to the experimental arm undergoing SABR + immunotherapy. IV. To evaluate the impact of treatment on level of inferior vena cava (IVC) thrombus. V. To compare accruing center identified iRECIST progression and centrally identified iRECIST progression events on computed tomography (CT). OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive one of the following immunotherapy regimens per physician discretion: nivolumab intravenously (IV) over 30 minutes and ipilimumab IV over 30 minutes every 3 weeks for 4 doses followed by nivolumab IV over 30 minutes every 2 or 4 weeks; pembrolizumab IV over 30 minutes every 3 or 6 weeks and axitinib orally (PO) twice daily (BID); avelumab IV over 60 minutes every 2 weeks and axitinib PO BID; nivolumab IV over 30 minutes every 2 or 4 weeks and cabozantinib PO once daily (QD); OR pembrolizumab IV over 30 minutes every 3 or 6 weeks and lenvatinib PO QD. Treatment with immunotherapy continues in the absence of disease progression or unacceptable toxicity. Patients also undergo computed tomography (CT) scan or magnetic resonance imaging (MRI) throughout the trial. Patients may also undergo a bone scan as clinically indicated and blood sample collection throughout the trial. ARM II: Patients undergo SABR on 3 different days over 1-3 weeks and receive immunotherapy as in Arm I. Patients also undergo CT scan or MRI throughout the trial. Patients may also undergo a bone scan as clinically indicated and blood sample collection throughout the trial. After completion of study treatment, patients are followed up every 6 months for 5 years, and then annually for 3 years.
Eligibility Criteria
Age Range: 18 years to No maximum
Interventions
Avelumab
Axitinib
Biospecimen Collection
Bone Scan
Cabozantinib
Computed Tomography
Ipilimumab
Lenvatinib
Magnetic Resonance Imaging
Nivolumab
Pembrolizumab
Stereotactic Ablative Radiotherapy
Conditions
Locations
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama 35233
United States
Kingman Regional Medical Center
Kingman, Arizona 86401
United States
Mayo Clinic Hospital in Arizona
Phoenix, Arizona 85054
United States
University of Arkansas for Medical Sciences
Little Rock, Arkansas 72205
United States
PCR Oncology
Arroyo Grande, California 93420
United States
Tower Cancer Research Foundation
Beverly Hills, California 90211
United States
Mills-Peninsula Medical Center
Burlingame, California 94010
United States
City of Hope Comprehensive Cancer Center
Duarte, California 91010
United States
UC San Diego Health System - Encinitas
Encinitas, California 92024
United States
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
Irvine, California 92612
United States
UC San Diego Moores Cancer Center
La Jolla, California 92093
United States
Los Angeles General 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
Memorial Medical Center
Modesto, California 95355
United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange, California 92868
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
UC San Diego Medical Center - Hillcrest
San Diego, California 92103
United States
UCSF Medical Center-Mission Bay
San Francisco, California 94158
United States
Pacific Central Coast Health Center-San Luis Obispo
San Luis Obispo, California 93401
United States
Mills Health Center
San Mateo, California 94401
United States
Ridley-Tree Cancer Center
Santa Barbara, California 93105
United States
Sutter Pacific Medical Foundation
Santa Rosa, California 95403
United States
UCHealth University of Colorado Hospital
Aurora, Colorado 80045
United States
UCHealth - Cherry Creek
Denver, Colorado 80206
United States
Poudre Valley Hospital
Fort Collins, Colorado 80524
United States
Cancer Care and Hematology-Fort Collins
Fort Collins, Colorado 80528
United States
UCHealth Greeley Hospital
Greeley, Colorado 80631
United States
UCHealth Highlands Ranch Hospital
Highlands Ranch, Colorado 80129
United States
UCHealth Lone Tree Health Center
Lone Tree, Colorado 80124
United States
Medical Center of the Rockies
Loveland, Colorado 80538
United States
Beebe Medical Center
Lewes, Delaware 19958
United States
Beebe South Coastal Health Campus
Millville, Delaware 19967
United States
Helen F Graham Cancer Center
Newark, Delaware 19713
United States
Medical Oncology Hematology Consultants PA
Newark, Delaware 19713
United States
Christiana Care Health System-Christiana Hospital
Newark, Delaware 19718
United States
Beebe Health Campus
Rehoboth Beach, Delaware 19971
United States
Christiana Care Health System-Wilmington Hospital
Wilmington, Delaware 19801
United States
Mount Sinai Comprehensive Cancer Center at Aventura
Aventura, Florida 33180
United States
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
Hollywood, Florida 33021
United States
Mayo Clinic in Florida
Jacksonville, Florida 32224-9980
United States
Miami Cancer Institute
Miami, Florida 33176
United States
Mount Sinai Medical Center
Miami Beach, Florida 33140
United States
Memorial Hospital West
Pembroke Pines, Florida 33028
United States
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho 83706
United States
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell, Idaho 83605
United States
Saint Alphonsus Cancer Care Center-Nampa
Nampa, Idaho 83687
United States
Alton Memorial Hospital
Alton, Illinois 62002
United States
Centralia Oncology Clinic
Centralia, Illinois 62801
United States
Northwestern University
Chicago, Illinois 60611
United States
University of Chicago Comprehensive Cancer Center
Chicago, Illinois 60637
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
Carle Physician Group-Effingham
Effingham, Illinois 62401
United States
Crossroads Cancer Center
Effingham, Illinois 62401
United States
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois 60134
United States
Northwestern Medicine Glenview Outpatient Center
Glenview, Illinois 60026
United States
Northwestern Medicine Grayslake Outpatient Center
Grayslake, Illinois 60030
United States
Ingalls Memorial Hospital
Harvey, Illinois 60426
United States
Northwestern Medicine Lake Forest Hospital
Lake Forest, Illinois 60045
United States
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois 61938
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
HSHS Saint Elizabeth's Hospital
O'Fallon, Illinois 62269
United States
Northwestern Medicine Oak Brook
Oak Brook, Illinois 60523
United States
Northwestern Medicine Orland Park
Orland Park, Illinois 60462
United States
University of Chicago Medicine-Orland Park
Orland Park, Illinois 60462
United States
UW Health Carbone Cancer Center Rockford
Rockford, Illinois 61114
United States
Memorial Hospital East
Shiloh, Illinois 62269
United States
Southern Illinois University School of Medicine
Springfield, Illinois 62702
United States
Springfield Clinic
Springfield, Illinois 62702
United States
Springfield Memorial Hospital
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
UChicago Medicine Northwest Indiana
Crown Point, Indiana 46307
United States
Franciscan Health Indianapolis
Indianapolis, Indiana 46237
United States
Franciscan Health Mooresville
Mooresville, Indiana 46158
United States
Mary Greeley Medical Center
Ames, Iowa 50010
United States
McFarland Clinic - Ames
Ames, Iowa 50010
United States
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny, Iowa 50023
United States
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive, Iowa 50325
United States
Iowa Methodist Medical Center
Des Moines, Iowa 50309
United States
UI Health Care Mission Cancer and Blood - Des Moines Clinic
Des Moines, Iowa 50309
United States
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines, Iowa 50314
United States
UI Health Care Mission Cancer and Blood - Waukee Clinic
Waukee, Iowa 50263
United States
Louisiana Hematology Oncology Associates LLC
Baton Rouge, Louisiana 70809
United States
Mary Bird Perkins Cancer Center
Baton Rouge, Louisiana 70809
United States
Mary Bird Perkins Cancer Center - Metairie
Metairie, Louisiana 70002
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
University Medical Center New Orleans
New Orleans, Louisiana 70112
United States
Touro Infirmary
New Orleans, Louisiana 70115
United States
MaineHealth Coastal Cancer Treatment Center
Bath, Maine 04530
United States
MaineHealth Maine Medical Center - Biddeford
Biddeford, Maine 04005
United States
MaineHealth Maine Medical Center - Portland
Portland, Maine 04102
United States
MaineHealth Cancer Care and IV Therapy - Sanford
Sanford, Maine 04073
United States
MaineHealth Cancer Care Center of York County
Sanford, Maine 04073
United States
MaineHealth Maine Medical Center- Scarborough
Scarborough, Maine 04074
United States
MaineHealth Cancer Care and IV Therapy - South Portland
South Portland, Maine 04106
United States
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland 21201
United States
Central Maryland Radiation Oncology in Howard County
Columbia, Maryland 21044
United States
UM Baltimore Washington Medical Center/Tate Cancer Center
Glen Burnie, Maryland 21061
United States
Beverly Hospital
Beverly, Massachusetts 01915
United States
Massachusetts General Hospital Cancer Center
Boston, Massachusetts 02114
United States
Brigham and Women's Hospital
Boston, Massachusetts 02115
United States
Dana-Farber Cancer Institute
Boston, Massachusetts 02215
United States
Lahey Hospital and Medical Center
Burlington, Massachusetts 01805
United States
Addison Gilbert Hospital
Gloucester, Massachusetts 01930
United States
Lahey Clinic Peabody
Peabody, Massachusetts 01960
United States
Beth Israel Deaconess Medical Center/Winchester Center for Cancer Care
Winchester, Massachusetts 01890
United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor, Michigan 48106
United States
University of Michigan Rogel Cancer Center
Ann Arbor, Michigan 48109
United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton, Michigan 48114
United States
Trinity Health Medical Center - Brighton
Brighton, Michigan 48114
United States
Trinity Health IHA Medical Group Hematology Oncology - Canton
Canton, Michigan 48188
United States
Trinity Health Medical Center - Canton
Canton, Michigan 48188
United States
Chelsea Hospital
Chelsea, Michigan 48118
United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Chelsea, Michigan 48118
United States
Corewell Health Dearborn Hospital
Dearborn, Michigan 48124
United States
Corewell Health Farmington Hills Hospital
Farmington Hills, Michigan 48336
United States
University of Michigan Health - Sparrow Lansing
Lansing, Michigan 48912
United States
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan 48154
United States
Corewell Health William Beaumont University Hospital
Royal Oak, Michigan 48073
United States
Corewell Health Beaumont Troy Hospital
Troy, Michigan 48085
United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
Ypsilanti, Michigan 48197
United States
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota 56601
United States
Essentia Health Saint Joseph's Medical Center
Brainerd, Minnesota 56401
United States
Minnesota Oncology Hematology PA-Chaska
Chaska, Minnesota 55318
United States
Essentia Health - Deer River Clinic
Deer River, Minnesota 56636
United States
Essentia Health Cancer Center
Duluth, Minnesota 55805
United States
Essentia Health Saint Mary's Medical Center
Duluth, Minnesota 55805
United States
Miller-Dwan Hospital
Duluth, Minnesota 55805
United States
Fairview Southdale Hospital
Edina, Minnesota 55435
United States
Essentia Health Hibbing Clinic
Hibbing, Minnesota 55746
United States
Fairview Clinics and Surgery Center Maple Grove
Maple Grove, Minnesota 55369
United States
Abbott-Northwestern Hospital
Minneapolis, Minnesota 55407
United States
Hennepin County Medical Center
Minneapolis, Minnesota 55415
United States
University of Minnesota/Masonic Cancer Center
Minneapolis, Minnesota 55455
United States
Mayo Clinic in Rochester
Rochester, Minnesota 55905
United States
Regions Hospital
Saint Paul, Minnesota 55101
United States
Essentia Health Sandstone
Sandstone, Minnesota 55072
United States
Saint Francis Regional Medical Center
Shakopee, Minnesota 55379
United States
Lakeview Hospital
Stillwater, Minnesota 55082
United States
Essentia Health Virginia Clinic
Virginia, Minnesota 55792
United States
Ridgeview Medical Center
Waconia, Minnesota 55387
United States
Saint Francis Medical Center
Cape Girardeau, Missouri 63703
United States
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri 63376
United States
MU Health - University Hospital/Ellis Fischel Cancer Center
Columbia, Missouri 65212
United States
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri 63141
United States
Mercy Hospital Springfield
Springfield, Missouri 65804
United States
Washington University School of Medicine
St Louis, Missouri 63110
United States
Mercy Hospital South
St Louis, Missouri 63128
United States
Siteman Cancer Center-South County
St Louis, Missouri 63129
United States
Siteman Cancer Center at Christian Hospital
St Louis, Missouri 63136
United States
Mercy Hospital Saint Louis
St Louis, Missouri 63141
United States
Nebraska Medicine-Bellevue
Bellevue, Nebraska 68123
United States
Nebraska Medicine-Village Pointe
Omaha, Nebraska 68118
United States
University of Nebraska Medical Center
Omaha, Nebraska 68198
United States
Memorial Sloan Kettering Basking Ridge
Basking Ridge, New Jersey 07920
United States
Cooper Hospital University Medical Center
Camden, New Jersey 08103
United States
Monmouth Medical Center Southern Campus
Lakewood, New Jersey 08701
United States
Monmouth Medical Center
Long Branch, New Jersey 07740
United States
Memorial Sloan Kettering Monmouth
Middletown, New Jersey 07748
United States
Memorial Sloan Kettering Bergen
Montvale, New Jersey 07645
United States
Cooper CyberKnife Center
Mount Laurel, New Jersey 08054
United States
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey 08903
United States
Rutgers New Jersey Medical School
Newark, New Jersey 07101
United States
Community Medical Center
Toms River, New Jersey 08755
United States
Lovelace Medical Center-Saint Joseph Square
Albuquerque, New Mexico 87102
United States
Lovelace Radiation Oncology
Albuquerque, New Mexico 87109
United States
Northwell Health Imbert Cancer Center
Bay Shore, New York 11706
United States
Memorial Sloan Kettering Commack
Commack, New York 11725
United States
Glens Falls Hospital
Glens Falls, New York 12801
United States
Northwell Health Cancer Institute at Huntington
Greenlawn, New York 11740
United States
Memorial Sloan Kettering Westchester
Harrison, New York 10604
United States
Northwell Health/Center for Advanced Medicine
Lake Success, New York 11042
United States
Northern Westchester Hospital
Mount Kisco, New York 10549
United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York 10016
United States
Manhattan Eye Ear and Throat Hospital
New York, New York 10065
United States
Memorial Sloan Kettering Cancer Center
New York, New York 10065
United States
Lenox Hill Hospital
New York, New York 10075
United States
Phelps Memorial Hospital Center
Sleepy Hollow, New York 10591
United States
Stony Brook University Medical Center
Stony Brook, New York 11794
United States
Memorial Sloan Kettering Nassau
Uniondale, New York 11553
United States
Duke Cancer Center Cary
Cary, North Carolina 27518
United States
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina 27599
United States
Carolinas Medical Center/Levine Cancer Institute
Charlotte, North Carolina 28203
United States
Atrium Health Pineville/LCI-Pineville
Charlotte, North Carolina 28210
United States
Atrium Health University City/LCI-University
Charlotte, North Carolina 28262
United States
Levine Cancer Institute-Ballantyne
Charlotte, North Carolina 28277
United States
Wake Forest University at Clemmons
Clemmons, North Carolina 27012
United States
Atrium Health Cabarrus/LCI-Concord
Concord, North Carolina 28025
United States
Duke University Medical Center
Durham, North Carolina 27710
United States
Levine Cancer Institute-Gaston
Gastonia, North Carolina 28054
United States
Hayworth Cancer Center
High Point, North Carolina 27262
United States
Atrium Health Union/LCI-Union
Monroe, North Carolina 28112
United States
Duke Cancer Center Raleigh
Raleigh, North Carolina 27609
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
Sanford Bismarck Medical Center
Bismarck, North Dakota 58501
United States
Sanford Broadway Medical Center
Fargo, North Dakota 58122
United States
Sanford Roger Maris Cancer Center
Fargo, North Dakota 58122
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
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
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
Premier Blood and Cancer Center
Dayton, Ohio 45409
United States
Dayton Physician LLC - Englewood
Dayton, Ohio 45415
United States
Miami Valley Hospital North
Dayton, Ohio 45415
United States
Atrium Medical Center-Middletown Regional Hospital
Franklin, Ohio 45005-1066
United States
Dayton Physicians LLC-Atrium
Franklin, Ohio 45005
United States
Miami Valley Cancer Care and Infusion
Greenville, Ohio 45331
United States
UH Seidman Cancer Center at Lake Health Mentor Campus
Mentor, Ohio 44060
United States
University Hospitals Parma Medical Center
Parma, Ohio 44129
United States
University Hospitals Portage Medical Center
Ravenna, Ohio 44266
United States
Upper Valley Medical Center
Troy, Ohio 45373
United States
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio 45069
United States
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma 73104
United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
Tulsa, Oklahoma 74146
United States
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania 18103
United States
UPMC-Heritage Valley Health System Beaver
Beaver, Pennsylvania 15009
United States
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania 18017
United States
Carlisle Regional Cancer Center
Carlisle, Pennsylvania 17015
United States
Christiana Care Health System-Concord Health Center
Chadds Ford, Pennsylvania 19317
United States
Geisinger Medical Center
Danville, Pennsylvania 17822
United States
UPMC Hillman Cancer Center Erie
Erie, Pennsylvania 16505
United States
Saint Vincent Hospital
Erie, Pennsylvania 16544
United States
UPMC Cancer Center at UPMC Horizon
Farrell, Pennsylvania 16121
United States
UPMC Cancer Centers - Arnold Palmer Pavilion
Greensburg, Pennsylvania 15601
United States
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
Harrisburg, Pennsylvania 17109
United States
Geisinger Medical Center-Cancer Center Hazleton
Hazleton, Pennsylvania 18201
United States
Penn State Milton S Hershey Medical Center
Hershey, Pennsylvania 17033-0850
United States
IRMC Cancer Center
Indiana, Pennsylvania 15701
United States
Jefferson Hospital
Jefferson Hills, Pennsylvania 15025
United States
Geisinger Medical Oncology-Lewisburg
Lewisburg, Pennsylvania 17837
United States
UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
Mechanicsburg, Pennsylvania 17050
United States
Forbes Hospital
Monroeville, Pennsylvania 15146
United States
UPMC Cancer Center - Monroeville
Monroeville, Pennsylvania 15146
United States
UPMC Hillman Cancer Center - Monroeville
Monroeville, Pennsylvania 15146
United States
UPMC Hillman Cancer Center - New Castle
New Castle, Pennsylvania 16105
United States
Allegheny General Hospital
Pittsburgh, Pennsylvania 15212
United States
UPMC-Magee Womens Hospital
Pittsburgh, Pennsylvania 15213
United States
UPMC-Saint Margaret
Pittsburgh, Pennsylvania 15215
United States
West Penn Hospital
Pittsburgh, Pennsylvania 15224
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
Geisinger Cancer Services-Pottsville
Pottsville, Pennsylvania 17901
United States
Community Medical Center
Scranton, Pennsylvania 18510
United States
UPMC Cancer Center at UPMC Northwest
Seneca, Pennsylvania 16346
United States
UPMC Cancer Center-Washington
Washington, Pennsylvania 15301
United States
UPMC Washington Hospital Radiation Oncology
Washington, Pennsylvania 15301
United States
Reading Hospital
West Reading, Pennsylvania 19611
United States
Wexford Health and Wellness Pavilion
Wexford, Pennsylvania 15090
United States
Geisinger Wyoming Valley/Henry Cancer Center
Wilkes-Barre, Pennsylvania 18711
United States
Divine Providence Hospital
Williamsport, Pennsylvania 17754
United States
UPMC Memorial
York, Pennsylvania 17408
United States
Medical University of South Carolina
Charleston, South Carolina 29425
United States
Self Regional Healthcare
Greenwood, South Carolina 29646
United States
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota 57104
United States
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota 57117-5134
United States
Parkland Memorial Hospital
Dallas, Texas 75235
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
UT Southwestern Clinical Center at Richardson/Plano
Richardson, Texas 75080
United States
Scott and White Memorial Hospital
Temple, Texas 76508
United States
Central Vermont Medical Center/National Life Cancer Treatment
Berlin Corners, Vermont 05602
United States
University of Vermont Medical Center
Burlington, Vermont 05401
United States
University of Vermont and State Agricultural College
Burlington, Vermont 05405
United States
Inova Alexandria Hospital
Alexandria, Virginia 22304
United States
Inova Schar Cancer Institute
Fairfax, Virginia 22031
United States
Inova Fair Oaks Hospital
Fairfax, Virginia 22033
United States
Bon Secours Saint Francis Medical Center
Midlothian, Virginia 23114
United States
Bon Secours Cancer Institute at Reynolds Crossing
Richmond, Virginia 23230
United States
Virginia Mason Medical Center
Seattle, Washington 98101
United States
West Virginia University Charleston Division
Charleston, West Virginia 25304
United States
Edwards Comprehensive Cancer Center
Huntington, West Virginia 25701
United States
Langlade Hospital and Cancer Center
Antigo, Wisconsin 54409
United States
Duluth Clinic Ashland
Ashland, Wisconsin 54806
United States
Northwest Wisconsin Cancer Center
Ashland, Wisconsin 54806
United States
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin 54701
United States
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin 54301
United States
Saint Vincent Hospital Cancer Center at Saint Mary's
Green Bay, Wisconsin 54303
United States
Essentia Health-Hayward Clinic
Hayward, Wisconsin 54843
United States
Gundersen Lutheran Medical Center
La Crosse, Wisconsin 54601
United States
Marshfield Medical Center - Ladysmith
Ladysmith, Wisconsin 54848
United States
University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
Madison, Wisconsin 53718
United States
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin 53792
United States
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin 54449
United States
Froedtert Menomonee Falls Hospital
Menomonee Falls, Wisconsin 53051
United States
Medical College of Wisconsin
Milwaukee, Wisconsin 53226
United States
Marshfield Medical Center - Minocqua
Minocqua, Wisconsin 54548
United States
ProHealth D N Greenwald Center
Mukwonago, Wisconsin 53149
United States
Marshfield Medical Center - Neillsville
Neillsville, Wisconsin 54456
United States
Cancer Center of Western Wisconsin
New Richmond, Wisconsin 54017
United States
Drexel Town Square Health Center
Oak Creek, Wisconsin 53154
United States
ProHealth Oconomowoc Memorial Hospital
Oconomowoc, Wisconsin 53066
United States
Aspirus Cancer Care - James Beck Cancer Center
Rhinelander, Wisconsin 54501
United States
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin 54868
United States
Saint Vincent Hospital Cancer Center at Sheboygan
Sheboygan, Wisconsin 53081
United States
Essentia Health-Spooner Clinic
Spooner, Wisconsin 54801
United States
Aspirus Cancer Care - Stevens Point
Stevens Point, Wisconsin 54481
United States
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin 54482
United States
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Sturgeon Bay, Wisconsin 54235-1495
United States
Essentia Health Saint Mary's Hospital - Superior
Superior, Wisconsin 54880
United States
UW Cancer Center at ProHealth Care
Waukesha, Wisconsin 53188
United States
Aspirus Regional Cancer Center
Wausau, Wisconsin 54401
United States
Froedtert West Bend Hospital/Kraemer Cancer Center
West Bend, Wisconsin 53095
United States
Marshfield Medical Center - Weston
Weston, Wisconsin 54476
United States
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin 54494
United States
Marshfield Clinic - Wisconsin Rapids Center
Wisconsin Rapids, Wisconsin 54494
United States
Peter MacCallum Cancer Centre
Melbourne, Victoria 3000
Australia
University Health Network-Princess Margaret Hospital
Toronto, Ontario M5G 2M9
Canada
CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)
Québec, Quebec G1R 2J6
Canada
Beacon Hospital
Dublin, Co Dublin 18
Ireland
Saint Lukes Hospital
Dublin, Co Dublin 6
Ireland