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NCT04166318
Quimioterapia y radioterapia a dosis más bajas en el tratamiento de pacientes con cáncer anal en estadio temprano: el estudio DECREASE.
Activo, No Reclutando
Fase 2
Descripción
Este ensayo de fase II estudia la eficacia de la quimioterapia a dosis más bajas combinada con radioterapia (quimiorradioterapia) en comparación con la quimiorradioterapia a dosis estándar en el tratamiento de pacientes con cáncer anal en etapa temprana. Los fármacos utilizados en la quimioterapia, como la mitomicina, el fluorouracilo y la capecitabina, actúan de diferentes maneras para detener el crecimiento de las células tumorales, ya sea matando las células, impidiendo que se dividan o impidiendo que se propaguen. La radioterapia utiliza rayos X de alta energía para matar las células tumorales y reducir el tamaño de los tumores. La administración de quimioterapia con radioterapia puede matar más células tumorales. Este estudio puede ayudar a los médicos a determinar si la quimiorradioterapia a dosis más bajas es tan eficaz y tiene menos efectos secundarios que la quimiorradioterapia a dosis estándar, que es el enfoque habitual para el tratamiento de este tipo de cáncer.
Criterios de Elegibilidad
Criterios de inclusión:
- FASE 0 (PRE-REGISTRO)
- El paciente debe tener ≥ 18 años de edad.
- Los pacientes deben hablar inglés para poder participar en el ensayo. (Tenga en cuenta que este requisito se debe a que los estudios de calidad de vida son obligatorios y actualmente no contamos con versiones traducidas completas de los cuestionarios a otros idiomas).
- El paciente debe tener un carcinoma de células escamosas invasivo del canal anal o del margen anal, confirmado histológicamente, con tumores que midan ≤ 4 cm. Esto puede incluir tumores de histología no queratinizante, como histología basaloide, de células transicionales o cloacogénica. No se requiere enfermedad medible.
- Los pacientes que hayan sido sometidos a una resección local o a un procedimiento de biopsia excisional son elegibles, siempre y cuando haya habido afectación tumoral del canal anal y/o del borde anal antes del procedimiento, si los márgenes fueron positivos y/o si el estadio es T2N0 según el tamaño del tumor antes del procedimiento. Esto significa que los pacientes con carcinoma de células escamosas del margen anal T1N0M0 que se hayan sometido a una resección quirúrgica con márgenes negativos y sin afectación del borde anal y/o del canal anal no son elegibles.
- El tamaño del tumor debe estar documentado en base al examen físico, incluyendo el examen rectal digital y/o la anoscopia/proctoscopia, dentro de las 4 semanas previas al pre-registro de la Fase 0.
- El estado del virus de la inmunodeficiencia humana (VIH) del paciente debe ser conocido y documentado al inicio del estudio.
- NOTA: Para los pacientes sin antecedentes de infección por VIH, se recomienda (pero no es obligatorio) que se realicen pruebas de VIH actualizadas dentro de un año desde la inclusión en el estudio.
- Los pacientes que sean VIH negativos se registrarán en el brazo R. No deben tener ganglios linfáticos que sean radiológicamente sospechosos de afectación por cáncer, utilizando criterios basados en la tomografía computarizada (TC) y la tomografía por emisión de positrones (TEP) con flúorodesoxiglucosa F-18 (FDG).
- NOTA: Los pacientes que sean VIH negativos y cumplan con los criterios a continuación pueden pasar directamente a la Fase 1 de aleatorización.
- Los pacientes se considerarán con ganglios linfáticos (GL) positivos y, por lo tanto, no serán elegibles en este estudio si los ganglios linfáticos cumplen alguno de los siguientes criterios:
- Ganglios linfáticos mesorrectales, presacrales, ilíacos internos u obturadores con:
- Eje corto que mida > 5 mm según la TC/resonancia magnética (RM) O
- Características morfológicas de borde irregular o necrosis central si se evalúa mediante RM y el tamaño del GL es > 3 mm O
- Captación de FDG > piscina sanguínea (Deauville 3-5) según la TEP-FDG o la TEP-RM
- Ganglios linfáticos ilíacos internos y obturadores con:
- Eje corto que mida > 7 mm según la TC/RM O
- Características morfológicas de borde irregular o necrosis central según la TC/RM O
- Captación de FDG > piscina sanguínea (Deauville 3-5) según la TEP-FDG o la TEP-RM
- Ganglios linfáticos ilíacos externos y comunes:
- Eje corto que mida > 10 mm según la TC/RM O
- Características morfológicas de borde irregular o necrosis central según la TC/RM O
- Captación de FDG > piscina sanguínea (Deauville 3-5) según la TEP-FDG o la TEP-RM
- Los ganglios linfáticos inguinales (superficiales y profundos) que cumplan alguno de los siguientes criterios no serán elegibles, a menos que se realice una aspiración con aguja fina (AAF) y la citología resultante sea negativa.
- Características morfológicas de borde irregular o necrosis central según la TC/RM
- Captación de FDG > hígado (Deauville 4) según la TEP-FDG.
- Los pacientes que sean VIH negativos y tengan ganglios linfáticos inguinales que no cumplan con los criterios anteriores deben someterse a una aspiración con aguja fina y tener una histología negativa para ser elegibles.
- Los pacientes que sean VIH positivos se registrarán en el brazo S. Deben cumplir con los criterios de elegibilidad a continuación:
- Un recuento de CD4 ≥ 200
- Imágenes enviadas a ECOG-ACRIN para su revisión central con el fin de confirmar la ausencia de afectación ganglionar.
- No tener antecedentes de complicaciones relacionadas con el síndrome de inmunodeficiencia adquirida (SIDA) en el último año, aparte de antecedentes de un recuento bajo de células T CD4+ (> 200/mm³) antes del inicio de la terapia antirretroviral combinada.
- El paciente debe estar sano en base a la enfermedad por VIH, con una alta probabilidad de tener una esperanza de vida casi normal si no fuera por el cáncer anal.
- El paciente DEBE recibir la atención y el tratamiento adecuados para la infección por VIH, incluidos los medicamentos antirretrovirales cuando esté clínicamente indicado, y debe estar bajo el cuidado de un médico con experiencia en el manejo del VIH. Los pacientes serán elegibles independientemente del medicamento antirretroviral, siempre y cuando el régimen haya sido estable durante al menos 4 semanas.
- FASE 1 DE ALEATORIZACIÓN
- El paciente debe haber cumplido con los criterios de elegibilidad según lo indicado en el pre-registro de la Fase 0.
- El paciente debe tener un estado de rendimiento del Grupo de Oncología Cooperativa del Este (ECOG) - Red de Imágenes del Colegio Americano de Radiología (ACRIN) de 0-2.
- El paciente no debe tener antecedentes de quimioterapia previa para esta neoplasia.
- Los pacientes no deben haberse sometido a radiación previa en la pelvis de tal manera que se esperen campos de radiación superpuestos.
- El paciente no debe haber sido sometido a una cirugía potencialmente curativa previa (es decir, resección abdominoperineal) para el carcinoma de ano. Sin embargo, los pacientes que se sometan a una resección local o a una biopsia excisional son elegibles, siempre y cuando cumplan con los criterios de inclusión.
- Los pacientes con carcinoma de células escamosas del margen anal T1N0M0 no deben haberse sometido a una resección quirúrgica con márgenes negativos y sin afectación del borde anal y/o del canal anal.
- El paciente no debe estar recibiendo ninguna otra terapia antitumoral estándar o agente experimental al mismo tiempo que los fármacos del estudio.
- El paciente no debe tener una enfermedad intercurrente, incluyendo, entre otras, una infección o una situación psiquiátrica/social activa que, a juicio del investigador, limite el cumplimiento de los requisitos del estudio.
- El paciente no debe haber tenido una enfermedad cardiovascular significativa, incluyendo infarto de miocardio, angina inestable, accidente cerebrovascular, accidente isquémico transitorio, enfermedad coronaria sintomática, insuficiencia cardíaca congestiva sintomática o arritmia cardíaca no controlada en los 6 meses previos a la aleatorización de la Fase 1.
- El paciente no debe tener antecedentes de una neoplasia diferente a menos que haya estado libre de la enfermedad durante al menos 2 años y el investigador lo considere de bajo riesgo de recurrencia.
- Las excepciones a esta regla son los individuos con cáncer cervical in situ, cánceres de piel no melanoma y pólipos de colon.
- El paciente no debe tener una enfermedad inflamatoria intestinal activa (pacientes que requieran intervenciones médicas actuales o que tengan síntomas).
- Los pacientes no deben tener una enfermedad autoinmune o del tejido conectivo activa que haya requerido tratamiento sistémico en los últimos dos años (es decir, con el uso de agentes modificadores, corticosteroides o fármacos inmunosupresores). La terapia de reemplazo (por ejemplo, tiroxina, insulina o terapia de reemplazo fisiológica de corticosteroides para insuficiencia adrenal o pituitaria, etc.) no se considera una forma de tratamiento sistémico.
- Los pacientes que estén tomando anticoagulantes con warfarina dentro de las 2 semanas previas a la aleatorización de la Fase 1 y que estén considerando el uso de capecitabina deben usar un anticoagulante alternativo.
- NOTA: Se permite la heparina de bajo peso molecular, siempre y cuando el tiempo de protrombina (TP)/relación normalizada internacional (RNI) del paciente sea < 1,5.
- Los pacientes que recibirán capecitabina y que están tomando Dilantin para un trastorno convulsivo deben tener sus niveles de Dilantin controlados semanalmente.
- Hemoglobina > 10 g/dL (dentro de las 2 semanas previas a la aleatorización de la Fase 1)
- Plaquetas ≥ 100.000/mm³ (dentro de las 2 semanas previas a la aleatorización de la Fase 1)
- Recuento absoluto de neutrófilos ≥ 1500/mm³ (dentro de las 2 semanas previas a la aleatorización de la Fase 1)
- La creatinina sérica debe ser < 1,5 X el límite superior normal (LSN), o la depuración de creatinina calculada debe ser > 50 ml/min (dentro de las 2 semanas previas a la aleatorización de la Fase 1)
- La bilirrubina total debe ser < 2 X LSN (dentro de las 2 semanas previas a la aleatorización de la Fase 1)
- Aspartato aminotransferasa (AST)/alanina aminotransferasa (ALT) ≤ 2,5 X LSN institucional (dentro de las 2 semanas previas a la aleatorización de la Fase 1)
- Albúmina ≥ 3,0 g/dL (dentro de las 2 semanas previas a la aleatorización de la Fase 1)
- Las mujeres no deben estar embarazadas ni amamantando, ya que el tratamiento del estudio administrado puede causar daño a un feto no nacido o a un niño en período de lactancia. Todas las mujeres en edad fértil deben someterse a una prueba de sangre o de orina dentro de las 2 semanas previas a la aleatorización de la Fase 1 para descartar el embarazo. Una mujer en edad fértil es cualquier mujer, independientemente de su orientación sexual o de si se ha sometido a una ligadura de trompas, que cumpla con los siguientes criterios: 1) ha tenido la menarquia en algún momento, 2) no se ha sometido a una histerectomía o ooforectomía bilateral; o 2) no ha tenido una menopausia natural (la amenorrea después de la terapia contra el cáncer no descarta la capacidad de tener hijos) durante al menos 24 meses consecutivos (es decir, ha tenido menstruación en algún momento en los 24 meses consecutivos anteriores).
- Se debe aconsejar encarecidamente a las mujeres en edad fértil y a los hombres sexualmente activos que utilicen métodos anticonceptivos aceptados y eficaces o que se abstengan de tener relaciones sexuales durante toda su participación en el estudio y durante al menos 6 meses después de la finalización del tratamiento.
Información del Ensayo
NCT04166318
Activo, No Reclutando
Fase 2
252 participantes
Ene 2020
Dic 2029
Ubicaciones659
United States (659)
Providence Regional Cancer System-Aberdeen
Aberdeen
Riverwood Healthcare Center
Aitkin
Lovelace Medical Center-Saint Joseph Square
Albuquerque
Lovelace Radiation Oncology
Albuquerque
Lovelace Women's Hospital
Albuquerque
University of New Mexico Cancer Center
Albuquerque
UPMC Altoona
Altoona
Mary Greeley Medical Center
Ames
McFarland Clinic - Ames
Ames
Community Hospital of Anaconda
Anaconda
Alaska Breast Care and Surgery LLC
Anchorage
Alaska Oncology and Hematology LLC
Anchorage
Alaska Women's Cancer Care
Anchorage
Anchorage Associates in Radiation Medicine
Anchorage
Anchorage Oncology Centre
Anchorage
Anchorage Radiation Therapy Center
Anchorage
Katmai Oncology Group
Anchorage
Providence Alaska Medical Center
Anchorage
AnMed Health Cancer Center
Anderson
Mission Cancer and Blood - Ankeny
Ankeny
University of Michigan Comprehensive Cancer Center
Ann Arbor
Luminis Health Anne Arundel Medical Center
Annapolis
ThedaCare Regional Cancer Center
Appleton
Mission Hope Medical Oncology - Arroyo Grande
Arroyo Grande
PCR Oncology
Arroyo Grande
Duluth Clinic Ashland
Ashland
Northwest Wisconsin Cancer Center
Ashland
Rocky Mountain Cancer Centers-Aurora
Aurora
Rush - Copley Medical Center
Aurora
UCHealth University of Colorado Hospital
Aurora
UM Sylvester Comprehensive Cancer Center at Aventura
Aventura
UH Seidman Cancer Center at UH Avon Health Center
Avon
Saint Alphonsus Cancer Care Center-Baker City
Baker City
Saint Louis Cancer and Breast Institute-Ballwin
Ballwin
Greater Baltimore Medical Center
Baltimore
Flaget Memorial Hospital
Bardstown
Advocate Good Shepherd Hospital
Barrington
Memorial Sloan Kettering Basking Ridge
Basking Ridge
MaineHealth Coastal Cancer Treatment Center
Bath
Bronson Battle Creek
Battle Creek
McLaren Cancer Institute-Bay City
Bay City
UHHS-Chagrin Highlands Medical Center
Beachwood
UPMC-Heritage Valley Health System Beaver
Beaver
Indu and Raj Soin Medical Center
Beavercreek
Overlake Medical Center
Bellevue
PeaceHealth Saint Joseph Medical Center
Bellingham
Sanford Joe Lueken Cancer Center
Bemidji
Saint Charles Health System
Bend
Central Vermont Medical Center/National Life Cancer Treatment
Berlin Corners
MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford
Biddeford
Billings Clinic Cancer Center
Billings
University of Alabama at Birmingham Cancer Center
Birmingham
Sanford Bismarck Medical Center
Bismarck
Illinois CancerCare-Bloomington
Bloomington
Saint Elizabeth Boardman Hospital
Boardman
Saint Alphonsus Cancer Care Center-Boise
Boise
Saint Luke's Cancer Institute - Boise
Boise
Central Care Cancer Center - Bolivar
Bolivar
Parkland Health Center-Bonne Terre
Bonne Terre
McFarland Clinic - Boone
Boone
Beth Israel Deaconess Medical Center
Boston
Boston Medical Center
Boston
Rocky Mountain Cancer Centers-Boulder
Boulder
Bozeman Health Deaconess Hospital
Bozeman
Essentia Health Saint Joseph's Medical Center
Brainerd
Cox Cancer Center Branson
Branson
Harrison HealthPartners Hematology and Oncology-Bremerton
Bremerton
University of Michigan - Brighton Center for Specialty Care
Brighton
Henry Ford Cancer Institute-Downriver
Brownstown
Saint Joseph Regional Cancer Center
Bryan
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank
Highline Medical Center-Main Campus
Burien
Aurora Cancer Care-Southern Lakes VLCC
Burlington
University of Vermont and State Agricultural College
Burlington
University of Vermont Medical Center
Burlington
Fairview Ridges Hospital
Burnsville
Minnesota Oncology - Burnsville
Burnsville
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell
Cambridge Medical Center
Cambridge
Cooper Hospital University Medical Center
Camden
Sands Cancer Center
Canandiaqua
Illinois CancerCare-Canton
Canton
Saint Francis Medical Center
Cape Girardeau
Southeast Cancer Center
Cape Girardeau
Memorial Hospital of Carbondale
Carbondale
Carlisle Regional Cancer Center
Carlisle
Mercy Cancer Center - Carmichael
Carmichael
Mercy San Juan Medical Center
Carmichael
Saint Anthony Regional Hospital
Carroll
Carson Tahoe Regional Medical Center
Carson City
SIH Cancer Institute
Carterville
Illinois CancerCare-Carthage
Carthage
Physicians' Clinic of Iowa PC
Cedar Rapids
Saint Luke's Hospital
Cedar Rapids
Dayton Physicians LLC-Miami Valley South
Centerville
Miami Valley Hospital South
Centerville
Centralia Oncology Clinic
Centralia
Providence Regional Cancer System-Centralia
Centralia
Saint Mary's Hospital
Centralia
Christiana Care Health System-Concord Health Center
Chadds Ford
Geauga Hospital
Chardon
Advocate Illinois Masonic Medical Center
Chicago
Northwestern University
Chicago
Rush University Medical Center
Chicago
University of Illinois
Chicago
Bethesda North Hospital
Cincinnati
Good Samaritan Hospital - Cincinnati
Cincinnati
Oncology Hematology Care Inc-Kenwood
Cincinnati
TriHealth Cancer Institute-Anderson
Cincinnati
TriHealth Cancer Institute-Westside
Cincinnati
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters
Clackamas Radiation Oncology Center
Clackamas
Providence Cancer Institute Clackamas Clinic
Clackamas
McLaren Cancer Institute-Clarkston
Clarkston
Case Western Reserve University
Cleveland
Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland
Cleveland Clinic Foundation
Cleveland
MetroHealth Medical Center
Cleveland
Henry Ford Macomb Hospital-Clinton Township
Clinton Township
Mercy Cancer Center-West Lakes
Clive
Mission Cancer and Blood - West Des Moines
Clive
Billings Clinic-Cody
Cody
Kootenai Health - Coeur d'Alene
Coeur d'Alene
Memorial Hospital North
Colorado Springs
Penrose-Saint Francis Healthcare
Colorado Springs
Rocky Mountain Cancer Centers-Penrose
Colorado Springs
Saint Francis Cancer Center
Colorado Springs
UCHealth Memorial Hospital Central
Colorado Springs
Ohio State University Comprehensive Cancer Center
Columbus
Memorial Sloan Kettering Commack
Commack
MD Anderson in The Woodlands
Conroe
Mercy Hospital
Coon Rapids
Mary Imogene Bassett Hospital
Cooperstown
Bay Area Hospital
Coos Bay
UM Sylvester Comprehensive Cancer Center at Coral Gables
Coral Gables
Commonwealth Cancer Center-Corbin
Corbin
Alegent Health Mercy Hospital
Council Bluffs
Heartland Oncology and Hematology LLP
Council Bluffs
Methodist Jennie Edmundson Hospital
Council Bluffs
Greater Regional Medical Center
Creston
Siteman Cancer Center at West County Hospital
Creve Coeur
AMG Crystal Lake - Oncology
Crystal Lake
Parkland Memorial Hospital
Dallas
UT Southwestern/Simmons Cancer Center-Dallas
Dallas
LincolnHealth - Miles Campus and Hospital
Damariscotta
Noyes Memorial Hospital/Myers Cancer Center
Dansville
Carle at The Riverfront
Danville
Geisinger Medical Center
Danville
Dayton Physician LLC - Englewood
Dayton
Miami Valley Hospital
Dayton
Miami Valley Hospital North
Dayton
Premier Blood and Cancer Center
Dayton
Corewell Health Dearborn Hospital
Dearborn
Henry Ford Medical Center-Fairlane
Dearborn
Cancer Care Specialists of Illinois - Decatur
Decatur
Decatur Memorial Hospital
Decatur
Essentia Health - Deer River Clinic
Deer River
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Deerfield Beach
Northwestern Medicine Cancer Center Kishwaukee
DeKalb
Porter Adventist Hospital
Denver
Presbyterian - Saint Lukes Medical Center - Health One
Denver
Smilow Cancer Hospital-Derby Care Center
Derby
Broadlawns Medical Center
Des Moines
Iowa Lutheran Hospital
Des Moines
Iowa Methodist Medical Center
Des Moines
Mercy Medical Center - Des Moines
Des Moines
Mission Cancer and Blood - Des Moines
Des Moines
Mission Cancer and Blood - Laurel
Des Moines
Henry Ford Hospital
Detroit
Wayne State University/Karmanos Cancer Institute
Detroit
Essentia Health Saint Mary's - Detroit Lakes Clinic
Detroit Lakes
Illinois CancerCare-Dixon
Dixon
Advocate Good Samaritan Hospital
Downers Grove
Essentia Health Cancer Center
Duluth
Essentia Health Saint Mary's Medical Center
Duluth
Miller-Dwan Hospital
Duluth
Mercy Medical Center
Durango
Southwest Oncology PC
Durango
Memorial Sloan Kettering Westchester
East White Plains
Marshfield Medical Center-EC Cancer Center
Eau Claire
Fairview Southdale Hospital
Edina
Swedish Cancer Institute-Edmonds
Edmonds
Carle Physician Group-Effingham
Effingham
Crossroads Cancer Center
Effingham
Advocate Sherman Hospital
Elgin
Mercy Cancer Center - Elk Grove
Elk Grove
Mercy Cancer Center-Elyria
Elyria
Walter Knox Memorial Hospital
Emmett
Mountain Blue Cancer Care Center - Swedish
Englewood
Swedish Medical Center
Englewood
The Melanoma and Skin Cancer Institute
Englewood
Saint Elizabeth Hospital
Enumclaw
UPMC Hillman Cancer Center Erie
Erie
Illinois CancerCare-Eureka
Eureka
Providence Regional Cancer Partnership
Everett
Fairbanks Memorial Hospital
Fairbanks
Smilow Cancer Hospital Care Center-Fairfield
Fairfield
University of Kansas Clinical Research Center
Fairway
Essentia Health Cancer Center-South University Clinic
Fargo
Sanford Broadway Medical Center
Fargo
Sanford Medical Center Fargo
Fargo
Sanford Roger Maris Cancer Center
Fargo
Sanford South University Medical Center
Fargo
Southpointe-Sanford Medical Center Fargo
Fargo
Farmington Health Center
Farmington
Parkland Health Center - Farmington
Farmington
Corewell Health Farmington Hills Hospital
Farmington Hills
Weisberg Cancer Treatment Center
Farmington Hills
UPMC Cancer Center at UPMC Horizon
Farrell
Saint Francis Hospital
Federal Way
Lake Region Healthcare Corporation-Cancer Care
Fergus Falls
Armes Family Cancer Center
Findlay
Blanchard Valley Hospital
Findlay
Orion Cancer Care
Findlay
McLaren Cancer Institute-Flint
Flint
Singh and Arora Hematology Oncology PC
Flint
Cancer Care and Hematology-Fort Collins
Fort Collins
Poudre Valley Hospital
Fort Collins
McFarland Clinic - Trinity Cancer Center
Fort Dodge
Trinity Regional Medical Center
Fort Dodge
Mercy Hospital Fort Smith
Fort Smith
UT Southwestern/Simmons Cancer Center-Fort Worth
Fort Worth
Essentia Health - Fosston
Fosston
Atrium Medical Center-Middletown Regional Hospital
Franklin
Dayton Physicians LLC-Atrium
Franklin
Unity Hospital
Fridley
Saint Luke's Cancer Institute - Fruitland
Fruitland
Gibbs Cancer Center-Gaffney
Gaffney
Illinois CancerCare-Galesburg
Galesburg
Western Illinois Cancer Treatment Center
Galesburg
Central Care Cancer Center - Garden City
Garden City
Northwestern Medicine Cancer Center Delnor
Geneva
Aurora Health Care Germantown Health Center
Germantown
Aurora Cancer Care-Grafton
Grafton
Nebraska Cancer Specialists/Oncology Hematology West PC
Grand Island
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids
Trinity Health Grand Rapids Hospital
Grand Rapids
Central Care Cancer Center - Great Bend
Great Bend
Benefis Sletten Cancer Institute
Great Falls
Great Falls Clinic
Great Falls
UCHealth Greeley Hospital
Greeley
Aurora BayCare Medical Center
Green Bay
UPMC Cancer Centers - Arnold Palmer Pavilion
Greensburg
Dayton Physicians LLC-Wayne
Greenville
Miami Valley Cancer Care and Infusion
Greenville
Prisma Health Cancer Institute - Eastside
Greenville
Prisma Health Cancer Institute - Faris
Greenville
Saint Francis Cancer Center
Greenville
Saint Francis Hospital
Greenville
Wayne Hospital
Greenville
Smilow Cancer Hospital Care Center at Greenwich
Greenwich
Gibbs Cancer Center-Pelham
Greer
Prisma Health Cancer Institute - Greer
Greer
Smilow Cancer Hospital Care Center - Guilford
Guilford
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
Harrisburg
Essentia Health-Hayward Clinic
Hayward
Advocate South Suburban Hospital
Hazel Crest
Cancer and Blood Specialists-Henderson
Henderson
Comprehensive Cancer Centers of Nevada - Henderson
Henderson
Comprehensive Cancer Centers of Nevada-Horizon Ridge
Henderson
Comprehensive Cancer Centers of Nevada-Southeast Henderson
Henderson
GenesisCare USA - Henderson
Henderson
Las Vegas Cancer Center-Henderson
Henderson
Las Vegas Urology - Green Valley
Henderson
Las Vegas Urology - Pebble
Henderson
OptumCare Cancer Care at Seven Hills
Henderson
Urology Specialists of Nevada - Green Valley
Henderson
Essentia Health Hibbing Clinic
Hibbing
CHI Saint Vincent Cancer Center Hot Springs
Hot Springs
M D Anderson Cancer Center
Houston
MD Anderson West Houston
Houston
Cleveland Clinic Cancer Center Independence
Independence
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
Irvine
Swedish Cancer Institute-Issaquah
Issaquah
Allegiance Health
Jackson
Essentia Health - Jamestown Clinic
Jamestown
McFarland Clinic - Jefferson
Jefferson
MU Health Care Goldschmidt Cancer Center
Jefferson City
University of Wisconsin Carbone Cancer Center - Johnson Creek
Johnson Creek
UPMC-Johnstown/John P. Murtha Regional Cancer Center
Johnstown
Freeman Health System
Joplin
Mercy Hospital Joplin
Joplin
Ascension Borgess Hospital
Kalamazoo
Bronson Methodist Hospital
Kalamazoo
West Michigan Cancer Center
Kalamazoo
Logan Health Medical Center
Kalispell
University of Kansas Cancer Center
Kansas City
University of Kansas Cancer Center - North
Kansas City
CHI Health Good Samaritan
Kearney
Kadlec Clinic Hematology and Oncology
Kennewick
Aurora Cancer Care-Kenosha South
Kenosha
First Dayton Cancer Care
Kettering
Greater Dayton Cancer Center
Kettering
Kettering Medical Center
Kettering
Illinois CancerCare-Kewanee Clinic
Kewanee
Kingman Regional Medical Center
Kingman
Gundersen Lutheran Medical Center
La Crosse
UC San Diego Moores Cancer Center
La Jolla
Providence Regional Cancer System-Lacey
Lacey
Northwestern Medicine Lake Forest Hospital
Lake Forest
Northwell Health/Center for Advanced Medicine
Lake Success
Saint Anthony Hospital
Lakewood
Saint Clare Hospital
Lakewood
Karmanos Cancer Institute at McLaren Greater Lansing
Lansing
Mid-Michigan Physicians-Lansing
Lansing
McLaren Cancer Institute-Lapeer Region
Lapeer
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas
Ann M Wierman MD LTD
Las Vegas
Cancer and Blood Specialists-Shadow
Las Vegas
Cancer and Blood Specialists-Tenaya
Las Vegas
Comprehensive Cancer Centers of Nevada
Las Vegas
Comprehensive Cancer Centers of Nevada - Central Valley
Las Vegas
Comprehensive Cancer Centers of Nevada - Northwest
Las Vegas
Comprehensive Cancer Centers of Nevada - Town Center
Las Vegas
Comprehensive Cancer Centers of Nevada-Summerlin
Las Vegas
Desert West Surgery
Las Vegas
GenesisCare USA - Fort Apache
Las Vegas
GenesisCare USA - Las Vegas
Las Vegas
GenesisCare USA - Vegas Tenaya
Las Vegas
HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
Las Vegas
HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
Las Vegas
HealthCare Partners Medical Group Oncology/Hematology-San Martin
Las Vegas
HealthCare Partners Medical Group Oncology/Hematology-Tenaya
Las Vegas
Hope Cancer Care of Nevada
Las Vegas
Las Vegas Cancer Center-Medical Center
Las Vegas
Las Vegas Prostate Cancer Center
Las Vegas
Las Vegas Urology - Cathedral Rock
Las Vegas
Las Vegas Urology - Pecos
Las Vegas
Las Vegas Urology - Smoke Ranch
Las Vegas
Las Vegas Urology - Sunset
Las Vegas
OptumCare Cancer Care at Charleston
Las Vegas
OptumCare Cancer Care at Fort Apache
Las Vegas
OptumCare Cancer Care at MountainView
Las Vegas
Radiation Oncology Centers of Nevada Central
Las Vegas
Radiation Oncology Centers of Nevada Southeast
Las Vegas
Summerlin Hospital Medical Center
Las Vegas
Sunrise Hospital and Medical Center
Las Vegas
University Cancer Center
Las Vegas
University Medical Center of Southern Nevada
Las Vegas
Urology Specialists of Nevada - Central
Las Vegas
Urology Specialists of Nevada - Northwest
Las Vegas
Urology Specialists of Nevada - Southwest
Las Vegas
Lawrence Memorial Hospital
Lawrence
Cancer Centers of Southwest Oklahoma Research
Lawton
MD Anderson League City
League City
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon
University of Kansas Cancer Center - Lee's Summit
Lee's Summit
Beebe Medical Center
Lewes
Geisinger Medical Oncology-Lewisburg
Lewisburg
Lewistown Hospital
Lewistown
Saint Joseph Hospital
Lexington
Saint Joseph Hospital East
Lexington
Saint Joseph Radiation Oncology Resource Center
Lexington
AMG Libertyville - Oncology
Libertyville
Condell Memorial Hospital
Libertyville
Saint Elizabeth Regional Medical Center
Lincoln
University of Arkansas for Medical Sciences
Little Rock
Littleton Adventist Hospital
Littleton
Rocky Mountain Cancer Centers-Littleton
Littleton
Saint Joseph London
London
Monmouth Medical Center
Long Branch
Longmont United Hospital
Longmont
Rocky Mountain Cancer Centers-Longmont
Longmont
PeaceHealth Saint John Medical Center
Longview
Jewish Hospital
Louisville
Norton Audubon Hospital and Medical Campus
Louisville
Norton Brownsboro Hospital and Medical Campus
Louisville
Norton Hospital Pavilion and Medical Campus
Louisville
Saints Mary and Elizabeth Hospital
Louisville
UofL Health Medical Center Northeast
Louisville
Medical Center of the Rockies
Loveland
Illinois CancerCare-Macomb
Macomb
University of Wisconsin Carbone Cancer Center - University Hospital
Madison
Fairview Clinics and Surgery Center Maple Grove
Maple Grove
Minnesota Oncology Hematology PA-Maplewood
Maplewood
Saint John's Hospital - Healtheast
Maplewood
Aurora Bay Area Medical Group-Marinette
Marinette
McFarland Clinic - Marshalltown
Marshalltown
Marshfield Medical Center-Marshfield
Marshfield
Contra Costa Regional Medical Center
Martinez
Carle Physician Group-Mattoon/Charleston
Mattoon
Hillcrest Hospital Cancer Center
Mayfield Heights
Loyola University Medical Center
Maywood
UPMC Cancer Center at UPMC McKeesport
McKeesport
UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
Mechanicsburg
UH Seidman Cancer Center at Lake Health Mentor Campus
Mentor
Mercy Cancer Center
Merced
Idaho Urologic Institute-Meridian
Meridian
Saint Luke's Cancer Institute - Meridian
Meridian
Miami Cancer Institute
Miami
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami
UH Seidman Cancer Center at Southwest General Hospital
Middleburg Heights
Memorial Sloan Kettering Monmouth
Middletown
Beebe South Coastal Health Campus
Millville
Aurora Cancer Care-Milwaukee
Milwaukee
Aurora Saint Luke's Medical Center
Milwaukee
Aurora Sinai Medical Center
Milwaukee
Medical College of Wisconsin
Milwaukee
Abbott-Northwestern Hospital
Minneapolis
Health Partners Inc
Minneapolis
Hennepin County Medical Center
Minneapolis
Marshfield Medical Center - Minocqua
Minocqua
Community Medical Center
Missoula
Saint Patrick Hospital - Community Hospital
Missoula
UPMC Cancer Center - Monroeville
Monroeville
Monticello Cancer Center
Monticello
Memorial Sloan Kettering Bergen
Montvale
UPMC Hillman Cancer Center in Coraopolis
Moon Township
McLaren Cancer Institute-Macomb
Mount Clemens
Northern Westchester Hospital
Mount Kisco
Good Samaritan Regional Health Center
Mount Vernon
Skagit Regional Health Cancer Care Center
Mount Vernon
ProHealth D N Greenwald Center
Mukwonago
Trinity Health Muskegon Hospital
Muskegon
Saint Alphonsus Cancer Care Center-Nampa
Nampa
Saint Luke's Cancer Institute - Nampa
Nampa
Vanderbilt University/Ingram Cancer Center
Nashville
Rutgers Cancer Institute of New Jersey
New Brunswick
UPMC Hillman Cancer Center - New Castle
New Castle
Smilow Cancer Center/Yale-New Haven Hospital
New Haven
Yale University
New Haven
Ochsner Medical Center Jefferson
New Orleans
Cancer Center of Western Wisconsin
New Richmond
New Ulm Medical Center
New Ulm
Lenox Hill Hospital
New York
Manhattan Eye Ear and Throat Hospital
New York
Memorial Sloan Kettering Cancer Center
New York
Mount Sinai Chelsea
New York
Mount Sinai Hospital
New York
Mount Sinai Union Square
New York
Mount Sinai West
New York
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York
Christiana Care Health System-Christiana Hospital
Newark
Delaware Clinical and Laboratory Physicians PA
Newark
Helen F Graham Cancer Center
Newark
Medical Oncology Hematology Consultants PA
Newark
Rutgers New Jersey Medical School
Newark
Providence Newberg Medical Center
Newberg
Corewell Health Lakeland Hospitals - Niles Hospital
Niles
Yale-New Haven Hospital North Haven Medical Center
North Haven
University of Kansas Cancer Center at North Kansas City Hospital
North Kansas City
Cancer and Hematology Centers of Western Michigan - Norton Shores
Norton Shores
Henry Ford Health Providence Novi Hospital
Novi
Henry Ford Medical Center-Columbus
Novi
Cancer Care Center of O'Fallon
O'Fallon
HSHS Saint Elizabeth's Hospital
O'Fallon
Advocate Christ Medical Center
Oak Lawn
Health Central
Ocoee
ProHealth Oconomowoc Memorial Hospital
Oconomowoc
Mercy Hospital Oklahoma City
Oklahoma City
University of Oklahoma Health Sciences Center
Oklahoma City
The University of Kansas Cancer Center - Olathe
Olathe
Alegent Health Bergan Mercy Medical Center
Omaha
Alegent Health Immanuel Medical Center
Omaha
Alegent Health Lakeside Hospital
Omaha
Creighton University Medical Center
Omaha
Nebraska Cancer Specialists/Oncology Hematology West PC - MECC
Omaha
Nebraska Methodist Hospital
Omaha
Oncology Associates PC
Omaha
Saint Alphonsus Cancer Care Center-Ontario
Ontario
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange
Providence Willamette Falls Medical Center
Oregon City
Orlando Health Cancer Institute
Orlando
Vince Lombardi Cancer Clinic - Oshkosh
Oshkosh
Illinois CancerCare-Ottawa Clinic
Ottawa
University of Kansas Cancer Center-Overland Park
Overland Park
Hope Cancer Care of Nevada-Pahrump
Pahrump
Stanford Cancer Institute Palo Alto
Palo Alto
Advocate High Tech Medical Park
Palos Heights
Midlands Community Hospital
Papillion
Essentia Health - Park Rapids
Park Rapids
Advocate Lutheran General Hospital
Park Ridge
Parker Adventist Hospital
Parker
University Hospitals Parma Medical Center
Parma
Illinois CancerCare-Pekin
Pekin
OSF Saint Francis Radiation Oncology at Pekin
Pekin
Illinois CancerCare-Peoria
Peoria
Methodist Medical Center of Illinois
Peoria
OSF Saint Francis Medical Center
Peoria
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
Peoria
Illinois CancerCare-Peru
Peru
Valley Radiation Oncology
Peru
McLaren Cancer Institute-Northern Michigan
Petoskey
Fox Chase Cancer Center
Philadelphia
Cancer Center at Saint Joseph's
Phoenix
FirstHealth of the Carolinas-Moore Regional Hospital
Pinehurst
Ascension Via Christi - Pittsburg
Pittsburg
UPMC-Magee Womens Hospital
Pittsburgh
UPMC-Passavant Hospital
Pittsburgh
UPMC-Saint Clair Hospital Cancer Center
Pittsburgh
UPMC-Saint Margaret
Pittsburgh
UPMC-Shadyside Hospital
Pittsburgh
UM Sylvester Comprehensive Cancer Center at Plantation
Plantation
McLaren-Port Huron
Port Huron
Maine Medical Center-Bramhall Campus
Portland
Oregon Health and Science University
Portland
Providence Portland Medical Center
Portland
Providence Saint Vincent Medical Center
Portland
Kootenai Clinic Cancer Services - Post Falls
Post Falls
Geisinger Cancer Services-Pottsville
Pottsville
Harrison HealthPartners Hematology and Oncology-Poulsbo
Poulsbo
Fairview Northland Medical Center
Princeton
Illinois CancerCare-Princeton
Princeton
Saint Mary Corwin Medical Center
Pueblo
Aurora Cancer Care-Racine
Racine
University Hospitals Portage Medical Center
Ravenna
Saint Charles Health System-Redmond
Redmond
Corewell Health Reed City Hospital
Reed City
Beebe Health Campus
Rehoboth Beach
Radiation Oncology Associates
Reno
Renown Regional Medical Center
Reno
Saint Mary's Regional Medical Center
Reno
Valley Medical Center
Renton
Marshfield Medical Center-Rice Lake
Rice Lake
UT Southwestern Clinical Center at Richardson/Plano
Richardson
Reid Health
Richmond
North Memorial Medical Health Center
Robbinsdale
Highland Hospital
Rochester
University of Rochester
Rochester
Wilmot Cancer Institute Radiation Oncology at Greece
Rochester
Mercy Cancer Center - Rocklin
Rocklin
Penobscot Bay Medical Center
Rockport
Delbert Day Cancer Institute at PCRMC
Rolla
Mercy Clinic-Rolla-Cancer and Hematology
Rolla
Corewell Health William Beaumont University Hospital
Royal Oak
Mercy Cancer Center - Sacramento
Sacramento
Dartmouth Cancer Center - North
Saint Johnsbury
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
Saint Joseph
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
Saint Joseph
Heartland Regional Medical Center
Saint Joseph
Park Nicollet Clinic - Saint Louis Park
Saint Louis Park
Regions Hospital
Saint Paul
United Hospital
Saint Paul
Sainte Genevieve County Memorial Hospital
Sainte Genevieve
Salina Regional Health Center
Salina
Huntsman Cancer Institute/University of Utah
Salt Lake City
University of Utah Sugarhouse Health Center
Salt Lake City
UC San Diego Medical Center - Hillcrest
San Diego
Pacific Central Coast Health Center-San Luis Obispo
San Luis Obispo
Kootenai Clinic Cancer Services - Sandpoint
Sandpoint
Essentia Health Sandstone
Sandstone
UH Seidman Cancer Center at Firelands Regional Medical Center
Sandusky
MaineHealth Cancer Care Center of York County
Sanford
MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford
Sanford
Mission Hope Medical Oncology - Santa Maria
Santa Maria
Maine Medical Center- Scarborough Campus
Scarborough
TidalHealth Nanticoke / Allen Cancer Center
Seaford
Pacific Gynecology Specialists
Seattle
Swedish Medical Center-Ballard Campus
Seattle
Swedish Medical Center-Cherry Hill
Seattle
Swedish Medical Center-First Hill
Seattle
PeaceHealth United General Medical Center
Sedro-Woolley
Prisma Health Cancer Institute - Seneca
Seneca
UPMC Cancer Center at UPMC Northwest
Seneca
Saint Francis Regional Medical Center
Shakopee
Vince Lombardi Cancer Clinic-Sheboygan
Sheboygan
Henry Ford Macomb Health Center - Shelby Township
Shelby
Providence Regional Cancer System-Shelton
Shelton
Jewish Hospital Medical Center South
Shepherdsville
Welch Cancer Center
Sheridan
Saint Michael Cancer Center
Silverdale
Sanford Cancer Center Oncology Clinic
Sioux Falls
Sanford USD Medical Center - Sioux Falls
Sioux Falls
Phelps Memorial Hospital Center
Sleepy Hollow
Maine Medical Partners - South Portland
South Portland
Henry Ford Health Providence Southfield Hospital
Southfield
Spartanburg Medical Center
Spartanburg
Essentia Health-Spooner Clinic
Spooner
CoxHealth South Hospital
Springfield
Mercy Hospital Springfield
Springfield
Southern Illinois University School of Medicine
Springfield
Springfield Clinic
Springfield
Springfield Memorial Hospital
Springfield
Springfield Regional Cancer Center
Springfield
Springfield Regional Medical Center
Springfield
Mercy Hospital Saint Louis
St Louis
Mercy Hospital South
St Louis
Missouri Baptist Medical Center
St Louis
Saint Louis Cancer and Breast Institute-South City
St Louis
Siteman Cancer Center at Christian Hospital
St Louis
Siteman Cancer Center-South County
St Louis
Washington University School of Medicine
St Louis
Smilow Cancer Hospital Care Center at Long Ridge
Stamford
Marshfield Medical Center-River Region at Stevens Point
Stevens Point
Lakeview Hospital
Stillwater
Cleveland Clinic Cancer Center Strongsville
Strongsville
MD Anderson in Sugar Land
Sugar Land
Missouri Baptist Sullivan Hospital
Sullivan
Aurora Medical Center in Summit
Summit
BJC Outpatient Center at Sunset Hills
Sunset Hills
Essentia Health Saint Mary's Hospital - Superior
Superior
Southwest Illinois Health Services LLP
Swansea
Franciscan Research Center-Northwest Medical Plaza
Tacoma
Northwest Medical Specialties PLLC
Tacoma
Tampa General Hospital
Tampa
Montefiore Medical Center - Moses Campus
The Bronx
Montefiore Medical Center-Einstein Campus
The Bronx
Montefiore Medical Center-Weiler Hospital
The Bronx
Sanford Thief River Falls Medical Center
Thief River Falls
Rocky Mountain Cancer Centers-Thornton
Thornton
Community Medical Center
Toms River
University of Kansas Health System Saint Francis Campus
Topeka
Munson Medical Center
Traverse City
Corewell Health Beaumont Troy Hospital
Troy
Dayton Physicians LLC - Troy
Troy
Upper Valley Medical Center
Troy
Smilow Cancer Hospital Care Center-Trumbull
Trumbull
Saint Luke's Cancer Institute - Twin Falls
Twin Falls
Vince Lombardi Cancer Clinic-Two Rivers
Two Rivers
MGC Hematology Oncology-Union
Union
Memorial Sloan Kettering Nassau
Uniondale
UPMC Uniontown Hospital Radiation Oncology
Uniontown
Carle Cancer Center
Urbana
The Carle Foundation Hospital
Urbana
PeaceHealth Southwest Medical Center
Vancouver
Essentia Health Virginia Clinic
Virginia
MD Anderson Cancer Center at Cooper-Voorhees
Voorhees Township
Ridgeview Medical Center
Waconia
Providence Saint Mary Regional Cancer Center
Walla Walla
Saint Joseph Warren Hospital
Warren
Northwestern Medicine Cancer Center Warrenville
Warrenville
Illinois CancerCare - Washington
Washington
Mercy Hospital Washington
Washington
UPMC Washington Hospital Radiation Oncology
Washington
MedStar Washington Hospital Center
Washington D.C.
Smilow Cancer Hospital Care Center - Waterford
Waterford
ProHealth Waukesha Memorial Hospital
Waukesha
UW Cancer Center at ProHealth Care
Waukesha
Aurora Cancer Care-Milwaukee West
Wauwatosa
Wilmot Cancer Institute at Webster
Webster
Aurora West Allis Medical Center
West Allis
Henry Ford West Bloomfield Hospital
West Bloomfield
University of Cincinnati Cancer Center-West Chester
West Chester
Mercy Medical Center-West Lakes
West Des Moines
Methodist West Hospital
West Des Moines
Reading Hospital
West Reading
Smilow Cancer Hospital Care Center - Westerly
Westerly
UH Seidman Cancer Center at Saint John Medical Center
Westlake
UHHS-Westlake Medical Center
Westlake
Cleveland Clinic-Weston
Weston
Diagnostic and Treatment Center
Weston
Marshfield Medical Center - Weston
Weston
University of Kansas Hospital-Westwood Cancer Center
Westwood
Geisinger Wyoming Valley/Henry Cancer Center
Wilkes-Barre
Divine Providence Hospital
Williamsport
UPMC Susquehanna
Williamsport
Rice Memorial Hospital
Willmar
Minnesota Oncology Hematology PA-Woodbury
Woodbury
Woodland Memorial Hospital
Woodland
Sanford Cancer Center Worthington
Worthington
Fairview Lakes Medical Center
Wyoming
University of Michigan Health - West
Wyoming
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
Yakima
Providence Regional Cancer System-Yelm
Yelm
UPMC Memorial
York
Rush-Copley Healthcare Center
Yorkville
Saint Elizabeth Youngstown Hospital
Youngstown