Randomized Phase III Trial Incorporating Apalutamide and Advanced Imaging Into Salvage Treatment for Patients With Node-Positive Prostate Cancer After Radical Prostatectomy (INNOVATE*) *INtensifying Treatment for NOde Positive Prostate Cancer by VArying the Hormonal ThErapy
Summary
This phase III trial studies whether adding apalutamide to the usual treatment improves outcome in patients with lymph node positive prostate cancer after surgery. Radiation therapy uses high energy x-ray to kill tumor cells and shrink tumors. Androgens, or male sex hormones, can cause the growth of prostate cancer cells. Drugs, such as apalutamide, may help stop or reduce the growth of prostate cancer cell growth by blocking the attachment of androgen to its receptors on cancer cells, a mechanism similar to stopping the entrance of a key into its lock. Adding apalutamide to the usual hormone therapy and radiation therapy after surgery may stabilize prostate cancer and prevent it from spreading and extend time without disease spreading compared to the usual approach.
Detailed description
PRIMARY OBJECTIVE: I. Compare metastasis-free survival (MFS) of salvage radiation therapy (RT) and gonadotropin releasing hormone (GnRH) agonist/antagonist versus (vs.) RT/GnRH agonist/antagonist with apalutamide for patients with pathologic node-positive prostate cancer after radical prostatectomy with detectable prostate-specific antigen (PSA). SECONDARY OBJECTIVES: I. Compare health-related quality of life (Expanded Prostate Cancer Index Composite \[EPIC\]-26, EuroQol \[EQ\]-5 Dimension \[D\]-5 Level \[L\], Brief Pain Inventory, Patient Reported Outcome Measurement Information System \[PROMIS\]-Fatigue) among the treatment arms. II. Compare overall survival, biochemical progression-free survival, time to local-regional progression, time to castrate resistance, and cancer-specific survival among the treatment arms. III. Compare the short-term and long-term treatment-related adverse events among the treatment arms. EXPLORATORY OBJECTIVES: I. Validate Decipher score for an exclusively node-positive population and use additional genomic information from Affymetrix Human Exon 1.0st array to develop and validate novel prognostic and predictive biomarkers. II. Validate the PAM50-based classification of prostate cancer into luminal A, luminal B, and basal subtypes as prognostic markers and determine whether the luminal B subtype is a predictive marker for having a larger improvement in outcome from the addition of apalutamide. III. To optimize quality assurance methodologies and processes for radiotherapy and imaging with machine learning strategies. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive standard of care hormone therapy per physician discretion for 24 months. Patients also undergo standard of care pelvis and prostate bed radiation therapy 5 days per week over 5-6 or 7-8 weeks beginning within 90 days of randomization in the absence of disease progression or unacceptable toxicity. ARM II: Patients undergo standard of care hormone therapy and radiation therapy as in Arm I. Patients also receive apalutamide orally (PO) once daily (QD) on days 1-90 of each cycle. Cycles repeat every 90 days for 8 cycles in the absence of disease progression or unacceptable toxicity. Patients in both arms may undergo computed tomography (CT), magnetic resonance imaging (MRI), bone scan, and positron emission tomography (PET) as clinically indicated throughout the study. Patients may also undergo blood sample collection throughout the study. After completion of study treatment, patients are followed up every 6 months for 3 years, then annually thereafter.
Arms & interventions
- DrugApalutamide
Given PO
- ProcedureBiospecimen Collection
Undergo blood sample collection
- ProcedureBone Scan
Undergo bone scan
- ProcedureComputed Tomography
Undergo CT
- DrugHormone Therapy
Receive hormone therapy
- ProcedureMagnetic Resonance Imaging
Undergo MRI
- ProcedurePositron Emission Tomography
Undergo PET
- OtherQuality-of-Life Assessment
Ancillary studies
- OtherQuestionnaire Administration
Ancillary studies
- RadiationRadiation Therapy
Undergo pelvis and prostate bed radiation therapy
Outcome measures
Primary
Metastasis-free survival (MFS)
Kaplan-Meier curves will be generated and metastasis-free survival compared between the two treatment groups by a logrank test, stratified by prostate specific antigen (PSA) level after prostatectomy (never detectable or rising). Cox regression modeling to assess and adjust for the effects of PSA stratum and other baseline covariates will also be performed. The proportional hazards assumption will be tested using Schoenfeld residuals and graphical methods. Martingale residual plots will be examined to determine the best functional form for incorporating covariates into the model. A competing risks analysis will also be performed with time to distant metastasis or death from prostate cancer as the event of interest and death from other causes as the competing risk. Cumulative incidence curves will be generated along with Fine-Gray's test. Patients alive and metastasis free will be censored as of the time of the last negative examination.
Time frame: From randomization to detection of metastatic disease or death from any cause, assessed up to 7.5 years
Secondary
Quality of life (QOL) between the two treatment arms
Time frame: Up to 3 years post treatment
Overall survival (OS)
Time frame: From randomization until date of death or censored at last date known alive, assessed up to 7.5 years
Biochemical progression-free survival (bPFS)
Time frame: From randomization until biochemical recurrence or death from prostate cancer, assessed up to 7.5 years
Time to local-regional progression
Time frame: Up to 7.5 years
Time to castrate resistance
Time frame: Up to 7.5 years
Cancer-specific survival
Time frame: Up to 7.5 years
Incidence of adverse events
Time frame: Up to 7.5 years
Eligibility criteria
Study locations (345)
Cancer Center at Saint Joseph's
Phoenix, Arizona, 85004
University of Arkansas for Medical Sciences
Little Rock, Arkansas, 72205
Kaiser Permanente-Anaheim
Anaheim, California, 92806
Kaiser Permanente-Baldwin Park
Baldwin Park, California, 91706
Kaiser Permanente-Bellflower
Bellflower, California, 90706
Mercy Cancer Center - Carmichael
Carmichael, California, 95608
Mercy San Juan Medical Center
Carmichael, California, 95608
Mercy Cancer Center - Elk Grove
Elk Grove, California, 95758
Kaiser Permanente-Fontana
Fontana, California, 92335
Marin General Hospital
Greenbrae, California, 94904
Kaiser Permanente South Bay
Harbor City, California, 90710
Kaiser Permanente-Irvine
Irvine, California, 92618
Tibor Rubin VA Medical Center
Long Beach, California, 90822
Kaiser Permanente Los Angeles Medical Center
Los Angeles, California, 90027
Los Angeles General Medical Center
Los Angeles, California, 90033
USC / Norris Comprehensive Cancer Center
Los Angeles, California, 90033
Kaiser Permanente West Los Angeles
Los Angeles, California, 90034
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California, 90095
Kaiser Permanente-Ontario
Ontario, California, 91761
Kaiser Permanente - Panorama City
Panorama City, California, 91402
Kaiser Permanente-Riverside
Riverside, California, 92505
Mercy Cancer Center - Rocklin
Rocklin, California, 95765
Mercy Cancer Center - Sacramento
Sacramento, California, 95816
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
Kaiser Permanente-San Diego Zion
San Diego, California, 92120
UCSF Medical Center-Mount Zion
San Francisco, California, 94115
UCSF Medical Center-Parnassus
San Francisco, California, 94143
UCSF Medical Center-Mission Bay
San Francisco, California, 94158
Kaiser Permanente-San Marcos
San Marcos, California, 92078
Ridley-Tree Cancer Center
Santa Barbara, California, 93105
Woodland Memorial Hospital
Woodland, California, 95695
Kaiser Permanente-Woodland Hills
Woodland Hills, California, 91367
Beebe South Coastal Health Campus
Millville, Delaware, 19967
Helen F Graham Cancer Center
Newark, Delaware, 19713
Medical Oncology Hematology Consultants PA
Newark, Delaware, 19713
Christiana Care Health System-Christiana Hospital
Newark, Delaware, 19718
Beebe Health Campus
Rehoboth Beach, Delaware, 19971
George Washington University Medical Center
Washington D.C., District of Columbia, 20037
UM Sylvester Comprehensive Cancer Center at Aventura
Aventura, Florida, 33180
UM Sylvester Comprehensive Cancer Center at Coral Gables
Coral Gables, Florida, 33146
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Deerfield Beach, Florida, 33442
UM Sylvester Comprehensive Cancer Center at Doral
Doral, Florida, 33166
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
UM Sylvester Comprehensive Cancer Center at Kendall
Miami, Florida, 33176
UM Sylvester Comprehensive Cancer Center at Plantation
Plantation, Florida, 33324
Tampa General Hospital
Tampa, Florida, 33606
Grady Health System
Atlanta, Georgia, 30303
Emory Proton Therapy Center
Atlanta, Georgia, 30308
Emory University Hospital Midtown
Atlanta, Georgia, 30308
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, 30322
Emory Saint Joseph's Hospital
Atlanta, Georgia, 30342
Emory Decatur Hospital
Decatur, Georgia, 30033
Emory Johns Creek Hospital
Johns Creek, Georgia, 30097
Alton Memorial Hospital
Alton, Illinois, 62002
Rush-Copley Medical Center
Aurora, Illinois, 60504
Advocate Outpatient Center - Aurora
Aurora, Illinois, 60506
Advocate Good Shepherd Hospital
Barrington, Illinois, 60010
Illinois CancerCare-Bloomington
Bloomington, Illinois, 61704
Illinois CancerCare-Canton
Canton, Illinois, 61520
Illinois CancerCare-Carthage
Carthage, Illinois, 62321
Northwestern University
Chicago, Illinois, 60611
Rush MD Anderson Cancer Center
Chicago, Illinois, 60612
University of Illinois
Chicago, Illinois, 60612
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, 60637
Advocate Illinois Masonic Medical Center
Chicago, Illinois, 60657
AMG Crystal Lake - Oncology
Crystal Lake, Illinois, 60014
Carle at The Riverfront
Danville, Illinois, 61832
Decatur Memorial Hospital
Decatur, Illinois, 62526
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois, 60115
Illinois CancerCare-Dixon
Dixon, Illinois, 61021
Advocate Good Samaritan Hospital
Downers Grove, Illinois, 60515
Carle Physician Group-Effingham
Effingham, Illinois, 62401
Crossroads Cancer Center
Effingham, Illinois, 62401
Advocate Sherman Hospital
Elgin, Illinois, 60123
Elmhurst Memorial Hospital
Elmhurst, Illinois, 60126
Illinois CancerCare-Eureka
Eureka, Illinois, 61530
NorthShore University HealthSystem-Evanston Hospital
Evanston, Illinois, 60201
Illinois CancerCare-Galesburg
Galesburg, Illinois, 61401
Western Illinois Cancer Treatment Center
Galesburg, Illinois, 61401
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois, 60134
NorthShore University HealthSystem-Glenbrook Hospital
Glenview, Illinois, 60026
Ingalls Memorial Hospital
Harvey, Illinois, 60426
Advocate South Suburban Hospital
Hazel Crest, Illinois, 60429
NorthShore University HealthSystem-Highland Park Hospital
Highland Park, Illinois, 60035
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois, 61443
AMG Libertyville - Oncology
Libertyville, Illinois, 60048
Condell Memorial Hospital
Libertyville, Illinois, 60048
Illinois CancerCare-Macomb
Macomb, Illinois, 61455
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
Loyola University Medical Center
Maywood, Illinois, 60153
Edward Hospital/Cancer Center
Naperville, Illinois, 60540
UC Comprehensive Cancer Center at Silver Cross
New Lenox, Illinois, 60451
HSHS Saint Elizabeth's Hospital
O'Fallon, Illinois, 62269
Northwestern Medicine Oak Brook
Oak Brook, Illinois, 60523
Advocate Christ Medical Center
Oak Lawn, Illinois, 60453-2699
Northwestern Medicine Orland Park
Orland Park, Illinois, 60462
University of Chicago Medicine-Orland Park
Orland Park, Illinois, 60462
Illinois CancerCare-Ottawa Clinic
Ottawa, Illinois, 61350
Advocate High Tech Medical Park
Palos Heights, Illinois, 60463
Advocate Lutheran General Hospital
Park Ridge, Illinois, 60068
Illinois CancerCare-Pekin
Pekin, Illinois, 61554
OSF Saint Francis Radiation Oncology at Pekin
Pekin, Illinois, 61554
Illinois CancerCare-Peoria
Peoria, Illinois, 61615
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
Peoria, Illinois, 61615
Methodist Medical Center of Illinois
Peoria, Illinois, 61636
OSF Saint Francis Medical Center
Peoria, Illinois, 61637
Illinois CancerCare-Peru
Peru, Illinois, 61354
Valley Radiation Oncology
Peru, Illinois, 61354
Illinois CancerCare-Princeton
Princeton, Illinois, 61356
Memorial Hospital East
Shiloh, Illinois, 62269
Southern Illinois University School of Medicine
Springfield, Illinois, 62702
Springfield Clinic
Springfield, Illinois, 62702
Springfield Memorial Hospital
Springfield, Illinois, 62781
Carle Cancer Center
Urbana, Illinois, 61801
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois, 60555
Illinois CancerCare - Washington
Washington, Illinois, 61571
Reid Health
Richmond, Indiana, 47374
McFarland Clinic - Ames
Ames, Iowa, 50010
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny, Iowa, 50023
Saint Anthony Regional Hospital
Carroll, Iowa, 51401
Saint Luke's Hospital
Cedar Rapids, Iowa, 52402
Mercy Hospital
Cedar Rapids, Iowa, 52403
Oncology Associates at Mercy Medical Center
Cedar Rapids, Iowa, 52403
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive, Iowa, 50325
Iowa Methodist Medical Center
Des Moines, Iowa, 50309
UI Health Care Mission Cancer and Blood - Des Moines Clinic
Des Moines, Iowa, 50309
Broadlawns Medical Center
Des Moines, Iowa, 50314
Mercy Medical Center - Des Moines
Des Moines, Iowa, 50314
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines, Iowa, 50314
Iowa Lutheran Hospital
Des Moines, Iowa, 50316
Methodist West Hospital
West Des Moines, Iowa, 50266-7700
University of Kansas Cancer Center
Kansas City, Kansas, 66160
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 Kansas Health System Saint Francis Campus
Topeka, Kansas, 66606
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas, 66205
LSU Health Baton Rouge-North Clinic
Baton Rouge, Louisiana, 70805
Our Lady of the Lake Physician Group
Baton Rouge, Louisiana, 70808
Mary Bird Perkins Cancer Center
Baton Rouge, Louisiana, 70809
Mary Bird Perkins Cancer Center - Metairie
Metairie, Louisiana, 70002
East Jefferson General Hospital
Metairie, Louisiana, 70006
LSU Healthcare Network / Metairie Multi-Specialty Clinic
Metairie, Louisiana, 70006
Tulane University School of Medicine
New Orleans, Louisiana, 70112
Ochsner Medical Center Jefferson
New Orleans, Louisiana, 70121
Lafayette Family Cancer Center-EMMC
Brewer, Maine, 04412
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, 02114
Brigham and Women's Hospital
Boston, Massachusetts, 02115
Dana-Farber Cancer Institute
Boston, Massachusetts, 02215
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor, Michigan, 48106
Trinity Health Medical Center - Brighton
Brighton, Michigan, 48114
Trinity Health Medical Center - Canton
Canton, Michigan, 48188
Chelsea Hospital
Chelsea, Michigan, 48118
Henry Ford Hospital
Detroit, Michigan, 48202
McLaren Cancer Institute-Flint
Flint, Michigan, 48532
Singh and Arora Hematology Oncology PC
Flint, Michigan, 48532
Karmanos Cancer Institute at McLaren Greater Lansing
Lansing, Michigan, 48910
Mid-Michigan Physicians-Lansing
Lansing, Michigan, 48912
University of Michigan Health - Sparrow Lansing
Lansing, Michigan, 48912
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan, 48154
McLaren Cancer Institute-Macomb
Mount Clemens, Michigan, 48043
McLaren Cancer Institute-Owosso
Owosso, Michigan, 48867
Trinity Health Saint Joseph Mercy Oakland Hospital
Pontiac, Michigan, 48341
Minnesota Oncology - Burnsville
Burnsville, Minnesota, 55337
Mercy Hospital
Coon Rapids, Minnesota, 55433
Fairview Southdale Hospital
Edina, Minnesota, 55435
Unity Hospital
Fridley, Minnesota, 55432
Fairview Clinics and Surgery Center Maple Grove
Maple Grove, Minnesota, 55369
Minnesota Oncology Hematology PA-Maplewood
Maplewood, Minnesota, 55109
Saint John's Hospital - Healtheast
Maplewood, Minnesota, 55109
Abbott-Northwestern Hospital
Minneapolis, Minnesota, 55407
Hennepin County Medical Center
Minneapolis, Minnesota, 55415
Monticello Cancer Center
Monticello, Minnesota, 55362
North Memorial Medical Health Center
Robbinsdale, Minnesota, 55422
Coborn Cancer Center at Saint Cloud Hospital
Saint Cloud, Minnesota, 56303
Park Nicollet Clinic - Saint Louis Park
Saint Louis Park, Minnesota, 55416
Regions Hospital
Saint Paul, Minnesota, 55101
United Hospital
Saint Paul, Minnesota, 55102
Saint Francis Regional Medical Center
Shakopee, Minnesota, 55379
Lakeview Hospital
Stillwater, Minnesota, 55082
Ridgeview Medical Center
Waconia, Minnesota, 55387
Rice Memorial Hospital
Willmar, Minnesota, 56201
Minnesota Oncology Hematology PA-Woodbury
Woodbury, Minnesota, 55125
Mercy Oncology and Hematology - Clayton-Clarkson
Ballwin, Missouri, 63011
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
Freeman Health System
Joplin, Missouri, 64804
University of Kansas Cancer Center - Briarcliff
Kansas City, Missouri, 64116
University of Kansas Cancer Center - North
Kansas City, Missouri, 64154
University of Kansas Cancer Center - Lee's Summit
Lee's Summit, Missouri, 64064
University of Kansas Cancer Center at North Kansas City Hospital
North Kansas City, Missouri, 64116
Washington University School of Medicine
St Louis, Missouri, 63110
Siteman Cancer Center-South County
St Louis, Missouri, 63129
Siteman Cancer Center at Christian Hospital
St Louis, Missouri, 63136
Mercy Hospital Saint Louis
St Louis, Missouri, 63141
Billings Clinic Cancer Center
Billings, Montana, 59101
Benefis Sletten Cancer Institute
Great Falls, Montana, 59405
Cancer Partners of Nebraska
Lincoln, Nebraska, 68516
Comprehensive Cancer Centers of Nevada - Henderson
Henderson, Nevada, 89052
OptumCare Cancer Care at Seven Hills
Henderson, Nevada, 89052
Oncology Las Vegas - Henderson
Henderson, Nevada, 89074
OptumCare Cancer Care at Charleston
Las Vegas, Nevada, 89102
Radiation Oncology Centers of Nevada Central
Las Vegas, Nevada, 89106
Radiation Oncology Centers of Nevada Southeast
Las Vegas, Nevada, 89119
Comprehensive Cancer Centers of Nevada - Northwest
Las Vegas, Nevada, 89128
Oncology Las Vegas - Tenaya
Las Vegas, Nevada, 89128
OptumCare Cancer Care at MountainView
Las Vegas, Nevada, 89128
Comprehensive Cancer Centers of Nevada - Town Center
Las Vegas, Nevada, 89144
Comprehensive Cancer Centers of Nevada-Summerlin
Las Vegas, Nevada, 89144
Summerlin Hospital Medical Center
Las Vegas, Nevada, 89144
Comprehensive Cancer Centers of Nevada
Las Vegas, Nevada, 89148
OptumCare Cancer Care at Fort Apache
Las Vegas, Nevada, 89148
Comprehensive Cancer Centers of Nevada - Central Valley
Las Vegas, Nevada, 89169
Renown Regional Medical Center
Reno, Nevada, 89502
New Hampshire Oncology Hematology PA-Concord
Concord, New Hampshire, 03301
Solinsky Center for Cancer Care
Manchester, New Hampshire, 03103
Memorial Sloan Kettering Basking Ridge
Basking Ridge, New Jersey, 07920
Cooper Hospital University Medical Center
Camden, New Jersey, 08103
Saint Barnabas Medical Center
Livingston, New Jersey, 07039
Memorial Sloan Kettering Monmouth
Middletown, New Jersey, 07748
Memorial Sloan Kettering Bergen
Montvale, New Jersey, 07645
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
MD Anderson Cancer Center at Cooper-Voorhees
Voorhees Township, New Jersey, 08043
Sands Cancer Center
Canandiaqua, New York, 14424
Memorial Sloan Kettering Commack
Commack, New York, 11725
Memorial Sloan Kettering Westchester
East White Plains, New York, 10604
Northwell Health Physicians Partners Radiation Medicine at Queens
Forest Hills, New York, 11375
Northwell Health/Center for Advanced Medicine
Lake Success, New York, 11042
Garnet Health Medical Center
Middletown, New York, 10940
Memorial Sloan Kettering Cancer Center
New York, New York, 10065
Queens Cancer Center
Rego Park, New York, 11374
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 Nassau
Uniondale, New York, 11553
Wilmot Cancer Institute at Webster
Webster, New York, 14580
Duke Cancer Center Cary
Cary, North Carolina, 27518
Duke University Medical Center
Durham, North Carolina, 27710
Duke Cancer Center Raleigh
Raleigh, North Carolina, 27609
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
Altru Cancer Center
Grand Forks, North Dakota, 58201
Cleveland Clinic Akron General
Akron, Ohio, 44307
Miami Valley Hospital South
Centerville, Ohio, 45459
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland, Ohio, 44111
Cleveland Clinic Foundation
Cleveland, Ohio, 44195
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210
Miami Valley Hospital
Dayton, Ohio, 45409
Premier Blood and Cancer Center
Dayton, Ohio, 45409
Miami Valley Hospital North
Dayton, Ohio, 45415
Armes Family Cancer Center
Findlay, Ohio, 45840
Atrium Medical Center-Middletown Regional Hospital
Franklin, Ohio, 45005-1066
Cleveland Clinic Cancer Center Mansfield
Mansfield, Ohio, 44906
Hillcrest Hospital Cancer Center
Mayfield Heights, Ohio, 44124
North Coast Cancer Care
Sandusky, Ohio, 44870
Cleveland Clinic Cancer Center Strongsville
Strongsville, Ohio, 44136
Upper Valley Medical Center
Troy, Ohio, 45373
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
Cleveland Clinic Wooster Family Health and Surgery Center
Wooster, Ohio, 44691
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Legacy Mount Hood Medical Center
Gresham, Oregon, 97030
Legacy Good Samaritan Hospital and Medical Center
Portland, Oregon, 97210
UPMC Altoona
Altoona, Pennsylvania, 16601
UPMC-Heritage Valley Health System Beaver
Beaver, Pennsylvania, 15009
Crozer-Keystone Regional Cancer Center at Broomall
Broomall, Pennsylvania, 19008
Carlisle Regional Cancer Center
Carlisle, Pennsylvania, 17015
Christiana Care Health System-Concord Health Center
Chadds Ford, Pennsylvania, 19317
Delaware County Memorial Hospital
Drexel Hill, Pennsylvania, 19026
UPMC Hillman Cancer Center Erie
Erie, Pennsylvania, 16505
UPMC Cancer Center at UPMC Horizon
Farrell, Pennsylvania, 16121
Crozer Regional Cancer Center at Brinton Lake
Glen Mills, Pennsylvania, 19342
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-Magee Womens Hospital
Pittsburgh, Pennsylvania, 15213
UPMC-Saint Margaret
Pittsburgh, Pennsylvania, 15215
UPMC-Shadyside Hospital
Pittsburgh, Pennsylvania, 15232
UPMC-Passavant Hospital
Pittsburgh, Pennsylvania, 15237
UPMC-Saint Clair Hospital Cancer Center
Pittsburgh, Pennsylvania, 15243
UPMC Cancer Center at UPMC Northwest
Seneca, Pennsylvania, 16346
UPMC Uniontown Hospital Radiation Oncology
Uniontown, Pennsylvania, 15401
Crozer-Chester Medical Center
Upland, Pennsylvania, 19013
UPMC Washington Hospital Radiation Oncology
Washington, Pennsylvania, 15301
Chester County Hospital
West Chester, Pennsylvania, 19380
Reading Hospital
West Reading, Pennsylvania, 19611
UPMC Memorial
York, Pennsylvania, 17408
Avera Cancer Institute - Mitchell
Mitchell, South Dakota, 57301
Avera Cancer Institute at Pierre
Pierre, South Dakota, 57501
Avera Cancer Institute
Sioux Falls, South Dakota, 57105
Parkland Memorial Hospital
Dallas, Texas, 75235
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
Tarrant County Hospital District/JPS Health Network
Fort Worth, Texas, 76104
UT Southwestern/Simmons Cancer Center-Fort Worth
Fort Worth, Texas, 76104
UT Southwestern Clinical Center at Richardson/Plano
Richardson, Texas, 75080
Audie L Murphy VA Hospital
San Antonio, Texas, 78229
VCU Massey Cancer Center at Hanover Medical Park
Mechanicsville, Virginia, 23116
Bon Secours Saint Francis Medical Center
Midlothian, Virginia, 23114
Bon Secours Cancer Institute at Reynolds Crossing
Richmond, Virginia, 23230
VCU Massey Cancer Center at Stony Point
Richmond, Virginia, 23235
VCU Massey Comprehensive Cancer Center
Richmond, Virginia, 23298
Legacy Salmon Creek Hospital
Vancouver, Washington, 98686
West Virginia University Charleston Division
Charleston, West Virginia, 25304
Langlade Hospital and Cancer Center
Antigo, Wisconsin, 54409
ThedaCare Regional Cancer Center
Appleton, Wisconsin, 54911
Aurora Cancer Care-Southern Lakes VLCC
Burlington, Wisconsin, 53105
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin, 54701
Aurora Health Care Germantown Health Center
Germantown, Wisconsin, 53022
Aurora Cancer Care-Grafton
Grafton, Wisconsin, 53024
Bellin Memorial Hospital
Green Bay, Wisconsin, 54301
Aurora BayCare Medical Center
Green Bay, Wisconsin, 54311
Aurora Cancer Care-Kenosha South
Kenosha, Wisconsin, 53142
Aurora Bay Area Medical Group-Marinette
Marinette, Wisconsin, 54143
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
Froedtert Menomonee Falls Hospital
Menomonee Falls, Wisconsin, 53051
Aurora Cancer Care-Milwaukee
Milwaukee, Wisconsin, 53209
Aurora Saint Luke's Medical Center
Milwaukee, Wisconsin, 53215
Medical College of Wisconsin
Milwaukee, Wisconsin, 53226
Aurora Sinai Medical Center
Milwaukee, Wisconsin, 53233
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
Vince Lombardi Cancer Clinic - Oshkosh
Oshkosh, Wisconsin, 54904
Aurora Cancer Care-Racine
Racine, Wisconsin, 53406
Aspirus Cancer Care - James Beck Cancer Center
Rhinelander, Wisconsin, 54501
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin, 54868
Vince Lombardi Cancer Clinic-Sheboygan
Sheboygan, Wisconsin, 53081
Aspirus Cancer Care - Stevens Point
Stevens Point, Wisconsin, 54481
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin, 54482
Aurora Medical Center in Summit
Summit, Wisconsin, 53066
Aspirus Regional Cancer Center
Wausau, Wisconsin, 54401
Aurora Cancer Care-Milwaukee West
Wauwatosa, Wisconsin, 53226
Aurora West Allis Medical Center
West Allis, Wisconsin, 53227
Froedtert West Bend Hospital/Kraemer Cancer Center
West Bend, Wisconsin, 53095
Marshfield Medical Center - Weston
Weston, Wisconsin, 54476
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin, 54494
References
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