Randomized Phase II/III Trial of Adjuvant Radiation Therapy With Cisplatin, Docetaxel-Cetuximab, or Cisplatin-Atezolizumab in Pathologic High-Risk Squamous Cell Cancer of the Head and Neck
Summary
This phase II/III trial studies how well radiation therapy works when given together with cisplatin, docetaxel, cetuximab, and/or atezolizumab after surgery in treating patients with high-risk stage III-IV head and neck cancer the begins in the thin, flat cells (squamous cell). Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. Drugs used in chemotherapy, such as cisplatin and docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Cetuximab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. Immunotherapy with monoclonal antibodies, such as atezolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. The purpose of this study is to compare the usual treatment (radiation therapy with cisplatin chemotherapy) to using radiation therapy with docetaxel and cetuximab chemotherapy, and using the usual treatment plus an immunotherapy drug, atezolizumab.
Detailed description
PRIMARY OBJECTIVES: I. To select the better docetaxel-based experimental arm to improve disease-free survival (DFS) over the control arm of radiation and cisplatin. (Phase II) (COMPLETE AS OF 20-MAR-2020) II. To determine if the combination of docetaxel-cetuximab and intensity-modulated radiation therapy (IMRT) is superior in terms of overall survival (OS) compared to standard cisplatin and IMRT in the adjuvant treatment of pathologic high risk, human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC). (Phase III) III. To determine if the combination of atezolizumab, cisplatin, and IMRT is superior in terms of OS compared to standard cisplatin and IMRT in the adjuvant treatment of pathologic high risk, HPV-negative HNSCC. (Phase III) SECONDARY OBJECTIVES: I. To compare disease-free survival (DFS) between each experimental arm and the control arm. (Phase III) II. To determine whether each experimental arm improves local-regional disease control and the rate of distant metastasis. (Phase III) III. To compare acute toxicity profiles between each experimental arm and the control arm. (Phase III) IV. To compare late toxicity profiles at 1, 3, and 5 years after treatment. (Phase III) V. To assess long term DFS and OS between each experimental arm and the control arm. (Phase III) VI. To compare symptom burden, as measured by the MD Anderson Symptom Inventory - Head and Neck (MDASI-HN) (primary patient reported outcome \[PRO\]), and quality of life, as measured by the Functional Assessment of Cancer Therapy - Head and Neck (FACT-H\&N) (secondary PRO), between each experimental arm and the control arm. (Phase III) EXPLORATORY OBJECTIVE: I. To collect blood and tissue specimens for future translational research. (Phase III) OUTLINE: Patients are randomized to 1 of 3 arms - Phase II (Arms 1, 2 or 3) and for Phase III (Arms 1, 3 or 4). ARM 1: Patients undergo intensity modulated radiation therapy (IMRT) once daily (QD) five days a week for 6 weeks and receive concurrent cisplatin intravenously (IV) over 1-2 hours once weekly for 6 weeks in the absence of disease progression or unacceptable toxicity. ARM 2: Patients undergo IMRT as in Arm I and receive concurrent docetaxel IV over 60 minutes once weekly for 6 weeks in the absence of disease progression or unacceptable toxicity. (CLOSED AS OF 20-MAR-2020) ARM 3: Patients receive cetuximab IV over 120 minutes on week 1 and over 60 minutes once weekly on weeks 2-7. Patients undergo IMRT as in Arm I and concurrently receive docetaxel once weekly for 6 weeks in the absence of disease progression or unacceptable toxicity. ARM 4: Patients undergo IMRT QD five days a week for 6 weeks and receive concurrent cisplatin IV over 1-2 hours once weekly for 6 weeks. Starting 1 week before IMRT, patients also receive atezolizumab IV over 30-60 minutes every 3 weeks for up to 8 doses (weeks -1, 3, 6, 9, 12, 15, 18, and 21) in the absence of disease progression and unacceptable toxicity. All patients undergo collection of blood samples during screening and throughout the study and may undergo computed tomography (CT) scans and/or magnetic resonance imaging (MRI) and biopsy as clinically indicated on study. After completion of study treatment, patients are followed up at 1 and 3 months, every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.
Arms & interventions
- DrugAtezolizumab
Given IV
- ProcedureBiopsy Procedure
Undergo biopsy
- ProcedureBiospecimen Collection
Undergo collection of blood
- BiologicalCetuximab
Given IV
- DrugCisplatin
Given IV
- ProcedureComputed Tomography
Undergo CT
- DrugDocetaxel
Given IV
- RadiationIntensity-Modulated Radiation Therapy
Undergo IMRT
- ProcedureMagnetic Resonance Imaging
Undergo MRI
- OtherSurvey Administration
Ancillary studies
Outcome measures
Primary
Disease-free survival (Phase II)
Estimated using the Kaplan-Meier method for each arm. Their distributions will be compared between treatment arms with a one-sided log rank test.
Time frame: From date of randomization until date of local-regional recurrence, distant metastasis or death due to any cause, assessed up to 7 years
Overall survival (Phase III)
Estimated using the Kaplan-Meier method for each arm. Their distributions will be compared between treatment arms with a one-sided log rank test. Multivariate analysis will be performed using the Cox proportional hazards model.
Time frame: From date of randomization to death due to any cause, assessed up to 7 years
Secondary
Local-regional failure
Time frame: From date of randomization until date of local-regional recurrence, assessed up to 7 years
Distant metastasis
Time frame: From date of randomization to date of distant metastasis, assessed up to 7 years
Toxicity
Time frame: From start of treatment to death or last follow-up
Patient-reported outcome, symptom burden
Time frame: Time from randomization to a first recovery within at least one MID unit of total symptom severity compared to the baseline (reference) score
Quality of life
Time frame: Baseline and 1 year post radiation therapy
Eligibility criteria
Study locations (338)
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, 35233
The Kirklin Clinic at Acton Road
Birmingham, Alabama, 35243
Banner University Medical Center - Tucson
Tucson, Arizona, 85719
University of Arizona Cancer Center-North Campus
Tucson, Arizona, 85719
University of Arkansas for Medical Sciences
Little Rock, Arkansas, 72205
Sutter Cancer Centers Radiation Oncology Services-Auburn
Auburn, California, 95603
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank, California, 91505
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
Cameron Park, California, 95682
Mercy San Juan Medical Center
Carmichael, California, 95608
UC San Diego Health System - Encinitas
Encinitas, California, 92024
UC San Diego Moores Cancer Center
La Jolla, California, 92093
Cedars-Sinai Medical Center
Los Angeles, California, 90048
Memorial Medical Center
Modesto, California, 95355
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange, California, 92868
Stanford Cancer Institute Palo Alto
Palo Alto, California, 94304
Sutter Cancer Centers Radiation Oncology Services-Roseville
Roseville, California, 95661
Sutter Medical Center Sacramento
Sacramento, California, 95816
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
UCSF Medical Center-Mount Zion
San Francisco, California, 94115
UCSF Medical Center-Mission Bay
San Francisco, California, 94158
Mills Health Center
San Mateo, California, 94401
Saint Helena Hospital
St. Helena, California, 94574
UCHealth University of Colorado Hospital
Aurora, Colorado, 80045
Rocky Mountain Cancer Centers-Boulder
Boulder, Colorado, 80304
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado, 80907
AdventHealth Porter
Denver, Colorado, 80210
Shaw Cancer Center
Edwards, Colorado, 81632
Banner North Colorado Medical Center
Greeley, Colorado, 80631
Rocky Mountain Cancer Centers-Littleton
Littleton, Colorado, 80120
Longmont United Hospital
Longmont, Colorado, 80501
Banner North Colorado Medical Center - Loveland Campus
Loveland, Colorado, 80539
AdventHealth Parker
Parker, Colorado, 80138
University of Connecticut
Farmington, Connecticut, 06030
Yale University
New Haven, Connecticut, 06520
Smilow Cancer Hospital Care Center - Waterford
Waterford, Connecticut, 06385
Helen F Graham Cancer Center
Newark, Delaware, 19713
Christiana Care Health System-Christiana Hospital
Newark, Delaware, 19718
George Washington University Medical Center
Washington D.C., District of Columbia, 20037
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Deerfield Beach, Florida, 33442
Holy Cross Hospital
Fort Lauderdale, Florida, 33308
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
AdventHealth Orlando
Orlando, Florida, 32803
Orlando Health Cancer Institute
Orlando, Florida, 32806
Moffitt Cancer Center at SouthShore
Ruskin, Florida, 33570
Moffitt Cancer Center-International Plaza
Tampa, Florida, 33607
Moffitt Cancer Center
Tampa, Florida, 33612
Emory University Hospital Midtown
Atlanta, Georgia, 30308
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, 30322
Augusta University Medical Center
Augusta, Georgia, 30912
Memorial Health University Medical Center
Savannah, Georgia, 31404
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Savannah, Georgia, 31405
Queen's Medical Center
Honolulu, Hawaii, 96813
The Cancer Center of Hawaii-Liliha
Honolulu, Hawaii, 96817
Saint Alphonsus Cancer Care Center-Nampa
Nampa, Idaho, 83687
Northwestern University
Chicago, Illinois, 60611
John H Stroger Jr Hospital of Cook County
Chicago, Illinois, 60612
Rush MD Anderson Cancer Center
Chicago, Illinois, 60612
University of Illinois
Chicago, Illinois, 60612
Decatur Memorial Hospital
Decatur, Illinois, 62526
Crossroads Cancer Center
Effingham, Illinois, 62401
NorthShore University HealthSystem-Evanston Hospital
Evanston, Illinois, 60201
NorthShore University HealthSystem-Glenbrook Hospital
Glenview, Illinois, 60026
NorthShore University HealthSystem-Highland Park Hospital
Highland Park, Illinois, 60035
HSHS Saint Elizabeth's Hospital
O'Fallon, Illinois, 62269
Advocate Christ Medical Center
Oak Lawn, Illinois, 60453-2699
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
Peoria, Illinois, 61615
OSF Saint Francis Medical Center
Peoria, Illinois, 61637
UW Health Carbone Cancer Center Rockford
Rockford, Illinois, 61114
Springfield Memorial Hospital
Springfield, Illinois, 62781
Carle Cancer Center
Urbana, Illinois, 61801
Ascension Saint Vincent Anderson
Anderson, Indiana, 46016
Elkhart General Hospital
Elkhart, Indiana, 46515
Radiation Oncology Associates PC
Fort Wayne, Indiana, 46804
Parkview Hospital Randallia
Fort Wayne, Indiana, 46805
Parkview Regional Medical Center
Fort Wayne, Indiana, 46845
Goshen Center for Cancer Care
Goshen, Indiana, 46526
Indiana University/Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, 46202
IU Health Methodist Hospital
Indianapolis, Indiana, 46202
IU Health Central Indiana Cancer Centers-East
Indianapolis, Indiana, 46219
Michiana Hematology Oncology PC-Mishawaka
Mishawaka, Indiana, 46545
Memorial Hospital of South Bend
South Bend, Indiana, 46601
McFarland Clinic - Ames
Ames, Iowa, 50010
Iowa Methodist Medical Center
Des Moines, Iowa, 50309
University of Kansas Cancer Center
Kansas City, Kansas, 66160
Lawrence Memorial Hospital
Lawrence, Kansas, 66044
The University of Kansas Cancer Center - Olathe
Olathe, Kansas, 66061
University of Kansas Cancer Center-Overland Park
Overland Park, Kansas, 66210
Salina Regional Health Center
Salina, Kansas, 67401
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
The James Graham Brown Cancer Center at University of Louisville
Louisville, Kentucky, 40202
UofL Health Medical Center Northeast
Louisville, Kentucky, 40245
LSU Health Baton Rouge-North Clinic
Baton Rouge, Louisiana, 70805
Our Lady of the Lake Physician Group
Baton Rouge, Louisiana, 70808
Our Lady of The Lake
Baton Rouge, Louisiana, 70808
Tulane University School of Medicine
New Orleans, Louisiana, 70112
University Medical Center New Orleans
New Orleans, Louisiana, 70112
Touro Infirmary
New Orleans, Louisiana, 70115
Ochsner Medical Center Jefferson
New Orleans, Louisiana, 70121
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
Greater Baltimore Medical Center
Baltimore, Maryland, 21204
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, 21287
UM Upper Chesapeake Medical Center
Bel Air, Maryland, 21014
Central Maryland Radiation Oncology in Howard County
Columbia, Maryland, 21044
UM Baltimore Washington Medical Center/Tate Cancer Center
Glen Burnie, Maryland, 21061
Holy Cross Hospital
Silver Spring, Maryland, 20910
Boston Medical Center
Boston, Massachusetts, 02118
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor, Michigan, 48106
University of Michigan Rogel Cancer Center
Ann Arbor, Michigan, 48109
Trinity Health Medical Center - Brighton
Brighton, Michigan, 48114
University of Michigan - Brighton Center for Specialty Care
Brighton, Michigan, 48116
Henry Ford Cancer Institute-Downriver
Brownstown, Michigan, 48183
Henry Ford Macomb Hospital-Clinton Township
Clinton Township, Michigan, 48038
Henry Ford Medical Center-Fairlane
Dearborn, Michigan, 48126
Henry Ford Hospital
Detroit, Michigan, 48202
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids, Michigan, 49503
Allegiance Health
Jackson, Michigan, 49201
West Michigan Cancer Center
Kalamazoo, Michigan, 49007
University of Michigan Health - Sparrow Lansing
Lansing, Michigan, 48912
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan, 48154
Henry Ford Medical Center-Columbus
Novi, Michigan, 48377
Corewell Health William Beaumont University Hospital
Royal Oak, Michigan, 48073
MyMichigan Medical Center Saginaw
Saginaw, Michigan, 48601
Corewell Health Beaumont Troy Hospital
Troy, Michigan, 48085
Henry Ford West Bloomfield Hospital
West Bloomfield, Michigan, 48322
Henry Ford Wyandotte Hospital
Wyandotte, Michigan, 48192
University of Michigan Health - West
Wyoming, Michigan, 49519
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota, 56601
Minnesota Oncology - Burnsville
Burnsville, Minnesota, 55337
Miller-Dwan Hospital
Duluth, Minnesota, 55805
Hennepin County Medical Center
Minneapolis, Minnesota, 55415
North Memorial Medical Health Center
Robbinsdale, Minnesota, 55422
Mayo Clinic in Rochester
Rochester, Minnesota, 55905
Coborn Cancer Center at Saint Cloud Hospital
Saint Cloud, Minnesota, 56303
University of Mississippi Medical Center
Jackson, Mississippi, 39216
Saint Francis Medical Center
Cape Girardeau, Missouri, 63703
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri, 63376
MU Health - University Hospital/Ellis Fischel Cancer Center
Columbia, Missouri, 65212
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri, 63141
North Kansas City Hospital
Kansas City, Missouri, 64116
The University of Kansas Cancer Center-South
Kansas City, Missouri, 64131
University of Kansas Cancer Center - North
Kansas City, Missouri, 64154
University of Kansas Cancer Center - Lee's Summit
Lee's Summit, Missouri, 64064
Phelps Health Delbert Day Cancer Institute
Rolla, Missouri, 65401
Mercy Hospital Springfield
Springfield, Missouri, 65804
CoxHealth South Hospital
Springfield, Missouri, 65807
Washington University School of Medicine
St Louis, Missouri, 63110
Siteman Cancer Center-South County
St Louis, Missouri, 63129
Missouri Baptist Medical Center
St Louis, Missouri, 63131
Mercy Hospital Saint Louis
St Louis, Missouri, 63141
CHI Health Good Samaritan
Kearney, Nebraska, 68847
Nebraska Methodist Hospital
Omaha, Nebraska, 68114
Alegent Health Bergan Mercy Medical Center
Omaha, Nebraska, 68124
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
Memorial Sloan Kettering Basking Ridge
Basking Ridge, New Jersey, 07920
The Cancer Institute of New Jersey Hamilton
Hamilton, New Jersey, 08690
Saint Barnabas Medical Center
Livingston, New Jersey, 07039
Monmouth Medical Center
Long Branch, New Jersey, 07740
Memorial Sloan Kettering Monmouth
Middletown, New Jersey, 07748
Memorial Sloan Kettering Bergen
Montvale, New Jersey, 07645
Virtua Memorial
Mount Holly, New Jersey, 08060
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, 08903
Rutgers New Jersey Medical School
Newark, New Jersey, 07101
Robert Wood Johnson University Hospital Somerset
Somerville, New Jersey, 08876
Sparta Cancer Treatment Center
Sparta, New Jersey, 07871
Community Medical Center
Toms River, New Jersey, 08755
Virtua Voorhees
Voorhees Township, New Jersey, 08043
University of New Mexico Cancer Center
Albuquerque, New Mexico, 87106
New Mexico Oncology Hematology Consultants
Albuquerque, New Mexico, 87109
South Shore University Hospital
Bay Shore, New York, 11706
New York-Presbyterian/Brooklyn Methodist Hospital
Brooklyn, New York, 11215
NYU Langone Hospital - Brooklyn
Brooklyn, New York, 11220
Roswell Park Cancer Institute
Buffalo, New York, 14263
Sands Cancer Center
Canandaigua, New York, 14424
Memorial Sloan Kettering Commack
Commack, New York, 11725
Arnot Ogden Medical Center/Falck Cancer Center
Elmira, New York, 14905
Memorial Sloan Kettering Westchester
Harrison, New York, 10604
Northwell Health/Center for Advanced Medicine
Lake Success, New York, 11042
NYU Langone Hospital - Long Island
Mineola, New York, 11501
Mount Sinai Union Square
New York, New York, 10003
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, 10016
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, 10032
Memorial Sloan Kettering Cancer Center
New York, New York, 10065
Wilmot Cancer Institute Radiation Oncology at Greece
Rochester, New York, 14606
Highland Hospital
Rochester, New York, 14620
University of Rochester
Rochester, New York, 14642
Memorial Sloan Kettering Sleepy Hollow
Sleepy Hollow, New York, 10591
State University of New York Upstate Medical University
Syracuse, New York, 13210
Montefiore Medical Center-Einstein Campus
The Bronx, New York, 10461
Montefiore Medical Center - Moses Campus
The Bronx, New York, 10467
Memorial Sloan Kettering Nassau
Uniondale, New York, 11553
Atrium Health Stanly/LCI-Albemarle
Albemarle, North Carolina, 28002
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, 27599
Carolinas Medical Center/Levine Cancer Institute
Charlotte, North Carolina, 28203
Atrium Health Pineville/LCI-Pineville
Charlotte, North Carolina, 28210
Atrium Health University City/LCI-University
Charlotte, North Carolina, 28262
Atrium Health Cabarrus/LCI-Concord
Concord, North Carolina, 28025
East Carolina University
Greenville, North Carolina, 27834
ECU Health Oncology Kinston
Kinston, North Carolina, 28501
Atrium Health Union/LCI-Union
Monroe, North Carolina, 28112
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
Sanford Bismarck Medical Center
Bismarck, North Dakota, 58501
Sanford Roger Maris Cancer Center
Fargo, North Dakota, 58122
Summa Health System - Akron Campus
Akron, Ohio, 44304
Cleveland Clinic Akron General
Akron, Ohio, 44307
UH Seidman Cancer Center at UH Avon Health Center
Avon, Ohio, 44011
Summa Health System - Barberton Campus
Barberton, Ohio, 44203
UHHS-Chagrin Highlands Medical Center
Beachwood, Ohio, 44122
Geauga Hospital
Chardon, Ohio, 44024
Adena Regional Medical Center
Chillicothe, Ohio, 45601
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
Case Western Reserve University
Cleveland, Ohio, 44106
MetroHealth Medical Center
Cleveland, Ohio, 44109
Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland, Ohio, 44111
Cleveland Clinic Foundation
Cleveland, Ohio, 44195
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210
Mercy Cancer Center-Elyria
Elyria, Ohio, 44035
Cleveland Clinic Cancer Center Independence
Independence, Ohio, 44131
OhioHealth Mansfield Hospital
Mansfield, Ohio, 44903
Hillcrest Hospital Cancer Center
Mayfield Heights, Ohio, 44124
Summa Health Medina Medical Center
Medina, Ohio, 44256
UH Seidman Cancer Center at Lake Health Mentor Campus
Mentor, Ohio, 44060
UH Seidman Cancer Center at Southwest General Hospital
Middleburg Heights, Ohio, 44130
University Hospitals Parma Medical Center
Parma, Ohio, 44129
Southern Ohio Medical Center
Portsmouth, Ohio, 45662
University Hospitals Portage Medical Center
Ravenna, Ohio, 44266
North Coast Cancer Care
Sandusky, Ohio, 44870
UH Seidman Cancer Center at Firelands Regional Medical Center
Sandusky, Ohio, 44870
Cleveland Clinic Cancer Center Strongsville
Strongsville, Ohio, 44136
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
UHHS-Westlake Medical Center
Westlake, Ohio, 44145
Cleveland Clinic Wooster Family Health and Surgery Center
Wooster, Ohio, 44691
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Clackamas Radiation Oncology Center
Clackamas, Oregon, 97015
Providence Portland Medical Center
Portland, Oregon, 97213
Providence Saint Vincent Medical Center
Portland, Oregon, 97225
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania, 18103
Saint Luke's Cancer Center - Allentown
Allentown, Pennsylvania, 18104
UPMC Altoona
Altoona, Pennsylvania, 16601
UPMC-Heritage Valley Health System Beaver
Beaver, Pennsylvania, 15009
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania, 18017
Carlisle Regional Cancer Center
Carlisle, Pennsylvania, 17015
Pocono Medical Center
East Stroudsburg, Pennsylvania, 18301
Saint Luke's Hospital-Anderson Campus
Easton, Pennsylvania, 18045
UPMC Hillman Cancer Center Erie
Erie, Pennsylvania, 16505
UPMC Cancer Center at UPMC Horizon
Farrell, Pennsylvania, 16121
UPMC Cancer Centers - Arnold Palmer Pavilion
Greensburg, Pennsylvania, 15601
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
Harrisburg, Pennsylvania, 17109
Penn State Milton S Hershey Medical Center
Hershey, Pennsylvania, 17033-0850
IRMC Cancer Center
Indiana, Pennsylvania, 15701
UPMC-Johnstown/John P. Murtha Regional Cancer Center
Johnstown, Pennsylvania, 15901
UPMC Cancer Center at UPMC McKeesport
McKeesport, Pennsylvania, 15132
UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
Mechanicsburg, Pennsylvania, 17050
UPMC Cancer Center - Monroeville
Monroeville, Pennsylvania, 15146
UPMC Hillman Cancer Center in Coraopolis
Moon Township, Pennsylvania, 15108
UPMC Cancer Center-Natrona Heights
Natrona Heights, Pennsylvania, 15065
UPMC Jameson
New Castle, Pennsylvania, 16105
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, 19107
Fox Chase Cancer Center
Philadelphia, Pennsylvania, 19111
Temple University Hospital
Philadelphia, Pennsylvania, 19140
Allegheny General Hospital
Pittsburgh, Pennsylvania, 15212
UPMC-Magee Womens Hospital
Pittsburgh, Pennsylvania, 15213
UPMC-Saint Margaret
Pittsburgh, Pennsylvania, 15215
UPMC-Shadyside Hospital
Pittsburgh, Pennsylvania, 15232
UPMC Jefferson Regional Radiation Oncology
Pittsburgh, Pennsylvania, 15236
UPMC-Passavant Hospital
Pittsburgh, Pennsylvania, 15237
UPMC-Saint Clair Hospital Cancer Center
Pittsburgh, Pennsylvania, 15243
Saint Luke's Hospital - Upper Bucks Campus
Quakertown, Pennsylvania, 18951
UPMC Cancer Center at UPMC Northwest
Seneca, Pennsylvania, 16346
Saint Luke's Hospital - Monroe Campus
Stroudsburg, Pennsylvania, 18360
UPMC Uniontown Hospital Radiation Oncology
Uniontown, Pennsylvania, 15401
UPMC Washington Hospital Radiation Oncology
Washington, Pennsylvania, 15301
Reading Hospital
West Reading, Pennsylvania, 19611
Wexford Health and Wellness Pavilion
Wexford, Pennsylvania, 15090
AnMed Health Cancer Center
Anderson, South Carolina, 29621
Saint Joseph's/Candler - Bluffton Campus
Bluffton, South Carolina, 29910
Prisma Health Cancer Institute - Spartanburg
Boiling Springs, South Carolina, 29316
Medical University of South Carolina
Charleston, South Carolina, 29425
Prisma Health Cancer Institute - Faris
Greenville, South Carolina, 29605
Prisma Health Cancer Institute - Eastside
Greenville, South Carolina, 29615
Prisma Health Cancer Institute - Greer
Greer, South Carolina, 29650
Gibbs Cancer Center-Pelham
Greer, South Carolina, 29651
Rock Hill Radiation Therapy Center
Rock Hill, South Carolina, 29730
Prisma Health Cancer Institute - Seneca
Seneca, South Carolina, 29672
Spartanburg Medical Center
Spartanburg, South Carolina, 29303
Rapid City Regional Hospital
Rapid City, South Dakota, 57701
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Vanderbilt University/Ingram Cancer Center
Nashville, Tennessee, 37232
MD Anderson in The Woodlands
Conroe, Texas, 77384
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
University of Texas Medical Branch
Galveston, Texas, 77555-0565
UT MD Anderson Cancer Center
Houston, Texas, 77030
MD Anderson West Houston
Houston, Texas, 77079
UT MD Anderson - League City
League City, Texas, 77573
UTMB Cancer Center at Victory Lakes
League City, Texas, 77573
Covenant Medical Center-Lakeside
Lubbock, Texas, 79410
MD Anderson in Sugar Land
Sugar Land, Texas, 77478
Intermountain Medical Center
Murray, Utah, 84107
Utah Cancer Specialists-Salt Lake City
Salt Lake City, Utah, 84106
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, 84112
Saint George Regional Medical Center
St. George, Utah, 84770
Dartmouth Cancer Center - North
Saint Johnsbury, Vermont, 05819
Inova Fairfax Hospital
Falls Church, Virginia, 22042
Sentara Cancer Institute at Sentara CarePlex Hospital
Hampton, Virginia, 23666
Sentara Norfolk General Hospital
Norfolk, Virginia, 23507
VCU Massey Comprehensive Cancer Center
Richmond, Virginia, 23298
Sentara Virginia Beach General Hospital
Virginia Beach, Virginia, 23454
Saint Francis Hospital
Federal Way, Washington, 98003
Tri-Cities Cancer Center
Kennewick, Washington, 99336
PeaceHealth Saint John Medical Center
Longview, Washington, 98632
Skagit Regional Health Cancer Care Center
Mount Vernon, Washington, 98274
University of Washington Medical Center - Montlake
Seattle, Washington, 98195
Spokane Valley Cancer Center-Mayfair
Spokane, Washington, 99208
Spokane Valley Cancer Center-Mission
Spokane, Washington, 99216
Wenatchee Valley Hospital and Clinics
Wenatchee, Washington, 98801
West Virginia University Healthcare
Morgantown, West Virginia, 26506
Camden Clark Medical Center
Parkersburg, West Virginia, 26101
Wheeling Hospital/Schiffler Cancer Center
Wheeling, West Virginia, 26003
Langlade Hospital and Cancer Center
Antigo, Wisconsin, 54409
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin, 54301
Saint Vincent Hospital Cancer Center at Saint Mary's
Green Bay, Wisconsin, 54303
University of Wisconsin Carbone Cancer Center - Johnson Creek
Johnson Creek, Wisconsin, 53038
Gundersen Lutheran Medical Center
La Crosse, Wisconsin, 54601
Mayo Clinic Health System-Franciscan Healthcare
La Crosse, Wisconsin, 54601
University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
Madison, Wisconsin, 53718
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792
Bay Area Medical Center
Marinette, Wisconsin, 54143
Marshfield Medical Center
Marshfield, Wisconsin, 54449
Froedtert Menomonee Falls Hospital
Menomonee Falls, Wisconsin, 53051
Medical College of Wisconsin
Milwaukee, Wisconsin, 53226
Marshfield Medical Center - Minocqua
Minocqua, Wisconsin, 54548
Cancer Center of Western Wisconsin
New Richmond, Wisconsin, 54017
Drexel Town Square Health Center
Oak Creek, Wisconsin, 53154
Aspirus Cancer Care - James Beck Cancer Center
Rhinelander, Wisconsin, 54501
Aspirus Cancer Care - Stevens Point
Stevens Point, Wisconsin, 54481
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Sturgeon Bay, Wisconsin, 54235-1495
Aspirus Regional Cancer Center
Wausau, Wisconsin, 54401
Froedtert West Bend Hospital/Kraemer Cancer Center
West Bend, Wisconsin, 53095
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin, 54494