Back to Trials
NCT06998940PHASE3Recruiting

Studying Chemotherapy With or Without Panitumumab for Unresectable, Locally Advanced, or Metastatic Pancreatic Cancer Without KRAS Mutations

SWOG Cancer Research Network

Start Date

5/13/2026

Completion Date

12/1/2030

Summary

This phase III trial compares the effect of adding panitumumab to standard chemotherapy (with nanoliposomal Irinotecan, leucovorin, and 5-fluorouracil \[5-FU\] or irinotecan, leucovorin, and 5-FU or nab-paclitaxel and gemcitabine) versus standard chemotherapy alone in treating patients with KRAS wild type (WT) pancreatic ductal adenocarcinoma that cannot be removed by sugery (unresectable) or that has spread to nearby tissue or lymph nodes (locally advanced) or that has spread from where it first started (primary site) to other places in the body (metastatic). Panitumumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. A monoclonal antibody is a type of protein that can bind to certain targets in the body, such as molecules that cause the body to make an immune response (antigens). Chemotherapy drugs, such as nanoliposomal irinotecan, leucovorin, 5-FU, irinotecan, nab-paclitaxel and gemcitabine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Adding panitumumab to standard chemotherapy may be effective in treating patients with unresectable, locally advanced, or metastatic KRAS WT pancreatic ductal adenocarcinoma.

Detailed Description

PRIMARY OBJECTIVE: I. To compare overall survival (OS) between participants with locally advanced or metastatic KRAS wild type (WT) pancreatic ductal adenocarcinoma (PDA) randomized to panitumumab plus second-line cytotoxic chemotherapy (5FU- or gemcitabine-based) versus chemotherapy alone. SECONDARY OBJECTIVES: I. To compare progression-free survival (PFS) between treatment arms. II. To compare the overall response rate (ORR) (ORR, including confirmed and unconfirmed, complete and partial response according to Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1 criteria) between treatment arms in participants with measurable disease. III. To compare disease control rate (DCR) (DCR, defined as ORR + stable disease rate \[SD\]) between treatment arms in participants with measurable disease. IV. To evaluate the frequency and severity of toxicity within each treatment arm. V. To compare duration of response (DoR) between treatment arms in participants with measurable disease. ADDITIONAL OBJECTIVES: I. To compare OS and PFS between treatment arms in the subgroup of participants with MAPK negative cancers, that is, cancers without any known mitogen-activated protein kinase (MAPK) pathway molecular alterations (type 1 or 2 BRAF mutations; BRAF, NRG1, ROS1, FGFR1-3 and RAF1 fusions; EGFR, KRAS, and FGFR1-3 amplification). II. To compare ORR in participants with MAPK negative cancers between treatment arms in participants with measurable disease. PATIENT-REPORTED OUTCOMES COMMON TERMINOLOGY CRITIERIA FOR ADVERSE EVENTS (CTCAE) OBJECTIVES: I. To compare health-related quality of life (QOL) by treatment arm at 8 weeks after randomization, measured by the Functional Assessment of Cancer Therapy - General (FACT-G) total score. II. To compare the impact of treatment toxicity by treatment arm at 8 weeks after randomization, measured by the Functional Assessment of Chronic Illness Therapy (FACIT) Item GP5. III. To compare changes from baseline in QOL and impact of treatment toxicity between treatment arms using FACT-G total score and FACIT Item GP5 to 24 weeks after randomization. IV. To assess patient-reported symptoms by treatment arm using selected patient reported outcome (PRO)-CTCAE items including gastrointestinal, dermatologic, and constitutional symptoms of pain and fatigue. BANKING OBJECTIVE: I. To bank specimens for future correlative studies. OUTLINE: Patients are randomized to 1 of 2 arms. ARM A: Patients receive panitumumab intravenously (IV) over 30-90 minutes on days 1 and 15. Patients also receive either nanoliposomal irinotecan IV over 90 minutes on days 1 and 15, leucovorin IV over 30 minutes on days 1 and 15, and 5-FU IV over 46 hours on days 1-3 and 15-17 or irinotecan IV over 90 minutes, leucovorin IV over 90-120 minutes on days 1 and 15, 5-FU IV bolus over 5-15 minutes on days 1 and 15 and 5FU IV continuous over 46 hours on days 1-3 and 15-17 or nab-paclitaxel IV over 30 minutes, and gemcitabine IV over 30 minutes on days 1, 8, and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo computed tomography (CT) scan and blood sample collection throughout the study. ARM B: Patients receive either nanoliposomal irinotecan IV over 90 minutes on days 1 and 15, leucovorin IV over 30 minutes on days 1 and 15, and 5-FU IV over 46 hours on days 1-3 and 15-17 or irinotecan IV over 90 minutes, leucovorin IV over 90-120 minutes on days 1 and 15, 5-FU IV bolus over 5-15 minutes on days 1 and 15 and 5FU IV continuous over 46 hours on days 1-3 and 15-17 or nab-paclitaxel IV over 30 minutes, and gemcitabine IV over 30 minutes on days 1, 8, and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan and blood sample collection throughout the study. After completion of study treatment, patients are followed up for up to 3 years post randomization.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: * Participants must have a histologically or cytologically confirmed diagnosis of ductal adenocarcinoma of the pancreas * Participants must have previously documented KRAS wild type (i.e. absence of any KRAS mutation) and BRAF V600E wild type (i.e. absence of a BRAF V600E mutation) status determined by tumor tissue-based NGS assay. The testing must be done within a laboratory with Clinical Laboratory Improvement Act (CLIA), International Organization for Standardization (ISO)/International Electrotechnical Commission (IEC), College of American Pathologists (CAP), or similar certification status * NOTE: Blood-based next generation sequencing (NGS) assays, such as circulating tumor deoxyribonucleic acid (DNA) (ctDNA) or liquid biopsies, will not be accepted for meeting eligibility criteria * Participants must have documented unresectable and/or metastatic disease on CT or magnetic resonance imaging (MRI) imaging completed prior to randomization. Imaging must have been completed within 28 days prior to randomization for participants with measurable disease. CT scans or MRIs used to assess non-measurable disease must have been completed within 42 days prior to randomization. All disease must be assessed and documented on the Baseline Tumor Assessment Form (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day) * Participants must not have known mutations in PTEN, NRAS, EGFR extracellular domain exons 1-16, no amplifications of HER2 and MET, and no gene fusions of RET, NTRK1, and ALK by tumor tissue-based NGS analysis * NOTE: Participants who are not tested for these mutations are eligible if they have previously documented KRAS wild type (i.e. absence of any KRAS mutation) and BRAF V600E wild type (i.e. absence of a BRAF V600E mutation) status * Participants must not have known brain metastases or cranial epidural disease unless adequately treated with radiotherapy and/or surgery and stable for at least 28 days before randomization (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day). * NOTE: Participants must be neurologically asymptomatic and without corticosteroid treatment at the time of enrollment * Participants must have received only one line of prior systemic cytotoxic chemotherapy for locally advanced or metastatic PDA, and have radiographically progressed, refractory, or intolerant to this therapy. * Prior neoadjuvant or adjuvant therapy with 5-FU or gemcitabine-based chemotherapy counts as a line of therapy if the participant's disease progressed to locally advanced or metastatic disease within 6 months of completing treatment * Participants with cancers harboring molecular alterations including microsatellite instability (MSI-high), elevated tumor mutational burden (TMB) (TMB ≥ 10 mut/Mb), and FGFR1-3, NRG1, and ROS fusions are allowed to have received an additional line of targeted therapy applicable to the respective molecular alterations at the treating investigators discretion. * Prior maintenance therapy with Olaparib or Rucaparib for germline or somatic BRCA1/2 or PALB2 mutations does not count as a line of therapy. * Participants must not have prior treatment with an anti-EGFR antibody (e.g., cetuximab or panitumumab) * Participants must not have prior treatment with an EGFR tyrosine kinase inhibitor (e.g., erlotinib) * Participants must not have received any pancreatic anticancer therapy (e.g., standard of care or investigational chemotherapy, molecularly targeted therapy, or radiation) within 14 days prior to randomization * Participants must not have a known contraindication to receiving chosen chemotherapy backbone at the planned doses in accordance with the local approved label * Participant must be ≥ 18 years old at the time of randomization * Participants must have Zubrod performance status of 0-2 * Participants must have a complete medical history and physical exam within 28 days prior to randomization (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day) * Absolute neutrophil count ≥ 1.0 x 10\^3/uL (within 28 days prior to randomization) (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day) * Note: Use of growth factor support (e.g., Granulocyte Colony-Stimulating Factor \[G-CSF\] or romiplostim \[Nplate\]) is permitted, and prior use does not constitute an exclusion criterion. Recent blood transfusions are also allowed * Hemoglobin ≥ 8 g/dL (within 28 days prior to randomization) (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day) * Note: Use of growth factor support (e.g., G-CSF or romiplostim \[Nplate\]) is permitted, and prior use does not constitute an exclusion criterion. Recent blood transfusions are also allowed * Platelets ≥ 75 x 10\^3/uL (within 28 days prior to randomization) (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day) * Note: Use of growth factor support (e.g., G-CSF or romiplostim \[Nplate\]) is permitted, and prior use does not constitute an exclusion criterion. Recent blood transfusions are also allowed * Total bilirubin ≤ 1.5 x institutional upper limit of normal (IULN) (within 28 days prior to randomization) (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day) * Aspartate aminotransferase (AST) ≤ 10 x upper limits of normal (ULN) (within 28 days prior to randomization) (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day) * Participants must have a creatinine ≤ the IULN OR measured OR calculated creatinine clearance ≥ 30 mL/min using the following Cockcroft-Gault Formula. This specimen must have been drawn and processed within 28 days prior to registration (In calculating days of tests and measurements, the day a test or measurement is done is considered Day 0. Therefore, if a test is done on a Monday, the Monday 4 weeks later would be considered Day 28. This allows for efficient participant scheduling without exceeding the guidelines. If Day 14 or 28 falls on a weekend or holiday, the limit may be extended to the next working day) * Participants with known history of human immunodeficiency virus (HIV)-infection must be on effective anti-retroviral therapy at registration and have undetectable viral load test on the most recent test results obtained within 6 months prior to randomization * Participants with a known history of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load while on suppressive therapy on the most recent test results obtained within 6 months prior to randomization, if indicated * Participants with a known history of hepatitis C virus (HCV) infection must have been treated and cured. Participants currently being treated for HCV infection must have undetectable HCV viral load test on the most recent test results obtained within 6 months prior to randomization, if indicated * Participants must not have a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) has the potential to interfere with the safety or efficacy assessment of the investigational regimen * Participants must not be pregnant or nursing (nursing includes breast milk fed to an infant by any means, including from the breast, milk expressed by hand, or pumped). Individuals who are of reproductive potential must have agreed to use an effective contraceptive method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen * Participants must be offered the opportunity to participate in specimen banking * Participants who can complete patient reported outcomes (FACT-G and PRO-CTCAE) questionnaires in English or Spanish must be offered the opportunity to participate in the quality-of-life studies * 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. * For participants with impaired decision-making capabilities, legally authorized representatives may sign and give informed consent on behalf of study participants in accordance with applicable federal, local, and Central Institutional Review Board (CIRB) regulations

Interventions

PROCEDURE

Biospecimen Collection

PROCEDURE

Computed Tomography

DRUG

Fluorouracil

DRUG

Gemcitabine

DRUG

Irinotecan

DRUG

Irinotecan Sucrosofate

DRUG

Leucovorin

DRUG

Nab-paclitaxel

BIOLOGICAL

Panitumumab

OTHER

Questionnaire Administration

Interested in This Trial?

Contact the trial locations directly using the information below to learn more about enrollment.

Expressing interest lets you review the study and consent before we connect you with the research site.

Conditions

Locally Advanced Pancreatic AdenocarcinomaMetastatic Pancreatic AdenocarcinomaStage III Pancreatic Cancer AJCC v8Stage IV Pancreatic Cancer AJCC v8Unresectable Pancreatic Adenocarcinoma

Locations

Anchorage Associates in Radiation Medicine

Anchorage, Alaska 98508

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

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

Highlands Oncology Group - Fayetteville

Fayetteville, Arkansas 72703

United States

NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro

Jonesboro, Arkansas 72401

United States

Highlands Oncology Group - Rogers

Rogers, Arkansas 72758

United States

Highlands Oncology Group

Springdale, Arkansas 72762

United States

Mission Hope Medical Oncology - Arroyo Grande

Arroyo Grande, California 93420

United States

Sutter Auburn Faith Hospital

Auburn, California 95602

United States

Sutter Cancer Centers Radiation Oncology Services-Auburn

Auburn, California 95603

United States

Alta Bates Summit Medical Center-Herrick Campus

Berkeley, California 94704

United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center

Burbank, California 91505

United States

Mills-Peninsula Medical Center

Burlingame, California 94010

United States

Sutter Cancer Centers Radiation Oncology Services-Cameron Park

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

Eden Hospital Medical Center

Castro Valley, California 94546

United States

Sutter Davis Hospital

Davis, California 95616

United States

Mercy Cancer Center - Elk Grove

Elk Grove, California 95758

United States

Palo Alto Medical Foundation-Fremont

Fremont, California 94538

United States

Mercy Cancer Center

Merced, California 95340

United States

Memorial Medical Center

Modesto, California 95355

United States

Palo Alto Medical Foundation-Camino Division

Mountain View, California 94040

United States

Palo Alto Medical Foundation-Gynecologic Oncology

Mountain View, California 94040

United States

Providence Queen of The Valley

Napa, California 94558

United States

Sutter Cancer Research Consortium

Novato, California 94945

United States

Palo Alto Medical Foundation Health Care

Palo Alto, California 94301

United States

Mercy Cancer Center - Rocklin

Rocklin, California 95765

United States

Sutter Cancer Centers Radiation Oncology Services-Roseville

Roseville, California 95661

United States

Sutter Roseville Medical Center

Roseville, California 95661

United States

Mercy Cancer Center - Sacramento

Sacramento, California 95816

United States

Sutter Medical Center Sacramento

Sacramento, California 95816

United States

California Pacific Medical Center-Pacific Campus

San Francisco, California 94115

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

Palo Alto Medical Foundation-Santa Cruz

Santa Cruz, California 95065

United States

Santa Cruz Radiation Oncology Medical Group

Santa Cruz, California 95065

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

Sutter Pacific Medical Foundation

Santa Rosa, California 95403

United States

Providence Santa Rosa Memorial Hospital

Santa Rosa, California 95405

United States

Saint Joseph's Medical Center

Stockton, California 95204

United States

Palo Alto Medical Foundation-Sunnyvale

Sunnyvale, California 94086

United States

Sutter Solano Medical Center/Cancer Center

Vallejo, California 94589

United States

Woodland Memorial Hospital

Woodland, California 95695

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

CommonSpirit Cancer Center Mercy

Durango, Colorado 81301

United States

Mercy Medical Center

Durango, Colorado 81301

United States

Saint Anthony Hospital

Lakewood, Colorado 80228

United States

Longmont United Hospital

Longmont, Colorado 80501

United States

Saint Mary Corwin Medical Center

Pueblo, Colorado 81004

United States

Saint Anthony North Hospital

Westminster, Colorado 80023

United States

Stamford Hospital/Bennett Cancer Center

Stamford, Connecticut 06904

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

The Watson Clinic

Lakeland, Florida 33805

United States

Emory University Hospital Midtown

Atlanta, Georgia 30308

United States

Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia 30322

United States

Emory Saint Joseph's Hospital

Atlanta, Georgia 30342

United States

Emory Decatur Hospital

Decatur, Georgia 30033

United States

Emory Johns Creek Hospital

Johns Creek, Georgia 30097

United States

Saint Luke's Cancer Institute - Boise

Boise, Idaho 83712

United States

Kootenai Health - Coeur d'Alene

Coeur d'Alene, Idaho 83814

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 83687

United States

Kootenai Clinic Cancer Services - Post Falls

Post Falls, Idaho 83854

United States

Kootenai Clinic Cancer Services - Sandpoint

Sandpoint, Idaho 83864

United States

Saint Luke's Cancer Institute - Twin Falls

Twin Falls, Idaho 83301

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

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

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

Carle BroMenn Medical Center

Normal, Illinois 61761

United States

Carle Cancer Institute Normal

Normal, Illinois 61761

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

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

Springfield Memorial Hospital

Springfield, Illinois 62781

United States

Carle Cancer Center

Urbana, Illinois 61801

United States

Illinois CancerCare - Washington

Washington, Illinois 61571

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

Mercy Hospital

Cedar Rapids, Iowa 52403

United States

Oncology Associates at Mercy Medical Center

Cedar Rapids, Iowa 52403

United States

Mercy Cancer Center-West Lakes

Clive, Iowa 50325

United States

Greater Regional Medical Center

Creston, Iowa 50801

United States

Mercy Medical Center - Des Moines

Des Moines, Iowa 50314

United States

McFarland Clinic - Trinity Cancer Center

Fort Dodge, Iowa 50501

United States

McFarland Clinic - Jefferson

Jefferson, Iowa 50129

United States

McFarland Clinic - Marshalltown

Marshalltown, Iowa 50158

United States

Mercy Medical Center-West Lakes

West Des Moines, Iowa 50266

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

LSU Health Baton Rouge-North Clinic

Baton Rouge, Louisiana 70805

United States

Our Lady of the Lake Physician Group

Baton Rouge, Louisiana 70808

United States

Our Lady of The Lake

Baton Rouge, Louisiana 70808

United States

Sinai Hospital of Baltimore

Baltimore, Maryland 21215

United States

Christiana Care - Union Hospital

Elkton, Maryland 21921

United States

Northwest Hospital Center

Randallstown, Maryland 21133

United States

William E Kahlert Regional Cancer Center/Sinai Hospital

Westminster, Maryland 21157

United States

Bronson Battle Creek

Battle Creek, Michigan 49017

United States

OSF Saint Francis Hospital and Medical Group

Escanaba, Michigan 49829

United States

Corewell Health Grand Rapids Hospitals - Butterworth Hospital

Grand Rapids, Michigan 49503

United States

Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital

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

Beacon Kalamazoo Cancer Center

Kalamazoo, Michigan 49009

United States

Beacon Kalamazoo

Kalamazoo, Michigan 49048

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

Corewell Health Reed City Hospital

Reed City, Michigan 49677

United States

Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center

Saint Joseph, Michigan 49085

United States

Corewell Health Lakeland Hospitals - Saint Joseph Hospital

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

Riverwood Healthcare Center

Aitkin, Minnesota 56431

United States

Essentia Health - Baxter Clinic

Baxter, Minnesota 56425

United States

Essentia Health Saint Joseph's Medical Center

Brainerd, Minnesota 56401

United States

Essentia Health - Saint Joseph's Crosslake Clinic

Crosslake, Minnesota 56442

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

Essentia Health - Ely Clinic

Ely, Minnesota 55731

United States

Essentia Health - Fosston

Fosston, Minnesota 56542

United States

Essentia Health Hibbing Clinic

Hibbing, Minnesota 55746

United States

Essentia Health - International Falls Clinic

International Falls, Minnesota 56649

United States

Essentia Health - Moose Lake Clinic

Moose Lake, Minnesota 55767

United States

Essentia Health - Park Rapids

Park Rapids, Minnesota 56470

United States

Essentia Health - Saint Joseph's Pequot Lakes Clinic

Pequot Lakes, Minnesota 56472

United States

Essentia Health - Saint Joseph's Pine River Clinic

Pine River, Minnesota 56474

United States

Essentia Health Sandstone

Sandstone, Minnesota 55072

United States

Essentia Health - Saint Joseph's Staples Clinic

Staples, Minnesota 56479

United States

Essentia Health Virginia Clinic

Virginia, Minnesota 55792

United States

Baptist Memorial Hospital and Cancer Center-Golden Triangle

Columbus, Mississippi 39705

United States

Baptist Cancer Center-Grenada

Grenada, Mississippi 38901

United States

Baptist Memorial Hospital and Cancer Center-Union County

New Albany, Mississippi 38652

United States

Baptist Memorial Hospital and Cancer Center-Oxford

Oxford, Mississippi 38655

United States

Baptist Memorial Hospital and Cancer Center-Desoto

Southhaven, Mississippi 38671

United States

Saint Francis Medical Center

Cape Girardeau, Missouri 63703

United States

Parkland Health Center - Farmington

Farmington, Missouri 63640

United States

Sainte Genevieve County Memorial Hospital

Sainte Genevieve, Missouri 63670

United States

Missouri Baptist Medical Center

St Louis, Missouri 63131

United States

Missouri Baptist Sullivan Hospital

Sullivan, Missouri 63080

United States

BJC Outpatient Center at Sunset Hills

Sunset Hills, Missouri 63127

United States

Community Hospital of Anaconda

Anaconda, Montana 59711

United States

Billings Clinic Cancer Center

Billings, Montana 59101

United States

Bozeman Health Deaconess Hospital

Bozeman, Montana 59715

United States

Benefis Sletten Cancer Institute

Great Falls, Montana 59405

United States

Great Falls Clinic

Great Falls, Montana 59405

United States

Hi-Line Sletten Cancer Center

Havre, Montana 59501

United States

Benefis Helena Specialty Center

Helena, Montana 59601

United States

Logan Health Medical Center

Kalispell, Montana 59901

United States

Saint Patrick Hospital - Community Hospital

Missoula, Montana 59802

United States

Community Medical Center

Missoula, Montana 59804

United States

CHI Health Saint Francis

Grand Island, Nebraska 68803

United States

CHI Health Good Samaritan

Kearney, Nebraska 68847

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

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

FirstHealth of the Carolinas-Moore Regional Hospital

Pinehurst, North Carolina 28374

United States

Essentia Health Cancer Center-South University Clinic

Fargo, North Dakota 58103

United States

Essentia Health - Jamestown Clinic

Jamestown, North Dakota 58401

United States

Miami Valley Hospital South

Centerville, Ohio 45459

United States

University of Cincinnati Cancer Center-UC Medical Center

Cincinnati, Ohio 45219

United States

Good Samaritan Hospital - Cincinnati

Cincinnati, Ohio 45220

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

Miami Valley Hospital

Dayton, Ohio 45409

United States

Premier Blood and Cancer Center

Dayton, Ohio 45409

United States

Miami Valley Hospital North

Dayton, Ohio 45415

United States

Atrium Medical Center-Middletown Regional Hospital

Franklin, Ohio 45005-1066

United States

Miami Valley Cancer Care and Infusion

Greenville, Ohio 45331

United States

Upper Valley Medical Center

Troy, Ohio 45373

United States

University of Cincinnati Cancer Center-West Chester

West Chester, Ohio 45069

United States

Saint Charles Health System

Bend, Oregon 97701

United States

Clackamas Radiation Oncology Center

Clackamas, Oregon 97015

United States

Bay Area Hospital

Coos Bay, Oregon 97420

United States

Providence Hood River Memorial Hospital

Hood River, Oregon 97031

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

Christiana Care Health System-Concord Health Center

Chadds Ford, Pennsylvania 19317

United States

Rapid City Regional Hospital

Rapid City, South Dakota 57701

United States

Baptist Memorial Hospital and Cancer Center-Collierville

Collierville, Tennessee 38017

United States

Baptist Memorial Hospital and Cancer Center-Memphis

Memphis, Tennessee 38120

United States

Inova Schar Cancer Institute

Fairfax, Virginia 22031

United States

Inova Fair Oaks Hospital

Fairfax, Virginia 22033

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

Skagit Regional Health Cancer Care Center

Mount Vernon, Washington 98274

United States

Swedish Medical Center-Ballard Campus

Seattle, Washington 98107

United States

Fred Hutchinson Cancer Center

Seattle, Washington 98109

United States

Swedish Medical Center-Cherry Hill

Seattle, Washington 98122-5711

United States

Swedish Medical Center-First Hill

Seattle, Washington 98122

United States

University of Washington Medical Center - Montlake

Seattle, Washington 98195

United States

PeaceHealth United General Medical Center

Sedro-Woolley, Washington 98284

United States

Saint Michael Cancer Center

Silverdale, Washington 98383

United States

Cancer Care Northwest - Spokane South

Spokane, Washington 99202

United States

Cancer Care Northwest-Valley

Spokane, Washington 99216

United States

Cancer Care Northwest-North Spokane

Spokane, Washington 99218

United States

PeaceHealth Southwest Medical Center

Vancouver, Washington 98664

United States

Providence Saint Mary Regional Cancer Center

Walla Walla, Washington 99362

United States

Duluth Clinic Ashland

Ashland, Wisconsin 54806

United States

Northwest Wisconsin Cancer Center

Ashland, Wisconsin 54806

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

Tamarack Health Hayward Medical Center

Hayward, Wisconsin 54843

United States

Gundersen Lutheran Medical Center

La Crosse, Wisconsin 54601

United States

Saint Vincent Hospital Cancer Center at Oconto Falls

Oconto Falls, Wisconsin 54154

United States

Saint Vincent Hospital Cancer Center at Sheboygan

Sheboygan, Wisconsin 53081

United States

Sheboygan Physicians Group

Sheboygan, Wisconsin 53081

United States

Essentia Health-Spooner Clinic

Spooner, Wisconsin 54801

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

Memorial Hospital of Laramie County

Cheyenne, Wyoming 82001

United States

Billings Clinic-Cody

Cody, Wyoming 82414

United States