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S1304, Carfilzomib and Dexamethasone for Treating Patients With Relapsed or Refractory Myeloma

3. dubna 2020 aktualizováno: Southwest Oncology Group

A Phase II Randomized Study Comparing Two Doses of Carfilzomib (NSC-756640) With Dexamethasone for Multiple Myeloma Patients With Relapsed or Refractory Disease

This randomized phase II trial compares how well two different doses of carfilzomib work when given with dexamethasone in treating patients with multiple myeloma that has come back after a period of improvement or has not responded to treatment. Carfilzomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving carfilzomib together with dexamethasone may kill more cancer cells. It is not yet known whether a higher or lower dose of carfilzomib works better when given with dexamethasone.

Přehled studie

Postavení

Dokončeno

Podmínky

Intervence / Léčba

Detailní popis

PRIMARY OBJECTIVES:

I. To evaluate and compare progression free survival (PFS) of two different doses of carfilzomib with dexamethasone in multiple myeloma (MM) patients with relapsed and/or refractory disease.

SECONDARY OBJECTIVES:

I. To evaluate and compare response rates (RR) for each arm. II. To evaluate response rates (RR) for patients that relapse on low dose carfilzomib and subsequently cross-over to high dose carfilzomib.

III. To evaluate the safety of this combination for this patient population. IV. To evaluate overall survival (OS).

TERTIARY OBJECTIVES:

I. To explore the molecular variability in MM cells obtained from extramedullary bone marrow relapse sites.

II. To explore the role of positron emission tomography (PET) scanning in assessing disease burden and as a tool to assess treatment response.

III. To explore changes in left ventricular ejection fraction (LVEF) in patients with relapsed or refractory multiple myeloma treated with low dose carfilzomib or high dose carfilzomib plus dexamethasone.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive dexamethasone intravenously (IV) and low-dose carfilzomib IV over 2-10 minutes on days 1, 2, 8, 9, 15, and 16. Patients with progression cross-over to Arm II.

ARM II: Patients receive dexamethasone IV and high-dose carfilzomib IV over 30 minutes on days 1, 2, 8, 9, 15, and 16.

Note that for the first course of treatment on both arms carfilzomib is given at a reduced rate to assess toxicity.

In both arms, treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 3 years from initial registration.

Typ studie

Intervenční

Zápis (Aktuální)

143

Fáze

  • Fáze 2

Kontakty a umístění

Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.

Studijní místa

  • Spojené státy
    • Alaska
      • Fairbanks, Alaska, Spojené státy, 99701
        • Fairbanks Memorial Hospital
    • Arizona
      • Tucson, Arizona, Spojené státy, 85719
        • University of Arizona Cancer Center-North Campus
      • Tucson, Arizona, Spojené státy, 85724
        • The University of Arizona Medical Center-University Campus
    • California
      • Anaheim, California, Spojené státy, 92807
        • Kaiser Permanente-Anaheim
      • Antioch, California, Spojené státy, 94531
        • Kaiser Permanente-Deer Valley Medical Center
      • Auburn, California, Spojené státy, 95602
        • Sutter Auburn Faith Hospital
      • Auburn, California, Spojené státy, 95603
        • Sutter Cancer Centers Radiation Oncology Services-Auburn
      • Baldwin Park, California, Spojené státy, 91706
        • Kaiser Permanente-Baldwin Park
      • Bellflower, California, Spojené státy, 90706
        • Kaiser Permanente-Bellflower
      • Berkeley, California, Spojené státy, 94704
        • Alta Bates Summit Medical Center-Herrick Campus
      • Burlingame, California, Spojené státy, 94010
        • Mills - Peninsula Hospitals
      • Cameron Park, California, Spojené státy, 95682
        • Sutter Cancer Centers Radiation Oncology Services-Cameron Park
      • Castro Valley, California, Spojené státy, 94546
        • Eden Hospital Medical Center
      • Concord, California, Spojené státy, 94520
        • John Muir Medical Center-Concord Campus
      • Davis, California, Spojené státy, 95616
        • Sutter Davis Hospital
      • Fontana, California, Spojené státy, 92335
        • Kaiser Permanente Hospital
      • Fremont, California, Spojené státy, 94538
        • Kaiser Permanente-Fremont
      • Fresno, California, Spojené státy, 93720
        • Kaiser Permanente
      • Harbor City, California, Spojené státy, 90710
        • Kaiser Permanente - Harbor City
      • Irvine, California, Spojené státy, 92618
        • Kaiser Permanente-Irvine
      • Los Angeles, California, Spojené státy, 90033
        • USC / Norris Comprehensive Cancer Center
      • Los Angeles, California, Spojené státy, 90033
        • Los Angeles County-USC Medical Center
      • Los Angeles, California, Spojené státy, 90027
        • Kaiser Permanente Los Angeles Medical Center
      • Los Angeles, California, Spojené státy, 90034
        • Kaiser Permanente-Cadillac
      • Marysville, California, Spojené státy, 95901
        • Fremont - Rideout Cancer Center
      • Modesto, California, Spojené státy, 95355
        • Memorial Medical Center
      • Modesto, California, Spojené státy, 95356
        • Kaiser Permanente-Modesto
      • Mountain View, California, Spojené státy, 94040
        • Palo Alto Medical Foundation-Camino Division
      • Mountain View, California, Spojené státy, 94040
        • Palo Alto Medical Foundation-Gynecologic Oncology
      • Newport Beach, California, Spojené státy, 92663
        • USC Norris Oncology/Hematology-Newport Beach
      • Novato, California, Spojené státy, 94945
        • Sutter Cancer Research Consortium
      • Oakland, California, Spojené státy, 94611
        • Kaiser Permanente-Oakland
      • Orange, California, Spojené státy, 92868
        • UC Irvine Health/Chao Family Comprehensive Cancer Center
      • Palo Alto, California, Spojené státy, 94301
        • Palo Alto Medical Foundation Health Care
      • Panorama City, California, Spojené státy, 91402
        • Kaiser Permanente - Panorama City
      • Redwood City, California, Spojené státy, 94063
        • Kaiser Permanente-Redwood City
      • Richmond, California, Spojené státy, 94801
        • Kaiser Permanente-Richmond
      • Riverside, California, Spojené státy, 92505
        • Kaiser Permanente-Riverside
      • Roseville, California, Spojené státy, 95661
        • Kaiser Permanente-Roseville
      • Roseville, California, Spojené státy, 95661
        • Sutter Cancer Centers Radiation Oncology Services-Roseville
      • Roseville, California, Spojené státy, 95661
        • Sutter Roseville Medical Center
      • Sacramento, California, Spojené státy, 95817
        • University of California Davis Comprehensive Cancer Center
      • Sacramento, California, Spojené státy, 95823
        • Kaiser Permanente-South Sacramento
      • Sacramento, California, Spojené státy, 95825
        • Kaiser Permanente - Sacramento
      • Sacramento, California, Spojené státy, 95816
        • Sutter General Hospital
      • San Diego, California, Spojené státy, 92120
        • Kaiser Permanente-San Diego Zion
      • San Diego, California, Spojené státy, 92108
        • Kaiser Permanente-San Diego Mission
      • San Francisco, California, Spojené státy, 94115
        • Kaiser Permanente-San Francisco
      • San Francisco, California, Spojené státy, 94115
        • California Pacific Medical Center-Pacific Campus
      • San Jose, California, Spojené státy, 95119
        • Kaiser Permanente-Santa Teresa-San Jose
      • San Leandro, California, Spojené státy, 94577
        • Kaiser Permanente San Leandro
      • San Marcos, California, Spojené státy, 92069
        • Kaiser Permanente-San Marcos
      • San Rafael, California, Spojené státy, 94903
        • Kaiser Permanente-San Rafael
      • Santa Clara, California, Spojené státy, 95051
        • Kaiser Permanente Medical Center - Santa Clara
      • Santa Cruz, California, Spojené státy, 95065
        • Palo Alto Medical Foundation-Santa Cruz
      • Santa Rosa, California, Spojené státy, 95403
        • Kaiser Permanente-Santa Rosa
      • Santa Rosa, California, Spojené státy, 95403
        • Sutter Pacific Medical Foundation
      • South San Francisco, California, Spojené státy, 94080
        • Kaiser Permanente-South San Francisco
      • Stockton, California, Spojené státy, 95210
        • Kaiser Permanente-Stockton
      • Sunnyvale, California, Spojené státy, 94086
        • Palo Alto Medical Foundation-Sunnyvale
      • Truckee, California, Spojené státy, 96161
        • Gene Upshaw Memorial Tahoe Forest Cancer Center
      • Vacaville, California, Spojené státy, 95688
        • Kaiser Permanente Medical Center-Vacaville
      • Vacaville, California, Spojené státy, 95687
        • Sutter Cancer Centers Radiation Oncology Services-Vacaville
      • Vallejo, California, Spojené státy, 94589
        • Kaiser Permanente-Vallejo
      • Vallejo, California, Spojené státy, 94589
        • Sutter Solano Medical Center/Cancer Center
      • Walnut Creek, California, Spojené státy, 94596
        • Kaiser Permanente-Walnut Creek
      • Walnut Creek, California, Spojené státy, 94598
        • John Muir Medical Center-Walnut Creek
      • Woodland Hills, California, Spojené státy, 91367
        • Kaiser Permanente
    • Connecticut
      • Derby, Connecticut, Spojené státy, 06418
        • Smilow Cancer Hospital-Derby Care Center
      • Fairfield, Connecticut, Spojené státy, 06824
        • Smilow Cancer Hospital Care Center-Fairfield
      • Guilford, Connecticut, Spojené státy, 06437
        • Medical Oncology and Hematology Group PC-Guilford
      • Hartford, Connecticut, Spojené státy, 06105
        • Smilow Cancer Hospital Care Center at Saint Francis
      • New Haven, Connecticut, Spojené státy, 06520
        • Yale University
      • North Haven, Connecticut, Spojené státy, 06473
        • Yale-New Haven Hospital North Haven Medical Center
      • Orange, Connecticut, Spojené státy, 06477
        • Smilow Cancer Hospital-Orange Care Center
      • Torrington, Connecticut, Spojené státy, 06790
        • Charlotte Hungerford Hospital Center for Cancer Care
      • Trumbull, Connecticut, Spojené státy, 06611
        • Smilow Cancer Hospital Care Center-Trumbull
      • Waterbury, Connecticut, Spojené státy, 06708
        • Smilow Cancer Hospital-Waterbury Care Center
    • Delaware
      • Lewes, Delaware, Spojené státy, 19958
        • Beebe Medical Center
      • Newark, Delaware, Spojené státy, 19713
        • Helen F Graham Cancer Center
      • Newark, Delaware, Spojené státy, 19713
        • Delaware Clinical and Laboratory Physicians PA
      • Newark, Delaware, Spojené státy, 19713
        • Medical Oncology Hematology Consultants PA
      • Newark, Delaware, Spojené státy, 19718
        • Christiana Care Health System-Christiana Hospital
      • Newark, Delaware, Spojené státy, 19713
        • Christiana Gynecologic Oncology LLC
      • Newark, Delaware, Spojené státy, 19713
        • Regional Hematology and Oncology PA
      • Rehoboth Beach, Delaware, Spojené státy, 19971
        • Beebe Health Campus
      • Seaford, Delaware, Spojené státy, 19973
        • Nanticoke Memorial Hospital
      • Wilmington, Delaware, Spojené státy, 19801
        • Christiana Care Health System-Wilmington Hospital
    • District of Columbia
      • Washington, District of Columbia, Spojené státy, 20010
        • MedStar Washington Hospital Center
      • Washington, District of Columbia, Spojené státy, 20007
        • Medstar Georgetown University Hospital
    • Florida
      • Gainesville, Florida, Spojené státy, 32610
        • University of Florida
      • Jacksonville, Florida, Spojené státy, 32224-9980
        • Mayo Clinic in Florida
      • Orlando, Florida, Spojené státy, 32803
        • Florida Hospital Orlando
    • Georgia
      • Savannah, Georgia, Spojené státy, 31405
        • Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
    • Hawaii
      • 'Aiea, Hawaii, Spojené státy, 96701
        • Pali Momi Medical Center
      • 'Aiea, Hawaii, Spojené státy, 96701
        • Hawaii Oncology Inc-Pali Momi
      • Honolulu, Hawaii, Spojené státy, 96813
        • Queen's Medical Center
      • Honolulu, Hawaii, Spojené státy, 96813
        • Straub Clinic and Hospital
      • Honolulu, Hawaii, Spojené státy, 96813
        • University of Hawaii Cancer Center
      • Honolulu, Hawaii, Spojené státy, 96817
        • Hawaii Cancer Care Inc-Liliha
      • Honolulu, Hawaii, Spojené státy, 96817
        • Kuakini Medical Center
      • Honolulu, Hawaii, Spojené státy, 96819
        • Kaiser Permanente Moanalua Medical Center
      • Honolulu, Hawaii, Spojené státy, 96813
        • Hawaii Cancer Care Inc-POB II
      • Honolulu, Hawaii, Spojené státy, 96817
        • Hawaii Oncology Inc-Kuakini
      • Kailua, Hawaii, Spojené státy, 96734
        • Castle Medical Center
      • Lihue, Hawaii, Spojené státy, 96766
        • Wilcox Memorial Hospital and Kauai Medical Clinic
    • Idaho
      • Boise, Idaho, Spojené státy, 83706
        • Saint Alphonsus Cancer Care Center-Boise
      • Coeur d'Alene, Idaho, Spojené státy, 83814
        • Kootenai Medical Center
      • Post Falls, Idaho, Spojené státy, 83854
        • Kootenai Cancer Center
      • Sandpoint, Idaho, Spojené státy, 83864
        • Kootenai Cancer Clinic
    • Illinois
      • Aurora, Illinois, Spojené státy, 60504
        • Rush - Copley Medical Center
      • Bloomington, Illinois, Spojené státy, 61704
        • Illinois CancerCare-Bloomington
      • Bloomington, Illinois, Spojené státy, 61701
        • Saint Joseph Medical Center
      • Canton, Illinois, Spojené státy, 61520
        • Illinois CancerCare-Canton
      • Carbondale, Illinois, Spojené státy, 62902
        • Memorial Hospital of Carbondale
      • Carthage, Illinois, Spojené státy, 62321
        • Illinois CancerCare-Carthage
      • Centralia, Illinois, Spojené státy, 62801
        • Centralia Oncology Clinic
      • Danville, Illinois, Spojené státy, 61832
        • Carle on Vermilion
      • Decatur, Illinois, Spojené státy, 62526
        • Decatur Memorial Hospital
      • Decatur, Illinois, Spojené státy, 62526
        • Cancer Care Center of Decatur
      • Effingham, Illinois, Spojené státy, 62401
        • Crossroads Cancer Center
      • Effingham, Illinois, Spojené státy, 62401
        • Carle Physician Group-Effingham
      • Eureka, Illinois, Spojené státy, 61530
        • Illinois CancerCare-Eureka
      • Galesburg, Illinois, Spojené státy, 61401
        • Western Illinois Cancer Treatment Center
      • Galesburg, Illinois, Spojené státy, 61401
        • Illinois CancerCare-Galesburg
      • Hinsdale, Illinois, Spojené státy, 60521
        • Hinsdale Hematology Oncology Associates Incorporated
      • Kewanee, Illinois, Spojené státy, 61443
        • Illinois CancerCare-Kewanee Clinic
      • Macomb, Illinois, Spojené státy, 61455
        • Illinois CancerCare-Macomb
      • Mattoon, Illinois, Spojené státy, 61938
        • Carle Physician Group-Mattoon/Charleston
      • Maywood, Illinois, Spojené státy, 60153
        • Loyola University Medical Center
      • Moline, Illinois, Spojené státy, 61265
        • Garneau, Stewart C MD (UIA Investigator)
      • Moline, Illinois, Spojené státy, 61265
        • Porubcin, Michael MD (UIA Investigator)
      • Moline, Illinois, Spojené státy, 61265
        • Spector, David MD (UIA Investigator)
      • Moline, Illinois, Spojené státy, 61265
        • Trinity Medical Center
      • Monmouth, Illinois, Spojené státy, 61462
        • Illinois CancerCare-Monmouth
      • Mount Vernon, Illinois, Spojené státy, 62864
        • Good Samaritan Regional Health Center
      • Normal, Illinois, Spojené státy, 61761
        • Community Cancer Center Foundation
      • Ottawa, Illinois, Spojené státy, 61350
        • Illinois CancerCare-Ottawa Clinic
      • Ottawa, Illinois, Spojené státy, 61350
        • Radiation Oncology of Northern Illinois
      • Pekin, Illinois, Spojené státy, 61554
        • Illinois CancerCare-Pekin
      • Pekin, Illinois, Spojené státy, 61554
        • OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
      • Peoria, Illinois, Spojené státy, 61637
        • OSF Saint Francis Medical Center
      • Peoria, Illinois, Spojené státy, 61615
        • Illinois CancerCare-Peoria
      • Peoria, Illinois, Spojené státy, 61615
        • OSF Saint Francis Radiation Oncology at Peoria Cancer Center
      • Peoria, Illinois, Spojené státy, 61603
        • Methodist Medical Center of Illinois
      • Peru, Illinois, Spojené státy, 61354
        • Illinois CancerCare-Peru
      • Peru, Illinois, Spojené státy, 61354
        • Valley Radiation Oncology
      • Princeton, Illinois, Spojené státy, 61356
        • Illinois CancerCare-Princeton
      • Rockford, Illinois, Spojené státy, 61114
        • SwedishAmerican Regional Cancer Center/ACT
      • Springfield, Illinois, Spojené státy, 62781
        • Memorial Medical Center
      • Springfield, Illinois, Spojené státy, 62702
        • Southern Illinois University School of Medicine
      • Springfield, Illinois, Spojené státy, 62702
        • Springfield Clinic
      • Springfield, Illinois, Spojené státy, 62702
        • Central Illinois Hematology Oncology Center
      • Swansea, Illinois, Spojené státy, 62226
        • Cancer Care Specialists of Illinois-Swansea
      • Urbana, Illinois, Spojené státy, 61801
        • Carle Cancer Center
      • Urbana, Illinois, Spojené státy, 61801
        • The Carle Foundation Hospital
      • Yorkville, Illinois, Spojené státy, 60560
        • Rush-Copley Healthcare Center
    • Indiana
      • Michigan City, Indiana, Spojené státy, 46360
        • Franciscan Saint Anthony Health-Michigan City
      • Michigan City, Indiana, Spojené státy, 46360
        • Woodland Cancer Care Center
      • Richmond, Indiana, Spojené státy, 47374
        • Reid Health
    • Iowa
      • Ames, Iowa, Spojené státy, 50010
        • Mary Greeley Medical Center
      • Ames, Iowa, Spojené státy, 50010
        • McFarland Clinic PC-William R Bliss Cancer Center
      • Bettendorf, Iowa, Spojené státy, 52722
        • Constantinou, Costas L MD (UIA Investigator)
      • Bettendorf, Iowa, Spojené státy, 52722
        • Hematology Oncology Associates-Quad Cities
      • Boone, Iowa, Spojené státy, 50036
        • McFarland Clinic PC-Boone
      • Clive, Iowa, Spojené státy, 50325
        • Mercy Cancer Center-West Lakes
      • Clive, Iowa, Spojené státy, 50325
        • Medical Oncology and Hematology Associates-West Des Moines
      • Davenport, Iowa, Spojené státy, 52803
        • Genesis Medical Center - East Campus
      • Des Moines, Iowa, Spojené státy, 50309
        • Iowa Methodist Medical Center
      • Des Moines, Iowa, Spojené státy, 50314
        • Mercy Medical Center - Des Moines
      • Des Moines, Iowa, Spojené státy, 50309
        • Medical Oncology and Hematology Associates-Des Moines
      • Des Moines, Iowa, Spojené státy, 50316
        • Iowa Lutheran Hospital
      • Des Moines, Iowa, Spojené státy, 50309
        • Iowa-Wide Oncology Research Coalition NCORP
      • Des Moines, Iowa, Spojené státy, 50314
        • Medical Oncology and Hematology Associates-Laurel
      • Fort Dodge, Iowa, Spojené státy, 50501
        • McFarland Clinic PC-Trinity Cancer Center
      • Jefferson, Iowa, Spojené státy, 50129
        • McFarland Clinic PC-Jefferson
      • Marshalltown, Iowa, Spojené státy, 50158
        • McFarland Clinic PC-Marshalltown
      • Sioux City, Iowa, Spojené státy, 51101
        • Siouxland Regional Cancer Center
      • Sioux City, Iowa, Spojené státy, 51104
        • Saint Luke's Regional Medical Center
      • Sioux City, Iowa, Spojené státy, 51104
        • Mercy Medical Center-Sioux City
      • West Des Moines, Iowa, Spojené státy, 50266-7700
        • Methodist West Hospital
      • West Des Moines, Iowa, Spojené státy, 50266
        • Mercy Medical Center-West Lakes
    • Kansas
      • Chanute, Kansas, Spojené státy, 66720
        • Cancer Center of Kansas - Chanute
      • Dodge City, Kansas, Spojené státy, 67801
        • Cancer Center of Kansas - Dodge City
      • El Dorado, Kansas, Spojené státy, 67042
        • Cancer Center of Kansas - El Dorado
      • Fort Scott, Kansas, Spojené státy, 66701
        • Cancer Center of Kansas - Fort Scott
      • Independence, Kansas, Spojené státy, 67301
        • Cancer Center of Kansas-Independence
      • Kingman, Kansas, Spojené státy, 67068
        • Cancer Center of Kansas-Kingman
      • Lawrence, Kansas, Spojené státy, 66044
        • Lawrence Memorial Hospital
      • Liberal, Kansas, Spojené státy, 67905
        • Cancer Center of Kansas-Liberal
      • Manhattan, Kansas, Spojené státy, 66502
        • Cancer Center of Kansas-Manhattan
      • McPherson, Kansas, Spojené státy, 67460
        • Cancer Center of Kansas - McPherson
      • Newton, Kansas, Spojené státy, 67114
        • Cancer Center of Kansas - Newton
      • Parsons, Kansas, Spojené státy, 67357
        • Cancer Center of Kansas - Parsons
      • Pratt, Kansas, Spojené státy, 67124
        • Cancer Center of Kansas - Pratt
      • Salina, Kansas, Spojené státy, 67401
        • Cancer Center of Kansas - Salina
      • Wellington, Kansas, Spojené státy, 67152
        • Cancer Center of Kansas - Wellington
      • Wichita, Kansas, Spojené státy, 67208
        • Cancer Center of Kansas-Wichita Medical Arts Tower
      • Wichita, Kansas, Spojené státy, 67214
        • Cancer Center of Kansas - Wichita
      • Wichita, Kansas, Spojené státy, 67208
        • Associates In Womens Health
      • Wichita, Kansas, Spojené státy, 67214
        • Wichita NCI Community Oncology Research Program
      • Wichita, Kansas, Spojené státy, 67214
        • Via Christi Regional Medical Center
      • Winfield, Kansas, Spojené státy, 67156
        • Cancer Center of Kansas - Winfield
    • Kentucky
      • Crestview Hills, Kentucky, Spojené státy, 41017
        • Oncology Hematology Care Inc-Crestview
    • Louisiana
      • Baton Rouge, Louisiana, Spojené státy, 70805
        • LSU Health Baton Rouge-North Clinic
      • Baton Rouge, Louisiana, Spojené státy, 70809
        • Louisiana Hematology Oncology Associates LLC
      • Baton Rouge, Louisiana, Spojené státy, 70809
        • Mary Bird Perkins Cancer Center
      • Baton Rouge, Louisiana, Spojené státy, 70809
        • Hematology/Oncology Clinic LLP
      • Baton Rouge, Louisiana, Spojené státy, 70809
        • Medical Oncology LLC
      • Covington, Louisiana, Spojené státy, 70433
        • Mary Bird Cancer Center/Saint Tammany Parish
      • Houma, Louisiana, Spojené státy, 70360
        • Mary Bird Perkins Cancer Center/Terrebonne General Medical Center
      • New Orleans, Louisiana, Spojené státy, 70112
        • Tulane University Health Sciences Center
    • Maine
      • Augusta, Maine, Spojené státy, 04330
        • Harold Alfond Center for Cancer Care
      • Bangor, Maine, Spojené státy, 04401
        • Eastern Maine Medical Center
      • Lewiston, Maine, Spojené státy, 04240
        • Central Maine Medical Center
      • Rockport, Maine, Spojené státy, 04856
        • Penobscot Bay Medical Center
    • Maryland
      • Salisbury, Maryland, Spojené státy, 21801
        • Peninsula Regional Medical Center
    • Massachusetts
      • Beverly, Massachusetts, Spojené státy, 01915
        • Beverly Hospital
      • Boston, Massachusetts, Spojené státy, 02118
        • Boston Medical Center
      • Burlington, Massachusetts, Spojené státy, 01805
        • Lahey Hospital and Medical Center
      • Gloucester, Massachusetts, Spojené státy, 01930
        • Addison Gilbert Hospital
    • Michigan
      • Adrian, Michigan, Spojené státy, 49221
        • Bixby Medical Center
      • Adrian, Michigan, Spojené státy, 49221
        • Hickman Cancer Center
      • Ann Arbor, Michigan, Spojené státy, 48106-0995
        • Saint Joseph Mercy Hospital
      • Ann Arbor, Michigan, Spojené státy, 48106
        • Michigan Cancer Research Consortium NCORP
      • Dearborn, Michigan, Spojené státy, 48124
        • Beaumont Hospital-Dearborn
      • Detroit, Michigan, Spojené státy, 48202
        • Henry Ford Hospital
      • Detroit, Michigan, Spojené státy, 48236
        • Saint John Hospital and Medical Center
      • Detroit, Michigan, Spojené státy, 48201
        • Wayne State University/Karmanos Cancer Institute
      • Escanaba, Michigan, Spojené státy, 49829
        • Green Bay Oncology - Escanaba
      • Farmington Hills, Michigan, Spojené státy, 48334
        • Weisberg Cancer Treatment Center
      • Flint, Michigan, Spojené státy, 48502
        • Hurley Medical Center
      • Flint, Michigan, Spojené státy, 48503
        • Genesys Hurley Cancer Institute
      • Iron Mountain, Michigan, Spojené státy, 49801
        • Green Bay Oncology - Iron Mountain
      • Jackson, Michigan, Spojené státy, 49201
        • Allegiance Health
      • Kalamazoo, Michigan, Spojené státy, 49007
        • West Michigan Cancer Center
      • Kalamazoo, Michigan, Spojené státy, 49007
        • Bronson Methodist Hospital
      • Kalamazoo, Michigan, Spojené státy, 49001
        • Borgess Medical Center
      • Lansing, Michigan, Spojené státy, 48912
        • Sparrow Hospital
      • Livonia, Michigan, Spojené státy, 48154
        • Saint Mary Mercy Hospital
      • Monroe, Michigan, Spojené státy, 48162
        • Mercy Memorial Hospital
      • Monroe, Michigan, Spojené státy, 48162
        • Toledo Clinic Cancer Centers-Monroe
      • Pontiac, Michigan, Spojené státy, 48341
        • Saint Joseph Mercy Oakland
      • Port Huron, Michigan, Spojené státy, 48060
        • Lake Huron Medical Center
      • Saginaw, Michigan, Spojené státy, 48601
        • Saint Mary's of Michigan
      • Southfield, Michigan, Spojené státy, 48075
        • Providence Hospital-Southfield Cancer Center
      • Warren, Michigan, Spojené státy, 48093
        • Saint John Macomb-Oakland Hospital
    • Minnesota
      • Bemidji, Minnesota, Spojené státy, 56601
        • Sanford Clinic North-Bemidgi
      • Burnsville, Minnesota, Spojené státy, 55337
        • Fairview Ridges Hospital
      • Coon Rapids, Minnesota, Spojené státy, 55433
        • Mercy Hospital
      • Edina, Minnesota, Spojené státy, 55435
        • Fairview-Southdale Hospital
      • Fridley, Minnesota, Spojené státy, 55432
        • Unity Hospital
      • Hutchinson, Minnesota, Spojené státy, 55350
        • Hutchinson Area Health Care
      • Maplewood, Minnesota, Spojené státy, 55109
        • Saint John's Hospital - Healtheast
      • Maplewood, Minnesota, Spojené státy, 55109
        • Minnesota Oncology Hematology PA-Maplewood
      • Minneapolis, Minnesota, Spojené státy, 55415
        • Hennepin County Medical Center
      • Minneapolis, Minnesota, Spojené státy, 55407
        • Abbott-Northwestern Hospital
      • Minneapolis, Minnesota, Spojené státy, 55454
        • Health Partners Inc
      • New Ulm, Minnesota, Spojené státy, 56073
        • New Ulm Medical Center
      • Robbinsdale, Minnesota, Spojené státy, 55422
        • North Memorial Medical Health Center
      • Rochester, Minnesota, Spojené státy, 55905
        • Mayo Clinic
      • Saint Louis Park, Minnesota, Spojené státy, 55416
        • Park Nicollet Clinic - Saint Louis Park
      • Saint Louis Park, Minnesota, Spojené státy, 55416
        • Metro Minnesota Community Oncology Research Consortium
      • Saint Paul, Minnesota, Spojené státy, 55101
        • Regions Hospital
      • Saint Paul, Minnesota, Spojené státy, 55102
        • United Hospital
      • Shakopee, Minnesota, Spojené státy, 55379
        • Saint Francis Regional Medical Center
      • Stillwater, Minnesota, Spojené státy, 55082
        • Lakeview Hospital
      • Waconia, Minnesota, Spojené státy, 55387
        • Ridgeview Medical Center
      • Willmar, Minnesota, Spojené státy, 56201
        • Rice Memorial Hospital
      • Woodbury, Minnesota, Spojené státy, 55125
        • Minnesota Oncology Hematology PA-Woodbury
    • Mississippi
      • Jackson, Mississippi, Spojené státy, 39216
        • University of Mississippi Medical Center
    • Missouri
      • Bolivar, Missouri, Spojené státy, 65613
        • Central Care Cancer Center-Carrie J Babb Cancer Center
      • Bonne Terre, Missouri, Spojené státy, 63628
        • Parkland Health Center-Bonne Terre
      • Branson, Missouri, Spojené státy, 65616
        • CoxHealth Cancer Center
      • Cape Girardeau, Missouri, Spojené státy, 63703
        • Saint Francis Medical Center
      • Cape Girardeau, Missouri, Spojené státy, 63703
        • Southeast Cancer Center
      • Chesterfield, Missouri, Spojené státy, 63017
        • Saint Luke's Hospital
      • Jefferson City, Missouri, Spojené státy, 65109
        • Capital Region Medical Center-Goldschmidt Cancer Center
      • Joplin, Missouri, Spojené státy, 64804
        • Freeman Health System
      • Rolla, Missouri, Spojené státy, 65401
        • Delbert Day Cancer Institute at PCRMC
      • Rolla, Missouri, Spojené státy, 65401
        • Saint John's Clinic-Rolla-Cancer and Hematology
      • Saint Louis, Missouri, Spojené státy, 63131
        • Missouri Baptist Medical Center
      • Saint Louis, Missouri, Spojené státy, 63141
        • Mercy Hospital Saint Louis
      • Saint Louis, Missouri, Spojené státy, 63109
        • Saint Louis Cancer and Breast Institute-South City
      • Sainte Genevieve, Missouri, Spojené státy, 63670
        • Sainte Genevieve County Memorial Hospital
      • Springfield, Missouri, Spojené státy, 65804
        • Cancer Research for the Ozarks NCORP
      • Springfield, Missouri, Spojené státy, 65807
        • CoxHealth South Hospital
      • Springfield, Missouri, Spojené státy, 65804
        • Mercy Hospital Springfield
      • Sullivan, Missouri, Spojené státy, 63080
        • Missouri Baptist Sullivan Hospital
      • Sunset Hills, Missouri, Spojené státy, 63127
        • Missouri Baptist Outpatient Center-Sunset Hills
    • Montana
      • Billings, Montana, Spojené státy, 59101
        • Billings Clinic Cancer Center
      • Billings, Montana, Spojené státy, 59101
        • Saint Vincent Healthcare
      • Billings, Montana, Spojené státy, 59101
        • Montana Cancer Consortium NCORP
      • Bozeman, Montana, Spojené státy, 59715
        • Bozeman Deaconess Hospital
      • Butte, Montana, Spojené státy, 59701
        • Saint James Community Hospital and Cancer Treatment Center
      • Great Falls, Montana, Spojené státy, 59405
        • Benefis Healthcare- Sletten Cancer Institute
      • Helena, Montana, Spojené státy, 59601
        • Saint Peter's Community Hospital
      • Kalispell, Montana, Spojené státy, 59901
        • Kalispell Regional Medical Center
      • Missoula, Montana, Spojené státy, 59804
        • Community Medical Hospital
      • Missoula, Montana, Spojené státy, 59802
        • Saint Patrick Hospital - Community Hospital
    • Nevada
      • Henderson, Nevada, Spojené státy, 89052
        • Comprehensive Cancer Centers of Nevada - Henderson
      • Henderson, Nevada, Spojené státy, 89052
        • Cancer and Blood Specialists-Henderson
      • Henderson, Nevada, Spojené státy, 89052
        • Las Vegas Cancer Center-Henderson
      • Henderson, Nevada, Spojené státy, 89074
        • Comprehensive Cancer Centers of Nevada-Southeast Henderson
      • Henderson, Nevada, Spojené státy, 89074
        • 21st Century Oncology - Henderson
      • Las Vegas, Nevada, Spojené státy, 89106
        • Radiation Oncology Centers of Nevada Central
      • Las Vegas, Nevada, Spojené státy, 89119
        • Radiation Oncology Centers of Nevada Southeast
      • Las Vegas, Nevada, Spojené státy, 89128
        • Comprehensive Cancer Centers of Nevada - Northwest
      • Las Vegas, Nevada, Spojené státy, 89144
        • Comprehensive Cancer Centers of Nevada-Summerlin
      • Las Vegas, Nevada, Spojené státy, 89148
        • Comprehensive Cancer Centers of Nevada
      • Las Vegas, Nevada, Spojené státy, 89169
        • Comprehensive Cancer Centers of Nevada - Central Valley
      • Las Vegas, Nevada, Spojené státy, 89102
        • University Medical Center of Southern Nevada
      • Las Vegas, Nevada, Spojené státy, 89106
        • Cancer and Blood Specialists-Shadow
      • Las Vegas, Nevada, Spojené státy, 89109
        • HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
      • Las Vegas, Nevada, Spojené státy, 89113
        • HealthCare Partners Medical Group Oncology/Hematology-San Martin
      • Las Vegas, Nevada, Spojené státy, 89121
        • Cancer Therapy and Integrative Medicine
      • Las Vegas, Nevada, Spojené státy, 89128
        • Cancer and Blood Specialists-Tenaya
      • Las Vegas, Nevada, Spojené státy, 89128
        • HealthCare Partners Medical Group Oncology/Hematology-Tenaya
      • Las Vegas, Nevada, Spojené státy, 89148-2405
        • Las Vegas Cancer Center-Medical Center
      • Las Vegas, Nevada, Spojené státy, 89149
        • HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
      • Las Vegas, Nevada, Spojené státy, 89109
        • 21st Century Oncology
      • Las Vegas, Nevada, Spojené státy, 89148
        • Cancer and Blood Specialists-Fort Apache
      • Las Vegas, Nevada, Spojené státy, 89106
        • Nevada Cancer Research Foundation CCOP
      • Las Vegas, Nevada, Spojené státy, 89148
        • 21st Century Oncology - Fort Apache
      • Las Vegas, Nevada, Spojené státy, 89182
        • 21st Century Oncology - Vegas Tenaya
    • New Jersey
      • Vineland, New Jersey, Spojené státy, 08360
        • Inspira Medical Center Vineland
      • Woodbury, New Jersey, Spojené státy, 08096
        • Inspira Medical Center Woodbury
    • New York
      • Middletown, New York, Spojené státy, 10940
        • Orange Regional Medical Center
    • North Carolina
      • Asheboro, North Carolina, Spojené státy, 27203
        • Randolph Hospital
      • Burlington, North Carolina, Spojené státy, 27215
        • Cone Health Cancer Center at Alamance Regional
      • Chapel Hill, North Carolina, Spojené státy, 27599
        • UNC Lineberger Comprehensive Cancer Center
      • Clinton, North Carolina, Spojené státy, 28328
        • Southeastern Medical Oncology Center-Clinton
      • Goldsboro, North Carolina, Spojené státy, 27534
        • Southeastern Medical Oncology Center-Goldsboro
      • Goldsboro, North Carolina, Spojené státy, 27534
        • Wayne Memorial Hospital
      • Greensboro, North Carolina, Spojené státy, 27403
        • Cone Health Cancer Center
      • Hendersonville, North Carolina, Spojené státy, 28791
        • Hendersonville Hematology and Oncology at Pardee
      • Hendersonville, North Carolina, Spojené státy, 28791
        • Margaret R Pardee Memorial Hospital
      • Jacksonville, North Carolina, Spojené státy, 28546
        • Southeastern Medical Oncology Center-Jacksonville
      • Kinston, North Carolina, Spojené státy, 28501
        • Kinston Medical Specialists PA
      • Mebane, North Carolina, Spojené státy, 27302
        • Cone Heath Cancer Center at Mebane
      • Reidsville, North Carolina, Spojené státy, 27320
        • Annie Penn Memorial Hospital
      • Statesville, North Carolina, Spojené státy, 28677
        • Iredell Memorial Hospital
      • Wilson, North Carolina, Spojené státy, 27893
        • Southeastern Medical Oncology Center-Wilson
      • Winston-Salem, North Carolina, Spojené státy, 27157
        • Wake Forest University Health Sciences
    • North Dakota
      • Bismarck, North Dakota, Spojené státy, 58501
        • Sanford Bismarck Medical Center
      • Fargo, North Dakota, Spojené státy, 58122
        • Sanford Clinic North-Fargo
      • Fargo, North Dakota, Spojené státy, 58122
        • Sanford Medical Center-Fargo
      • Fargo, North Dakota, Spojené státy, 58122
        • Roger Maris Cancer Center
    • Ohio
      • Belpre, Ohio, Spojené státy, 45714
        • Strecker Cancer Center-Belpre
      • Bowling Green, Ohio, Spojené státy, 43402
        • Toledo Clinic Cancer Centers-Bowling Green
      • Canton, Ohio, Spojené státy, 44710
        • Aultman Health Foundation
      • Centerville, Ohio, Spojené státy, 45459
        • Miami Valley Hospital South
      • Chillicothe, Ohio, Spojené státy, 45601
        • Adena Regional Medical Center
      • Cincinnati, Ohio, Spojené státy, 45242
        • Oncology Hematology Care Inc-Blue Ash
      • Cincinnati, Ohio, Spojené státy, 45202
        • Oncology Hematology Care Inc-Eden Park
      • Cincinnati, Ohio, Spojené státy, 45211
        • Oncology Hematology Care Inc-Mercy West
      • Cincinnati, Ohio, Spojené státy, 45236
        • Oncology Hematology Care Inc-Kenwood
      • Cincinnati, Ohio, Spojené státy, 45230
        • Oncology Hematology Care Inc - Anderson
      • Columbus, Ohio, Spojené státy, 43214
        • Riverside Methodist Hospital
      • Columbus, Ohio, Spojené státy, 43219
        • The Mark H Zangmeister Center
      • Columbus, Ohio, Spojené státy, 43214
        • Columbus Oncology and Hematology Associates Inc
      • Columbus, Ohio, Spojené státy, 43228
        • Doctors Hospital
      • Columbus, Ohio, Spojené státy, 43213
        • Mount Carmel East Hospital
      • Columbus, Ohio, Spojené státy, 43215
        • Grant Medical Center
      • Columbus, Ohio, Spojené státy, 43222
        • Mount Carmel Health Center West
      • Columbus, Ohio, Spojené státy, 43215
        • Columbus NCI Community Oncology Research Program
      • Dayton, Ohio, Spojené státy, 45406
        • Good Samaritan Hospital - Dayton
      • Dayton, Ohio, Spojené státy, 45409
        • Miami Valley Hospital
      • Dayton, Ohio, Spojené státy, 45415
        • Samaritan North Health Center
      • Dayton, Ohio, Spojené státy, 45420
        • Dayton NCI Community Oncology Research Program
      • Delaware, Ohio, Spojené státy, 43015
        • Delaware Health Center-Grady Cancer Center
      • Delaware, Ohio, Spojené státy, 43015
        • Delaware Radiation Oncology
      • Delaware, Ohio, Spojené státy, 43015
        • Grady Memorial Hospital
      • Fairfield, Ohio, Spojené státy, 45014
        • Oncology Hematology Care Inc-Healthplex
      • Findlay, Ohio, Spojené státy, 45840
        • Blanchard Valley Hospital
      • Franklin, Ohio, Spojené státy, 45005-1066
        • Atrium Medical Center-Middletown Regional Hospital
      • Greenville, Ohio, Spojené státy, 45331
        • Wayne Hospital
      • Kettering, Ohio, Spojené státy, 45429
        • Kettering Medical Center
      • Lancaster, Ohio, Spojené státy, 43130
        • Fairfield Medical Center
      • Lancaster, Ohio, Spojené státy, 43130
        • Lancaster Radiation Oncology
      • Lima, Ohio, Spojené státy, 45804
        • Lima Memorial Hospital
      • Marietta, Ohio, Spojené státy, 45750
        • Marietta Memorial Hospital
      • Marion, Ohio, Spojené státy, 43302
        • OneHealth Marion General Hospital
      • Maumee, Ohio, Spojené státy, 43537
        • Toledo Clinic Cancer Centers-Maumee
      • Maumee, Ohio, Spojené státy, 43537
        • Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
      • Mount Vernon, Ohio, Spojené státy, 43050
        • Knox Community Hospital
      • Newark, Ohio, Spojené státy, 43055
        • Licking Memorial Hospital
      • Newark, Ohio, Spojené státy, 43055
        • Newark Radiation Oncology
      • Oregon, Ohio, Spojené státy, 43616
        • Saint Charles Hospital
      • Oregon, Ohio, Spojené státy, 43616
        • Toledo Clinic Cancer Centers-Oregon
      • Portsmouth, Ohio, Spojené státy, 45662
        • Southern Ohio Medical Center
      • Springfield, Ohio, Spojené státy, 45505
        • Springfield Regional Medical Center
      • Springfield, Ohio, Spojené státy, 45504
        • Springfield Regional Cancer Center
      • Sylvania, Ohio, Spojené státy, 43560
        • Flower Hospital
      • Tiffin, Ohio, Spojené státy, 44883
        • Mercy Hospital of Tiffin
      • Toledo, Ohio, Spojené státy, 43608
        • Saint Vincent Mercy Medical Center
      • Toledo, Ohio, Spojené státy, 43623
        • Toledo Clinic Cancer Centers-Toledo
      • Toledo, Ohio, Spojené státy, 43614
        • University of Toledo
      • Toledo, Ohio, Spojené státy, 43617
        • Toledo Community Hospital Oncology Program CCOP
      • Toledo, Ohio, Spojené státy, 43606
        • The Toledo Hospital/Toledo Children's Hospital
      • Toledo, Ohio, Spojené státy, 43623
        • Mercy Saint Anne Hospital
      • Troy, Ohio, Spojené státy, 45373
        • Upper Valley Medical Center
      • Wauseon, Ohio, Spojené státy, 43567
        • Fulton County Health Center
      • Westerville, Ohio, Spojené státy, 43081
        • Saint Ann's Hospital
      • Wright-Patterson Air Force Base, Ohio, Spojené státy, 45433-5529
        • Wright-Patterson Medical Center
      • Zanesville, Ohio, Spojené státy, 43701
        • Genesis Healthcare System Cancer Care Center
    • Oklahoma
      • Oklahoma City, Oklahoma, Spojené státy, 73104
        • University of Oklahoma Health Sciences Center
    • Pennsylvania
      • Bryn Mawr, Pennsylvania, Spojené státy, 19010
        • Bryn Mawr Hospital
      • Danville, Pennsylvania, Spojené státy, 17822
        • Geisinger Medical Center
      • Hazleton, Pennsylvania, Spojené státy, 18201
        • Geisinger Medical Center-Cancer Center Hazleton
      • Lewisburg, Pennsylvania, Spojené státy, 17837
        • Geisinger Medical Oncology-Lewisburg
      • Lewistown, Pennsylvania, Spojené státy, 17044
        • Lewistown Hospital
      • Media, Pennsylvania, Spojené státy, 19063
        • Riddle Memorial Hospital
      • Paoli, Pennsylvania, Spojené státy, 19301
        • Paoli Memorial Hospital
      • Philadelphia, Pennsylvania, Spojené státy, 19104
        • University of Pennsylvania/Abramson Cancer Center
      • Pottsville, Pennsylvania, Spojené státy, 17901
        • Geisinger Medical Oncology-Pottsville
      • Reading, Pennsylvania, Spojené státy, 19605
        • Penn State Health Saint Joseph Medical Center
      • Sellersville, Pennsylvania, Spojené státy, 18960
        • Grand View Hospital
      • State College, Pennsylvania, Spojené státy, 16801
        • Geisinger Medical Group
      • West Reading, Pennsylvania, Spojené státy, 19611
        • Reading Hospital
      • Wilkes-Barre, Pennsylvania, Spojené státy, 18711
        • Geisinger Wyoming Valley/Henry Cancer Center
      • Wynnewood, Pennsylvania, Spojené státy, 19096
        • Lankenau Medical Center
      • Wynnewood, Pennsylvania, Spojené státy, 19096
        • Main Line Health NCORP
    • South Carolina
      • Anderson, South Carolina, Spojené státy, 29621
        • AnMed Health Cancer Center
      • Florence, South Carolina, Spojené státy, 29506
        • McLeod Regional Medical Center
    • South Dakota
      • Rapid City, South Dakota, Spojené státy, 57701
        • Rapid City Regional Hospital
      • Sioux Falls, South Dakota, Spojené státy, 57117-5134
        • Sanford USD Medical Center - Sioux Falls
      • Sioux Falls, South Dakota, Spojené státy, 57104
        • Sanford Cancer Center-Oncology Clinic
    • Texas
      • Houston, Texas, Spojené státy, 77030
        • M D Anderson Cancer Center
    • Virginia
      • Fredericksburg, Virginia, Spojené státy, 22401
        • Fredericksburg Oncology Inc
    • Washington
      • Seattle, Washington, Spojené státy, 98101
        • Virginia Mason Medical Center
      • Seattle, Washington, Spojené státy, 98104
        • Pacific Medical Center-First Hill
    • Wisconsin
      • Burlington, Wisconsin, Spojené státy, 53105
        • Aurora Cancer Care-Southern Lakes VLCC
      • Chippewa Falls, Wisconsin, Spojené státy, 54729
        • Marshfield Clinic-Chippewa Center
      • Eau Claire, Wisconsin, Spojené státy, 54701
        • Marshfield Clinic Cancer Center at Sacred Heart
      • Eau Claire, Wisconsin, Spojené státy, 54701
        • Sacred Heart Hospital
      • Fond Du Lac, Wisconsin, Spojené státy, 54937
        • Aurora Health Center-Fond du Lac
      • Germantown, Wisconsin, Spojené státy, 53022
        • Aurora Health Care Germantown Health Center
      • Grafton, Wisconsin, Spojené státy, 53024
        • Aurora Cancer Care-Grafton
      • Green Bay, Wisconsin, Spojené státy, 54311
        • Aurora BayCare Medical Center
      • Green Bay, Wisconsin, Spojené státy, 54301
        • Saint Vincent Hospital Cancer Center Green Bay
      • Green Bay, Wisconsin, Spojené státy, 54303
        • Saint Vincent Hospital Cancer Center at Saint Mary's
      • Green Bay, Wisconsin, Spojené státy, 54303
        • Green Bay Oncology Limited at Saint Mary's Hospital
      • Green Bay, Wisconsin, Spojené státy, 54301-3526
        • Green Bay Oncology at Saint Vincent Hospital
      • Janesville, Wisconsin, Spojené státy, 53547
        • Mercy Health System
      • Kenosha, Wisconsin, Spojené státy, 53142
        • Aurora Cancer Care-Kenosha South
      • Manitowoc, Wisconsin, Spojené státy, 54221
        • Holy Family Memorial Hospital
      • Marinette, Wisconsin, Spojené státy, 54143
        • Bay Area Medical Center
      • Marinette, Wisconsin, Spojené státy, 54143
        • Vince Lombardi Cancer Clinic-Marinette
      • Marshfield, Wisconsin, Spojené státy, 54449
        • Marshfield Clinic
      • Marshfield, Wisconsin, Spojené státy, 54449
        • Saint Joseph's Hospital
      • Milwaukee, Wisconsin, Spojené státy, 53209
        • Aurora Cancer Care-Milwaukee
      • Milwaukee, Wisconsin, Spojené státy, 53215
        • Aurora Saint Luke's Medical Center
      • Milwaukee, Wisconsin, Spojené státy, 53233
        • Aurora Sinai Medical Center
      • Minocqua, Wisconsin, Spojené státy, 54548
        • Marshfield Clinic-Minocqua Center
      • Mukwonago, Wisconsin, Spojené státy, 53149
        • ProHealth D N Greenwald Center
      • New Richmond, Wisconsin, Spojené státy, 54017
        • Cancer Center of Western Wisconsin
      • Oconomowoc, Wisconsin, Spojené státy, 53066
        • ProHealth Oconomowoc Memorial Hospital
      • Oconto Falls, Wisconsin, Spojené státy, 54154
        • Green Bay Oncology - Oconto Falls
      • Oshkosh, Wisconsin, Spojené státy, 54904
        • Vince Lombardi Cancer Clinic - Oshkosh
      • Racine, Wisconsin, Spojené státy, 53406
        • Aurora Cancer Care-Racine
      • Rhinelander, Wisconsin, Spojené státy, 54501
        • Saint Mary's Hospital
      • Rhinelander, Wisconsin, Spojené státy, 54501
        • Marshfield Clinic at James Beck Cancer Center
      • Rice Lake, Wisconsin, Spojené státy, 54868
        • Lakeview Medical Center-Marshfield Clinic
      • Rice Lake, Wisconsin, Spojené státy, 54868
        • Marshfield Clinic-Rice Lake Center
      • Sheboygan, Wisconsin, Spojené státy, 53081
        • Vince Lombardi Cancer Clinic-Sheboygan
      • Sheboygan, Wisconsin, Spojené státy, 53081
        • HSHS Saint Nicholas Hospital
      • Stevens Point, Wisconsin, Spojené státy, 54481
        • Saint Michael's Hospital
      • Stevens Point, Wisconsin, Spojené státy, 54481
        • Marshfield Clinic Cancer Care at Saint Michael's Hospital
      • Sturgeon Bay, Wisconsin, Spojené státy, 54235
        • Green Bay Oncology - Sturgeon Bay
      • Summit, Wisconsin, Spojené státy, 53066
        • Aurora Medical Center in Summit
      • Two Rivers, Wisconsin, Spojené státy, 54241
        • Vince Lombardi Cancer Clinic-Two Rivers
      • Waukesha, Wisconsin, Spojené státy, 53188
        • UW Cancer Center at ProHealth Care
      • Waukesha, Wisconsin, Spojené státy, 53188
        • ProHealth Waukesha Memorial Hospital
      • Waukesha, Wisconsin, Spojené státy, 53188
        • Aurora Cancer Care-Waukesha
      • Wausau, Wisconsin, Spojené státy, 54401
        • Marshfield Clinic-Wausau Center
      • Wauwatosa, Wisconsin, Spojené státy, 53226
        • Aurora Cancer Care-Milwaukee West
      • West Allis, Wisconsin, Spojené státy, 53227
        • Aurora West Allis Medical Center
      • Weston, Wisconsin, Spojené státy, 54476
        • Marshfield Clinic - Weston Center
      • Weston, Wisconsin, Spojené státy, 54476
        • Saint Clare's Hospital
      • Wisconsin Rapids, Wisconsin, Spojené státy, 54494
        • Marshfield Clinic - Wisconsin Rapids Center
    • Wyoming
      • Casper, Wyoming, Spojené státy, 82609
        • Rocky Mountain Oncology
      • Cody, Wyoming, Spojené státy, 82414
        • Big Horn Basin Cancer Center
      • Cody, Wyoming, Spojené státy, 82414
        • Billings Clinic-Cody
      • Sheridan, Wyoming, Spojené státy, 82801
        • Welch Cancer Center

Kritéria účasti

Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.

Kritéria způsobilosti

Věk způsobilý ke studiu

18 let a starší (Dospělý, Starší dospělý)

Přijímá zdravé dobrovolníky

Ne

Pohlaví způsobilá ke studiu

Všechno

Popis

Inclusion Criteria:

  • REGISTRATION STEP 1: INITIAL RANDOMIZATION
  • Patients must have a confirmed diagnosis of symptomatic multiple myeloma and must be currently relapsed or refractory; all tests for establishing disease status must be completed within 28 days prior to registration and documented on the Baseline Tumor Assessment Form for Multiple Myeloma
  • Patients must have measurable disease within 28 days prior to registration

  • Patients must have received at least one prior regimen of chemotherapy for symptomatic multiple myeloma; patients may not have more than six (6) previous regimens of therapy for the disease; prior chemotherapy must have been completed at least 21 days prior to registration; for study purposes, a regimen is defined as follows:

    • An anti-myeloma therapy used at the time of initial diagnosis or documented disease progression which is given with the intent to decrease disease burden
    • Any maintenance therapy used after an Induction should be considered part of that Induction regimen
    • Use of any agent or combination of agents more than once during the patient's disease history for separate documented disease progressions will be counted as separate regimens (e.g., if a patient receives lenalidomide/bortezomib at initial diagnosis and achieves response, but then progresses and receives lenalidomide/bortezomib after progression, these count as 2 separate regimens)
    • In cases of allogeneic or autologous stem cell transplant, the entire induction + stem cell mobilization + conditioning + planned maintenance should be considered one regimen
  • Patients may not have received any prior carfilzomib treatment
  • Patients must not be receiving any other concurrent therapy considered to be investigational; patients must not be planning to receive any radiotherapy (except localized radiation for palliative care); patients must not be planning to receive any concurrent chemotherapy, immunotherapy, radiotherapy or other treatment with curative intent
  • Patients must have complete history and physical examination within 28 days prior to registration
  • Patients must have baseline PET scan within 28 days prior to registration; note that images are submitted centrally for review
  • Patients with non-secretory MM or known primary amyloidosis are not eligible
  • Patients must have Zubrod performance status 0-2
  • Patients must not have clinically significant illness including uncontrolled, active infection requiring intravenous antibiotics, New York Heart Association (NYHA) class III or class IV heart failure, unstable angina pectoris, myocardial infarction within the past 6 months, or >= grade 3 cardiac arrhythmias
  • Patients must have undergone an electrocardiogram (EKG) within 28 days prior to registration
  • Patients must have either echocardiogram (ECHO) with ejection fraction >= 45% within 28 days prior to registration
  • Patients must not have > grade 2 neuropathy and/or POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes)
  • Total bilirubin =< 1.5 x upper limit of normal (ULN)
  • Serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) =< 3 x ULN
  • Absolute neutrophil count (ANC) >= 1,000 cell/mm^3 without growth factor support within 14 days prior to registration
  • Platelets >= 50,000 cells/mm^3 for patients who have bone marrow plasmacytosis < 50% or >= 30,000 cells/mm^3 for patients who have bone marrow plasmacytosis of >= 50% within 14 days prior to registration
  • Calculated or measured creatinine clearance >= 30 ml/min within 14 days prior to registration

  • Patients who are known to be human immunodeficiency virus positive (HIV+) are eligible providing they meet all of the following additional criteria within 28 days prior to registration:

    • Cluster of differentiation (CD)4 cells >= 500/mm^3
    • Viral load of < 50 copies HIV messenger ribonucleic acid (mRNA)/mm^3 if on combination antiretroviral therapy (cART) or < 25,000 copies HIV mRNA if not on cART
    • No zidovudine or stavudine as part of cART
    • Patients who are HIV+ and do not meet all of these criteria are not eligible for this study
  • Patients with known hepatitis B or hepatitis C infection must have viral load < 800,000 IU/L within 28 days prior to registration
  • Patients must have baseline skeletal survey to document lytic lesions, osteopenia or compression fracture within 28 days prior to registration
  • Patients may have received palliative external beam radiation therapy (XRT) for local disease control with no curative intent. XRT must be completed at least 7 days prior to registration
  • Patients must be offered participation in specimen submission for translational medicine studies and banking; with patient consent, specimens must be submitted
  • Patients must not be pregnant or nursing; women/men of reproductive potential must have agreed to use an effective contraceptive method; a woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months; in addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation; however, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures
  • No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for three years
  • Patients or their legally authorized representative must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines
  • As a part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system
  • REGISTRATION STEP 2: CROSSOVER
  • Patient must have been eligible for and initially randomized to Arm 1 (low dose carfilzomib), begun cycle 2 of treatment, and progressed prior to completing 12 cycles of protocol therapy
  • At least 14 days and no more than 28 days must have elapsed between the last day of treatment on Arm 1 and registration to Arm 3
  • Patients must have recovered from all non-hematologic toxicities to =< grade 2 and from all hematologic toxicities to =< grade 3 prior to registration
  • Patients must have begun cycle 2 (carfilzomib - 27 mg/m^2) and must not have received any dose reduction for toxicity in the last cycle of treatment, immediately preceding progression
  • Patients must have serum protein electrophoresis (SPEP) and kappa and lambda light chain testing performed within 14 days prior to registration in order to establish baseline measurements
  • Patients must not have ejection fraction decrease > 10% from baseline (as determined by ECHO) or other ejection fraction decrease accompanied by other clinical signs/symptoms of New York Heart Association (NYHA) class III or IV heart failure, measured within 28 days prior to registration; if any question exists regarding individual patient eligibility in this situation, contact the study chair for determination

Studijní plán

Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.

Jak je studie koncipována?

Detaily designu

  • Primární účel: Léčba
  • Přidělení: Randomizované
  • Intervenční model: Crossover Assignment
  • Maskování: Žádné (otevřený štítek)

Zbraně a zásahy

Skupina účastníků / Arm
Intervence / Léčba
Experimentální: Arm I (dexamethasone, low-dose carfilzomib)
Patients receive dexamethasone IV and low-dose carfilzomib IV over 2-10 minutes on days 1, 2, 8, 9, 15, and 16. (Note that course 1 is given at a reduced dose.) Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Patients with progression cross-over to Arm II.
Jiný: Laboratorní analýza biomarkerů
Korelační studie
Lék: Carfilzomib
Vzhledem k tomu, IV
Ostatní jména:
  • Kyprolis
  • PR-171
Lék: Dexamethason
Vzhledem k tomu, IV
Ostatní jména:
  • Decadron
  • Aacidexam
  • Adexon
  • Aknichthol Dexa
  • Alba-Dex
  • Alin
  • Alin Depot
  • Alin Oftalmico
  • Amplidermis
  • Anemul mono
  • Auricularum
  • Auxiloson
  • Baycuten
  • Baycuten N
  • Cortidexason
  • Cortisumman
  • Dekakort
  • Decadrol
  • Decalix
  • Dekameth
  • Decasone R.p.
  • Dectancyl
  • Dekacort
  • Deltafluoren
  • Deronil
  • Desamethason
  • Desameton
  • Dexa-Mamallet
  • Dexa-Rhinosan
  • Dexa-Scheroson
  • Dexa-sine
  • Dexacortal
  • Dexacortin
  • Dexafarma
  • Dexafluoren
  • Dexalocal
  • Dexamecortin
  • Dexameth
  • Dexamethasonum
  • Dexamonozon
  • Dexapos
  • Dexinoral
  • Dexone
  • Dinormon
  • Fluorodelta
  • Fortecortin
  • Gammacorten
  • Hexadecadrol
  • Hexadrol
  • Lokalison-F
  • Loverine
  • Methylfluorprednisolon
  • Millicorten
  • Mymethason
  • Orgadron
  • Spersadex
  • Visumetazon
Experimentální: Arm II (dexamethasone, high-dose carfilzomib)
Patients receive dexamethasone IV and high-dose carfilzomib IV over 30 minutes on days 1, 2, 8, 9, 15, and 16. (Note that course 1 is given at a reduced dose over 2-10 minutes.) Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Jiný: Laboratorní analýza biomarkerů
Korelační studie
Lék: Carfilzomib
Vzhledem k tomu, IV
Ostatní jména:
  • Kyprolis
  • PR-171
Lék: Dexamethason
Vzhledem k tomu, IV
Ostatní jména:
  • Decadron
  • Aacidexam
  • Adexon
  • Aknichthol Dexa
  • Alba-Dex
  • Alin
  • Alin Depot
  • Alin Oftalmico
  • Amplidermis
  • Anemul mono
  • Auricularum
  • Auxiloson
  • Baycuten
  • Baycuten N
  • Cortidexason
  • Cortisumman
  • Dekakort
  • Decadrol
  • Decalix
  • Dekameth
  • Decasone R.p.
  • Dectancyl
  • Dekacort
  • Deltafluoren
  • Deronil
  • Desamethason
  • Desameton
  • Dexa-Mamallet
  • Dexa-Rhinosan
  • Dexa-Scheroson
  • Dexa-sine
  • Dexacortal
  • Dexacortin
  • Dexafarma
  • Dexafluoren
  • Dexalocal
  • Dexamecortin
  • Dexameth
  • Dexamethasonum
  • Dexamonozon
  • Dexapos
  • Dexinoral
  • Dexone
  • Dinormon
  • Fluorodelta
  • Fortecortin
  • Gammacorten
  • Hexadecadrol
  • Hexadrol
  • Lokalison-F
  • Loverine
  • Methylfluorprednisolon
  • Millicorten
  • Mymethason
  • Orgadron
  • Spersadex
  • Visumetazon

Co je měření studie?

Primární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Progression-free Survival
Časové okno: From date of registration to date of first documentation of progression or symptomatic deterioration, or death due to any cause, assessed up to 2 years
Assessed in each arm using the method of Kaplan Meier and compared between arms using the stratified long-rank test. Progression is defined using the International Uniform Response Criteria for Multiple Myeloma as new or increase in size of existing bone lesions or soft tissue plasmacytomas; or development of hypercalcemia attributable solely to MM; or ≥ 25% increase from baseline or lowest response level of either serum M protein, urine M protein, difference in involved & uninvolved serum free light chain level or bone marrow plasma cell percentage.
From date of registration to date of first documentation of progression or symptomatic deterioration, or death due to any cause, assessed up to 2 years

Sekundární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Overall Survival
Časové okno: From date of registration to date of death due to any cause, assessed up to 3 years
Assessed in each arm using the method of Kaplan Meier and compared between arms using the stratified log-rank test.
From date of registration to date of death due to any cause, assessed up to 3 years
Best Overall Response - Partial Response (PR), Very Good Partial Response (VGPR), Unconfirmed PR (uPR), Stable Disease (SD) Progression (PROG)
Časové okno: From date of registration to date of best response while on study treatment
Per International Uniform Response Criteria for Multiple Myeloma PR- ≥ 50% reduction in size of soft tissue plasmacytomas & plasma cells; ≥ 50% decrease in serum & reduction in urine M protein ≥ 90% or to < 200 mg/24hr or ≥ 50% decrease in difference in uninvolved & involved serum free light chain levels; VGPR- PR + Serum and urine M proteins detectable by immunofixation but not on electrophoresis or ≥ 90% reduction in serum M protein & urine M protein < 100 mg/24 hrs; uPR- 1 objective status of PR, but confirmation studies are not done, or do not meet the requirements necessary to confirm response; SD- does not meet criteria for sCR, CR, VGPR, PR or PROG; PROG- new or increase in size of existing bone lesions or soft tissue plasmacytomas/ development of hypercalcemia attributable solely to MM/ ≥ 25% increase from baseline/ lowest response level of either serum or Urine M protein, difference in involved & uninvolved serum free light chain level or bone marrow plasma cell percentage.
From date of registration to date of best response while on study treatment
Progression-free Survival of Crossover Group
Časové okno: From date of crossover to date of subsequent documentation of progression or symptomatic deterioration, or death due to any cause, assessed up to 3 years from randomization
Assessed in the crossover arm using the method of Kaplan Meier. Progression is defined using the International Uniform Response Criteria for Multiple Myeloma as new or increase in size of existing bone lesions or soft tissue plasmacytomas; or development of hypercalcemia attributable solely to MM; or ≥ 25% increase from baseline or lowest response level of either serum M protein, urine M protein, difference in involved & uninvolved serum free light chain level or bone marrow plasma cell percentage.
From date of crossover to date of subsequent documentation of progression or symptomatic deterioration, or death due to any cause, assessed up to 3 years from randomization
Overall Survival Crossover Group
Časové okno: From date of crossover to date of death due to any cause, assessed up to 3 years from randomization
Assessed in the crossover arm using the method of Kaplan Meier.
From date of crossover to date of death due to any cause, assessed up to 3 years from randomization

Další výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Gene Expression Profiles
Časové okno: Up to 3 years
Bone marrow compared to that of an aspirate taken at the site of the EMP. Data will be log-transformed before analysis. Exploratory analyses will examine underlying distributions using boxplots, density plots, scatter plots, etc. For differential expression analysis of the two sample types t-tests will be conducted on genes. False discovery rate will be used to control the average false positive proportions among selected genes. Genes will be ranked by their q-value and pathway analysis conducted upon selected genes to determine biological plausibility and relevance to molecular functionality.
Up to 3 years
Incidence of CR by PET, Defined as the Disappearance of All Focal Lesions and the Resolution of EMD
Časové okno: Up to week 45
Univariate and multivariate logistic regression will be used to determine the impact of biochemical CR on CR by PET. In the multivariate analysis adjustment for standard prognostic factors such as age, albumin, beta-2 microglobulin, serum creatinine, c-reactive protein and lactate dehydrogenase will be included.
Up to week 45

Spolupracovníci a vyšetřovatelé

Zde najdete lidi a organizace zapojené do této studie.

Sponzor

Southwest Oncology Group

Spolupracovníci

National Cancer Institute (NCI)

Vyšetřovatelé

  • Vrchní vyšetřovatel: Sikander Ailawadhi, Southwest Oncology Group

Publikace a užitečné odkazy

Osoba odpovědná za zadávání informací o studiu tyto publikace poskytuje dobrovolně. Mohou se týkat čehokoli, co souvisí se studiem.

Obecné publikace

Termíny studijních záznamů

Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.

Hlavní termíny studia

Začátek studia

1. října 2013

Primární dokončení (Aktuální)

1. listopadu 2017

Dokončení studie (Aktuální)

7. března 2019

Termíny zápisu do studia

První předloženo

16. července 2013

První předloženo, které splnilo kritéria kontroly kvality

16. července 2013

První zveřejněno (Odhad)

19. července 2013

Aktualizace studijních záznamů

Poslední zveřejněná aktualizace (Aktuální)

14. dubna 2020

Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality

3. dubna 2020

Naposledy ověřeno

1. dubna 2020

Více informací

Termíny související s touto studií

Klíčová slova

Další relevantní podmínky MeSH

Další identifikační čísla studie

  • S1304 (Jiný identifikátor: CTEP)
  • U10CA032102 (Grant/smlouva NIH USA)
  • U10CA180888 (Grant/smlouva NIH USA)
  • NCI-2013-00796 (Identifikátor registru: CTRP (Clinical Trial Reporting Program))
  • PS1304_A07PAMDREVW01
  • SWOG-S1304

Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .

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