Comparing Combinations of Drugs to Treat Newly Diagnosed Multiple Myeloma (NDMM) When a Stem Cell Transplant is Not a Medically Suitable Treatment
Start Date
10/12/2023
Completion Date
5/30/2031
Summary
This phase III trial compares three-drug induction regimens followed by double-or single-drug maintenance therapy for the treatment of newly diagnosed multiple myeloma in patients who are not receiving a stem cell transplant and are considered frail or intermediate-fit based on age, comorbidities, and functional status. Treatment for multiple myeloma includes initial treatment (induction) which is the first treatment a patient receives for cancer followed by ongoing treatment (maintenance) which is given after initial treatment to help keep the cancer from coming back. There are three combinations of four different drugs being studied. Bortezomib is one of the drugs that may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Lenalidomide works by helping bone marrow to produce normal blood cells and killing cancer cells. Anti-inflammatory drugs, such as dexamethasone, lower the body's immune response and are used with other drugs in the treatment of some types of cancer. Daratumumab and hyaluronidase-fihj is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Patients receive 1 of 3 combinations of these drugs for treatment to determine which combination of study drugs works better to shrink and control multiple myeloma.
Detailed Description
PRIMARY OBJECTIVES: I. To compare progression-free survival (PFS) in frail or selected intermediate fit newly diagnosed multiple myeloma (NDMM) participants treated with bortezomib with lenalidomide and dexamethasone at reduced dosing (VRd-Lite) induction followed by lenalidomide maintenance (Arm 1) versus daratumumab and hyaluronidase-fihj with lenalidomide and dexamethasone (DRd) induction followed by lenalidomide maintenance (Arm 2). II. To compare overall survival (OS) in frail or selected intermediate fit NDMM participants treated with VRd-Lite induction followed by lenalidomide maintenance (Arm 1) versus DRd induction followed by lenalidomide and daratumumab and hyaluronidase-fihj maintenance (Arm 3). SECONDARY OBJECTIVES: I. To compare PFS in Arm 1 versus Arm 3 II. To compare OS in Arm 1 versus Arm 2. III. To compare PFS in Arm 2 versus 3. IV. To compare the overall response rate (ORR) of Arm 1 against the ORR of Arm 2 and Arm 3. V. To compare the safety of Arm 1 with the safety of Arm 2 and Arm 3. VI. To explore veinous thrombo-embolism (VTE) incidence in participants receiving lenalidomide during induction across the three study arms. VII. To describe median time to response (complete response \[CR\] or better per International Myeloma Working Group \[IMWG\] criteria, very good partial response \[VGPR\] or better per IMWG criteria, partial response \[PR\] or better per IMWG criteria) on the three study arms. PRIMARY QUALITY OF LIFE (QOL) OBJECTIVE: I. To compare patient-reported global health status between treatment arms (Arm 1 versus the combination of Arms 2 and 3) at 9 months after randomization (end of induction therapy) using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30). SECONDARY QOL OBJECTIVE: II. To compare longitudinal changes in global health status between treatment arms (Arm 1 versus the combination of Arms 2 and 3) from baseline to 9 months after randomization (end of induction therapy). PATIENT REPORTED OUTCOMES-COMMON TERMINOLOGY CRITERIA FOR ADVERSE EVENTS (PRO-CTCAE) OBJECTIVE: I. To compare selected patient-reported outcome symptoms using PRO-CTCAE items among the 3 study arms. ADDITIONAL OBJECTIVES: I. To compare the rate of minimal residual disease (MRD) by clonoSEQ after 9 cycles of induction in Arm 1 versus Arm 2 and Arm 3, respectively. II. To compare the rate of MRD conversion after 1 year of maintenance in participants who were MRD positive after induction in Arm 1 versus Arm 2 and Arm 3, respectively. III. To compare the rate of sustained MRD negativity at time points of post-induction, post-1 year maintenance in Arm 1 versus Arm 2 and Arm 3, respectively. BANKING OBJECTIVES: I. To bank specimens for future correlative studies. OUTLINE: Patients are randomized to 1 of 3 arms. ARM I (VRd-Lite): INDUCTION CYCLES 1-9: Patients receive bortezomib subcutaneously (SC) on days 1, 8, 15, and 22 of each cycle, lenalidomide orally (PO) on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. ARM II (DRd-R): INDUCTION CYCLES 1-9: Patients receive daratumumab and hyaluronidase-fihj SC on days 1, 8, 15, and 22 of cycles 1-2, days 1 and 15 of cycles 3-6, and day 1 of cycles 7-9, lenalidomide PO on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. ARM III (DRd-DR): INDUCTION CYCLES 1-9: Patients receive daratumumab and hyaluronidase-fihj SC on days 1, 8, 15, and 22 of cycles 1-2, days 1 and 15 of cycles 3-6, and day 1 of cycles 7-9, lenalidomide PO on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive daratumumab and hyaluronidase-fihj SC on day 1 of each cycle and lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 1 year, every 6 months for 2 years, and then annually for up to 10 years.
Eligibility Criteria
Age Range: No minimum to No maximum
Interventions
Bortezomib
Daratumumab and Hyaluronidase-fihj
Dexamethasone
Lenalidomide
Quality-of-Life Assessment
Questionnaire Administration
Conditions
Locations
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
Cancer Center at Saint Joseph's
Phoenix, Arizona 85004
United States
Mercy Hospital Fort Smith
Fort Smith, Arkansas 72903
United States
CARTI Cancer Center
Little Rock, Arkansas 72205
United States
John L McClellan Memorial Veterans Hospital
Little Rock, Arkansas 72205
United States
University of Arkansas for Medical Sciences
Little Rock, Arkansas 72205
United States
Mission Hope Medical Oncology - Arroyo Grande
Arroyo Grande, California 93420
United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank, California 91505
United States
Marshall Cancer Center
Cameron Park, California 95682
United States
Mercy Cancer Center - Carmichael
Carmichael, California 95608
United States
Mercy San Juan Medical Center
Carmichael, California 95608
United States
Mercy Cancer Center - Elk Grove
Elk Grove, California 95758
United States
Fremont - Rideout Cancer Center
Marysville, California 95901
United States
Mercy UC Davis Cancer Center
Merced, California 95340
United States
Providence Queen of The Valley
Napa, California 94558
United States
Mercy Cancer Center - Rocklin
Rocklin, California 95765
United States
Mercy Cancer Center - Sacramento
Sacramento, California 95816
United States
University of California Davis Comprehensive Cancer Center
Sacramento, California 95817
United States
Pacific Central Coast Health Center-San Luis Obispo
San Luis Obispo, California 93401
United States
Mission Hope Medical Oncology - Santa Maria
Santa Maria, California 93444
United States
Providence Medical Foundation - Santa Rosa
Santa Rosa, California 95403
United States
Providence Santa Rosa Memorial Hospital
Santa Rosa, California 95405
United States
Gene Upshaw Memorial Tahoe Forest Cancer Center
Truckee, California 96161
United States
Woodland Memorial Hospital
Woodland, California 95695
United States
Rocky Mountain Regional VA Medical Center
Aurora, Colorado 80045
United States
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado 80907
United States
Rocky Mountain Cancer Centers-Penrose
Colorado Springs, Colorado 80907
United States
Saint Francis Cancer Center
Colorado Springs, Colorado 80923
United States
Porter Adventist Hospital
Denver, Colorado 80210
United States
Mercy Medical Center
Durango, Colorado 81301
United States
Southwest Oncology PC
Durango, Colorado 81301
United States
Saint Anthony Hospital
Lakewood, Colorado 80228
United States
Littleton Adventist Hospital
Littleton, Colorado 80122
United States
Longmont United Hospital
Longmont, Colorado 80501
United States
Parker Adventist Hospital
Parker, Colorado 80138
United States
Saint Mary Corwin Medical Center
Pueblo, Colorado 81004
United States
Smilow Cancer Hospital-Derby Care Center
Derby, Connecticut 06418
United States
Smilow Cancer Hospital Care Center-Fairfield
Fairfield, Connecticut 06824
United States
Smilow Cancer Hospital Care Center at Glastonbury
Glastonbury, Connecticut 06033
United States
Smilow Cancer Hospital Care Center at Greenwich
Greenwich, Connecticut 06830
United States
Smilow Cancer Hospital Care Center - Guilford
Guilford, Connecticut 06437
United States
Smilow Cancer Hospital Care Center at Saint Francis
Hartford, Connecticut 06105
United States
Smilow Cancer Center/Yale-New Haven Hospital
New Haven, Connecticut 06510
United States
Yale University
New Haven, Connecticut 06520
United States
Yale-New Haven Hospital North Haven Medical Center
North Haven, Connecticut 06473
United States
Smilow Cancer Hospital Care Center at Long Ridge
Stamford, Connecticut 06902
United States
Smilow Cancer Hospital-Torrington Care Center
Torrington, Connecticut 06790
United States
Smilow Cancer Hospital Care Center-Trumbull
Trumbull, Connecticut 06611
United States
Smilow Cancer Hospital-Waterbury Care Center
Waterbury, Connecticut 06708
United States
Smilow Cancer Hospital Care Center - Waterford
Waterford, Connecticut 06385
United States
Holy Cross Hospital
Fort Lauderdale, Florida 33308
United States
Mayo Clinic in Florida
Jacksonville, Florida 32224-9980
United States
Jupiter Medical Center
Jupiter, Florida 33458
United States
Saint Luke's Cancer Institute - Boise
Boise, Idaho 83712
United States
Saint Luke's Cancer Institute - Fruitland
Fruitland, Idaho 83619
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 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
Saint Joseph Medical Center
Bloomington, Illinois 61701
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
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
Edward Hines Jr VA Hospital
Hines, Illinois 60141
United States
Loyola Medicine Homer Glen
Homer Glen, Illinois 60491
United States
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois 61443
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
Cancer Care Center of O'Fallon
O'Fallon, Illinois 62269
United States
HSHS Saint Elizabeth's Hospital
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
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
IU Health North Hospital
Carmel, Indiana 46032
United States
Northwest Cancer Center - Main Campus
Crown Point, Indiana 46307
United States
Northwest Oncology LLC
Dyer, Indiana 46311
United States
Northwest Cancer Center - Hobart
Hobart, Indiana 46342
United States
Saint Mary Medical Center
Hobart, Indiana 46342
United States
Indiana University/Melvin and Bren Simon Cancer Center
Indianapolis, Indiana 46202
United States
Saint Catherine Hospital
Indianapolis, Indiana 46312
United States
The Community Hospital
Munster, Indiana 46321
United States
Women's Diagnostic Center - Munster
Munster, Indiana 46321
United States
Reid Health
Richmond, Indiana 47374
United States
Northwest Cancer Center - Valparaiso
Valparaiso, Indiana 46383
United States
Mission Cancer and Blood - Ankeny
Ankeny, Iowa 50023
United States
University of Iowa Healthcare Cancer Services Quad Cities
Bettendorf, Iowa 52722
United States
Physicians' Clinic of Iowa PC
Cedar Rapids, Iowa 52402
United States
Medical Oncology and Hematology Associates-West Des Moines
Clive, Iowa 50325
United States
Mercy Cancer Center-West Lakes
Clive, Iowa 50325
United States
Alegent Health Mercy Hospital
Council Bluffs, Iowa 51503
United States
Greater Regional Medical Center
Creston, Iowa 50801
United States
Mercy Medical Center - Des Moines
Des Moines, Iowa 50314
United States
Mission Cancer and Blood - Laurel
Des Moines, Iowa 50314
United States
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa 52242
United States
Mercy Medical Center-West Lakes
West Des Moines, Iowa 50266
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
Flaget Memorial Hospital
Bardstown, Kentucky 40004
United States
Commonwealth Cancer Center-Corbin
Corbin, Kentucky 40701
United States
Saint Joseph Hospital
Lexington, Kentucky 40504
United States
Saint Joseph Radiation Oncology Resource Center
Lexington, Kentucky 40504
United States
Saint Joseph Hospital East
Lexington, Kentucky 40509
United States
Saint Joseph London
London, Kentucky 40741
United States
Saint Joseph Mount Sterling
Mount Sterling, Kentucky 40353
United States
Greater Baltimore Medical Center
Baltimore, Maryland 21204
United States
Saint Joseph Mercy Hospital
Ann Arbor, Michigan 48106
United States
Bronson Battle Creek
Battle Creek, Michigan 49017
United States
Saint Joseph Mercy Brighton
Brighton, Michigan 48114
United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton, Michigan 48114
United States
Saint Joseph Mercy Canton
Canton, Michigan 48188
United States
Trinity Health IHA Medical Group Hematology Oncology - Canton
Canton, Michigan 48188
United States
Caro Cancer Center
Caro, Michigan 48723
United States
Saint Joseph Mercy Chelsea
Chelsea, Michigan 48118
United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Chelsea, Michigan 48118
United States
Hematology Oncology Consultants-Clarkston
Clarkston, Michigan 48346
United States
Newland Medical Associates-Clarkston
Clarkston, Michigan 48346
United States
Ascension Saint John Hospital
Detroit, Michigan 48236
United States
Great Lakes Cancer Management Specialists-Doctors Park
East China, Michigan 48054
United States
Genesee Cancer and Blood Disease Treatment Center
Flint, Michigan 48503
United States
Genesee Hematology Oncology PC
Flint, Michigan 48503
United States
Genesys Hurley Cancer Institute
Flint, Michigan 48503
United States
Hurley Medical Center
Flint, Michigan 48503
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
Academic Hematology Oncology Specialists
Grosse Pointe Woods, Michigan 48236
United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
Grosse Pointe Woods, Michigan 48236
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
University of Michigan Health - Sparrow Lansing
Lansing, Michigan 48912
United States
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan 48154
United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus
Macomb, Michigan 48044
United States
Saint Mary's Oncology/Hematology Associates of Marlette
Marlette, Michigan 48453
United States
Trinity Health Muskegon Hospital
Muskegon, Michigan 49444
United States
Corewell Health Lakeland Hospitals - Niles Hospital
Niles, Michigan 49120
United States
Cancer and Hematology Centers of Western Michigan - Norton Shores
Norton Shores, Michigan 49444
United States
21st Century Oncology-Pontiac
Pontiac, Michigan 48341
United States
Hope Cancer Center
Pontiac, Michigan 48341
United States
Newland Medical Associates-Pontiac
Pontiac, Michigan 48341
United States
Saint Joseph Mercy Oakland
Pontiac, Michigan 48341
United States
Corewell Health Reed City Hospital
Reed City, Michigan 49677
United States
Ascension Saint Mary's Hospital
Saginaw, Michigan 48601
United States
Oncology Hematology Associates of Saginaw Valley PC
Saginaw, Michigan 48604
United States
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
Saint Joseph, Michigan 49085
United States
Lakeland Medical Center Saint Joseph
Saint Joseph, Michigan 49085
United States
Bhadresh Nayak MD PC-Sterling Heights
Sterling Heights, Michigan 48312
United States
Ascension Saint Joseph Hospital
Tawas City, Michigan 48764
United States
Munson Medical Center
Traverse City, Michigan 49684
United States
Advanced Breast Care Center PLLC
Warren, Michigan 48088
United States
Great Lakes Cancer Management Specialists-Macomb Professional Building
Warren, Michigan 48093
United States
Macomb Hematology Oncology PC
Warren, Michigan 48093
United States
Michigan Breast Specialists-Warren
Warren, Michigan 48093
United States
Saint John Macomb-Oakland Hospital
Warren, Michigan 48093
United States
Saint Mary's Oncology/Hematology Associates of West Branch
West Branch, Michigan 48661
United States
University of Michigan Health - West
Wyoming, Michigan 49519
United States
Huron Gastroenterology PC
Ypsilanti, Michigan 48106
United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
Ypsilanti, Michigan 48197
United States
Riverwood Healthcare Center
Aitkin, Minnesota 56431
United States
Essentia Health - Baxter Clinic
Baxter, Minnesota 56425
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 - Burnsville
Burnsville, Minnesota 55337
United States
Cambridge Medical Center
Cambridge, Minnesota 55008
United States
Mercy Hospital
Coon Rapids, Minnesota 55433
United States
Essentia Health - Deer River Clinic
Deer River, Minnesota 56636
United States
Essentia Health Saint Mary's - Detroit Lakes Clinic
Detroit Lakes, Minnesota 56501
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 - Ely Clinic
Ely, Minnesota 55731
United States
Essentia Health - Fosston
Fosston, Minnesota 56542
United States
Unity Hospital
Fridley, Minnesota 55432
United States
Essentia Health Hibbing Clinic
Hibbing, Minnesota 55746
United States
Essentia Health - International Falls Clinic
International Falls, Minnesota 56649
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
Essentia Health - Moose Lake Clinic
Moose Lake, Minnesota 55767
United States
New Ulm Medical Center
New Ulm, Minnesota 56073
United States
Essentia Health - Park Rapids
Park Rapids, Minnesota 56470
United States
Fairview Northland Medical Center
Princeton, Minnesota 55371
United States
North Memorial Medical Health Center
Robbinsdale, Minnesota 55422
United States
Mayo Clinic in Rochester
Rochester, Minnesota 55905
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
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
Sanford Thief River Falls Medical Center
Thief River Falls, Minnesota 56701
United States
Essentia Health Virginia Clinic
Virginia, Minnesota 55792
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
Sanford Cancer Center Worthington
Worthington, Minnesota 56187
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
Research Medical Center
Kansas City, Missouri 64132
United States
Lake Regional Hospital
Osage Beach, Missouri 65065
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
BJC Outpatient Center at Sunset Hills
Sunset Hills, Missouri 63127
United States
Mercy Hospital Washington
Washington, Missouri 63090
United States
Saint Patrick Hospital - Community Hospital
Missoula, Montana 59802
United States
CHI Health Good Samaritan
Kearney, Nebraska 68847
United States
Saint Elizabeth Regional Medical Center
Lincoln, Nebraska 68510
United States
Alegent Health Immanuel Medical Center
Omaha, Nebraska 68122
United States
Alegent Health Bergan Mercy Medical Center
Omaha, Nebraska 68124
United States
Alegent Health Lakeside Hospital
Omaha, Nebraska 68130
United States
Creighton University Medical Center
Omaha, Nebraska 68131
United States
Midlands Community Hospital
Papillion, Nebraska 68046
United States
Exeter Hospital
Exeter, New Hampshire 03833
United States
Lovelace Medical Center-Saint Joseph Square
Albuquerque, New Mexico 87102
United States
University of New Mexico Cancer Center
Albuquerque, New Mexico 87102
United States
Presbyterian Kaseman Hospital
Albuquerque, New Mexico 87110
United States
Presbyterian Rust Medical Center/Jorgensen Cancer Center
Rio Rancho, New Mexico 87124
United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York 10032
United States
University of Rochester
Rochester, New York 14642
United States
Sanford Bismarck Medical Center
Bismarck, North Dakota 58501
United States
Essentia Health Cancer Center-South University Clinic
Fargo, North Dakota 58103
United States
Sanford South University Medical Center
Fargo, North Dakota 58103
United States
Southpointe-Sanford Medical Center Fargo
Fargo, North Dakota 58103
United States
Sanford Medical Center Fargo
Fargo, North Dakota 58104
United States
Sanford Broadway Medical Center
Fargo, North Dakota 58122
United States
Sanford Roger Maris Cancer Center
Fargo, North Dakota 58122
United States
Essentia Health - Jamestown Clinic
Jamestown, North Dakota 58401
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
Good Samaritan Hospital - Cincinnati
Cincinnati, Ohio 45220
United States
Oncology Hematology Care Inc-Kenwood
Cincinnati, Ohio 45236
United States
Bethesda North Hospital
Cincinnati, Ohio 45242
United States
TriHealth Cancer Institute-Westside
Cincinnati, Ohio 45247
United States
TriHealth Cancer Institute-Anderson
Cincinnati, Ohio 45255
United States
Dayton Physician LLC-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
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
Dayton Physicians LLC - Troy
Troy, Ohio 45373
United States
Saint Joseph Warren Hospital
Warren, Ohio 44484
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
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
Rogue Valley Medical Center
Medford, Oregon 97504
United States
Providence Newberg Medical Center
Newberg, Oregon 97132
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
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania 18103
United States
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania 18017
United States
Geisinger Medical Center
Danville, Pennsylvania 17822
United States
Pocono Medical Center
East Stroudsburg, Pennsylvania 18301
United States
Lehigh Valley Hospital-Hazleton
Hazleton, Pennsylvania 18201
United States
Geisinger Medical Oncology-Lewisburg
Lewisburg, Pennsylvania 17837
United States
Community Medical Center
Scranton, Pennsylvania 18510
United States
Geisinger Wyoming Valley/Henry Cancer Center
Wilkes-Barre, Pennsylvania 18711
United States
Smilow Cancer Hospital Care Center - Westerly
Westerly, Rhode Island 02891
United States
Prisma Health Cancer Institute - Spartanburg
Boiling Springs, South Carolina 29316
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 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
Avera Cancer Institute-Aberdeen
Aberdeen, South Dakota 57401
United States
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota 57104
United States
Avera Cancer Institute
Sioux Falls, South Dakota 57105
United States
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota 57117-5134
United States
Avera Cancer Institute at Yankton
Yankton, South Dakota 57078
United States
MD Anderson in The Woodlands
Conroe, Texas 77384
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
M D Anderson Cancer Center
Houston, Texas 77030
United States
Michael E DeBakey VA Medical Center
Houston, Texas 77030
United States
MD Anderson West Houston
Houston, Texas 77079
United States
MD Anderson League City
League City, Texas 77573
United States
University of Texas Health Science Center at San Antonio
San Antonio, Texas 78229
United States
MD Anderson in Sugar Land
Sugar Land, Texas 77478
United States
Sovah Health Martinsville
Martinsville, Virginia 24115
United States
Virginia Cancer Institute
Richmond, Virginia 23229
United States
VCU Massey Cancer Center at Stony Point
Richmond, Virginia 23235
United States
Virginia Commonwealth University/Massey Cancer Center
Richmond, Virginia 23298
United States
VCU Community Memorial Health Center
South Hill, Virginia 23970
United States
Providence Regional Cancer System-Aberdeen
Aberdeen, Washington 98520
United States
PeaceHealth Saint Joseph Medical Center
Bellingham, Washington 98225
United States
Harrison Medical Center
Bremerton, Washington 98310
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
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
West Virginia University Charleston Division
Charleston, West Virginia 25304
United States
Langlade Hospital and Cancer Center
Antigo, Wisconsin 54409
United States
ThedaCare Regional Cancer Center
Appleton, Wisconsin 54911
United States
Duluth Clinic Ashland
Ashland, Wisconsin 54806
United States
Northwest Wisconsin Cancer Center
Ashland, Wisconsin 54806
United States
Marshfield Clinic-Chippewa Center
Chippewa Falls, Wisconsin 54729
United States
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin 54701
United States
Essentia Health-Hayward Clinic
Hayward, Wisconsin 54843
United States
Gundersen Lutheran Medical Center
La Crosse, Wisconsin 54601
United States
Marshfield Clinic - Ladysmith Center
Ladysmith, Wisconsin 54848
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
Marshfield Medical Center - Neillsville
Neillsville, Wisconsin 54456
United States
Cancer Center of Western Wisconsin
New Richmond, Wisconsin 54017
United States
Ascension Saint Mary's Hospital
Rhinelander, Wisconsin 54501
United States
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin 54868
United States
Essentia Health-Spooner Clinic
Spooner, Wisconsin 54801
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
Essentia Health Saint Mary's Hospital - Superior
Superior, Wisconsin 54880
United States
Aspirus Regional Cancer Center
Wausau, Wisconsin 54401
United States
Marshfield Clinic-Wausau 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
Marshfield Clinic - Wisconsin Rapids Center
Wisconsin Rapids, Wisconsin 54494
United States