A Randomized Phase III Study of BRAF-Targeted Therapy vs Cabozantinib in RAI-Refractory Differentiated Thyroid Cancer With BRAF V600Em
Summary
This phase III trial compares the effect of cabozantinib versus combination dabrafenib and trametinib for the treatment of patients with differentiated thyroid cancer that does not respond to treatment (refractory) and which expresses a BRAF V600E mutation. Cabozantinib is in a class of medications called receptor tyrosine kinase inhibitors. It binds to and blocks the action of several enzymes which are often over-expressed in a variety of tumor cell types. This may help stop or slow the growth of tumor cells and blood vessels the tumor needs to survive. Dabrafenib is an enzyme inhibitor that binds to and inhibits the activity of a protein called B-raf, which may inhibit the proliferation of tumor cells which contain a mutated BRAF gene. Trametinib is also an enzyme inhibitor. It binds to and inhibits the activity of proteins called MEK 1 and 2, which play a key role in activating pathways that regulate cell growth. This may inhibit the growth of tumor cells mediated by these pathways. The usual approach for patients with thyroid cancer is targeted therapy with dabrafenib and trametinib. This trial may help researchers decide which treatment option (cabozantinib alone or dabrafenib in combination with trametinib) is safer and/or more effective in treating patients with refractory BRAF V600E-mutated differentiated thyroid cancer.
Detailed description
PRIMARY OBJECTIVE: I. To compare progression-free survival (PFS) in patients with BRAF V600Em differentiated thyroid cancer who progressed on frontline multikinase inhibitor treated with dabrafenib/trametinib or cabozantinib. SECONDARY OBJECTIVES: I. To compare the objective response rate in patients with BRAF V600Em differentiated thyroid cancer that progressed on frontline multikinase inhibitor treated with dabrafenib/trametinib or cabozantinib. II. To compare the duration of response in patients with BRAF V600Em differentiated thyroid cancer that progressed on frontline multikinase inhibitor treated with dabrafenib/trametinib or cabozantinib. III. To compare the overall survival in patients with BRAF V600Em differentiated thyroid cancer that progressed on frontline multikinase inhibitor treated with dabrafenib/trametinib or cabozantinib. IV. To compare the PFS2 in patients with BRAF V600Em differentiated thyroid cancer that progressed on frontline multikinase inhibitor treated with dabrafenib/trametinib or cabozantinib. V. To compare the safety/tolerability in patients with BRAF V600Em differentiated thyroid cancer that progressed on frontline multikinase inhibitor treated with dabrafenib/trametinib or cabozantinib. QUALITY OF LIFE OBJECTIVE: I. To assess patient tolerability of treatment using the Functional Assessment Cancer Therapy General (FACT G)P5 and general quality of life using the FACT-G7. OUTLINE: Patients are randomized to 1 of 2 arms. Patients may crossover to other treatment arm at the time of progression. ARM A: Patients receive dabrafenib orally (PO) twice per day (BID) and trametinib PO once per day (QD) on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo computed tomography (CT) scan, blood sample collection and may undergo magnetic resonance imaging (MRI) throughout the study. ARM B: Patients receive cabozantinib PO QD on days 1-28 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan, blood sample collection and may undergo MRI throughout the study. After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months thereafter up to 5 years.
Arms & interventions
- ProcedureBiospecimen Collection
Undergo blood sample collection
- DrugCabozantinib
Given PO
- ProcedureComputed Tomography
Undergo CT scan
- DrugDabrafenib
Given PO
- ProcedureMagnetic Resonance Imaging
Undergo MRI
- OtherQuestionnaire Administration
Ancillary study
- DrugTrametinib
Given PO
Outcome measures
Primary
Progression free survival (PFS)
PFS will be compared between the two groups using a stratified log-rank test with one-sided type I error of 0.05. Median PFS and 95% confidence interval (CI) for each treatment arm will be estimated using the Kaplan-Meier method. The stratified hazard ratio and 95% CI will be estimated using a Cox proportional hazard model with treatment group as the independent variable.
Time frame: From randomization to radiographic progression of disease by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 or death from any cause, up to 5 years
Secondary
Objective response
Time frame: Up to 5 years
Overall survival
Time frame: From randomization to death from any cause, up to 5 years
Duration of response
Time frame: From confirmed response (complete response or partial response) to progression among patients who achieve a response, up to 5 years
PFS2 - the time from randomization to progression on subsequent therapy or death from any cause (whichever occurs first)
Time frame: From randomization to progression on subsequent therapy or death from any cause, up to 5 years
Incidence of adverse events
Time frame: at 2 weeks, 4 weeks, 8 weeks, 16 weeks, and then every 12 weeks after the 16-week confirmatory scan
Eligibility criteria
Study locations (301)
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
Katmai Oncology Group
Anchorage, Alaska, 99508
Providence Alaska Medical Center
Anchorage, Alaska, 99508
Mercy Hospital Fort Smith
Fort Smith, Arkansas, 72903
CARTI Cancer Center
Little Rock, Arkansas, 72205
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank, California, 91505
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
Irvine, California, 92612
Providence Queen of The Valley
Napa, California, 94558
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange, California, 92868
Stanford Cancer Institute Palo Alto
Palo Alto, California, 94304
Providence Medical Foundation - Santa Rosa
Santa Rosa, California, 95403
Providence Santa Rosa Memorial Hospital
Santa Rosa, California, 95405
UCHealth University of Colorado Hospital
Aurora, Colorado, 80045
UCHealth Highlands Ranch Hospital
Highlands Ranch, Colorado, 80129
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
Emory University Hospital Midtown
Atlanta, Georgia, 30308
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 Alphonsus Cancer Care Center-Nampa
Nampa, Idaho, 83687
Saint Luke's Cancer Institute - Nampa
Nampa, Idaho, 83687
Kootenai Clinic Cancer Services - Post Falls
Post Falls, Idaho, 83854
Kootenai Clinic Cancer Services - Sandpoint
Sandpoint, Idaho, 83864
Saint Luke's Cancer Institute - Twin Falls
Twin Falls, Idaho, 83301
OSF Saint Anthony's Health Center
Alton, Illinois, 62002
Advocate Outpatient Center - Aurora
Aurora, Illinois, 60506
Advocate Good Shepherd Hospital
Barrington, Illinois, 60010
Saint Mary's Hospital
Centralia, Illinois, 62801
Northwestern University
Chicago, Illinois, 60611
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
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois, 60115
Advocate Good Samaritan Hospital
Downers Grove, Illinois, 60515
Advocate Sherman Hospital
Elgin, Illinois, 60123
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois, 60134
Northwestern Medicine Glenview Outpatient Center
Glenview, Illinois, 60026
Northwestern Medicine Grayslake Outpatient Center
Grayslake, Illinois, 60030
Advocate South Suburban Hospital
Hazel Crest, Illinois, 60429
Northwestern Medicine Lake Forest Hospital
Lake Forest, Illinois, 60045
AMG Libertyville - Oncology
Libertyville, Illinois, 60048
Condell Memorial Hospital
Libertyville, Illinois, 60048
SSM Health Good Samaritan
Mount Vernon, Illinois, 62864
UC Comprehensive Cancer Center at Silver Cross
New Lenox, Illinois, 60451
Advocate Christ Medical Center
Oak Lawn, Illinois, 60453-2699
Advocate Outpatient Center - Oak Lawn
Oak Lawn, Illinois, 60453
Northwestern Medicine Orland Park
Orland Park, Illinois, 60462
University of Chicago Medicine-Orland Park
Orland Park, Illinois, 60462
Advocate High Tech Medical Park
Palos Heights, Illinois, 60463
Advocate Lutheran General Hospital
Park Ridge, Illinois, 60068
Memorial Hospital East
Shiloh, Illinois, 62269
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois, 60555
UChicago Medicine Northwest Indiana
Crown Point, Indiana, 46307
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny, Iowa, 50023
University of Iowa Healthcare Cancer Services Quad Cities
Bettendorf, Iowa, 52722
Saint Anthony Regional Hospital
Carroll, Iowa, 51401
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
Heartland Oncology and Hematology LLP
Council Bluffs, Iowa, 51503
Methodist Jennie Edmundson Hospital
Council Bluffs, Iowa, 51503
Nebraska Cancer Specialists/Oncology Hematology West PC - MEJ
Council Bluffs, Iowa, 51503
Greater Regional Medical Center
Creston, Iowa, 50801
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
UI Healthcare Mission Cancer and Blood - Fort Dodge
Fort Dodge, Iowa, 50501
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, 52242
UI Healthcare Mission Cancer and Blood - Pella
Pella, Iowa, 50219
UI Health Care Mission Cancer and Blood - Waukee Clinic
Waukee, Iowa, 50263
Mercy Medical Center-West Lakes
West Des Moines, Iowa, 50266
The Iowa Clinic PC
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
Mercy Hospital Pittsburg
Pittsburg, Kansas, 66762
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
MyMichigan Medical Center Gratiot
Alma, Michigan, 48801
MyMichigan Medical Center Alpena
Alpena, Michigan, 49707
Trinity Health IHA - Obstetrics and Gynecology West Arbor
Ann Arbor, Michigan, 48103
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor, Michigan, 48106
University of Michigan Rogel Cancer Center
Ann Arbor, Michigan, 48109
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton, Michigan, 48114
Trinity Health Medical Center - Brighton
Brighton, Michigan, 48114
University of Michigan - Brighton Center for Specialty Care
Brighton, Michigan, 48116
Trinity Health IHA Medical Group Hematology Oncology - Canton
Canton, Michigan, 48188
Trinity Health Medical Center - Canton
Canton, Michigan, 48188
Caro Cancer Center
Caro, Michigan, 48723
Chelsea Hospital
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
Henry Ford Health Saint John Hospital
Detroit, Michigan, 48236
Henry Ford River District Hospital
East China, Michigan, 48054
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
MyMichigan Medical Center Gladwin
Gladwin, Michigan, 48624
Henry Ford Saint John Hospital - Academic
Grosse Pointe Woods, Michigan, 48236
Henry Ford Saint John Hospital - Breast
Grosse Pointe Woods, Michigan, 48236
Henry Ford Saint John Hospital - Van Elslander
Grosse Pointe Woods, Michigan, 48236
University of Michigan Health - Sparrow Lansing
Lansing, Michigan, 48912
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan, 48154
Henry Ford Saint John Hospital - Macomb Medical
Macomb, Michigan, 48044
Henry Ford Warren Hospital - Breast Macomb
Macomb, Michigan, 48044
Saint Mary's Oncology/Hematology Associates of Marlette
Marlette, Michigan, 48453
MyMichigan Medical Center Midland
Midland, Michigan, 48670
MyMichigan Medical Center Mount Pleasant
Mount Pleasant, Michigan, 48858
Hope Cancer Center
Pontiac, Michigan, 48341
Michigan Healthcare Professionals Pontiac
Pontiac, Michigan, 48341
Newland Medical Associates-Pontiac
Pontiac, Michigan, 48341
Trinity Health Saint Joseph Mercy Oakland Hospital
Pontiac, Michigan, 48341
MyMichigan Medical Center Saginaw
Saginaw, Michigan, 48601
Oncology Hematology Associates of Saginaw Valley PC
Saginaw, Michigan, 48604
MyMichigan Medical Center Tawas
Tawas City, Michigan, 48764
Henry Ford Health Warren Hospital
Warren, Michigan, 48093
Henry Ford Madison Heights Hospital - Breast
Warren, Michigan, 48093
Henry Ford Warren Hospital - GLCMS
Warren, Michigan, 48093
Saint Mary's Oncology/Hematology Associates of West Branch
West Branch, Michigan, 48661
Huron Gastroenterology PC
Ypsilanti, Michigan, 48106
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
Cambridge Medical Center
Cambridge, Minnesota, 55008
Minnesota Oncology Hematology PA-Chaska
Chaska, Minnesota, 55318
Mercy Hospital
Coon Rapids, Minnesota, 55433
Minnesota Oncology - Coon Rapids
Coon Rapids, Minnesota, 55433
Fairview Southdale Hospital
Edina, Minnesota, 55435
Minnesota Oncology - Edina
Edina, Minnesota, 55435
Fairview Clinics and Surgery Center Maple Grove
Maple Grove, Minnesota, 55369
Minnesota Oncology - 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
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
Saint Francis Regional Medical Center
Shakopee, Minnesota, 55379
Lakeview Hospital
Stillwater, Minnesota, 55082
Sanford Thief River Falls Medical Center
Thief River Falls, Minnesota, 56701
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
Mercy Oncology and Hematology - Clayton-Clarkson
Ballwin, Missouri, 63011
Central Care Cancer Center - Bolivar
Bolivar, Missouri, 65613
Cox Cancer Center Branson
Branson, Missouri, 65616
Mercy Cancer Center - Cape Girardeau
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
Freeman Health System
Joplin, Missouri, 64804
Mercy Hospital Joplin
Joplin, Missouri, 64804
Lake Regional Hospital
Osage Beach, Missouri, 65065
Mercy Clinic-Rolla-Cancer and Hematology
Rolla, Missouri, 65401
Phelps Health Delbert Day Cancer Institute
Rolla, Missouri, 65401
Heartland Regional Medical Center
Saint Joseph, Missouri, 64506
Mercy Hospital Springfield
Springfield, Missouri, 65804
CoxHealth South Hospital
Springfield, Missouri, 65807
Mercy Infusion Center - Chippewa
St Louis, Missouri, 63109
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
Mercy Hospital Saint Louis
St Louis, Missouri, 63141
Mercy Hospital Washington
Washington, Missouri, 63090
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
Great Falls Clinic
Great Falls, Montana, 59405
Hi-Line Sletten Cancer Center
Havre, Montana, 59501
Benefis Helena Specialty Center
Helena, Montana, 59601
Logan Health Medical Center
Kalispell, Montana, 59901
Saint Patrick Hospital - Community Hospital
Missoula, Montana, 59802
Community Medical Center
Missoula, Montana, 59804
Nebraska Cancer Specialists/Oncology Hematology West PC - MECC
Omaha, Nebraska, 68114
Nebraska Methodist Hospital
Omaha, Nebraska, 68114
Oncology Associates PC
Omaha, Nebraska, 68114
Duke Cancer Center Cary
Cary, North Carolina, 27518
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, 27599
Duke University Medical Center
Durham, North Carolina, 27710
Duke Cancer Center Raleigh
Raleigh, North Carolina, 27609
Sanford Bismarck Medical Center
Bismarck, North Dakota, 58501
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
Cancer Centers of Southwest Oklahoma Research
Lawton, Oklahoma, 73505
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma, 73120
Saint Alphonsus Cancer Care 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 Hood River Memorial Hospital
Hood River, Oregon, 97031
Providence Newberg Medical Center
Newberg, Oregon, 97132
Saint Alphonsus Cancer Care 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
Oregon Health and Science University
Portland, Oregon, 97239
Saint Charles Health System-Redmond
Redmond, Oregon, 97756
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania, 18103
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania, 18017
Pocono Medical Center
East Stroudsburg, Pennsylvania, 18301
UPMC Hillman Cancer Center Erie
Erie, Pennsylvania, 16505
Lehigh Valley Hospital-Hazleton
Hazleton, Pennsylvania, 18201
University of Pennsylvania/Abramson Cancer Center
Philadelphia, Pennsylvania, 19104
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, 15232
Smilow Cancer Hospital Care Center - Westerly
Westerly, Rhode Island, 02891
Medical University of South Carolina
Charleston, South Carolina, 29425
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota, 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Vanderbilt Breast Center at One Hundred Oaks
Nashville, Tennessee, 37204
Vanderbilt University/Ingram Cancer Center
Nashville, Tennessee, 37232
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
Skagit Regional Health Cancer Care Center
Mount Vernon, Washington, 98274
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
Cancer Care Northwest - Spokane South
Spokane, Washington, 99202
Cancer Care Northwest-Valley
Spokane, Washington, 99216
Cancer Care Northwest-North Spokane
Spokane, Washington, 99218
PeaceHealth Southwest Medical Center
Vancouver, Washington, 98664
Providence Saint Mary Regional Cancer Center
Walla Walla, Washington, 99362
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
Aurora Health Care Germantown Health Center
Germantown, Wisconsin, 53022
Aurora Cancer Care-Grafton
Grafton, Wisconsin, 53024
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
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
Cancer Center of Western Wisconsin
New Richmond, Wisconsin, 54017
Vince Lombardi Cancer Clinic - Oshkosh
Oshkosh, Wisconsin, 54904
Aurora Cancer Care-Racine
Racine, Wisconsin, 53406
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin, 54868
Vince Lombardi Cancer Clinic-Sheboygan
Sheboygan, Wisconsin, 53081
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin, 54482
Aurora Medical Center in Summit
Summit, Wisconsin, 53066
Vince Lombardi Cancer Clinic-Two Rivers
Two Rivers, Wisconsin, 54241
Aurora Cancer Care-Milwaukee West
Wauwatosa, Wisconsin, 53226
Aurora West Allis Medical Center
West Allis, Wisconsin, 53227
Marshfield Medical Center - Weston
Weston, Wisconsin, 54476
Memorial Hospital of Laramie County
Cheyenne, Wyoming, 82001
Billings Clinic-Cody
Cody, Wyoming, 82414
Welch Cancer Center
Sheridan, Wyoming, 82801