A Randomized Phase 2 Trial of Encorafenib + Binimetinib + Nivolumab vs Ipilimumab + Nivolumab in BRAF-V600 Mutant Melanoma With Brain Metastases
Summary
This phase II trial compares the effect of encorafenib, binimetinib, and nivolumab versus ipilimumab and nivolumab in treating patients with BRAF- V600 mutant melanoma that has spread to the brain (brain metastases). Encorafenib and binimetinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Ipilimumab and nivolumab are monoclonal antibodies that may interfere with the ability of tumor cells to grow and spread. This trial aims to find out which approach is more effective in shrinking and controlling brain metastases from melanoma.
Detailed description
PRIMARY OBJECTIVE: I. To compare progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 between participants randomized to the triplet combination of encorafenib + binimetinib + nivolumab versus the doublet combination of ipilimumab + nivolumab among participants with BRAF-V600 mutant melanoma that has metastasized to the brain. SECONDARY OBJECTIVES: I. To estimate the overall survival (OS) of participants in each treatment arm. II. To estimate the objective response rate (ORR) (confirmed and unconfirmed, complete and partial responses) per RECIST 1.1 in each treatment arm. III. To estimate the intracranial response rate (ICRR), defined as confirmed and unconfirmed complete and partial response per modified RECIST for brain metastases (mRECIST). IV. To evaluate the duration of response, per RECIST 1.1 and the duration of ICRR per mRECIST, and per Response Assessment in Neuro-Oncology (RANO)-Brain Metastases (BM) (and immunotherapy \[i\]RANO) in each treatment arm. V. To evaluate the toxicity profile of each treatment arm. VI. To evaluate current and emerging radiographic response criteria (modified RECIST 1.1, modified RANO-BM and iRANO) by a retrospective blinded independent centralized review (BICR) of banked images. BANKING OBJECTIVE: I. To bank tumor tissue, cerebral spinal fluid (CSF), stool and blood samples for future correlative studies. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive encorafenib orally (PO) once daily (QD) on days 1-28, binimetinib PO twice daily (BID) on days 1-28, and nivolumab intravenously (IV) on day 1. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive nivolumab IV on day 1 of all cycles and ipilimumab IV over 30 minutes on day 1 of cycles 1-4. Cycles repeat every 21 days for 4 cycles and then every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 6 months for 2 years, and then annually until 3 years after randomization.
Arms & interventions
- DrugBinimetinib
Given PO
- DrugEncorafenib
Given PO
- BiologicalIpilimumab
Given IV
- BiologicalNivolumab
Given IV
Outcome measures
Primary
Progression-free survival
Will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.
Time frame: From date of registration to date of first documentation of progression, or symptomatic deterioration, or death due to any cause, assessed up to 3 years after randomization
Secondary
Overall survival (OS)
Time frame: From date of registration to date of death due to any cause, assessed up to 3 years after randomization
Intracranial response rate (ICRR)
Time frame: Up to 3 years after randomization
Objective response rate
Time frame: Up to 3 years after randomization
Duration of response
Time frame: Up to 3 years after randomization
Eligibility criteria
Study locations (331)
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, 35233
Thomas Hospital
Fairhope, Alabama, 36532
Mobile Infirmary Medical Center
Mobile, Alabama, 36607
Anchorage Associates in Radiation Medicine
Anchorage, Alaska, 98508
Anchorage Radiation Therapy Center
Anchorage, Alaska, 99504
Alaska Breast Care and Surgery LLC
Anchorage, Alaska, 99508
Alaska Oncology and Hematology LLC
Anchorage, Alaska, 99508
Alaska Women's Cancer Care
Anchorage, Alaska, 99508
Anchorage Oncology Centre
Anchorage, Alaska, 99508
Katmai Oncology Group
Anchorage, Alaska, 99508
Providence Alaska Medical Center
Anchorage, Alaska, 99508
Fairbanks Memorial Hospital
Fairbanks, Alaska, 99701
Mercy Hospital Fort Smith
Fort Smith, Arkansas, 72903
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank, California, 91505
Epic Care-Dublin
Dublin, California, 94568
Bay Area Breast Surgeons Inc
Emeryville, California, 94608
Epic Care Partners in Cancer Care
Emeryville, California, 94608
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California, 90095
Contra Costa Regional Medical Center
Martinez, California, 94553-3156
Providence Queen of The Valley
Napa, California, 94558
Alta Bates Summit Medical Center - Summit Campus
Oakland, California, 94609
Bay Area Tumor Institute
Oakland, California, 94609
Sharp Memorial Hospital
San Diego, California, 92123
Providence Medical Foundation - Santa Rosa
Santa Rosa, California, 95403
Providence Santa Rosa Memorial Hospital
Santa Rosa, California, 95405
Epic Care Cyberknife Center
Walnut Creek, California, 94597
Rocky Mountain Cancer Centers-Aurora
Aurora, Colorado, 80012
The Medical Center of Aurora
Aurora, Colorado, 80012
University of Colorado Hospital
Aurora, Colorado, 80045
Boulder Community Foothills Hospital
Boulder, Colorado, 80303
Rocky Mountain Cancer Centers-Boulder
Boulder, Colorado, 80304
Rocky Mountain Cancer Centers - Centennial
Centennial, Colorado, 80112
The Women's Imaging Center
Denver, Colorado, 80209
Colorado Blood Cancer Institute
Denver, Colorado, 80218
Presbyterian - Saint Lukes Medical Center - Health One
Denver, Colorado, 80218
Rocky Mountain Cancer Centers-Midtown
Denver, Colorado, 80218
Rocky Mountain Cancer Centers-Rose
Denver, Colorado, 80220
Rose Medical Center
Denver, Colorado, 80220
Western Surgical Care
Denver, Colorado, 80220
Mountain Blue Cancer Care Center - Swedish
Englewood, Colorado, 80113
Rocky Mountain Cancer Centers - Swedish
Englewood, Colorado, 80113
Swedish Medical Center
Englewood, Colorado, 80113
The Melanoma and Skin Cancer Institute
Englewood, Colorado, 80113
North Colorado Medical Center
Greeley, Colorado, 80631
Rocky Mountain Cancer Centers-Lakewood
Lakewood, Colorado, 80228
Rocky Mountain Cancer Centers-Littleton
Littleton, Colorado, 80120
Rocky Mountain Cancer Centers-Sky Ridge
Lone Tree, Colorado, 80124
Sky Ridge Medical Center
Lone Tree, Colorado, 80124
McKee Medical Center
Loveland, Colorado, 80539
Rocky Mountain Cancer Centers-Thornton
Thornton, Colorado, 80260
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
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
UM Sylvester Comprehensive Cancer Center at Kendall
Miami, Florida, 33176
Orlando Health Cancer Institute
Orlando, Florida, 32806
UM Sylvester Comprehensive Cancer Center at Plantation
Plantation, Florida, 33324
Moffitt Cancer Center-International Plaza
Tampa, Florida, 33607
Moffitt Cancer Center - McKinley Campus
Tampa, Florida, 33612
Moffitt Cancer Center
Tampa, Florida, 33612
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Savannah, Georgia, 31405
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho, 83706
Saint Luke's Cancer Institute - Boise
Boise, Idaho, 83712
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell, Idaho, 83605
Kootenai Health - Coeur d'Alene
Coeur d'Alene, Idaho, 83814
Walter Knox Memorial Hospital
Emmett, Idaho, 83617
Saint Luke's Cancer Institute - Fruitland
Fruitland, Idaho, 83619
Idaho Urologic Institute-Meridian
Meridian, Idaho, 83642
Saint Luke's Cancer Institute - Meridian
Meridian, Idaho, 83642
Saint Luke's Cancer Institute - Nampa
Nampa, Idaho, 83686
Saint Alphonsus Cancer Care Center-Nampa
Nampa, Idaho, 83687
Kootenai Clinic Cancer Services - Post Falls
Post Falls, Idaho, 83854
Kootenai Cancer Clinic
Sandpoint, Idaho, 83864
Saint Luke's Cancer Institute - Twin Falls
Twin Falls, Idaho, 83301
Saint Anthony's Health
Alton, Illinois, 62002
Rush - Copley Medical Center
Aurora, Illinois, 60504
Illinois CancerCare-Bloomington
Bloomington, Illinois, 61704
Illinois CancerCare-Canton
Canton, Illinois, 61520
Memorial Hospital of Carbondale
Carbondale, Illinois, 62902
SIH Cancer Institute
Carterville, Illinois, 62918
Illinois CancerCare-Carthage
Carthage, Illinois, 62321
Centralia Oncology Clinic
Centralia, Illinois, 62801
Saint Mary's Hospital
Centralia, Illinois, 62801
Northwestern University
Chicago, Illinois, 60611
Carle at The Riverfront
Danville, Illinois, 61832
Cancer Care Specialists of Illinois - Decatur
Decatur, Illinois, 62526
Decatur Memorial Hospital
Decatur, Illinois, 62526
Illinois CancerCare-Dixon
Dixon, Illinois, 61021
Carle Physician Group-Effingham
Effingham, Illinois, 62401
Crossroads Cancer Center
Effingham, Illinois, 62401
Illinois CancerCare-Eureka
Eureka, Illinois, 61530
Illinois CancerCare-Galesburg
Galesburg, Illinois, 61401
Western Illinois Cancer Treatment Center
Galesburg, Illinois, 61401
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois, 61443
Northwestern Medicine Lake Forest Hospital
Lake Forest, Illinois, 60045
Illinois CancerCare-Macomb
Macomb, Illinois, 61455
Good Samaritan Regional Health Center
Mount Vernon, Illinois, 62864
Cancer Care Center of O'Fallon
O'Fallon, Illinois, 62269
Illinois CancerCare-Ottawa Clinic
Ottawa, Illinois, 61350
Illinois CancerCare-Pekin
Pekin, Illinois, 61554
Illinois CancerCare-Peoria
Peoria, Illinois, 61615
Methodist Medical Center of Illinois
Peoria, Illinois, 61636
Illinois CancerCare-Peru
Peru, Illinois, 61354
Valley Radiation Oncology
Peru, Illinois, 61354
Illinois CancerCare-Princeton
Princeton, Illinois, 61356
Southern Illinois University School of Medicine
Springfield, Illinois, 62702
Springfield Clinic
Springfield, Illinois, 62702
Memorial Medical Center
Springfield, Illinois, 62781
Southwest Illinois Health Services LLP
Swansea, Illinois, 62226
Carle Cancer Center
Urbana, Illinois, 61801
The Carle Foundation Hospital
Urbana, Illinois, 61801
Illinois CancerCare - Washington
Washington, Illinois, 61571
Rush-Copley Healthcare Center
Yorkville, Illinois, 60560
Reid Health
Richmond, Indiana, 47374
Mary Greeley Medical Center
Ames, Iowa, 50010
McFarland Clinic - Ames
Ames, Iowa, 50010
McFarland Clinic - Boone
Boone, Iowa, 50036
Saint Anthony Regional Hospital
Carroll, Iowa, 51401
Iowa Methodist Medical Center
Des Moines, Iowa, 50309
Medical Oncology and Hematology Associates-Des Moines
Des Moines, Iowa, 50309
Broadlawns Medical Center
Des Moines, Iowa, 50314
Iowa Lutheran Hospital
Des Moines, Iowa, 50316
McFarland Clinic - Trinity Cancer Center
Fort Dodge, Iowa, 50501
Trinity Regional Medical Center
Fort Dodge, Iowa, 50501
McFarland Clinic - Jefferson
Jefferson, Iowa, 50129
McFarland Clinic - Marshalltown
Marshalltown, Iowa, 50158
Methodist West Hospital
West Des Moines, Iowa, 50266-7700
Central Care Cancer Center - Garden City
Garden City, Kansas, 67846
Central Care Cancer Center - Great Bend
Great Bend, Kansas, 67530
Mercy Health - Paducah Medical Oncology and Hematology
Paducah, Kentucky, 42003
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, 48109
Bronson Battle Creek
Battle Creek, Michigan, 49017
University of Michigan - Brighton Center for Specialty Care
Brighton, Michigan, 48116
Helen DeVos Children's Hospital at Spectrum Health
Grand Rapids, Michigan, 49503
Spectrum Health at Butterworth Campus
Grand Rapids, Michigan, 49503
Trinity Health Grand Rapids Hospital
Grand Rapids, Michigan, 49503
Bronson Methodist Hospital
Kalamazoo, Michigan, 49007
West Michigan Cancer Center
Kalamazoo, Michigan, 49007
Ascension Borgess Cancer Center
Kalamazoo, Michigan, 49009
Borgess Medical Center
Kalamazoo, Michigan, 49048
Trinity Health Muskegon Hospital
Muskegon, Michigan, 49444
Lakeland Hospital Niles
Niles, Michigan, 49120
Cancer and Hematology Centers of Western Michigan - Norton Shores
Norton Shores, Michigan, 49444
Spectrum Health Reed City Hospital
Reed City, Michigan, 49677
Lakeland Medical Center Saint Joseph
Saint Joseph, Michigan, 49085
Marie Yeager Cancer Center
Saint Joseph, Michigan, 49085
Munson Medical Center
Traverse City, Michigan, 49684
University of Michigan Health - West
Wyoming, Michigan, 49519
Fairview Ridges Hospital
Burnsville, Minnesota, 55337
Minnesota Oncology - Burnsville
Burnsville, Minnesota, 55337
Cambridge Medical Center
Cambridge, Minnesota, 55008
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
Health Partners Inc
Minneapolis, Minnesota, 55454
Monticello Cancer Center
Monticello, Minnesota, 55362
New Ulm Medical Center
New Ulm, Minnesota, 56073
Fairview Northland Medical Center
Princeton, Minnesota, 55371
North Memorial Medical Health Center
Robbinsdale, Minnesota, 55422
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
Fairview Lakes Medical Center
Wyoming, Minnesota, 55092
Saint Louis Cancer and Breast Institute-Ballwin
Ballwin, Missouri, 63011
Central Care Cancer Center - Bolivar
Bolivar, Missouri, 65613
Cox Cancer Center Branson
Branson, Missouri, 65616
Saint Francis Medical Center
Cape Girardeau, Missouri, 63703
Southeast Cancer Center
Cape Girardeau, Missouri, 63703
Parkland Health Center - Farmington
Farmington, Missouri, 63640
Capital Region Southwest Campus
Jefferson City, Missouri, 65109
Freeman Health System
Joplin, Missouri, 64804
Mercy Hospital Joplin
Joplin, Missouri, 64804
Delbert Day Cancer Institute at PCRMC
Rolla, Missouri, 65401
Mercy Clinic-Rolla-Cancer and Hematology
Rolla, Missouri, 65401
Heartland Regional Medical Center
Saint Joseph, Missouri, 64506
Sainte Genevieve County Memorial Hospital
Sainte Genevieve, Missouri, 63670
Mercy Hospital Springfield
Springfield, Missouri, 65804
CoxHealth South Hospital
Springfield, Missouri, 65807
Saint Louis Cancer and Breast Institute-South City
St Louis, Missouri, 63109
Mercy Hospital South
St Louis, Missouri, 63128
Missouri Baptist Medical Center
St Louis, Missouri, 63131
Mercy Hospital Saint Louis
St Louis, Missouri, 63141
Missouri Baptist Sullivan Hospital
Sullivan, Missouri, 63080
Missouri Baptist Outpatient Center-Sunset Hills
Sunset Hills, Missouri, 63127
Mercy Hospital Washington
Washington, Missouri, 63090
Community Hospital of Anaconda
Anaconda, Montana, 59711
Billings Clinic Cancer Center
Billings, Montana, 59101
Bozeman Deaconess Hospital
Bozeman, Montana, 59715
Benefis Healthcare- Sletten Cancer Institute
Great Falls, Montana, 59405
Great Falls Clinic
Great Falls, Montana, 59405
Kalispell Regional Medical Center
Kalispell, Montana, 59901
Saint Patrick Hospital - Community Hospital
Missoula, Montana, 59802
Community Medical Hospital
Missoula, Montana, 59804
Cancer Partners of Nebraska - Pine Lake
Lincoln, Nebraska, 68516
Southeast Nebraska Cancer Center - 68th Street Place
Lincoln, Nebraska, 68516
Roswell Park Cancer Institute
Buffalo, New York, 14263
Wake Forest University at Clemmons
Clemmons, North Carolina, 27012
Southeastern Medical Oncology Center-Clinton
Clinton, North Carolina, 28328
Southeastern Medical Oncology Center-Goldsboro
Goldsboro, North Carolina, 27534
Southeastern Medical Oncology Center-Jacksonville
Jacksonville, North Carolina, 28546
Wake Forest Baptist Health - Hematology Oncology - Statesville
Statesville, North Carolina, 28677
Wake Forest Baptist Health - Wilkes Medical Center
Wilkesboro, North Carolina, 28659
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
UHHS-Chagrin Highlands Medical Center
Beachwood, Ohio, 44122
Indu and Raj Soin Medical Center
Beavercreek, Ohio, 45431
Strecker Cancer Center-Belpre
Belpre, Ohio, 45714
Saint Elizabeth Boardman Hospital
Boardman, Ohio, 44512
Dayton Physicians LLC-Miami Valley South
Centerville, Ohio, 45459
Miami Valley Hospital South
Centerville, Ohio, 45459
Geauga Hospital
Chardon, Ohio, 44024
Adena Regional Medical Center
Chillicothe, Ohio, 45601
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
Oncology Hematology Care Inc-Kenwood
Cincinnati, Ohio, 45236
Case Western Reserve University
Cleveland, Ohio, 44106
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210
Mount Carmel East Hospital
Columbus, Ohio, 43213
Columbus Oncology and Hematology Associates Inc
Columbus, Ohio, 43214
Riverside Methodist Hospital
Columbus, Ohio, 43214
Grant Medical Center
Columbus, Ohio, 43215
The Mark H Zangmeister Center
Columbus, Ohio, 43219
Mount Carmel Health Center West
Columbus, Ohio, 43222
Doctors Hospital
Columbus, Ohio, 43228
Miami Valley Hospital
Dayton, Ohio, 45409
Dayton Physician LLC-Miami Valley Hospital North
Dayton, Ohio, 45415
Miami Valley Hospital North
Dayton, Ohio, 45415
Delaware Health Center-Grady Cancer Center
Delaware, Ohio, 43015
Grady Memorial Hospital
Delaware, Ohio, 43015
Columbus Oncology and Hematology Associates
Dublin, Ohio, 43016
Dublin Methodist Hospital
Dublin, Ohio, 43016
Armes Family Cancer Center
Findlay, Ohio, 45840
Blanchard Valley Hospital
Findlay, Ohio, 45840
Orion Cancer Care
Findlay, Ohio, 45840
Atrium Medical Center-Middletown Regional Hospital
Franklin, Ohio, 45005-1066
Dayton Physicians LLC-Atrium
Franklin, Ohio, 45005
Central Ohio Breast and Endocrine Surgery
Gahanna, Ohio, 43230
Dayton Physicians LLC-Wayne
Greenville, Ohio, 45331
Wayne Hospital
Greenville, Ohio, 45331
Mount Carmel Grove City Hospital
Grove City, Ohio, 43123
Zangmeister Center Grove City
Grove City, Ohio, 43123
Greater Dayton Cancer Center
Kettering, Ohio, 45409
Kettering Medical Center
Kettering, Ohio, 45429
Fairfield Medical Center
Lancaster, Ohio, 43130
Saint Rita's Medical Center
Lima, Ohio, 45801
OhioHealth Mansfield Hospital
Mansfield, Ohio, 44903
Marietta Memorial Hospital
Marietta, Ohio, 45750
OhioHealth Marion General Hospital
Marion, Ohio, 43302
UH Seidman Cancer Center at Southwest General Hospital
Middleburg Heights, Ohio, 44130
Knox Community Hospital
Mount Vernon, Ohio, 43050
Mount Carmel New Albany Surgical Hospital
New Albany, Ohio, 43054
Licking Memorial Hospital
Newark, Ohio, 43055
Newark Radiation Oncology
Newark, Ohio, 43055
University Hospitals Parma Medical Center
Parma, Ohio, 44129
Mercy Health Perrysburg Cancer Center
Perrysburg, Ohio, 43551
Southern Ohio Medical Center
Portsmouth, Ohio, 45662
University Hospitals Portage Medical Center
Ravenna, Ohio, 44266
UH Seidman Cancer Center at Firelands Regional Medical Center
Sandusky, Ohio, 44870
Springfield Regional Cancer Center
Springfield, Ohio, 45504
Springfield Regional Medical Center
Springfield, Ohio, 45505
Saint Vincent Mercy Medical Center
Toledo, Ohio, 43608
Mercy Health - Saint Anne Hospital
Toledo, Ohio, 43623
Dayton Physicians LLC - Troy
Troy, Ohio, 45373
Upper Valley Medical Center
Troy, Ohio, 45373
University Hospitals Sharon Health Center
Wadsworth, Ohio, 44281
Saint Joseph Warren Hospital
Warren, Ohio, 44484
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
Saint Ann's Hospital
Westerville, Ohio, 43081
UH Seidman Cancer Center at Saint John Medical Center
Westlake, Ohio, 44145
Saint Elizabeth Youngstown Hospital
Youngstown, Ohio, 44501
Genesis Healthcare System Cancer Care Center
Zanesville, Ohio, 43701
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma, 73120
Saint Alphonsus Medical Center-Baker City
Baker City, Oregon, 97814
Saint Charles Health System
Bend, Oregon, 97701
Clackamas Radiation Oncology Center
Clackamas, Oregon, 97015
Providence Cancer Institute Clackamas Clinic
Clackamas, Oregon, 97015
Bay Area Hospital
Coos Bay, Oregon, 97420
Providence Newberg Medical Center
Newberg, Oregon, 97132
Saint Alphonsus Medical Center-Ontario
Ontario, Oregon, 97914
Providence Willamette Falls Medical Center
Oregon City, Oregon, 97045
Providence Portland Medical Center
Portland, Oregon, 97213
Providence Saint Vincent Medical Center
Portland, Oregon, 97225
Saint Charles Health System-Redmond
Redmond, Oregon, 97756
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, 15232
Avera Cancer Institute
Sioux Falls, South Dakota, 57105
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, 84112
Providence Regional Cancer System-Aberdeen
Aberdeen, Washington, 98520
PeaceHealth Saint Joseph Medical Center
Bellingham, Washington, 98225
Providence Regional Cancer System-Centralia
Centralia, Washington, 98531
Swedish Cancer Institute-Edmonds
Edmonds, Washington, 98026
Providence Regional Cancer Partnership
Everett, Washington, 98201
Swedish Cancer Institute-Issaquah
Issaquah, Washington, 98029
Kadlec Clinic Hematology and Oncology
Kennewick, Washington, 99336
Providence Regional Cancer System-Lacey
Lacey, Washington, 98503
PeaceHealth Saint John Medical Center
Longview, Washington, 98632
Jefferson Healthcare
Port Townsend, Washington, 98368
Pacific Gynecology Specialists
Seattle, Washington, 98104
Swedish Medical Center-Ballard Campus
Seattle, Washington, 98107
Swedish Medical Center-Cherry Hill
Seattle, Washington, 98122-5711
Swedish Medical Center-First Hill
Seattle, Washington, 98122
PeaceHealth United General Medical Center
Sedro-Woolley, Washington, 98284
Providence Regional Cancer System-Shelton
Shelton, Washington, 98584
PeaceHealth Southwest Medical Center
Vancouver, Washington, 98664
Providence Saint Mary Regional Cancer Center
Walla Walla, Washington, 99362
Providence Regional Cancer System-Yelm
Yelm, Washington, 98597
Langlade Hospital and Cancer Center
Antigo, Wisconsin, 54409
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin, 54701
Gundersen Lutheran Medical Center
La Crosse, Wisconsin, 54601
University of Wisconsin Carbone Cancer Center
Madison, Wisconsin, 53792
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
Aspirus Medford Hospital
Medford, Wisconsin, 54451
Marshfield Clinic-Minocqua Center
Minocqua, Wisconsin, 54548
Cancer Center of Western Wisconsin
New Richmond, Wisconsin, 54017
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin, 54868
Ascension Saint Michael's Hospital
Stevens Point, Wisconsin, 54481
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin, 54482
Aspirus Regional Cancer Center
Wausau, Wisconsin, 54401
Marshfield Medical Center - Weston
Weston, Wisconsin, 54476
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin, 54494
Cheyenne Regional Medical Center-West
Cheyenne, Wyoming, 82001
Billings Clinic-Cody
Cody, Wyoming, 82414
Welch Cancer Center
Sheridan, Wyoming, 82801