A Randomized Phase III Trial of Chemo-Immunotherapy vs Immunotherapy Alone for the Vulnerable Older Adult With Advanced Non-Small Cell Lung Cancer: The ACHIEVE Study
Summary
This phase III trial compares the effect of adding chemotherapy to immunotherapy (pembrolizumab) versus immunotherapy alone in treating patients with stage IIIB-IV lung cancer. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving pembrolizumab and chemotherapy may help stabilize lung cancer.
Detailed description
PRIMARY OBJECTIVE: I. To evaluate whether there is an improvement in overall survival (OS) with chemotherapy combined with pembrolizumab compared to single agent pembrolizumab in this vulnerable older adult patient population. SECONDARY OBJECTIVES: I. To evaluate any difference in progression free survival (PFS) with chemotherapy combined with pembrolizumab as compared to single agent pembrolizumab. II. To evaluate the difference in PFS rate at 3 months and at 6 months with chemotherapy combined with pembrolizumab as compared to single agent pembrolizumab. III. To evaluate the difference in best objective response rate using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria to assess whether chemotherapy combined with pembrolizumab results in improved response rates compared to treatment with single agent pembrolizumab. IV. To evaluate toxicity in those treated with chemotherapy combined with pembrolizumab compared to those treated with single agent pembrolizumab. V. To evaluate patient reported quality of life (QOL) evaluations between treatment arms. EXPLORATORY OBJECTIVES: I. To compare safety and tolerability between treatment arms. II. To explore factors within the pre-treatment geriatric assessment (GA) as predictors of toxicity and outcomes. To describe changes between the intended chemotherapy treatment planned versus treatment given and referrals placed by treating provider based on GA results. III. To evaluate the assessment of a novel, composite fPFS score using disease progression/functional impairment assessment as a potential correlate to OS in this vulnerable population. IV. To evaluate the correlation of 3-months PFS with OS as a potential surrogate of OS benefit. V. To evaluate the correlation of 6-months PFS with OS as a potential surrogate of OS benefit. VI. To assess elective dose intensity of chemotherapy of patients who receive doublet chemotherapy versus single agent chemotherapy. EXPLORATORY CORRELATIVE OBJECTIVE: I. To relate gut microbe abundances to treatment outcomes, toxicity, and geriatric assessments. OUTLINE: Patients are randomized to 1 of 2 arms. ARM A: INDUCTION: Patients receive pembrolizumab intravenously (IV) over 30 minutes on day 1 of each cycle. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Cycles repeat every 21 or 42 days for 2 years in the absence of disease progression or unacceptable toxicity. ARM B: INDUCTION: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Patients also receive investigator's choice of a chemotherapy regimen: 1) Pemetrexed IV over 10 minutes + carboplatin IV over 30-60 minutes on day 1 of each cycle; 2) Nab-paclitaxel IV over 30 on days 1, 8, and 15 of each cycle + carboplatin IV over 30-60 minutes on day 1 of each cycle; 3) Paclitaxel IV over 1 hour on day 1, 8, and 15 of each cycle or over 3 hours on day 1 of each cycle + carboplatin IV over 30-60 minutes on day 1 of each cycle; 4) Nab-paclitaxel IV over 30 minutes on days 1, 8 and 15 of each cycle; 5) Paclitaxel IV over 3 hours on day 1 of each cycle or over 1 hour on days 1, 8, and 15 of each cycle; or 6) Pemetrexed IV over 10 minutes on day 1 of each cycle. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Cycles repeat every 21 or 42 days for 2 years in the absence of disease progression or unacceptable toxicity. All patients undergo magnetic resonance imaging (MRI) at baseline and computed tomography (CT) and/or positron emission tomography (PET) on the trial at baseline and throughout the trial. After completion of study treatment, patients are followed up every 3 months if \< 2 years from randomization and every 6 months if 2-5 years from Step 1 registration.
Arms & interventions
- DrugCarboplatin
Given IV
- ProcedureComputed Tomography
Undergo CT scan
- ProcedureMagnetic Resonance Imaging
Undergo MRI
- DrugNab-paclitaxel
Given IV
- DrugPaclitaxel
Given IV
- BiologicalPembrolizumab
Given IV
- DrugPemetrexed
Given IV
- ProcedurePositron Emission Tomography
Undergo PET
- OtherQuestionnaire Administration
Ancillary studies
Outcome measures
Primary
Overall survival (OS)
Will be estimated using the Kaplan-Meier method, and Cox proportional hazards models will be used to estimate hazard ratios. Comparison of OS will use a logrank test stratified on the randomization stratification factors with a one-sided type I error rate of 0.025. Other comparisons of groups will be made using the log rank test and Cox modeling.
Time frame: From randomization to death from any cause, and patients who are alive at the time of final analysis will be censored at the last date of contact, assessed up to 5 years
Secondary
Progression free survival (PFS)
Time frame: From randomization to documented disease progression per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 or death from any cause, whichever occurs first, assessed up to 5 years
Six month PFS
Time frame: From randomization to documented disease progression per RECIST 1.1 or death from any cause, whichever occurs first, assessed at 6 months
Best objective response
Time frame: Up to 5 years
Incidence of adverse events
Time frame: Up to 2 years
Evaluation of quality of life (QOL) measures
Time frame: Baseline up to 6 months
Eligibility criteria
Study locations (319)
Highlands Oncology Group - Fayetteville
Fayetteville, Arkansas, 72703
Mercy Hospital Fort Smith
Fort Smith, Arkansas, 72903
Highlands Oncology Group - Rogers
Rogers, Arkansas, 72758
Highlands Oncology Group
Springdale, Arkansas, 72762
Kaiser Permanente Dublin
Dublin, California, 94568
Kaiser Permanente-Fremont
Fremont, California, 94538
Kaiser Permanente Fresno Orchard Plaza
Fresno, California, 93720
Kaiser Permanente-Fresno
Fresno, California, 93720
Kaiser Permanente- Modesto MOB II
Modesto, California, 95356
Kaiser Permanente-Modesto
Modesto, California, 95356
Kaiser Permanente-Oakland
Oakland, California, 94611
VA Palo Alto Health Care System
Palo Alto, California, 94304
Kaiser Permanente-Roseville
Roseville, California, 95661
Kaiser Permanente Downtown Commons
Sacramento, California, 95814
Kaiser Permanente-South Sacramento
Sacramento, California, 95823
Kaiser Permanente-San Francisco
San Francisco, California, 94115
Kaiser Permanente-Santa Teresa-San Jose
San Jose, California, 95119
Kaiser Permanente San Leandro
San Leandro, California, 94577
Kaiser San Rafael-Gallinas
San Rafael, California, 94903
Kaiser Permanente Medical Center - Santa Clara
Santa Clara, California, 95051
Kaiser Permanente-Santa Rosa
Santa Rosa, California, 95403
Kaiser Permanente-South San Francisco
South San Francisco, California, 94080
Kaiser Permanente-Vallejo
Vallejo, California, 94589
Kaiser Permanente-Walnut Creek
Walnut Creek, California, 94596
Stamford Hospital/Bennett Cancer Center
Stamford, Connecticut, 06904
Veterans Affairs Connecticut Healthcare System-West Haven Campus
West Haven, Connecticut, 06516
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
Holy Cross Hospital
Fort Lauderdale, Florida, 33308
Malcom Randall Veterans Administration Medical Center
Gainesville, Florida, 32610
UF Health Cancer Institute - Gainesville
Gainesville, Florida, 32610
The Watson Clinic
Lakeland, Florida, 33805
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
UM Sylvester Comprehensive Cancer Center at Kendall
Miami, Florida, 33176
Sacred Heart Hospital
Pensacola, Florida, 32504
UM Sylvester Comprehensive Cancer Center at Plantation
Plantation, Florida, 33324
Moffitt Cancer Center-International Plaza
Tampa, Florida, 33607
James A. Haley Veterans Affairs Hospital
Tampa, Florida, 33612
Moffitt Cancer Center - McKinley Campus
Tampa, Florida, 33612
Moffitt Cancer Center
Tampa, Florida, 33612
Moffitt Cancer Center at Wesley Chapel
Wesley Chapel, Florida, 33544
CTCA at Southeastern Regional Medical Center
Newnan, Georgia, 30265
Kaiser Permanente Moanalua Medical Center
Honolulu, Hawaii, 96819
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho, 83706
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell, Idaho, 83605
Kootenai Health - Coeur d'Alene
Coeur d'Alene, Idaho, 83814
Saint Alphonsus Cancer Care Center-Nampa
Nampa, Idaho, 83687
Kootenai Clinic Cancer Services - Post Falls
Post Falls, Idaho, 83854
Kootenai Clinic Cancer Services - Sandpoint
Sandpoint, Idaho, 83864
Rush-Copley Medical Center
Aurora, Illinois, 60504
Advocate Outpatient Center - Aurora
Aurora, Illinois, 60506
Advocate Good Shepherd Hospital
Barrington, Illinois, 60010
SIH Cancer Institute
Carterville, Illinois, 62918
University of Illinois
Chicago, Illinois, 60612
Advocate Illinois Masonic Medical Center
Chicago, Illinois, 60657
AMG Crystal Lake - Oncology
Crystal Lake, Illinois, 60014
Carle at The Riverfront
Danville, Illinois, 61832
Cancer Care Specialists of Illinois - Decatur
Decatur, Illinois, 62526
Decatur Memorial Hospital
Decatur, Illinois, 62526
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
Advocate South Suburban Hospital
Hazel Crest, Illinois, 60429
AMG Libertyville - Oncology
Libertyville, Illinois, 60048
Condell Memorial Hospital
Libertyville, Illinois, 60048
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
Loyola University Medical Center
Maywood, Illinois, 60153
SSM Health Good Samaritan
Mount Vernon, Illinois, 62864
Cancer Care Center of O'Fallon
O'Fallon, Illinois, 62269
Advocate Christ Medical Center
Oak Lawn, Illinois, 60453-2699
Advocate Lutheran General Hospital
Park Ridge, Illinois, 60068
UW Health Carbone Cancer Center Rockford
Rockford, Illinois, 61114
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
Northwest Cancer Center - Crown Point
Crown Point, Indiana, 46307
Northwest Oncology LLC
Dyer, Indiana, 46311
Northwest Cancer Center - Hobart
Hobart, Indiana, 46342
Saint Mary Medical Center
Hobart, Indiana, 46342
Saint Catherine Hospital
Indianapolis, Indiana, 46312
The Community Hospital
Munster, Indiana, 46321
Women's Diagnostic Center - Munster
Munster, Indiana, 46321
Northwest Cancer Center - Valparaiso
Valparaiso, Indiana, 46383
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny, Iowa, 50023
Mercy Hospital
Cedar Rapids, Iowa, 52403
Oncology Associates at Mercy Medical Center
Cedar Rapids, Iowa, 52403
Mercy Cancer Center-West Lakes
Clive, Iowa, 50325
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive, Iowa, 50325
UI Health Care Mission Cancer and Blood - Des Moines Clinic
Des Moines, Iowa, 50309
Mercy Medical Center - Des Moines
Des Moines, Iowa, 50314
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines, Iowa, 50314
UI Health Care Mission Cancer and Blood - Waukee Clinic
Waukee, Iowa, 50263
University of Kansas Clinical Research Center
Fairway, Kansas, 66205
HaysMed
Hays, Kansas, 67601
University of Kansas Cancer Center
Kansas City, Kansas, 66160
Lawrence Memorial Hospital
Lawrence, Kansas, 66044
Veteran Administration Eastern Kansas Healthcare
Leavenworth, Kansas, 66048
The University of Kansas Cancer Center - Olathe
Olathe, Kansas, 66061
University of Kansas Cancer Center-Overland Park
Overland Park, Kansas, 66210
University of Kansas Hospital-Indian Creek Campus
Overland Park, Kansas, 66211
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
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
Lafayette Family Cancer Center-EMMC
Brewer, Maine, 04412
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
Sinai Hospital of Baltimore
Baltimore, Maryland, 21215
William E Kahlert Regional Cancer Center/Sinai Hospital
Westminster, Maryland, 21157
Tufts Medical Center
Boston, Massachusetts, 02111
Dana-Farber Cancer Institute at Boston Medical Center - Brighton
Brighton, Massachusetts, 02135
Dana-Farber Cancer Institute at Foxborough
Foxborough, Massachusetts, 02035
Dana Farber-Merrimack Valley
Methuen, Massachusetts, 01844
Dana-Farber/Brigham and Women's Cancer Center at Milford Regional
Milford, Massachusetts, 01757
Dana-Farber/Brigham and Women's Cancer Center at South Shore
South Weymouth, Massachusetts, 02190
UMass Memorial Medical Center - University Campus
Worcester, Massachusetts, 01655
Bronson Battle Creek
Battle Creek, Michigan, 49017
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton, Michigan, 48114
Trinity Health IHA Medical Group Hematology Oncology - Canton
Canton, Michigan, 48188
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Chelsea, Michigan, 48118
Cancer Hematology Centers - Flint
Flint, Michigan, 48503
Genesee Hematology Oncology PC
Flint, Michigan, 48503
Genesys Hurley Cancer Institute
Flint, Michigan, 48503
Hurley Medical Center
Flint, Michigan, 48503
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
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
University of Michigan Health - Sparrow Lansing
Lansing, Michigan, 48912
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan, 48154
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
Michigan Healthcare Professionals Pontiac
Pontiac, Michigan, 48341
Trinity Health Saint Joseph Mercy Oakland Hospital
Pontiac, Michigan, 48341
Corewell Health Reed City Hospital
Reed City, Michigan, 49677
MyMichigan Medical Center Saginaw
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
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
Saint Joseph, Michigan, 49085
MyMichigan Medical Center Tawas
Tawas City, Michigan, 48764
Munson Medical Center
Traverse City, Michigan, 49684
Saint Mary's Oncology/Hematology Associates of West Branch
West Branch, Michigan, 48661
University of Michigan Health - West
Wyoming, Michigan, 49519
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
Ypsilanti, Michigan, 48197
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota, 56601
Minnesota Oncology - Burnsville
Burnsville, Minnesota, 55337
Mercy Hospital
Coon Rapids, Minnesota, 55433
Essentia Health - Deer River Clinic
Deer River, Minnesota, 56636
Essentia Health Cancer Center
Duluth, Minnesota, 55805
Fairview Southdale Hospital
Edina, Minnesota, 55435
Essentia Health Hibbing Clinic
Hibbing, Minnesota, 55746
Mayo Clinic Health Systems-Mankato
Mankato, Minnesota, 56001
Abbott-Northwestern Hospital
Minneapolis, Minnesota, 55407
New Ulm Medical Center
New Ulm, Minnesota, 56073
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
Essentia Health Sandstone
Sandstone, Minnesota, 55072
Saint Francis Regional Medical Center
Shakopee, Minnesota, 55379
Essentia Health Virginia Clinic
Virginia, Minnesota, 55792
Saint Francis Medical Center
Cape Girardeau, Missouri, 63703
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri, 63376
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri, 63141
University Health Truman Medical Center
Kansas City, Missouri, 64108
University of Kansas Cancer Center - Briarcliff
Kansas City, Missouri, 64116
Kansas City Veterans Affairs Medical Center
Kansas City, Missouri, 64128
University of Kansas Cancer Center - North
Kansas City, Missouri, 64154
University of Kansas Cancer Center - Lee's Summit
Lee's Summit, Missouri, 64064
Lake Regional Hospital
Osage Beach, Missouri, 65065
Washington University School of Medicine
St Louis, Missouri, 63110
Mercy Hospital South
St Louis, Missouri, 63128
Siteman Cancer Center-South County
St Louis, Missouri, 63129
Siteman Cancer Center at Christian Hospital
St Louis, Missouri, 63136
Community Hospital of Anaconda
Anaconda, Montana, 59711
Billings Clinic Cancer Center
Billings, Montana, 59101
Bozeman Health Deaconess Hospital
Bozeman, Montana, 59715
Benefis Sletten Cancer Institute
Great Falls, Montana, 59405
Logan Health Medical Center
Kalispell, Montana, 59901
Community Medical Center
Missoula, Montana, 59804
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
The Dana-Farber Cancer Institute at Londonderry
Londonderry, New Hampshire, 03053
Jefferson Cherry Hill Hospital
Cherry Hill, New Jersey, 08002
Inspira Medical Center Mullica Hill
Mullica Hill, New Jersey, 08062
Penn Medicine Princeton Health
Plainsboro, New Jersey, 08536
Sidney Kimmel Cancer Center Washington Township
Sewell, New Jersey, 08080
Glens Falls Hospital
Glens Falls, New York, 12801
Upstate Cancer Center at Oswego
Oswego, New York, 13126
University of Rochester
Rochester, New York, 14642
Stony Brook University Medical Center
Stony Brook, New York, 11794
State University of New York Upstate Medical University
Syracuse, New York, 13210
SUNY Upstate Medical Center-Community Campus
Syracuse, New York, 13215
Montefiore Medical Center-Einstein Campus
The Bronx, New York, 10461
Montefiore Medical Center - Moses Campus
The Bronx, New York, 10467
Upstate Cancer Center at Verona
Verona, New York, 13478
Wilmot Cancer Institute at Webster
Webster, New York, 14580
Durham VA Medical Center
Durham, North Carolina, 27705
Sanford Bismarck Medical Center
Bismarck, North Dakota, 58501
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
Sanford Roger Maris Cancer Center
Fargo, North Dakota, 58122
UH Seidman Cancer Center at UH Avon Health Center
Avon, Ohio, 44011
UHHS-Chagrin Highlands Medical Center
Beachwood, Ohio, 44122
Strecker Cancer Center-Belpre
Belpre, Ohio, 45714
Aultman Health Foundation
Canton, Ohio, 44710
Miami Valley Hospital South
Centerville, Ohio, 45459
Adena Regional Medical Center
Chillicothe, Ohio, 45601
Case Western Reserve University
Cleveland, Ohio, 44106
MetroHealth Medical Center
Cleveland, Ohio, 44109
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210
The Mark H Zangmeister Center
Columbus, Ohio, 43219
Miami Valley Hospital
Dayton, Ohio, 45409
Premier Blood and Cancer Center
Dayton, Ohio, 45409
Miami Valley Hospital North
Dayton, Ohio, 45415
Atrium Medical Center-Middletown Regional Hospital
Franklin, Ohio, 45005-1066
Miami Valley Cancer Care and Infusion
Greenville, Ohio, 45331
Mount Carmel Grove City Hospital
Grove City, Ohio, 43123
Memorial Hospital
Marysville, Ohio, 43040
UH Seidman Cancer Center at Lake Health Mentor Campus
Mentor, Ohio, 44060
Knox Community Hospital
Mount Vernon, Ohio, 43050
Licking Memorial Hospital
Newark, Ohio, 43055
Mercy Health - Perrysburg Hospital
Perrysburg, Ohio, 43551
Springfield Regional Cancer Center
Springfield, Ohio, 45504
Mercy Health - Saint Anne Hospital
Toledo, Ohio, 43623
Upper Valley Medical Center
Troy, Ohio, 45373
Genesis Healthcare System Cancer Care Center
Zanesville, Ohio, 43701
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma, 73120
Saint Alphonsus Cancer Care Center-Ontario
Ontario, Oregon, 97914
Bryn Mawr Hospital
Bryn Mawr, Pennsylvania, 19010
Penn State Milton S Hershey Medical Center
Hershey, Pennsylvania, 17033-0850
Lancaster General Ann B Barshinger Cancer Institute
Lancaster, Pennsylvania, 17601
Riddle Memorial Hospital
Media, Pennsylvania, 19063
Paoli Memorial Hospital
Paoli, Pennsylvania, 19301
ECOG-ACRIN Cancer Research Group
Philadelphia, Pennsylvania, 19103
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, 19107
Jefferson Torresdale Hospital
Philadelphia, Pennsylvania, 19114
Reading Hospital McGlinn Cancer Institute at Phoenixville
Phoenixville, Pennsylvania, 19460
Guthrie Medical Group PC-Robert Packer Hospital
Sayre, Pennsylvania, 18840
Reading Hospital
West Reading, Pennsylvania, 19611
Asplundh Cancer Pavilion
Willow Grove, Pennsylvania, 19090
Lankenau Medical Center
Wynnewood, Pennsylvania, 19096
Ralph H Johnson VA Medical Center
Charleston, South Carolina, 29401
Medical University of South Carolina
Charleston, South Carolina, 29425
Rapid City Regional Hospital
Rapid City, South Dakota, 57701
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota, 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Parkland Memorial Hospital
Dallas, Texas, 75235
UT Southwestern Simmons Cancer Center - RedBird
Dallas, Texas, 75237
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
UT Southwestern/Simmons Cancer Center-Fort Worth
Fort Worth, Texas, 76104
UT Southwestern Clinical Center at Richardson/Plano
Richardson, Texas, 75080
Dartmouth Cancer Center - North
Saint Johnsbury, Vermont, 05819
White River Junction Veteran Administration Medical Center
White River Junction, Vermont, 05009
University of Virginia Cancer Center
Charlottesville, Virginia, 22908
VCU Massey Cancer Center at Stony Point
Richmond, Virginia, 23235
VCU Massey Comprehensive Cancer Center
Richmond, Virginia, 23298
VCU Community Memorial Health Center
South Hill, Virginia, 23970
VCU Health Tappahannock Hospital
Tappahannock, Virginia, 22560
Swedish Cancer Institute-Edmonds
Edmonds, Washington, 98026
Swedish Cancer Institute-Issaquah
Issaquah, Washington, 98029
Swedish Medical Center-First Hill
Seattle, Washington, 98122
Edwards Comprehensive Cancer Center
Huntington, West Virginia, 25701
Langlade Hospital and Cancer Center
Antigo, Wisconsin, 54409
ThedaCare Regional Cancer Center
Appleton, Wisconsin, 54911
Duluth Clinic Ashland
Ashland, Wisconsin, 54806
ThedaCare Cancer Care - Berlin
Berlin, Wisconsin, 54923
Aurora Cancer Care-Southern Lakes VLCC
Burlington, Wisconsin, 53105
Aurora Saint Luke's South Shore
Cudahy, Wisconsin, 53110
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin, 54701
Mayo Clinic Health System-Eau Claire Clinic
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
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin, 54301
Saint Vincent Hospital Cancer Center at Saint Mary's
Green Bay, Wisconsin, 54303
Aurora BayCare Medical Center
Green Bay, Wisconsin, 54311
Mercyhealth Hospital and Cancer Center - Janesville
Janesville, Wisconsin, 53548
Aurora Cancer Care-Kenosha South
Kenosha, Wisconsin, 53142
Gundersen Lutheran Medical Center
La Crosse, Wisconsin, 54601
Aurora Bay Area Medical Group-Marinette
Marinette, Wisconsin, 54143
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
Aspirus Medford Hospital
Medford, Wisconsin, 54451
Aurora Cancer Care-Milwaukee
Milwaukee, Wisconsin, 53209
Aurora Saint Luke's Medical Center
Milwaukee, Wisconsin, 53215
Aurora Sinai Medical Center
Milwaukee, Wisconsin, 53233
Marshfield Medical Center - Minocqua
Minocqua, Wisconsin, 54548
ProHealth D N Greenwald Center
Mukwonago, Wisconsin, 53149
ThedaCare Regional Medical Center - Neenah
Neenah, Wisconsin, 54956
ThedaCare Cancer Care - New London
New London, Wisconsin, 54961
ProHealth Oconomowoc Memorial Hospital
Oconomowoc, Wisconsin, 53066
Saint Vincent Hospital Cancer Center at Oconto Falls
Oconto Falls, Wisconsin, 54154
ThedaCare Cancer Care - Oshkosh
Oshkosh, Wisconsin, 54904
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
ThedaCare Cancer Care - Shawano
Shawano, Wisconsin, 54166
Saint Vincent Hospital Cancer Center at Sheboygan
Sheboygan, Wisconsin, 53081
Sheboygan Physicians Group
Sheboygan, Wisconsin, 53081
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
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Sturgeon Bay, Wisconsin, 54235-1495
Aurora Medical Center in Summit
Summit, Wisconsin, 53066
Vince Lombardi Cancer Clinic-Two Rivers
Two Rivers, Wisconsin, 54241
ProHealth Waukesha Memorial Hospital
Waukesha, Wisconsin, 53188
UW Cancer Center at ProHealth Care
Waukesha, Wisconsin, 53188
ThedaCare Cancer Care - Waupaca
Waupaca, Wisconsin, 54981
Aspirus Regional Cancer Center
Wausau, Wisconsin, 54401
Aurora Cancer Care-Milwaukee West
Wauwatosa, Wisconsin, 53226
Aurora West Allis Medical Center
West Allis, Wisconsin, 53227
Marshfield Medical Center - Weston
Weston, Wisconsin, 54476
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin, 54494