A Phase III Randomized Trial for Newly Diagnosed Multiple Myeloma (NDMM) Patients Considered Frail or in a Subset of "Intermediate Fit" Comparing Upfront Three-Drug Induction Regimens Followed by Double or Single-Agent Maintenance
Summary
This phase III trial compares three-drug induction regimens followed by double-or single-drug maintenance therapy for the treatment of newly diagnosed multiple myeloma in patients who are not receiving a stem cell transplant and are considered frail or intermediate-fit based on age, comorbidities, and functional status. Treatment for multiple myeloma includes initial treatment (induction) which is the first treatment a patient receives for cancer followed by ongoing treatment (maintenance) which is given after initial treatment to help keep the cancer from coming back. There are three combinations of four different drugs being studied. Bortezomib is one of the drugs that may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Lenalidomide works by helping bone marrow to produce normal blood cells and killing cancer cells. Anti-inflammatory drugs, such as dexamethasone, lower the body's immune response and are used with other drugs in the treatment of some types of cancer. Daratumumab and hyaluronidase-fihj is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Patients receive 1 of 3 combinations of these drugs for treatment to determine which combination of study drugs works better to shrink and control multiple myeloma.
Detailed description
PRIMARY OBJECTIVES: I. To compare progression-free survival (PFS) in frail or selected intermediate fit newly diagnosed multiple myeloma (NDMM) participants treated with bortezomib with lenalidomide and dexamethasone at reduced dosing (VRd-Lite) induction followed by lenalidomide maintenance (Arm 1) versus daratumumab and hyaluronidase-fihj with lenalidomide and dexamethasone (DRd) induction followed by lenalidomide maintenance (Arm 2). II. To compare overall survival (OS) in frail or selected intermediate fit NDMM participants treated with VRd-Lite induction followed by lenalidomide maintenance (Arm 1) versus DRd induction followed by lenalidomide and daratumumab and hyaluronidase-fihj maintenance (Arm 3). SECONDARY OBJECTIVES: I. To compare PFS in Arm 1 versus Arm 3 II. To compare OS in Arm 1 versus Arm 2. III. To compare PFS in Arm 2 versus 3. IV. To compare the overall response rate (ORR) of Arm 1 against the ORR of Arm 2 and Arm 3. V. To compare the safety of Arm 1 with the safety of Arm 2 and Arm 3. VI. To explore veinous thrombo-embolism (VTE) incidence in participants receiving lenalidomide during induction across the three study arms. VII. To describe median time to response (complete response \[CR\] or better per International Myeloma Working Group \[IMWG\] criteria, very good partial response \[VGPR\] or better per IMWG criteria, partial response \[PR\] or better per IMWG criteria) on the three study arms. PRIMARY QUALITY OF LIFE (QOL) OBJECTIVE: I. To compare patient-reported global health status between treatment arms (Arm 1 versus the combination of Arms 2 and 3) at 9 months after randomization (end of induction therapy) using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30). SECONDARY QOL OBJECTIVE: II. To compare longitudinal changes in global health status between treatment arms (Arm 1 versus the combination of Arms 2 and 3) from baseline to 9 months after randomization (end of induction therapy). PATIENT REPORTED OUTCOMES-COMMON TERMINOLOGY CRITERIA FOR ADVERSE EVENTS (PRO-CTCAE) OBJECTIVE: I. To compare selected patient-reported outcome symptoms using PRO-CTCAE items among the 3 study arms. ADDITIONAL OBJECTIVES: I. To compare the rate of minimal residual disease (MRD) by clonoSEQ after 9 cycles of induction in Arm 1 versus Arm 2 and Arm 3, respectively. II. To compare the rate of MRD conversion after 1 year of maintenance in participants who were MRD positive after induction in Arm 1 versus Arm 2 and Arm 3, respectively. III. To compare the rate of sustained MRD negativity at time points of post-induction, post-1 year maintenance in Arm 1 versus Arm 2 and Arm 3, respectively. BANKING OBJECTIVES: I. To bank specimens for future correlative studies. OUTLINE: Patients are randomized to 1 of 3 arms. ARM I (VRd-Lite): INDUCTION CYCLES 1-9: Patients receive bortezomib subcutaneously (SC) on days 1, 8, 15, and 22 of each cycle, lenalidomide orally (PO) on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. ARM II (DRd-R): INDUCTION CYCLES 1-9: Patients receive daratumumab and hyaluronidase-fihj SC on days 1, 8, 15, and 22 of cycles 1-2, days 1 and 15 of cycles 3-6, and day 1 of cycles 7-9, lenalidomide PO on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. ARM III (DRd-DR): INDUCTION CYCLES 1-9: Patients receive daratumumab and hyaluronidase-fihj SC on days 1, 8, 15, and 22 of cycles 1-2, days 1 and 15 of cycles 3-6, and day 1 of cycles 7-9, lenalidomide PO on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive daratumumab and hyaluronidase-fihj SC on day 1 of each cycle and lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 1 year, every 6 months for 2 years, and then annually for up to 10 years.
Arms & interventions
- DrugBortezomib
Given SC
- DrugDaratumumab and Hyaluronidase-fihj
Given SC
- DrugDexamethasone
Given PO
- DrugLenalidomide
Given PO
- OtherQuality-of-Life Assessment
Ancillary studies
- OtherQuestionnaire Administration
Ancillary studies
Outcome measures
Primary
Progression free survival (PFS) of Arm 1 versus (vs.) Arm 2
Analysis of each of the dual primary endpoints will be performed using a stratified log-rank test for comparison between arms. The analyses will be stratified according to frailty score (frail vs. intermediate fit), presence of one or more high-risk abnormalities by fluorescence in situ hybridization (iFISH) (yes vs. no), and prior therapy (yes vs. no). All eligible participants will be considered in analyses of the dual primary endpoints, according to their assigned arm at randomization.
Time frame: From date of randomization to date of first documentation of progression or symptomatic deterioration, or death due to any cause, or assessed up to 10 years
Overall survival (OS) of Arm 1 vs. Arm 3
Analysis of each of the dual primary endpoints will be performed using a stratified log-rank test for comparison between arms. The analyses will be stratified according to frailty score (frail vs. intermediate fit), presence of one or more high-risk abnormalities by iFISH (yes vs. no), and prior therapy (yes vs. no). All eligible participants will be considered in analyses of the dual primary endpoints, according to their assigned arm at randomization.
Time frame: From date of randomization to date of death due to any cause, or assessed up to 10 years
Secondary
PFS
Time frame: From date of randomization to date of first documentation of progression or symptomatic deterioration, or death due to any cause, or assessed up to 10 years
OS
Time frame: From date of randomization to date of death due to any cause, or assessed up to 10 years
Overall response rate (ORR)
Time frame: Up to 10 years
Time to complete response (CR)
Time frame: The time from the date of registration to the date of the first documented incidence of a response of CR or better, assessed up to 10 years
Time to very good partial response (VGFR)
Time frame: The time from the date of registration to the date of the first documented incidence of a response of VGPR or better, assessed up to 10 years
Time to PR
Time frame: The time from the date of registration to the date of the first documented incidence of a response of PR or better, assessed up to 10 years
Minimal residual disease (MRD)
Time frame: At 9 months of induction therapy and 1 year of maintenance therapy
Patient report out comes (PRO) quality-of-life (QOL)
Time frame: At baseline and months 1, 3, 9, and 18 after randomization
Patient-reported toxicity (PRO-Common Terminology Criteria for Adverse Events [CTCAE])
Time frame: At baseline, at each treatment cycle up to month 18 from randomization, and at discontinuation of treatment
Eligibility criteria
Study locations (397)
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
Cancer Center at Saint Joseph's
Phoenix, Arizona, 85004
Mercy Hospital Fort Smith
Fort Smith, Arkansas, 72903
CARTI Cancer Center
Little Rock, Arkansas, 72205
John L McClellan Memorial Veterans Hospital
Little Rock, Arkansas, 72205
University of Arkansas for Medical Sciences
Little Rock, Arkansas, 72205
Mission Hope Medical Oncology - Arroyo Grande
Arroyo Grande, California, 93420
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank, California, 91505
Marshall Cancer Center
Cameron Park, California, 95682
Mercy Cancer Center - Carmichael
Carmichael, California, 95608
Mercy San Juan Medical Center
Carmichael, California, 95608
Mercy Cancer Center - Elk Grove
Elk Grove, California, 95758
Fremont - Rideout Cancer Center
Marysville, California, 95901
Mercy UC Davis Cancer Center
Merced, California, 95340
Providence Queen of The Valley
Napa, California, 94558
Mercy Cancer Center - Rocklin
Rocklin, California, 95765
Mercy Cancer Center - Sacramento
Sacramento, California, 95816
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
Pacific Central Coast Health Center-San Luis Obispo
San Luis Obispo, California, 93401
Mission Hope Medical Oncology - Santa Maria
Santa Maria, California, 93444
Providence Medical Foundation - Santa Rosa
Santa Rosa, California, 95403
Providence Santa Rosa Memorial Hospital
Santa Rosa, California, 95405
Gene Upshaw Memorial Tahoe Forest Cancer Center
Truckee, California, 96161
Woodland Memorial Hospital
Woodland, California, 95695
Rocky Mountain Regional VA Medical Center
Aurora, Colorado, 80045
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado, 80907
Rocky Mountain Cancer Centers-Penrose
Colorado Springs, Colorado, 80907
Saint Francis Cancer Center
Colorado Springs, Colorado, 80923
Porter Adventist Hospital
Denver, Colorado, 80210
Mercy Medical Center
Durango, Colorado, 81301
Southwest Oncology PC
Durango, Colorado, 81301
Saint Anthony Hospital
Lakewood, Colorado, 80228
Littleton Adventist Hospital
Littleton, Colorado, 80122
Longmont United Hospital
Longmont, Colorado, 80501
Parker Adventist Hospital
Parker, Colorado, 80138
Saint Mary Corwin Medical Center
Pueblo, Colorado, 81004
Smilow Cancer Hospital-Derby Care Center
Derby, Connecticut, 06418
Smilow Cancer Hospital Care Center-Fairfield
Fairfield, Connecticut, 06824
Smilow Cancer Hospital Care Center at Glastonbury
Glastonbury, Connecticut, 06033
Smilow Cancer Hospital Care Center at Greenwich
Greenwich, Connecticut, 06830
Smilow Cancer Hospital Care Center - Guilford
Guilford, Connecticut, 06437
Smilow Cancer Hospital Care Center at Saint Francis
Hartford, Connecticut, 06105
Smilow Cancer Center/Yale-New Haven Hospital
New Haven, Connecticut, 06510
Yale University
New Haven, Connecticut, 06520
Yale-New Haven Hospital North Haven Medical Center
North Haven, Connecticut, 06473
Smilow Cancer Hospital Care Center at Long Ridge
Stamford, Connecticut, 06902
Smilow Cancer Hospital-Torrington Care Center
Torrington, Connecticut, 06790
Smilow Cancer Hospital Care Center-Trumbull
Trumbull, Connecticut, 06611
Smilow Cancer Hospital-Waterbury Care Center
Waterbury, Connecticut, 06708
Smilow Cancer Hospital Care Center - Waterford
Waterford, Connecticut, 06385
Holy Cross Hospital
Fort Lauderdale, Florida, 33308
Mayo Clinic in Florida
Jacksonville, Florida, 32224-9980
Jupiter Medical Center
Jupiter, Florida, 33458
Saint Luke's Cancer Institute - Boise
Boise, Idaho, 83712
Saint Luke's Cancer Institute - Fruitland
Fruitland, Idaho, 83619
Saint Luke's Cancer Institute - Meridian
Meridian, Idaho, 83642
Saint Luke's Cancer Institute - Nampa
Nampa, Idaho, 83686
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
Saint Joseph Medical Center
Bloomington, Illinois, 61701
Illinois CancerCare-Bloomington
Bloomington, Illinois, 61704
Loyola Center for Health at Burr Ridge
Burr Ridge, Illinois, 60527
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
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
Edward Hines Jr VA Hospital
Hines, Illinois, 60141
Loyola Medicine Homer Glen
Homer Glen, Illinois, 60491
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois, 61443
Illinois CancerCare-Macomb
Macomb, Illinois, 61455
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
Loyola University Medical Center
Maywood, Illinois, 60153
Marjorie Weinberg Cancer Center at Loyola-Gottlieb
Melrose Park, Illinois, 60160
Good Samaritan Regional Health Center
Mount Vernon, Illinois, 62864
Cancer Care Center of O'Fallon
O'Fallon, Illinois, 62269
HSHS Saint Elizabeth's Hospital
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
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
IU Health North Hospital
Carmel, Indiana, 46032
Northwest Cancer Center - Main Campus
Crown Point, Indiana, 46307
Northwest Oncology LLC
Dyer, Indiana, 46311
Northwest Cancer Center - Hobart
Hobart, Indiana, 46342
Saint Mary Medical Center
Hobart, Indiana, 46342
Indiana University/Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, 46202
Saint Catherine Hospital
Indianapolis, Indiana, 46312
The Community Hospital
Munster, Indiana, 46321
Women's Diagnostic Center - Munster
Munster, Indiana, 46321
Reid Health
Richmond, Indiana, 47374
Northwest Cancer Center - Valparaiso
Valparaiso, Indiana, 46383
Mission Cancer and Blood - Ankeny
Ankeny, Iowa, 50023
University of Iowa Healthcare Cancer Services Quad Cities
Bettendorf, Iowa, 52722
Physicians' Clinic of Iowa PC
Cedar Rapids, Iowa, 52402
Medical Oncology and Hematology Associates-West Des Moines
Clive, Iowa, 50325
Mercy Cancer Center-West Lakes
Clive, Iowa, 50325
Alegent Health Mercy Hospital
Council Bluffs, Iowa, 51503
Greater Regional Medical Center
Creston, Iowa, 50801
Mercy Medical Center - Des Moines
Des Moines, Iowa, 50314
Mission Cancer and Blood - Laurel
Des Moines, Iowa, 50314
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, 52242
Mercy Medical Center-West Lakes
West Des Moines, Iowa, 50266
Central Care Cancer Center - Garden City
Garden City, Kansas, 67846
Central Care Cancer Center - Great Bend
Great Bend, Kansas, 67530
Flaget Memorial Hospital
Bardstown, Kentucky, 40004
Commonwealth Cancer Center-Corbin
Corbin, Kentucky, 40701
Saint Joseph Hospital
Lexington, Kentucky, 40504
Saint Joseph Radiation Oncology Resource Center
Lexington, Kentucky, 40504
Saint Joseph Hospital East
Lexington, Kentucky, 40509
Saint Joseph London
London, Kentucky, 40741
Saint Joseph Mount Sterling
Mount Sterling, Kentucky, 40353
Greater Baltimore Medical Center
Baltimore, Maryland, 21204
Saint Joseph Mercy Hospital
Ann Arbor, Michigan, 48106
Bronson Battle Creek
Battle Creek, Michigan, 49017
Saint Joseph Mercy Brighton
Brighton, Michigan, 48114
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton, Michigan, 48114
Saint Joseph Mercy Canton
Canton, Michigan, 48188
Trinity Health IHA Medical Group Hematology Oncology - Canton
Canton, Michigan, 48188
Caro Cancer Center
Caro, Michigan, 48723
Saint Joseph Mercy Chelsea
Chelsea, Michigan, 48118
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Chelsea, Michigan, 48118
Hematology Oncology Consultants-Clarkston
Clarkston, Michigan, 48346
Newland Medical Associates-Clarkston
Clarkston, Michigan, 48346
Ascension Saint John Hospital
Detroit, Michigan, 48236
Great Lakes Cancer Management Specialists-Doctors Park
East China, Michigan, 48054
Genesee Cancer and Blood Disease Treatment Center
Flint, Michigan, 48503
Genesee Hematology Oncology PC
Flint, Michigan, 48503
Genesys Hurley Cancer Institute
Flint, Michigan, 48503
Hurley Medical Center
Flint, Michigan, 48503
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
Academic Hematology Oncology Specialists
Grosse Pointe Woods, Michigan, 48236
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
Grosse Pointe Woods, Michigan, 48236
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
University of Michigan Health - Sparrow Lansing
Lansing, Michigan, 48912
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan, 48154
Great Lakes Cancer Management Specialists-Macomb Medical Campus
Macomb, Michigan, 48044
Saint Mary's Oncology/Hematology Associates of Marlette
Marlette, Michigan, 48453
Trinity Health Muskegon Hospital
Muskegon, Michigan, 49444
Corewell Health Lakeland Hospitals - Niles Hospital
Niles, Michigan, 49120
Cancer and Hematology Centers of Western Michigan - Norton Shores
Norton Shores, Michigan, 49444
21st Century Oncology-Pontiac
Pontiac, Michigan, 48341
Hope Cancer Center
Pontiac, Michigan, 48341
Newland Medical Associates-Pontiac
Pontiac, Michigan, 48341
Saint Joseph Mercy Oakland
Pontiac, Michigan, 48341
Corewell Health Reed City Hospital
Reed City, Michigan, 49677
Ascension Saint Mary's Hospital
Saginaw, Michigan, 48601
Oncology Hematology Associates of Saginaw Valley PC
Saginaw, Michigan, 48604
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
Saint Joseph, Michigan, 49085
Lakeland Medical Center Saint Joseph
Saint Joseph, Michigan, 49085
Bhadresh Nayak MD PC-Sterling Heights
Sterling Heights, Michigan, 48312
Ascension Saint Joseph Hospital
Tawas City, Michigan, 48764
Munson Medical Center
Traverse City, Michigan, 49684
Advanced Breast Care Center PLLC
Warren, Michigan, 48088
Great Lakes Cancer Management Specialists-Macomb Professional Building
Warren, Michigan, 48093
Macomb Hematology Oncology PC
Warren, Michigan, 48093
Michigan Breast Specialists-Warren
Warren, Michigan, 48093
Saint John Macomb-Oakland Hospital
Warren, Michigan, 48093
Saint Mary's Oncology/Hematology Associates of West Branch
West Branch, Michigan, 48661
University of Michigan Health - West
Wyoming, Michigan, 49519
Huron Gastroenterology PC
Ypsilanti, Michigan, 48106
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
Ypsilanti, Michigan, 48197
Riverwood Healthcare Center
Aitkin, Minnesota, 56431
Essentia Health - Baxter Clinic
Baxter, Minnesota, 56425
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota, 56601
Essentia Health Saint Joseph's Medical Center
Brainerd, Minnesota, 56401
Minnesota Oncology - Burnsville
Burnsville, Minnesota, 55337
Cambridge Medical Center
Cambridge, Minnesota, 55008
Mercy Hospital
Coon Rapids, Minnesota, 55433
Essentia Health - Deer River Clinic
Deer River, Minnesota, 56636
Essentia Health Saint Mary's - Detroit Lakes Clinic
Detroit Lakes, Minnesota, 56501
Essentia Health Cancer Center
Duluth, Minnesota, 55805
Essentia Health Saint Mary's Medical Center
Duluth, Minnesota, 55805
Miller-Dwan Hospital
Duluth, Minnesota, 55805
Fairview Southdale Hospital
Edina, Minnesota, 55435
Essentia Health - Ely Clinic
Ely, Minnesota, 55731
Essentia Health - Fosston
Fosston, Minnesota, 56542
Unity Hospital
Fridley, Minnesota, 55432
Essentia Health Hibbing Clinic
Hibbing, Minnesota, 55746
Essentia Health - International Falls Clinic
International Falls, Minnesota, 56649
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
Essentia Health - Moose Lake Clinic
Moose Lake, Minnesota, 55767
New Ulm Medical Center
New Ulm, Minnesota, 56073
Essentia Health - Park Rapids
Park Rapids, Minnesota, 56470
Fairview Northland Medical Center
Princeton, Minnesota, 55371
North Memorial Medical Health Center
Robbinsdale, Minnesota, 55422
Mayo Clinic in Rochester
Rochester, Minnesota, 55905
Park Nicollet Clinic - Saint Louis Park
Saint Louis Park, Minnesota, 55416
Regions Hospital
Saint Paul, Minnesota, 55101
United Hospital
Saint Paul, Minnesota, 55102
Essentia Health Sandstone
Sandstone, Minnesota, 55072
Saint Francis Regional Medical Center
Shakopee, Minnesota, 55379
Lakeview Hospital
Stillwater, Minnesota, 55082
Sanford Thief River Falls Medical Center
Thief River Falls, Minnesota, 56701
Essentia Health Virginia Clinic
Virginia, Minnesota, 55792
Ridgeview Medical Center
Waconia, Minnesota, 55387
Rice Memorial Hospital
Willmar, Minnesota, 56201
Minnesota Oncology Hematology PA-Woodbury
Woodbury, Minnesota, 55125
Sanford Cancer Center Worthington
Worthington, Minnesota, 56187
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
Research Medical Center
Kansas City, Missouri, 64132
Lake Regional Hospital
Osage Beach, Missouri, 65065
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
BJC Outpatient Center at Sunset Hills
Sunset Hills, Missouri, 63127
Mercy Hospital Washington
Washington, Missouri, 63090
Saint Patrick Hospital - Community Hospital
Missoula, Montana, 59802
CHI Health Good Samaritan
Kearney, Nebraska, 68847
Saint Elizabeth Regional Medical Center
Lincoln, Nebraska, 68510
Alegent Health Immanuel Medical Center
Omaha, Nebraska, 68122
Alegent Health Bergan Mercy Medical Center
Omaha, Nebraska, 68124
Alegent Health Lakeside Hospital
Omaha, Nebraska, 68130
Creighton University Medical Center
Omaha, Nebraska, 68131
Midlands Community Hospital
Papillion, Nebraska, 68046
Exeter Hospital
Exeter, New Hampshire, 03833
Lovelace Medical Center-Saint Joseph Square
Albuquerque, New Mexico, 87102
University of New Mexico Cancer Center
Albuquerque, New Mexico, 87102
Presbyterian Kaseman Hospital
Albuquerque, New Mexico, 87110
Presbyterian Rust Medical Center/Jorgensen Cancer Center
Rio Rancho, New Mexico, 87124
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, 10032
University of Rochester
Rochester, New York, 14642
Sanford Bismarck Medical Center
Bismarck, North Dakota, 58501
Essentia Health Cancer Center-South University Clinic
Fargo, North Dakota, 58103
Sanford South University Medical Center
Fargo, North Dakota, 58103
Southpointe-Sanford Medical Center Fargo
Fargo, North Dakota, 58103
Sanford Medical Center Fargo
Fargo, North Dakota, 58104
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
Sanford Roger Maris Cancer Center
Fargo, North Dakota, 58122
Essentia Health - Jamestown Clinic
Jamestown, North Dakota, 58401
Indu and Raj Soin Medical Center
Beavercreek, Ohio, 45431
Saint Elizabeth Boardman Hospital
Boardman, Ohio, 44512
Dayton Physicians LLC-Miami Valley South
Centerville, Ohio, 45459
Good Samaritan Hospital - Cincinnati
Cincinnati, Ohio, 45220
Oncology Hematology Care Inc-Kenwood
Cincinnati, Ohio, 45236
Bethesda North Hospital
Cincinnati, Ohio, 45242
TriHealth Cancer Institute-Westside
Cincinnati, Ohio, 45247
TriHealth Cancer Institute-Anderson
Cincinnati, Ohio, 45255
Dayton Physician LLC-Miami Valley Hospital North
Dayton, Ohio, 45415
Armes Family Cancer Center
Findlay, Ohio, 45840
Blanchard Valley Hospital
Findlay, Ohio, 45840
Orion Cancer Care
Findlay, Ohio, 45840
Dayton Physicians LLC-Atrium
Franklin, Ohio, 45005
Dayton Physicians LLC-Wayne
Greenville, Ohio, 45331
Wayne Hospital
Greenville, Ohio, 45331
Greater Dayton Cancer Center
Kettering, Ohio, 45409
Kettering Medical Center
Kettering, Ohio, 45429
Dayton Physicians LLC - Troy
Troy, Ohio, 45373
Saint Joseph Warren Hospital
Warren, Ohio, 44484
Saint Elizabeth Youngstown Hospital
Youngstown, Ohio, 44501
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma, 73120
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
Rogue Valley Medical Center
Medford, Oregon, 97504
Providence Newberg Medical Center
Newberg, Oregon, 97132
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
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania, 18103
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania, 18017
Geisinger Medical Center
Danville, Pennsylvania, 17822
Pocono Medical Center
East Stroudsburg, Pennsylvania, 18301
Lehigh Valley Hospital-Hazleton
Hazleton, Pennsylvania, 18201
Geisinger Medical Oncology-Lewisburg
Lewisburg, Pennsylvania, 17837
Community Medical Center
Scranton, Pennsylvania, 18510
Geisinger Wyoming Valley/Henry Cancer Center
Wilkes-Barre, Pennsylvania, 18711
Smilow Cancer Hospital Care Center - Westerly
Westerly, Rhode Island, 02891
Prisma Health Cancer Institute - Spartanburg
Boiling Springs, South Carolina, 29316
Prisma Health Cancer Institute - Easley
Easley, South Carolina, 29640
Prisma Health Cancer Institute - Butternut
Greenville, South Carolina, 29605
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
Prisma Health Cancer Institute - Seneca
Seneca, South Carolina, 29672
Avera Cancer Institute-Aberdeen
Aberdeen, South Dakota, 57401
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota, 57104
Avera Cancer Institute
Sioux Falls, South Dakota, 57105
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Avera Cancer Institute at Yankton
Yankton, South Dakota, 57078
MD Anderson in The Woodlands
Conroe, Texas, 77384
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston, Texas, 77030
Ben Taub General Hospital
Houston, Texas, 77030
M D Anderson Cancer Center
Houston, Texas, 77030
Michael E DeBakey VA Medical Center
Houston, Texas, 77030
MD Anderson West Houston
Houston, Texas, 77079
MD Anderson League City
League City, Texas, 77573
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
MD Anderson in Sugar Land
Sugar Land, Texas, 77478
Sovah Health Martinsville
Martinsville, Virginia, 24115
Virginia Cancer Institute
Richmond, Virginia, 23229
VCU Massey Cancer Center at Stony Point
Richmond, Virginia, 23235
Virginia Commonwealth University/Massey Cancer Center
Richmond, Virginia, 23298
VCU Community Memorial Health Center
South Hill, Virginia, 23970
Providence Regional Cancer System-Aberdeen
Aberdeen, Washington, 98520
PeaceHealth Saint Joseph Medical Center
Bellingham, Washington, 98225
Harrison Medical Center
Bremerton, Washington, 98310
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
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
West Virginia University Charleston Division
Charleston, West Virginia, 25304
Langlade Hospital and Cancer Center
Antigo, Wisconsin, 54409
ThedaCare Regional Cancer Center
Appleton, Wisconsin, 54911
Duluth Clinic Ashland
Ashland, Wisconsin, 54806
Northwest Wisconsin Cancer Center
Ashland, Wisconsin, 54806
Marshfield Clinic-Chippewa Center
Chippewa Falls, Wisconsin, 54729
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin, 54701
Essentia Health-Hayward Clinic
Hayward, Wisconsin, 54843
Gundersen Lutheran Medical Center
La Crosse, Wisconsin, 54601
Marshfield Clinic - Ladysmith Center
Ladysmith, Wisconsin, 54848
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
Aspirus Medford Hospital
Medford, Wisconsin, 54451
Marshfield Clinic-Minocqua Center
Minocqua, Wisconsin, 54548
Marshfield Medical Center - Neillsville
Neillsville, Wisconsin, 54456
Cancer Center of Western Wisconsin
New Richmond, Wisconsin, 54017
Ascension Saint Mary's Hospital
Rhinelander, Wisconsin, 54501
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin, 54868
Essentia Health-Spooner Clinic
Spooner, Wisconsin, 54801
Ascension Saint Michael's Hospital
Stevens Point, Wisconsin, 54481
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin, 54482
Essentia Health Saint Mary's Hospital - Superior
Superior, Wisconsin, 54880
Aspirus Regional Cancer Center
Wausau, Wisconsin, 54401
Marshfield Clinic-Wausau Center
Wausau, Wisconsin, 54401
Marshfield Medical Center - Weston
Weston, Wisconsin, 54476
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin, 54494
Marshfield Clinic - Wisconsin Rapids Center
Wisconsin Rapids, Wisconsin, 54494