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Sammenligning af to behandlingskombinationer, Gemcitabin og Nab-Paclitaxel med 5-Fluorouracil, Leucovorin og Liposomal Irinotecan for ældre patienter med kræft i bugspytkirtlen, der har spredt sig

9. juli 2026 opdateret af: ECOG-ACRIN Cancer Research Group

Et randomiseret fase II-studie af gemcitabin og Nab-Paclitaxel sammenlignet med 5-fluorouracil, leucovorin og liposomal irinotecan hos ældre patienter med behandlingsnaive metastatisk bugspytkirtelkræft (GIANT)

Dette fase II-forsøg sammenligner to behandlingskombinationer: gemcitabinhydrochlorid og nab-paclitaxel eller fluorouracil, leucovorincalcium og liposomalt irinotecan hos ældre patienter med bugspytkirtelkræft, der har spredt sig til andre steder i kroppen (metastatisk). Lægemidler, der anvendes i kemoterapi, såsom gemcitabinhydrochlorid, nab-paclitaxel, fluorouracil, leucovorin calcium og liposomalt irinotecan, virker på forskellige måder for at stoppe væksten af tumorceller, enten ved at dræbe cellerne, ved at stoppe dem i at dele sig eller ved at stoppe dem fra at sprede sig. Denne undersøgelse kan hjælpe læger med at finde ud af, hvilken behandlingskombination der er bedre til at forlænge livet hos ældre patienter med metastatisk bugspytkirtelkræft.

Studieoversigt

Status

Aktiv, ikke rekrutterende

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

PRIMÆR MÅL:

I. Samlet overlevelse.

SEKUNDÆRE MÅL:

I. Progressionsfri overlevelse. II. Objektiv tumorrespons.

III. Omfattende geriatrisk vurdering (CGA)/livskvalitet (QOL) relaterede mål:

IIIa. Antag, at lavere score i funktionel statusvurderingsværktøj - instrumentelle aktiviteter i dagliglivet (IADL) vil korrelere med højere rater af grad 3 eller højere kemoterapitoksicitet.

IV. CGA/QOL-relaterede udforskningsmål:

IVa. Evaluering af andre CGA-domæner før behandling, herunder følgesygdomme, depression, ernæring og kognition som prædiktorer for kemoterapitolerance.

IVb. Evaluering af sammenhængen mellem ændring i funktionel status under behandlingsforløb (sammenligning mellem daglige aktiviteter [ADL] og IADL-score forud for behandling og på tidspunktet for sygdomsevaluering) som forudsigere for kemoterapitolerance.

IVc. Evaluering af sammenhængen mellem CGA-domæner og samlet overlevelse efter behandlingsarm.

IVd. Evaluering af forskellen i QOL-score (Functional Assessment of Cancer Therapy - Hepatitis [FACT-Hep] version 4) mellem baseline-målinger og vurdering under behandlingsforløb mellem af behandlingsarme.

V. Fokuseret evaluering af toksiciteter, der er af interesse for ældre patienter, herunder: perifer neuropati, træthed, fald, skadestuebesøg, hospitalsindlæggelse, behandlingsændring og seponering.

VI. Imaging korrelative undersøgelsesmål:

VIa. Evaluer sammenhængen mellem baseline og ændring under behandling af skeletmuskelindeks (SMI) og intermuskulært fedtvæv (IMAT) og frekvenser af grad 3 eller højere kemoterapitoksicitet oplevet under behandling.

VIb. Evaluer sammenhængen mellem baseline og ændring under behandling af skeletmuskelindeks (SMI) og intermuskulært fedtvæv (IMAT) og overordnet overlevelse blandt ældre patienter med metastatisk bugspytkirtelcancer.

VIc. Evaluer sammenhængen mellem baseline og ændring under behandling af skeletmuskelindeks (SMI) og intermuskulært fedtvæv (IMAT) og geriatriske vurderingsscore, der evaluerer funktionel status.

VII. Laboratorie korrelative undersøgelsesmål:

VIIa. Evaluering af sammenhængen mellem basislinjeniveauer af biomarkører for aldring (CRP og IL-6) og rater af grad 3 eller højere kemoterapitoksicitet under behandling.

VIIb. Evaluering af sammenhængen mellem ændringer i niveauer af CRP og IL-6 under terapi og rater af grad 3 kemoterapitoksicitet.

VIIc. Evaluering af sammenhængen mellem baseline niveauer af biomarkører for aldring (CRP og IL-6) og samlet overlevelse blandt ældre patienter med metastatisk bugspytkirtelcancer.

VIId. Evaluering af sammenhængen mellem niveauer af baseline biomarkører for aldring (CRP og IL-6) og geriatriske vurderinger scorer evaluering funktionel status.

OVERSIGT: Patienterne randomiseres til 1 af 2 arme.

ARM A: Patienterne får gemcitabin intravenøst (IV) over 30 minutter og nab-paclitaxel IV over 30 minutter på dag 1. Cykler gentages hver 14. dag i fravær af sygdomsprogression eller uacceptabel toksicitet.

ARM B: Patienter får fluorouracil IV over 46 timer fra dag 1. Patienter får også leucovorin IV over 90-120 minutter og liposomal irinotecan IV over 90 minutter på dag 1. Cykler gentages hver 14. dag i fravær af sygdomsprogression eller uacceptabel toksicitet.

Efter afsluttet undersøgelsesbehandling følges patienterne hver 3. måned i 2 år.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

176

Fase

Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Navn: Efrat Dotan, MD
Telefonnummer: 215-728-2500
E-mail: Efrat.Dotan@fccc.edu

Studiesteder

Forenede Stater
- Alabama
  - Birmingham, Alabama, Forenede Stater, 35233
    - University of Alabama at Birmingham Cancer Center
  - Fairhope, Alabama, Forenede Stater, 36532
    - Thomas Hospital
  - Mobile, Alabama, Forenede Stater, 36607
    - Mobile Infirmary Medical Center
- Alaska
  - Anchorage, Alaska, Forenede Stater, 98508
    - Anchorage Associates in Radiation Medicine
  - Anchorage, Alaska, Forenede Stater, 99508
    - Alaska Breast Care and Surgery LLC
  - Anchorage, Alaska, Forenede Stater, 99508
    - Alaska Oncology and Hematology LLC
  - Anchorage, Alaska, Forenede Stater, 99508
    - Alaska Women's Cancer Care
  - Anchorage, Alaska, Forenede Stater, 99508
    - Anchorage Oncology Centre
  - Anchorage, Alaska, Forenede Stater, 99508
    - Katmai Oncology Group
  - Anchorage, Alaska, Forenede Stater, 99508
    - Providence Alaska Medical Center
  - Anchorage, Alaska, Forenede Stater, 99504
    - Anchorage Radiation Therapy Center
- Arizona
  - Kingman, Arizona, Forenede Stater, 86401
    - Kingman Regional Medical Center
  - Phoenix, Arizona, Forenede Stater, 85004
    - Cancer Center at Saint Joseph's
- Arkansas
  - Fort Smith, Arkansas, Forenede Stater, 72903
    - Mercy Hospital Fort Smith
  - Hot Springs, Arkansas, Forenede Stater, 71913
    - CHI Saint Vincent Cancer Center Hot Springs
  - Jonesboro, Arkansas, Forenede Stater, 72401
    - NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
- California
  - Arroyo Grande, California, Forenede Stater, 93420
    - PCR Oncology
  - Arroyo Grande, California, Forenede Stater, 93420
    - Mission Hope Medical Oncology - Arroyo Grande
  - Burbank, California, Forenede Stater, 91505
    - Providence Saint Joseph Medical Center/Disney Family Cancer Center
  - Carmichael, California, Forenede Stater, 95608
    - Mercy San Juan Medical Center
  - Carmichael, California, Forenede Stater, 95608
    - Mercy Cancer Center �� Carmichael
  - Clovis, California, Forenede Stater, 93611
    - Community Cancer Institute
  - Clovis, California, Forenede Stater, 93611
    - University Oncology Associates
  - Duarte, California, Forenede Stater, 91010
    - City of Hope Comprehensive Cancer Center
  - Elk Grove, California, Forenede Stater, 95758
    - Mercy Cancer Center - Elk Grove
  - Irvine, California, Forenede Stater, 92618
    - City of Hope at Irvine Lennar
  - Orange, California, Forenede Stater, 92868
    - UC Irvine Health/Chao Family Comprehensive Cancer Center
  - Palo Alto, California, Forenede Stater, 94304
    - Stanford Cancer Institute Palo Alto
  - Rocklin, California, Forenede Stater, 95765
    - Mercy Cancer Center - Rocklin
  - Sacramento, California, Forenede Stater, 95816
    - Mercy Cancer Center - Sacramento
  - Salinas, California, Forenede Stater, 93901
    - Salinas Valley Memorial
  - San Luis Obispo, California, Forenede Stater, 93401
    - Pacific Central Coast Health Center-San Luis Obispo
  - Santa Maria, California, Forenede Stater, 93444
    - Mission Hope Medical Oncology - Santa Maria
  - South Pasadena, California, Forenede Stater, 91030
    - City of Hope South Pasadena
  - Upland, California, Forenede Stater, 91786
    - City of Hope Upland
  - Woodland, California, Forenede Stater, 95695
    - Woodland Memorial Hospital
- Colorado
  - Colorado Springs, Colorado, Forenede Stater, 80907
    - Penrose-Saint Francis Healthcare
  - Colorado Springs, Colorado, Forenede Stater, 80909
    - UCHealth Memorial Hospital Central
  - Colorado Springs, Colorado, Forenede Stater, 80907
    - Rocky Mountain Cancer Centers-Penrose
  - Colorado Springs, Colorado, Forenede Stater, 80920
    - Memorial Hospital North
  - Colorado Springs, Colorado, Forenede Stater, 80923
    - Saint Francis Cancer Center
  - Denver, Colorado, Forenede Stater, 80210
    - Porter Adventist Hospital
  - Durango, Colorado, Forenede Stater, 81301
    - Mercy Medical Center
  - Durango, Colorado, Forenede Stater, 81301
    - Southwest Oncology PC
  - Fort Collins, Colorado, Forenede Stater, 80524
    - Poudre Valley Hospital
  - Fort Collins, Colorado, Forenede Stater, 80528
    - Cancer Care and Hematology-Fort Collins
  - Greeley, Colorado, Forenede Stater, 80631
    - UCHealth Greeley Hospital
  - Lakewood, Colorado, Forenede Stater, 80228
    - Saint Anthony Hospital
  - Littleton, Colorado, Forenede Stater, 80122
    - Littleton Adventist Hospital
  - Longmont, Colorado, Forenede Stater, 80501
    - Longmont United Hospital
  - Longmont, Colorado, Forenede Stater, 80501
    - Rocky Mountain Cancer Centers-Longmont
  - Loveland, Colorado, Forenede Stater, 80538
    - Medical Center of the Rockies
  - Parker, Colorado, Forenede Stater, 80138
    - Parker Adventist Hospital
  - Pueblo, Colorado, Forenede Stater, 81004
    - Saint Mary Corwin Medical Center
- Delaware
  - Frankford, Delaware, Forenede Stater, 19945
    - Beebe South Coastal Health Campus
  - Lewes, Delaware, Forenede Stater, 19958
    - Beebe Medical Center
  - Newark, Delaware, Forenede Stater, 19713
    - Helen F Graham Cancer Center
  - Newark, Delaware, Forenede Stater, 19713
    - Delaware Clinical and Laboratory Physicians PA
  - Newark, Delaware, Forenede Stater, 19713
    - Medical Oncology Hematology Consultants PA
  - Newark, Delaware, Forenede Stater, 19718
    - Christiana Care Health System-Christiana Hospital
  - Rehoboth Beach, Delaware, Forenede Stater, 19971
    - Beebe Health Campus
  - Seaford, Delaware, Forenede Stater, 19973
    - TidalHealth Nanticoke / Allen Cancer Center
  - Wilmington, Delaware, Forenede Stater, 19801
    - Christiana Care Health System-Wilmington Hospital
- District of Columbia
  - Washington D.C., District of Columbia, Forenede Stater, 20037
    - George Washington University Medical Center
  - Washington D.C., District of Columbia, Forenede Stater, 20010
    - MedStar Washington Hospital Center
- Florida
  - Altamonte Springs, Florida, Forenede Stater, 32701
    - AdventHealth Altamonte
  - Celebration, Florida, Forenede Stater, 34747
    - AdventHealth Celebration
  - Fort Lauderdale, Florida, Forenede Stater, 33308
    - Holy Cross Hospital
  - Fort Myers, Florida, Forenede Stater, 33905
    - Regional Cancer Center-Lee Memorial Health System
  - Gainesville, Florida, Forenede Stater, 32610
    - University of Florida Health Science Center - Gainesville
  - Kissimmee, Florida, Forenede Stater, 34744
    - AdventHealth Kissimmee
  - Lakeland, Florida, Forenede Stater, 33805
    - The Watson Clinic
  - Orlando, Florida, Forenede Stater, 32803
    - AdventHealth Orlando
  - Orlando, Florida, Forenede Stater, 32803
    - AdventHealth Medical Group Urology at Orlando
  - Orlando, Florida, Forenede Stater, 32822
    - AdventHealth East Orlando
  - Tampa, Florida, Forenede Stater, 33612
    - Moffitt Cancer Center
  - Tampa, Florida, Forenede Stater, 33607
    - Moffitt Cancer Center-International Plaza
  - Tampa, Florida, Forenede Stater, 33612
    - Moffitt Cancer Center - McKinley Campus
  - Wesley Chapel, Florida, Forenede Stater, 33544
    - Moffitt Cancer Center at Wesley Chapel
  - Winter Park, Florida, Forenede Stater, 32792
    - AdventHealth Winter Park
- Georgia
  - Augusta, Georgia, Forenede Stater, 30901
    - Augusta Oncology Associates PC-D'Antignac
  - Augusta, Georgia, Forenede Stater, 30909
    - Augusta Oncology Associates PC-Wheeler
  - Savannah, Georgia, Forenede Stater, 31405
    - Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
- Hawaii
  - Honolulu, Hawaii, Forenede Stater, 96813
    - Queen's Medical Center
  - Honolulu, Hawaii, Forenede Stater, 96817
    - The Cancer Center of Hawaii-Liliha
  - Honolulu, Hawaii, Forenede Stater, 96813
    - Hawaii Cancer Care Inc - Waterfront Plaza
  - Honolulu, Hawaii, Forenede Stater, 96813
    - Queen's Cancer Cenrer - POB I
  - Honolulu, Hawaii, Forenede Stater, 96813
    - Straub Clinic and Hospital
  - Honolulu, Hawaii, Forenede Stater, 96813
    - University of Hawaii Cancer Center
  - Honolulu, Hawaii, Forenede Stater, 96817
    - Hawaii Cancer Care Inc-Liliha
  - Honolulu, Hawaii, Forenede Stater, 96817
    - Kuakini Medical Center
  - Honolulu, Hawaii, Forenede Stater, 96817
    - Queen's Cancer Center - Kuakini
  - Honolulu, Hawaii, Forenede Stater, 96826
    - Kapiolani Medical Center for Women and Children
  - Honolulu, Hawaii, Forenede Stater, 96813
    - Island Urology
  - Lihue, Hawaii, Forenede Stater, 96766
    - Wilcox Memorial Hospital and Kauai Medical Clinic
  - ‘Aiea, Hawaii, Forenede Stater, 96701
    - Hawaii Cancer Care - Westridge
  - ‘Aiea, Hawaii, Forenede Stater, 96701
    - Pali Momi Medical Center
  - ‘Aiea, Hawaii, Forenede Stater, 96701
    - Queen's Cancer Center - Pearlridge
  - ‘Aiea, Hawaii, Forenede Stater, 96701
    - The Cancer Center of Hawaii-Pali Momi
- Idaho
  - Boise, Idaho, Forenede Stater, 83706
    - Saint Alphonsus Cancer Care Center-Boise
  - Boise, Idaho, Forenede Stater, 83712
    - Saint Luke's Cancer Institute - Boise
  - Caldwell, Idaho, Forenede Stater, 83605
    - Saint Alphonsus Cancer Care Center-Caldwell
  - Coeur d'Alene, Idaho, Forenede Stater, 83814
    - Kootenai Health - Coeur d'Alene
  - Emmett, Idaho, Forenede Stater, 83617
    - Walter Knox Memorial Hospital
  - Fruitland, Idaho, Forenede Stater, 83619
    - Saint Luke's Cancer Institute - Fruitland
  - Meridian, Idaho, Forenede Stater, 83642
    - Idaho Urologic Institute-Meridian
  - Meridian, Idaho, Forenede Stater, 83642
    - Saint Luke's Cancer Institute - Meridian
  - Nampa, Idaho, Forenede Stater, 83686
    - Saint Luke's Cancer Institute - Nampa
  - Nampa, Idaho, Forenede Stater, 83687
    - Saint Alphonsus Cancer Care Center-Nampa
  - Post Falls, Idaho, Forenede Stater, 83854
    - Kootenai Clinic Cancer Services - Post Falls
  - Sandpoint, Idaho, Forenede Stater, 83864
    - Kootenai Cancer Clinic
  - Twin Falls, Idaho, Forenede Stater, 83301
    - Saint Luke's Cancer Institute - Twin Falls
- Illinois
  - Alton, Illinois, Forenede Stater, 62002
    - Saint Anthony's Health
  - Aurora, Illinois, Forenede Stater, 60504
    - Rush - Copley Medical Center
  - Bloomington, Illinois, Forenede Stater, 61704
    - Illinois CancerCare-Bloomington
  - Canton, Illinois, Forenede Stater, 61520
    - Illinois CancerCare-Canton
  - Carbondale, Illinois, Forenede Stater, 62902
    - Memorial Hospital of Carbondale
  - Carterville, Illinois, Forenede Stater, 62918
    - SIH Cancer Institute
  - Carthage, Illinois, Forenede Stater, 62321
    - Illinois CancerCare-Carthage
  - Centralia, Illinois, Forenede Stater, 62801
    - Centralia Oncology Clinic
  - Centralia, Illinois, Forenede Stater, 62801
    - Saint Mary's Hospital
  - Chicago, Illinois, Forenede Stater, 60611
    - Northwestern University
  - Chicago, Illinois, Forenede Stater, 60625
    - Swedish Covenant Hospital
  - Danville, Illinois, Forenede Stater, 61832
    - Carle on Vermilion
  - DeKalb, Illinois, Forenede Stater, 60115
    - Northwestern Medicine Cancer Center Kishwaukee
  - Decatur, Illinois, Forenede Stater, 62526
    - Decatur Memorial Hospital
  - Decatur, Illinois, Forenede Stater, 62526
    - Cancer Care Specialists of Illinois - Decatur
  - Dixon, Illinois, Forenede Stater, 61021
    - Illinois CancerCare-Dixon
  - Effingham, Illinois, Forenede Stater, 62401
    - Crossroads Cancer Center
  - Effingham, Illinois, Forenede Stater, 62401
    - Carle Physician Group-Effingham
  - Eureka, Illinois, Forenede Stater, 61530
    - Illinois CancerCare-Eureka
  - Galesburg, Illinois, Forenede Stater, 61401
    - Western Illinois Cancer Treatment Center
  - Galesburg, Illinois, Forenede Stater, 61401
    - Illinois CancerCare-Galesburg
  - Geneva, Illinois, Forenede Stater, 60134
    - Northwestern Medicine Cancer Center Delnor
  - Harvey, Illinois, Forenede Stater, 60426
    - Ingalls Memorial Hospital
  - Joliet, Illinois, Forenede Stater, 60435
    - Duly Health and Care Joliet
  - Kewanee, Illinois, Forenede Stater, 61443
    - Illinois CancerCare-Kewanee Clinic
  - Lake Forest, Illinois, Forenede Stater, 60045
    - Northwestern Medicine Lake Forest Hospital
  - Macomb, Illinois, Forenede Stater, 61455
    - Illinois CancerCare-Macomb
  - Mattoon, Illinois, Forenede Stater, 61938
    - Carle Physician Group-Mattoon/Charleston
  - Mount Vernon, Illinois, Forenede Stater, 62864
    - Good Samaritan Regional Health Center
  - O'Fallon, Illinois, Forenede Stater, 62269
    - Cancer Care Center of O'Fallon
  - Ottawa, Illinois, Forenede Stater, 61350
    - Illinois CancerCare-Ottawa Clinic
  - Pekin, Illinois, Forenede Stater, 61554
    - Illinois CancerCare-Pekin
  - Peoria, Illinois, Forenede Stater, 61636
    - Methodist Medical Center of Illinois
  - Peoria, Illinois, Forenede Stater, 61615
    - Illinois CancerCare-Peoria
  - Peru, Illinois, Forenede Stater, 61354
    - Illinois CancerCare-Peru
  - Peru, Illinois, Forenede Stater, 61354
    - Valley Radiation Oncology
  - Princeton, Illinois, Forenede Stater, 61356
    - Illinois CancerCare-Princeton
  - Springfield, Illinois, Forenede Stater, 62781
    - Memorial Medical Center
  - Springfield, Illinois, Forenede Stater, 62702
    - Southern Illinois University School of Medicine
  - Springfield, Illinois, Forenede Stater, 62702
    - Springfield Clinic
  - Swansea, Illinois, Forenede Stater, 62226
    - Southwest Illinois Health Services LLP
  - Urbana, Illinois, Forenede Stater, 61801
    - Carle Cancer Center
  - Urbana, Illinois, Forenede Stater, 61801
    - The Carle Foundation Hospital
  - Warrenville, Illinois, Forenede Stater, 60555
    - Northwestern Medicine Cancer Center Warrenville
  - Washington, Illinois, Forenede Stater, 61571
    - Illinois CancerCare - Washington
  - Yorkville, Illinois, Forenede Stater, 60560
    - Rush-Copley Healthcare Center
- Indiana
  - Carmel, Indiana, Forenede Stater, 46032
    - IU Health North Hospital
  - Crown Point, Indiana, Forenede Stater, 46307
    - Northwest Cancer Center - Main Campus
  - Dyer, Indiana, Forenede Stater, 46311
    - Northwest Oncology LLC
  - Hobart, Indiana, Forenede Stater, 46342
    - Northwest Cancer Center - Hobart
  - Hobart, Indiana, Forenede Stater, 46342
    - Saint Mary Medical Center
  - Indianapolis, Indiana, Forenede Stater, 46202
    - Indiana University/Melvin and Bren Simon Cancer Center
  - Indianapolis, Indiana, Forenede Stater, 46312
    - Saint Catherine Hospital
  - Munster, Indiana, Forenede Stater, 46321
    - The Community Hospital
  - Munster, Indiana, Forenede Stater, 46321
    - Women's Diagnostic Center - Munster
  - Richmond, Indiana, Forenede Stater, 47374
    - Reid Health
  - Valparaiso, Indiana, Forenede Stater, 46383
    - Northwest Cancer Center - Valparaiso
- Iowa
  - Ames, Iowa, Forenede Stater, 50010
    - McFarland Clinic PC - Ames
  - Ames, Iowa, Forenede Stater, 50010
    - Mary Greeley Medical Center
  - Boone, Iowa, Forenede Stater, 50036
    - McFarland Clinic PC-Boone
  - Carroll, Iowa, Forenede Stater, 51401
    - Saint Anthony Regional Hospital
  - Clive, Iowa, Forenede Stater, 50325
    - Mercy Cancer Center-West Lakes
  - Clive, Iowa, Forenede Stater, 50325
    - Medical Oncology and Hematology Associates-West Des Moines
  - Council Bluffs, Iowa, Forenede Stater, 51503
    - Alegent Health Mercy Hospital
  - Council Bluffs, Iowa, Forenede Stater, 51502
    - Jennie Edmundson Memorial Hospital
  - Council Bluffs, Iowa, Forenede Stater, 51503
    - Heartland Oncology and Hematology LLP
  - Creston, Iowa, Forenede Stater, 50801
    - Greater Regional Medical Center
  - Des Moines, Iowa, Forenede Stater, 50309
    - Iowa Methodist Medical Center
  - Des Moines, Iowa, Forenede Stater, 50314
    - Mercy Medical Center - Des Moines
  - Des Moines, Iowa, Forenede Stater, 50309
    - Medical Oncology and Hematology Associates-Des Moines
  - Des Moines, Iowa, Forenede Stater, 50314
    - Broadlawns Medical Center
  - Des Moines, Iowa, Forenede Stater, 50314
    - Mission Cancer and Blood - Laurel
  - Des Moines, Iowa, Forenede Stater, 50316
    - Iowa Lutheran Hospital
  - Fort Dodge, Iowa, Forenede Stater, 50501
    - McFarland Clinic PC-Trinity Cancer Center
  - Fort Dodge, Iowa, Forenede Stater, 50501
    - Trinity Regional Medical Center
  - Jefferson, Iowa, Forenede Stater, 50129
    - McFarland Clinic PC-Jefferson
  - Marshalltown, Iowa, Forenede Stater, 50158
    - McFarland Clinic PC-Marshalltown
  - West Des Moines, Iowa, Forenede Stater, 50266-7700
    - Methodist West Hospital
  - West Des Moines, Iowa, Forenede Stater, 50266
    - Mercy Medical Center-West Lakes
- Kansas
  - Garden City, Kansas, Forenede Stater, 67846
    - Central Care Cancer Center - Garden City
  - Great Bend, Kansas, Forenede Stater, 67530
    - Central Care Cancer Center - Great Bend
  - Overland Park, Kansas, Forenede Stater, 66209
    - Menorah Medical Center
  - Topeka, Kansas, Forenede Stater, 66606
    - Cotton O'Neil Cancer Center / Stormont Vail Health
- Kentucky
  - Bardstown, Kentucky, Forenede Stater, 40004
    - Flaget Memorial Hospital
  - Corbin, Kentucky, Forenede Stater, 40701
    - Commonwealth Cancer Center-Corbin
  - Lexington, Kentucky, Forenede Stater, 40504
    - Saint Joseph Radiation Oncology Resource Center
  - Lexington, Kentucky, Forenede Stater, 40509
    - Saint Joseph Hospital East
  - Lexington, Kentucky, Forenede Stater, 40504
    - Saint Joseph Hospital
  - London, Kentucky, Forenede Stater, 40741
    - Saint Joseph London
  - Louisville, Kentucky, Forenede Stater, 40202
    - Jewish Hospital
  - Louisville, Kentucky, Forenede Stater, 40245
    - UofL Health Medical Center Northeast
  - Louisville, Kentucky, Forenede Stater, 40215
    - Saints Mary and Elizabeth Hospital
  - Mount Sterling, Kentucky, Forenede Stater, 40353
    - Saint Joseph Mount Sterling
  - Shepherdsville, Kentucky, Forenede Stater, 40165
    - Jewish Hospital Medical Center South
- Louisiana
  - Baton Rouge, Louisiana, Forenede Stater, 70805
    - LSU Health Baton Rouge-North Clinic
  - Baton Rouge, Louisiana, Forenede Stater, 70809
    - Louisiana Hematology Oncology Associates LLC
  - Baton Rouge, Louisiana, Forenede Stater, 70809
    - Mary Bird Perkins Cancer Center
  - Baton Rouge, Louisiana, Forenede Stater, 70809
    - Our Lady of the Lake Physicians Group - Medical Oncology
  - Baton Rouge, Louisiana, Forenede Stater, 70808
    - Our Lady of The Lake
  - Covington, Louisiana, Forenede Stater, 70433
    - Northshore Oncology Associates-Covington
  - Houma, Louisiana, Forenede Stater, 70360
    - Terrebonne General Medical Center
- Maine
  - Augusta, Maine, Forenede Stater, 04330
    - Harold Alfond Center for Cancer Care
  - Biddeford, Maine, Forenede Stater, 04005
    - MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford
  - Sanford, Maine, Forenede Stater, 04073
    - MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford
  - South Portland, Maine, Forenede Stater, 04106
    - Maine Medical Partners - South Portland
- Maryland
  - Baltimore, Maryland, Forenede Stater, 21229
    - Saint Agnes Hospital
- Massachusetts
  - Boston, Massachusetts, Forenede Stater, 02111
    - Tufts Medical Center
  - Springfield, Massachusetts, Forenede Stater, 01104
    - Mercy Medical Center
  - Worcester, Massachusetts, Forenede Stater, 01655
    - UMass Memorial Medical Center - University Campus
- Michigan
  - Adrian, Michigan, Forenede Stater, 49221
    - Hickman Cancer Center
  - Ann Arbor, Michigan, Forenede Stater, 48106
    - Saint Joseph Mercy Hospital
  - Battle Creek, Michigan, Forenede Stater, 49017
    - Bronson Battle Creek
  - Bay City, Michigan, Forenede Stater, 48706
    - McLaren Cancer Institute-Bay City
  - Brighton, Michigan, Forenede Stater, 48114
    - Saint Joseph Mercy Brighton
  - Brighton, Michigan, Forenede Stater, 48114
    - Trinity Health IHA Medical Group Hematology Oncology - Brighton
  - Canton, Michigan, Forenede Stater, 48188
    - Saint Joseph Mercy Canton
  - Canton, Michigan, Forenede Stater, 48188
    - Trinity Health IHA Medical Group Hematology Oncology - Canton
  - Caro, Michigan, Forenede Stater, 48723
    - Caro Cancer Center
  - Chelsea, Michigan, Forenede Stater, 48118
    - Saint Joseph Mercy Chelsea
  - Chelsea, Michigan, Forenede Stater, 48118
    - Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
  - Clarkston, Michigan, Forenede Stater, 48346
    - Hematology Oncology Consultants-Clarkston
  - Clarkston, Michigan, Forenede Stater, 48346
    - Newland Medical Associates-Clarkston
  - Detroit, Michigan, Forenede Stater, 48201
    - Wayne State University/Karmanos Cancer Institute
  - Detroit, Michigan, Forenede Stater, 48236
    - Ascension Saint John Hospital
  - East China, Michigan, Forenede Stater, 48054
    - Great Lakes Cancer Management Specialists-Doctors Park
  - Farmington Hills, Michigan, Forenede Stater, 48334
    - Weisberg Cancer Treatment Center
  - Flint, Michigan, Forenede Stater, 48532
    - McLaren Cancer Institute-Flint
  - Flint, Michigan, Forenede Stater, 48503
    - Hurley Medical Center
  - Flint, Michigan, Forenede Stater, 48503
    - Genesee Cancer and Blood Disease Treatment Center
  - Flint, Michigan, Forenede Stater, 48503
    - Genesee Hematology Oncology PC
  - Flint, Michigan, Forenede Stater, 48503
    - Genesys Hurley Cancer Institute
  - Grand Rapids, Michigan, Forenede Stater, 49503
    - Spectrum Health at Butterworth Campus
  - Grand Rapids, Michigan, Forenede Stater, 49503
    - Helen DeVos Children's Hospital at Spectrum Health
  - Grand Rapids, Michigan, Forenede Stater, 49503
    - Trinity Health Grand Rapids Hospital
  - Grosse Pointe Woods, Michigan, Forenede Stater, 48236
    - Academic Hematology Oncology Specialists
  - Grosse Pointe Woods, Michigan, Forenede Stater, 48236
    - Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
  - Grosse Pointe Woods, Michigan, Forenede Stater, 48236
    - Michigan Breast Specialists-Grosse Pointe Woods
  - Kalamazoo, Michigan, Forenede Stater, 49007
    - West Michigan Cancer Center
  - Kalamazoo, Michigan, Forenede Stater, 49007
    - Bronson Methodist Hospital
  - Kalamazoo, Michigan, Forenede Stater, 49048
    - Borgess Medical Center
  - Kalamazoo, Michigan, Forenede Stater, 49009
    - Ascension Borgess Cancer Center
  - Lansing, Michigan, Forenede Stater, 48912
    - Sparrow Hospital
  - Livonia, Michigan, Forenede Stater, 48154
    - Trinity Health Saint Mary Mercy Livonia Hospital
  - Livonia, Michigan, Forenede Stater, 48154
    - Hope Cancer Clinic
  - Macomb, Michigan, Forenede Stater, 48044
    - Great Lakes Cancer Management Specialists-Macomb Medical Campus
  - Macomb, Michigan, Forenede Stater, 48044
    - Michigan Breast Specialists-Macomb Township
  - Marlette, Michigan, Forenede Stater, 48453
    - Saint Mary's Oncology/Hematology Associates of Marlette
  - Monroe, Michigan, Forenede Stater, 48162
    - Toledo Clinic Cancer Centers-Monroe
  - Mount Clemens, Michigan, Forenede Stater, 48043
    - McLaren Cancer Institute-Macomb
  - Mount Pleasant, Michigan, Forenede Stater, 48858
    - McLaren Cancer Institute-Central Michigan
  - Muskegon, Michigan, Forenede Stater, 49444
    - Trinity Health Muskegon Hospital
  - Niles, Michigan, Forenede Stater, 49120
    - Lakeland Hospital Niles
  - Norton Shores, Michigan, Forenede Stater, 49444
    - Cancer and Hematology Centers of Western Michigan - Norton Shores
  - Novi, Michigan, Forenede Stater, 48374
    - Ascension Providence Hospitals - Novi
  - Pontiac, Michigan, Forenede Stater, 48341
    - Saint Joseph Mercy Oakland
  - Pontiac, Michigan, Forenede Stater, 48341
    - 21st Century Oncology-Pontiac
  - Pontiac, Michigan, Forenede Stater, 48341
    - Hope Cancer Center
  - Pontiac, Michigan, Forenede Stater, 48341
    - Newland Medical Associates-Pontiac
  - Port Huron, Michigan, Forenede Stater, 48060
    - McLaren-Port Huron
  - Reed City, Michigan, Forenede Stater, 49677
    - Spectrum Health Reed City Hospital
  - Rochester Hills, Michigan, Forenede Stater, 48309
    - Great Lakes Cancer Management Specialists-Rochester Hills
  - Saginaw, Michigan, Forenede Stater, 48601
    - Ascension Saint Mary's Hospital
  - Saginaw, Michigan, Forenede Stater, 48604
    - Oncology Hematology Associates of Saginaw Valley PC
  - Saint Joseph, Michigan, Forenede Stater, 49085
    - Lakeland Medical Center Saint Joseph
  - Saint Joseph, Michigan, Forenede Stater, 49085
    - Marie Yeager Cancer Center
  - Southfield, Michigan, Forenede Stater, 48075
    - Ascension Providence Hospitals - Southfield
  - Sterling Heights, Michigan, Forenede Stater, 48312
    - Bhadresh Nayak MD PC-Sterling Heights
  - Tawas City, Michigan, Forenede Stater, 48764
    - Ascension Saint Joseph Hospital
  - Traverse City, Michigan, Forenede Stater, 49684
    - Munson Medical Center
  - Warren, Michigan, Forenede Stater, 48093
    - Saint John Macomb-Oakland Hospital
  - Warren, Michigan, Forenede Stater, 48088
    - Advanced Breast Care Center PLLC
  - Warren, Michigan, Forenede Stater, 48093
    - Great Lakes Cancer Management Specialists-Macomb Professional Building
  - Warren, Michigan, Forenede Stater, 48093
    - Macomb Hematology Oncology PC
  - Warren, Michigan, Forenede Stater, 48093
    - Michigan Breast Specialists-Warren
  - West Branch, Michigan, Forenede Stater, 48661
    - Saint Mary's Oncology/Hematology Associates of West Branch
  - Wyoming, Michigan, Forenede Stater, 49519
    - Metro Health Hospital
  - Ypsilanti, Michigan, Forenede Stater, 48197
    - Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
  - Ypsilanti, Michigan, Forenede Stater, 48106
    - Huron Gastroenterology PC
- Minnesota
  - Aitkin, Minnesota, Forenede Stater, 56431
    - Riverwood Healthcare Center
  - Baxter, Minnesota, Forenede Stater, 56425
    - Essentia Health - Baxter Clinic
  - Bemidji, Minnesota, Forenede Stater, 56601
    - Sanford Joe Lueken Cancer Center
  - Brainerd, Minnesota, Forenede Stater, 56401
    - Essentia Health Saint Joseph's Medical Center
  - Burnsville, Minnesota, Forenede Stater, 55337
    - Fairview Ridges Hospital
  - Burnsville, Minnesota, Forenede Stater, 55337
    - Minnesota Oncology - Burnsville
  - Cambridge, Minnesota, Forenede Stater, 55008
    - Cambridge Medical Center
  - Coon Rapids, Minnesota, Forenede Stater, 55433
    - Mercy Hospital
  - Deer River, Minnesota, Forenede Stater, 56636
    - Essentia Health - Deer River Clinic
  - Detroit Lakes, Minnesota, Forenede Stater, 56501
    - Essentia Health Saint Mary's - Detroit Lakes Clinic
  - Duluth, Minnesota, Forenede Stater, 55805
    - Essentia Health Cancer Center
  - Duluth, Minnesota, Forenede Stater, 55805
    - Essentia Health Saint Mary's Medical Center
  - Duluth, Minnesota, Forenede Stater, 55805
    - Miller-Dwan Hospital
  - Edina, Minnesota, Forenede Stater, 55435
    - Fairview Southdale Hospital
  - Ely, Minnesota, Forenede Stater, 55731
    - Essentia Health - Ely Clinic
  - Fergus Falls, Minnesota, Forenede Stater, 56537
    - Lake Region Healthcare Corporation-Cancer Care
  - Fosston, Minnesota, Forenede Stater, 56542
    - Essentia Health - Fosston
  - Fridley, Minnesota, Forenede Stater, 55432
    - Unity Hospital
  - Hibbing, Minnesota, Forenede Stater, 55746
    - Essentia Health Hibbing Clinic
  - International Falls, Minnesota, Forenede Stater, 56649
    - Essentia Health - International Falls Clinic
  - Maple Grove, Minnesota, Forenede Stater, 55369
    - Fairview Clinics and Surgery Center Maple Grove
  - Maplewood, Minnesota, Forenede Stater, 55109
    - Saint John's Hospital - Healtheast
  - Maplewood, Minnesota, Forenede Stater, 55109
    - Minnesota Oncology Hematology PA-Maplewood
  - Minneapolis, Minnesota, Forenede Stater, 55415
    - Hennepin County Medical Center
  - Minneapolis, Minnesota, Forenede Stater, 55407
    - Abbott-Northwestern Hospital
  - Minneapolis, Minnesota, Forenede Stater, 55454
    - Health Partners Inc
  - Monticello, Minnesota, Forenede Stater, 55362
    - Monticello Cancer Center
  - Moose Lake, Minnesota, Forenede Stater, 55767
    - Essentia Health - Moose Lake Clinic
  - New Ulm, Minnesota, Forenede Stater, 56073
    - New Ulm Medical Center
  - Park Rapids, Minnesota, Forenede Stater, 56470
    - Essentia Health - Park Rapids
  - Princeton, Minnesota, Forenede Stater, 55371
    - Fairview Northland Medical Center
  - Robbinsdale, Minnesota, Forenede Stater, 55422
    - North Memorial Medical Health Center
  - Saint Louis Park, Minnesota, Forenede Stater, 55416
    - Park Nicollet Clinic - Saint Louis Park
  - Saint Paul, Minnesota, Forenede Stater, 55101
    - Regions Hospital
  - Saint Paul, Minnesota, Forenede Stater, 55102
    - United Hospital
  - Sandstone, Minnesota, Forenede Stater, 55072
    - Essentia Health Sandstone
  - Shakopee, Minnesota, Forenede Stater, 55379
    - Saint Francis Regional Medical Center
  - Stillwater, Minnesota, Forenede Stater, 55082
    - Lakeview Hospital
  - Thief River Falls, Minnesota, Forenede Stater, 56701
    - Sanford Thief River Falls Medical Center
  - Virginia, Minnesota, Forenede Stater, 55792
    - Essentia Health Virginia Clinic
  - Waconia, Minnesota, Forenede Stater, 55387
    - Ridgeview Medical Center
  - Willmar, Minnesota, Forenede Stater, 56201
    - Rice Memorial Hospital
  - Woodbury, Minnesota, Forenede Stater, 55125
    - Minnesota Oncology Hematology PA-Woodbury
  - Worthington, Minnesota, Forenede Stater, 56187
    - Sanford Cancer Center Worthington
  - Wyoming, Minnesota, Forenede Stater, 55092
    - Fairview Lakes Medical Center
- Mississippi
  - Grenada, Mississippi, Forenede Stater, 38901
    - Baptist Cancer Center-Grenada
  - New Albany, Mississippi, Forenede Stater, 38652
    - Baptist Memorial Hospital and Cancer Center-Union County
  - Oxford, Mississippi, Forenede Stater, 38655
    - Baptist Memorial Hospital and Cancer Center-Oxford
  - Southhaven, Mississippi, Forenede Stater, 38671
    - Baptist Memorial Hospital and Cancer Center-Desoto
- Missouri
  - Ballwin, Missouri, Forenede Stater, 63011
    - Saint Louis Cancer and Breast Institute-Ballwin
  - Bolivar, Missouri, Forenede Stater, 65613
    - Central Care Cancer Center - Bolivar
  - Branson, Missouri, Forenede Stater, 65616
    - Cox Cancer Center Branson
  - Cape Girardeau, Missouri, Forenede Stater, 63703
    - Saint Francis Medical Center
  - Cape Girardeau, Missouri, Forenede Stater, 63703
    - Southeast Cancer Center
  - City of Saint Peters, Missouri, Forenede Stater, 63376
    - Siteman Cancer Center at Saint Peters Hospital
  - Creve Coeur, Missouri, Forenede Stater, 63141
    - Siteman Cancer Center at West County Hospital
  - Farmington, Missouri, Forenede Stater, 63640
    - Parkland Health Center - Farmington
  - Independence, Missouri, Forenede Stater, 64057
    - Centerpoint Medical Center LLC
  - Jefferson City, Missouri, Forenede Stater, 65109
    - Capital Region Southwest Campus
  - Joplin, Missouri, Forenede Stater, 64804
    - Freeman Health System
  - Joplin, Missouri, Forenede Stater, 64804
    - Mercy Hospital Joplin
  - Kansas City, Missouri, Forenede Stater, 64111
    - Saint Luke's Hospital of Kansas City
  - Kansas City, Missouri, Forenede Stater, 64132
    - Research Medical Center
  - Lee's Summit, Missouri, Forenede Stater, 64086
    - Saint Luke's East - Lee's Summit
  - Rolla, Missouri, Forenede Stater, 65401
    - Delbert Day Cancer Institute at PCRMC
  - Rolla, Missouri, Forenede Stater, 65401
    - Mercy Clinic-Rolla-Cancer and Hematology
  - Saint Joseph, Missouri, Forenede Stater, 64506
    - Heartland Regional Medical Center
  - Sainte Genevieve, Missouri, Forenede Stater, 63670
    - Sainte Genevieve County Memorial Hospital
  - Springfield, Missouri, Forenede Stater, 65807
    - CoxHealth South Hospital
  - Springfield, Missouri, Forenede Stater, 65804
    - Mercy Hospital Springfield
  - St Louis, Missouri, Forenede Stater, 63110
    - Washington University School of Medicine
  - St Louis, Missouri, Forenede Stater, 63129
    - Siteman Cancer Center-South County
  - St Louis, Missouri, Forenede Stater, 63136
    - Siteman Cancer Center at Christian Hospital
  - St Louis, Missouri, Forenede Stater, 63131
    - Missouri Baptist Medical Center
  - St Louis, Missouri, Forenede Stater, 63141
    - Mercy Hospital Saint Louis
  - St Louis, Missouri, Forenede Stater, 63128
    - Mercy Hospital South
  - St Louis, Missouri, Forenede Stater, 63109
    - Saint Louis Cancer and Breast Institute-South City
  - Sullivan, Missouri, Forenede Stater, 63080
    - Missouri Baptist Sullivan Hospital
  - Sunset Hills, Missouri, Forenede Stater, 63127
    - Missouri Baptist Outpatient Center-Sunset Hills
  - Washington, Missouri, Forenede Stater, 63090
    - Mercy Hospital Washington
- Montana
  - Anaconda, Montana, Forenede Stater, 59711
    - Community Hospital of Anaconda
  - Billings, Montana, Forenede Stater, 59101
    - Billings Clinic Cancer Center
  - Bozeman, Montana, Forenede Stater, 59715
    - Bozeman Deaconess Hospital
  - Great Falls, Montana, Forenede Stater, 59405
    - Great Falls Clinic
  - Great Falls, Montana, Forenede Stater, 59405
    - Benefis Healthcare- Sletten Cancer Institute
  - Kalispell, Montana, Forenede Stater, 59901
    - Kalispell Regional Medical Center
  - Missoula, Montana, Forenede Stater, 59804
    - Community Medical Hospital
  - Missoula, Montana, Forenede Stater, 59802
    - Saint Patrick Hospital - Community Hospital
- Nebraska
  - Grand Island, Nebraska, Forenede Stater, 68803
    - CHI Health Saint Francis
  - Kearney, Nebraska, Forenede Stater, 68847
    - CHI Health Good Samaritan
  - Lincoln, Nebraska, Forenede Stater, 68516
    - Southeast Nebraska Cancer Center - 68th Street Place
  - Lincoln, Nebraska, Forenede Stater, 68510
    - Saint Elizabeth Regional Medical Center
  - Lincoln, Nebraska, Forenede Stater, 68516
    - Cancer Partners of Nebraska - Pine Lake
  - Omaha, Nebraska, Forenede Stater, 68114
    - Nebraska Methodist Hospital
  - Omaha, Nebraska, Forenede Stater, 68124
    - Alegent Health Bergan Mercy Medical Center
  - Omaha, Nebraska, Forenede Stater, 68122
    - Alegent Health Immanuel Medical Center
  - Omaha, Nebraska, Forenede Stater, 68130
    - Alegent Health Lakeside Hospital
  - Omaha, Nebraska, Forenede Stater, 68131
    - Creighton University Medical Center
  - Omaha, Nebraska, Forenede Stater, 68114
    - Oncology Associates PC
  - Omaha, Nebraska, Forenede Stater, 68114
    - Nebraska Cancer Specialists/Oncology Hematology West PC - MECC
  - Papillion, Nebraska, Forenede Stater, 68046
    - Midlands Community Hospital
- Nevada
  - Carson City, Nevada, Forenede Stater, 89703
    - Carson Tahoe Regional Medical Center
  - Henderson, Nevada, Forenede Stater, 89052
    - Comprehensive Cancer Centers of Nevada - Henderson
  - Henderson, Nevada, Forenede Stater, 89052
    - OptumCare Cancer Care at Seven Hills
  - Henderson, Nevada, Forenede Stater, 89052
    - Cancer and Blood Specialists-Henderson
  - Henderson, Nevada, Forenede Stater, 89052
    - Las Vegas Cancer Center-Henderson
  - Henderson, Nevada, Forenede Stater, 89074
    - Comprehensive Cancer Centers of Nevada-Southeast Henderson
  - Henderson, Nevada, Forenede Stater, 89074
    - GenesisCare USA - Henderson
  - Henderson, Nevada, Forenede Stater, 89052
    - Comprehensive Cancer Centers of Nevada-Horizon Ridge
  - Henderson, Nevada, Forenede Stater, 89074
    - Las Vegas Urology - Green Valley
  - Henderson, Nevada, Forenede Stater, 89074
    - Las Vegas Urology - Pebble
  - Henderson, Nevada, Forenede Stater, 89074
    - Urology Specialists of Nevada - Green Valley
  - Las Vegas, Nevada, Forenede Stater, 89144
    - Summerlin Hospital Medical Center
  - Las Vegas, Nevada, Forenede Stater, 89109
    - Sunrise Hospital and Medical Center
  - Las Vegas, Nevada, Forenede Stater, 89102
    - OptumCare Cancer Care at Charleston
  - Las Vegas, Nevada, Forenede Stater, 89106
    - Radiation Oncology Centers of Nevada Central
  - Las Vegas, Nevada, Forenede Stater, 89109
    - GenesisCare USA - Las Vegas
  - Las Vegas, Nevada, Forenede Stater, 89119
    - Radiation Oncology Centers of Nevada Southeast
  - Las Vegas, Nevada, Forenede Stater, 89128
    - Comprehensive Cancer Centers of Nevada - Northwest
  - Las Vegas, Nevada, Forenede Stater, 89128
    - OptumCare Cancer Care at MountainView
  - Las Vegas, Nevada, Forenede Stater, 89135
    - Alliance for Childhood Diseases/Cure 4 the Kids Foundation
  - Las Vegas, Nevada, Forenede Stater, 89144
    - Comprehensive Cancer Centers of Nevada - Town Center
  - Las Vegas, Nevada, Forenede Stater, 89144
    - Comprehensive Cancer Centers of Nevada-Summerlin
  - Las Vegas, Nevada, Forenede Stater, 89148
    - Comprehensive Cancer Centers of Nevada
  - Las Vegas, Nevada, Forenede Stater, 89148
    - OptumCare Cancer Care at Fort Apache
  - Las Vegas, Nevada, Forenede Stater, 89169
    - Comprehensive Cancer Centers of Nevada - Central Valley
  - Las Vegas, Nevada, Forenede Stater, 89102
    - University Medical Center of Southern Nevada
  - Las Vegas, Nevada, Forenede Stater, 89128
    - GenesisCare USA - Vegas Tenaya
  - Las Vegas, Nevada, Forenede Stater, 89148-2405
    - Las Vegas Cancer Center-Medical Center
  - Las Vegas, Nevada, Forenede Stater, 89148
    - GenesisCare USA - Fort Apache
  - Las Vegas, Nevada, Forenede Stater, 89128
    - Ann M Wierman MD LTD
  - Las Vegas, Nevada, Forenede Stater, 89074
    - Las Vegas Urology - Pecos
  - Las Vegas, Nevada, Forenede Stater, 89102
    - Desert West Surgery
  - Las Vegas, Nevada, Forenede Stater, 89103
    - Hope Cancer Care of Nevada
  - Las Vegas, Nevada, Forenede Stater, 89106
    - Urology Specialists of Nevada - Central
  - Las Vegas, Nevada, Forenede Stater, 89113
    - Las Vegas Prostate Cancer Center
  - Las Vegas, Nevada, Forenede Stater, 89113
    - Las Vegas Urology - Sunset
  - Las Vegas, Nevada, Forenede Stater, 89128
    - Las Vegas Urology - Cathedral Rock
  - Las Vegas, Nevada, Forenede Stater, 89128
    - Las Vegas Urology - Smoke Ranch
  - Las Vegas, Nevada, Forenede Stater, 89128
    - Urology Specialists of Nevada - Northwest
  - Las Vegas, Nevada, Forenede Stater, 89169
    - University Cancer Center
  - Las Vegas, Nevada, Forenede Stater, 89113
    - Urology Specialists of Nevada - Southwest
  - Pahrump, Nevada, Forenede Stater, 89048
    - Hope Cancer Care of Nevada-Pahrump
  - Reno, Nevada, Forenede Stater, 89502
    - Renown Regional Medical Center
  - Reno, Nevada, Forenede Stater, 89503
    - Saint Mary's Regional Medical Center
  - Reno, Nevada, Forenede Stater, 89509
    - Radiation Oncology Associates
- New Jersey
  - Basking Ridge, New Jersey, Forenede Stater, 07920
    - Memorial Sloan Kettering Basking Ridge
  - Englewood, New Jersey, Forenede Stater, 07631
    - Englewood Hospital and Medical Center
  - Middletown, New Jersey, Forenede Stater, 07748
    - Memorial Sloan Kettering Monmouth
  - Montvale, New Jersey, Forenede Stater, 07645
    - Memorial Sloan Kettering Bergen
  - Paramus, New Jersey, Forenede Stater, 07652
    - The Valley Hospital-Luckow Pavilion
  - Ridgewood, New Jersey, Forenede Stater, 07450
    - Valley Hospital
  - Ridgewood, New Jersey, Forenede Stater, 07450
    - Neurosurgeons of New Jersey-Ridgewood
  - Teaneck, New Jersey, Forenede Stater, 07666
    - Holy Name Hospital
  - Wayne, New Jersey, Forenede Stater, 07470
    - Valley Medical Group - Wayne Multispecialty Practice
  - Westwood, New Jersey, Forenede Stater, 07675
    - Valley Health System-Hematology/Oncology
- New Mexico
  - Albuquerque, New Mexico, Forenede Stater, 87102
    - University of New Mexico Cancer Center
- New York
  - Bay Shore, New York, Forenede Stater, 11706
    - Northwell Health Imbert Cancer Center
  - Commack, New York, Forenede Stater, 11725
    - Memorial Sloan Kettering Commack
  - East White Plains, New York, Forenede Stater, 10604
    - Memorial Sloan Kettering Westchester
  - Fresh Meadows, New York, Forenede Stater, 11366
    - Queens Medical Associates PC
  - Glens Falls, New York, Forenede Stater, 12801
    - Glens Falls Hospital
  - Lake Success, New York, Forenede Stater, 11042
    - Northwell Health/Center for Advanced Medicine
  - Mineola, New York, Forenede Stater, 11501
    - NYU Winthrop Hospital
  - New York, New York, Forenede Stater, 10065
    - Memorial Sloan Kettering Cancer Center
  - New York, New York, Forenede Stater, 10029
    - Mount Sinai Hospital
  - New York, New York, Forenede Stater, 10016
    - Laura and Isaac Perlmutter Cancer Center at NYU Langone
  - Rochester, New York, Forenede Stater, 14642
    - University of Rochester
  - Rochester, New York, Forenede Stater, 14620
    - Highland Hospital
  - Sleepy Hollow, New York, Forenede Stater, 10591
    - Phelps Memorial Hospital Center
  - Staten Island, New York, Forenede Stater, 10305
    - Staten Island University Hospital
  - Stony Brook, New York, Forenede Stater, 11794
    - Stony Brook University Medical Center
  - The Bronx, New York, Forenede Stater, 10461
    - Montefiore Medical Center-Einstein Campus
  - The Bronx, New York, Forenede Stater, 10467
    - Montefiore Medical Center - Moses Campus
  - The Bronx, New York, Forenede Stater, 10461
    - Montefiore Medical Center-Weiler Hospital
  - Uniondale, New York, Forenede Stater, 11553
    - Memorial Sloan Kettering Nassau
  - Webster, New York, Forenede Stater, 14580
    - Wilmot Cancer Institute at Webster
- North Carolina
  - Clemmons, North Carolina, Forenede Stater, 27012
    - Wake Forest University at Clemmons
  - Clinton, North Carolina, Forenede Stater, 28328
    - Southeastern Medical Oncology Center-Clinton
  - Elkin, North Carolina, Forenede Stater, 28521
    - Wake Forest University at Elkin
  - Goldsboro, North Carolina, Forenede Stater, 27534
    - Southeastern Medical Oncology Center-Goldsboro
  - Greenville, North Carolina, Forenede Stater, 27834
    - East Carolina University
  - Hendersonville, North Carolina, Forenede Stater, 28791
    - Margaret R Pardee Memorial Hospital
  - Jacksonville, North Carolina, Forenede Stater, 28546
    - Southeastern Medical Oncology Center-Jacksonville
  - Lexington, North Carolina, Forenede Stater, 27292
    - Wake Forest University at Lexington
  - Mount Airy, North Carolina, Forenede Stater, 27030
    - Wake Forest University at Mount Airy
  - Statesville, North Carolina, Forenede Stater, 28677
    - Wake Forest Baptist Health - Hematology Oncology - Statesville
  - Washington, North Carolina, Forenede Stater, 27889
    - Marion L Shepard Cancer Center at Vidant Beaufort Hospital
  - Wilkesboro, North Carolina, Forenede Stater, 28659
    - Wake Forest Baptist Health - Wilkes Medical Center
  - Winston-Salem, North Carolina, Forenede Stater, 27157
    - Wake Forest University Health Sciences
- North Dakota
  - Bismarck, North Dakota, Forenede Stater, 58501
    - Sanford Bismarck Medical Center
  - Fargo, North Dakota, Forenede Stater, 58122
    - Sanford Roger Maris Cancer Center
  - Fargo, North Dakota, Forenede Stater, 58103
    - Essentia Health Cancer Center-South University Clinic
  - Fargo, North Dakota, Forenede Stater, 58122
    - Sanford Broadway Medical Center
  - Fargo, North Dakota, Forenede Stater, 58103
    - Sanford South University Medical Center
  - Fargo, North Dakota, Forenede Stater, 58103
    - Southpointe-Sanford Medical Center Fargo
  - Fargo, North Dakota, Forenede Stater, 58104
    - Sanford Medical Center Fargo
  - Jamestown, North Dakota, Forenede Stater, 58401
    - Essentia Health - Jamestown Clinic
- Ohio
  - Beavercreek, Ohio, Forenede Stater, 45431
    - Indu and Raj Soin Medical Center
  - Belpre, Ohio, Forenede Stater, 45714
    - Strecker Cancer Center-Belpre
  - Boardman, Ohio, Forenede Stater, 44512
    - Saint Elizabeth Boardman Hospital
  - Canton, Ohio, Forenede Stater, 44708
    - Cleveland Clinic Mercy Hospital
  - Canton, Ohio, Forenede Stater, 44708
    - Mercy Hematology and Oncology Associates Inc
  - Centerville, Ohio, Forenede Stater, 45459
    - Miami Valley Hospital South
  - Centerville, Ohio, Forenede Stater, 45459
    - Dayton Physicians LLC-Miami Valley South
  - Chillicothe, Ohio, Forenede Stater, 45601
    - Adena Regional Medical Center
  - Cincinnati, Ohio, Forenede Stater, 45220
    - Good Samaritan Hospital - Cincinnati
  - Cincinnati, Ohio, Forenede Stater, 45242
    - Bethesda North Hospital
  - Cincinnati, Ohio, Forenede Stater, 45236
    - Oncology Hematology Care Inc-Kenwood
  - Cincinnati, Ohio, Forenede Stater, 45247
    - TriHealth Cancer Institute-Westside
  - Cincinnati, Ohio, Forenede Stater, 45255
    - TriHealth Cancer Institute-Anderson
  - Cleveland, Ohio, Forenede Stater, 44195
    - Cleveland Clinic Foundation
  - Cleveland, Ohio, Forenede Stater, 44111
    - Cleveland Clinic Cancer Center/Fairview Hospital
  - Columbus, Ohio, Forenede Stater, 43214
    - Riverside Methodist Hospital
  - Columbus, Ohio, Forenede Stater, 43219
    - The Mark H Zangmeister Center
  - Columbus, Ohio, Forenede Stater, 43214
    - Columbus Oncology and Hematology Associates Inc
  - Columbus, Ohio, Forenede Stater, 43228
    - Doctors Hospital
  - Columbus, Ohio, Forenede Stater, 43213
    - Mount Carmel East Hospital
  - Columbus, Ohio, Forenede Stater, 43215
    - Grant Medical Center
  - Columbus, Ohio, Forenede Stater, 43222
    - Mount Carmel Health Center West
  - Dayton, Ohio, Forenede Stater, 45409
    - Miami Valley Hospital
  - Dayton, Ohio, Forenede Stater, 45415
    - Dayton Physician LLC-Miami Valley Hospital North
  - Dayton, Ohio, Forenede Stater, 45415
    - Miami Valley Hospital North
  - Dayton, Ohio, Forenede Stater, 45409
    - Dayton Blood and Cancer Center
  - Delaware, Ohio, Forenede Stater, 43015
    - Delaware Health Center-Grady Cancer Center
  - Delaware, Ohio, Forenede Stater, 43015
    - Grady Memorial Hospital
  - Dublin, Ohio, Forenede Stater, 43016
    - Dublin Methodist Hospital
  - Dublin, Ohio, Forenede Stater, 43016
    - Columbus Oncology and Hematology Associates
  - Findlay, Ohio, Forenede Stater, 45840
    - Blanchard Valley Hospital
  - Findlay, Ohio, Forenede Stater, 45840
    - Armes Family Cancer Center
  - Findlay, Ohio, Forenede Stater, 45840
    - Orion Cancer Care
  - Franklin, Ohio, Forenede Stater, 45005-1066
    - Atrium Medical Center-Middletown Regional Hospital
  - Franklin, Ohio, Forenede Stater, 45005
    - Dayton Physicians LLC-Atrium
  - Gahanna, Ohio, Forenede Stater, 43230
    - Central Ohio Breast and Endocrine Surgery
  - Greenville, Ohio, Forenede Stater, 45331
    - Wayne Hospital
  - Greenville, Ohio, Forenede Stater, 45331
    - Dayton Physicians LLC-Wayne
  - Grove City, Ohio, Forenede Stater, 43123
    - Mount Carmel Grove City Hospital
  - Grove City, Ohio, Forenede Stater, 43123
    - Zangmeister Center Grove City
  - Independence, Ohio, Forenede Stater, 44131
    - Cleveland Clinic Cancer Center Independence
  - Kettering, Ohio, Forenede Stater, 45429
    - Kettering Medical Center
  - Kettering, Ohio, Forenede Stater, 45409
    - Greater Dayton Cancer Center
  - Kettering, Ohio, Forenede Stater, 45420
    - First Dayton Cancer Care
  - Lancaster, Ohio, Forenede Stater, 43130
    - Fairfield Medical Center
  - Lima, Ohio, Forenede Stater, 45801
    - Saint Rita's Medical Center
  - Mansfield, Ohio, Forenede Stater, 44906
    - Cleveland Clinic Cancer Center Mansfield
  - Mansfield, Ohio, Forenede Stater, 44903
    - OhioHealth Mansfield Hospital
  - Marietta, Ohio, Forenede Stater, 45750
    - Marietta Memorial Hospital
  - Marion, Ohio, Forenede Stater, 43302
    - OhioHealth Marion General Hospital
  - Maumee, Ohio, Forenede Stater, 43537
    - Toledo Clinic Cancer Centers-Maumee
  - Mayfield Heights, Ohio, Forenede Stater, 44124
    - Hillcrest Hospital Cancer Center
  - Mount Vernon, Ohio, Forenede Stater, 43050
    - Knox Community Hospital
  - Newark, Ohio, Forenede Stater, 43055
    - Licking Memorial Hospital
  - Newark, Ohio, Forenede Stater, 43055
    - Newark Radiation Oncology
  - Perrysburg, Ohio, Forenede Stater, 43551
    - Mercy Health Perrysburg Cancer Center
  - Portsmouth, Ohio, Forenede Stater, 45662
    - Southern Ohio Medical Center
  - Sandusky, Ohio, Forenede Stater, 44870
    - North Coast Cancer Care
  - Springfield, Ohio, Forenede Stater, 45505
    - Springfield Regional Medical Center
  - Springfield, Ohio, Forenede Stater, 45504
    - Springfield Regional Cancer Center
  - Steubenville, Ohio, Forenede Stater, 43952
    - Trinity's Tony Teramana Cancer Center
  - Strongsville, Ohio, Forenede Stater, 44136
    - Cleveland Clinic Cancer Center Strongsville
  - Sylvania, Ohio, Forenede Stater, 43560
    - ProMedica Flower Hospital
  - Toledo, Ohio, Forenede Stater, 43606
    - ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
  - Toledo, Ohio, Forenede Stater, 43608
    - Saint Vincent Mercy Medical Center
  - Toledo, Ohio, Forenede Stater, 43623
    - Mercy Health - Saint Anne Hospital
  - Toledo, Ohio, Forenede Stater, 43623
    - Toledo Clinic Cancer Centers-Toledo
  - Toledo, Ohio, Forenede Stater, 43614
    - University of Toledo
  - Troy, Ohio, Forenede Stater, 45373
    - Upper Valley Medical Center
  - Troy, Ohio, Forenede Stater, 45373
    - Dayton Physicians LLC - Troy
  - Warren, Ohio, Forenede Stater, 44484
    - Saint Joseph Warren Hospital
  - Warrensville Heights, Ohio, Forenede Stater, 44122
    - South Pointe Hospital
  - Westerville, Ohio, Forenede Stater, 43081
    - Saint Ann's Hospital
  - Wooster, Ohio, Forenede Stater, 44691
    - Cleveland Clinic Wooster Family Health and Surgery Center
  - Youngstown, Ohio, Forenede Stater, 44501
    - Saint Elizabeth Youngstown Hospital
  - Zanesville, Ohio, Forenede Stater, 43701
    - Genesis Healthcare System Cancer Care Center
- Oklahoma
  - Oklahoma City, Oklahoma, Forenede Stater, 73104
    - University of Oklahoma Health Sciences Center
  - Oklahoma City, Oklahoma, Forenede Stater, 73120
    - Mercy Hospital Oklahoma City
- Oregon
  - Baker City, Oregon, Forenede Stater, 97814
    - Saint Alphonsus Medical Center-Baker City
  - Bend, Oregon, Forenede Stater, 97701
    - Saint Charles Health System
  - Clackamas, Oregon, Forenede Stater, 97015
    - Clackamas Radiation Oncology Center
  - Clackamas, Oregon, Forenede Stater, 97015
    - Providence Cancer Institute Clackamas Clinic
  - Coos Bay, Oregon, Forenede Stater, 97420
    - Bay Area Hospital
  - Newberg, Oregon, Forenede Stater, 97132
    - Providence Newberg Medical Center
  - Ontario, Oregon, Forenede Stater, 97914
    - Saint Alphonsus Medical Center-Ontario
  - Oregon City, Oregon, Forenede Stater, 97045
    - Providence Willamette Falls Medical Center
  - Portland, Oregon, Forenede Stater, 97213
    - Providence Portland Medical Center
  - Portland, Oregon, Forenede Stater, 97225
    - Providence Saint Vincent Medical Center
  - Redmond, Oregon, Forenede Stater, 97756
    - Saint Charles Health System-Redmond
- Pennsylvania
  - Allentown, Pennsylvania, Forenede Stater, 18103
    - Lehigh Valley Hospital-Cedar Crest
  - Allentown, Pennsylvania, Forenede Stater, 18104
    - Saint Luke's Cancer Center - Allentown
  - Altoona, Pennsylvania, Forenede Stater, 16601
    - UPMC Altoona
  - Bethlehem, Pennsylvania, Forenede Stater, 18017
    - Lehigh Valley Hospital - Muhlenberg
  - Bethlehem, Pennsylvania, Forenede Stater, 18015
    - Saint Luke's University Hospital-Bethlehem Campus
  - Bryn Mawr, Pennsylvania, Forenede Stater, 19010
    - Bryn Mawr Hospital
  - Chadds Ford, Pennsylvania, Forenede Stater, 19317
    - Christiana Care Health System-Concord Health Center
  - Chambersburg, Pennsylvania, Forenede Stater, 17201
    - Chambersburg Hospital
  - Chambersburg, Pennsylvania, Forenede Stater, 17201
    - WellSpan Medical Oncology and Hematology
  - Danville, Pennsylvania, Forenede Stater, 17822
    - Geisinger Medical Center
  - East Stroudsburg, Pennsylvania, Forenede Stater, 18301
    - Pocono Medical Center
  - Easton, Pennsylvania, Forenede Stater, 18045
    - Saint Luke's Hospital-Anderson Campus
  - Ephrata, Pennsylvania, Forenede Stater, 17522
    - Ephrata Cancer Center
  - Erie, Pennsylvania, Forenede Stater, 16505
    - UPMC Hillman Cancer Center Erie
  - Erie, Pennsylvania, Forenede Stater, 16544
    - Saint Vincent Hospital
  - Gettysburg, Pennsylvania, Forenede Stater, 17325
    - Adams Cancer Center
  - Greensburg, Pennsylvania, Forenede Stater, 15601
    - UPMC Cancer Centers - Arnold Palmer Pavilion
  - Hanover, Pennsylvania, Forenede Stater, 17331
    - Cherry Tree Cancer Center
  - Hazleton, Pennsylvania, Forenede Stater, 18201
    - Geisinger Medical Center-Cancer Center Hazleton
  - Hazleton, Pennsylvania, Forenede Stater, 18201
    - Lehigh Valley Hospital-Hazleton
  - Indiana, Pennsylvania, Forenede Stater, 15701
    - IRMC Cancer Center
  - Jefferson Hills, Pennsylvania, Forenede Stater, 15025
    - Jefferson Hospital
  - Lebanon, Pennsylvania, Forenede Stater, 17042
    - Sechler Family Cancer Center
  - Lewisburg, Pennsylvania, Forenede Stater, 17837
    - Geisinger Medical Oncology-Lewisburg
  - Media, Pennsylvania, Forenede Stater, 19063
    - Riddle Memorial Hospital
  - Monroeville, Pennsylvania, Forenede Stater, 15146
    - Forbes Hospital
  - Monroeville, Pennsylvania, Forenede Stater, 15146
    - UPMC Hillman Cancer Center - Monroeville
  - Mount Pleasant, Pennsylvania, Forenede Stater, 15666
    - UPMC Hillman Cancer Center - Part of Frick Hospital
  - North Huntingdon, Pennsylvania, Forenede Stater, 15642
    - Arnold Palmer Cancer Center Medical Oncology Norwin
  - Paoli, Pennsylvania, Forenede Stater, 19301
    - Paoli Memorial Hospital
  - Philadelphia, Pennsylvania, Forenede Stater, 19111
    - Fox Chase Cancer Center
  - Philadelphia, Pennsylvania, Forenede Stater, 19107
    - Thomas Jefferson University Hospital
  - Philadelphia, Pennsylvania, Forenede Stater, 19140
    - Temple University Hospital
  - Phoenixville, Pennsylvania, Forenede Stater, 19460
    - Phoenixville Hospital
  - Pittsburgh, Pennsylvania, Forenede Stater, 15212
    - Allegheny General Hospital
  - Pittsburgh, Pennsylvania, Forenede Stater, 15224
    - West Penn Hospital
  - Pittsburgh, Pennsylvania, Forenede Stater, 15232
    - University of Pittsburgh Cancer Institute (UPCI)
  - Pittsburgh, Pennsylvania, Forenede Stater, 15243
    - UPMC-Saint Clair Hospital Cancer Center
  - Pottsville, Pennsylvania, Forenede Stater, 17901
    - Geisinger Cancer Services-Pottsville
  - Quakertown, Pennsylvania, Forenede Stater, 18951
    - Saint Luke's Hospital-Quakertown Campus
  - Scranton, Pennsylvania, Forenede Stater, 18510
    - Community Medical Center
  - Selinsgrove, Pennsylvania, Forenede Stater, 17870
    - Geisinger Medical Oncology-Selinsgrove
  - Seneca, Pennsylvania, Forenede Stater, 16346
    - UPMC Cancer Center at UPMC Northwest
  - Uniontown, Pennsylvania, Forenede Stater, 15401
    - UPMC Cancer Center-Uniontown
  - Washington, Pennsylvania, Forenede Stater, 15301
    - UPMC Cancer Center-Washington
  - West Reading, Pennsylvania, Forenede Stater, 19611
    - Reading Hospital
  - Wexford, Pennsylvania, Forenede Stater, 15090
    - Wexford Health and Wellness Pavilion
  - Wilkes-Barre, Pennsylvania, Forenede Stater, 18711
    - Geisinger Wyoming Valley/Henry Cancer Center
  - Williamsport, Pennsylvania, Forenede Stater, 17701
    - UPMC Susquehanna
  - Williamsport, Pennsylvania, Forenede Stater, 17754
    - Divine Providence Hospital
  - Willow Grove, Pennsylvania, Forenede Stater, 19090
    - Asplundh Cancer Pavilion
  - Wynnewood, Pennsylvania, Forenede Stater, 19096
    - Lankenau Medical Center
  - York, Pennsylvania, Forenede Stater, 17403
    - WellSpan Health-York Cancer Center
  - York, Pennsylvania, Forenede Stater, 17403
    - WellSpan Health-York Hospital
  - York, Pennsylvania, Forenede Stater, 17403
    - Cancer Care Associates of York
- South Carolina
  - Bluffton, South Carolina, Forenede Stater, 29910
    - Saint Joseph's/Candler - Bluffton Campus
  - Charleston, South Carolina, Forenede Stater, 29425
    - Medical University of South Carolina
  - Gaffney, South Carolina, Forenede Stater, 29341
    - Gibbs Cancer Center-Gaffney
  - Georgetown, South Carolina, Forenede Stater, 29440
    - Tidelands Georgetown Memorial Hospital
  - Greer, South Carolina, Forenede Stater, 29651
    - Gibbs Cancer Center-Pelham
  - Hilton Head Island, South Carolina, Forenede Stater, 29926-3827
    - South Carolina Cancer Specialists PC
  - Spartanburg, South Carolina, Forenede Stater, 29303
    - Spartanburg Medical Center
  - Union, South Carolina, Forenede Stater, 29379
    - MGC Hematology Oncology-Union
- South Dakota
  - Sioux Falls, South Dakota, Forenede Stater, 57117-5134
    - Sanford USD Medical Center - Sioux Falls
  - Sioux Falls, South Dakota, Forenede Stater, 57104
    - Sanford Cancer Center Oncology Clinic
- Tennessee
  - Bristol, Tennessee, Forenede Stater, 37620
    - Bristol Regional Medical Center
  - Collierville, Tennessee, Forenede Stater, 38017
    - Baptist Memorial Hospital and Cancer Center-Collierville
  - Kingsport, Tennessee, Forenede Stater, 37660
    - Ballad Health Cancer Care - Kingsport
  - Kingsport, Tennessee, Forenede Stater, 37660
    - Wellmont Holston Valley Hospital and Medical Center
  - Knoxville, Tennessee, Forenede Stater, 37916
    - Thompson Cancer Survival Center
  - Knoxville, Tennessee, Forenede Stater, 37932
    - Thompson Cancer Survival Center - West
  - Lenoir City, Tennessee, Forenede Stater, 37772
    - Thompson Oncology Group-Lenoir City
  - Memphis, Tennessee, Forenede Stater, 38120
    - Baptist Memorial Hospital and Cancer Center-Memphis
  - Nashville, Tennessee, Forenede Stater, 37232
    - Vanderbilt University/Ingram Cancer Center
  - Oak Ridge, Tennessee, Forenede Stater, 37830
    - Thompson Oncology Group-Oak Ridge
- Texas
  - Abilene, Texas, Forenede Stater, 79601
    - Hendrick Medical Center
  - Bryan, Texas, Forenede Stater, 77802
    - Saint Joseph Regional Cancer Center
  - Dallas, Texas, Forenede Stater, 75390
    - UT Southwestern/Simmons Cancer Center-Dallas
  - Fort Worth, Texas, Forenede Stater, 76104
    - UT Southwestern/Simmons Cancer Center-Fort Worth
  - Richardson, Texas, Forenede Stater, 75080
    - UT Southwestern Clinical Center at Richardson/Plano
  - San Antonio, Texas, Forenede Stater, 78229
    - University of Texas Health Science Center at San Antonio
- Utah
  - Farmington, Utah, Forenede Stater, 84025
    - Farmington Health Center
  - Salt Lake City, Utah, Forenede Stater, 84112
    - Huntsman Cancer Institute/University of Utah
  - Salt Lake City, Utah, Forenede Stater, 84106
    - University of Utah Sugarhouse Health Center
- Virginia
  - Bristol, Virginia, Forenede Stater, 24201
    - Wellmont Medical Associates-Bristol
  - Chesapeake, Virginia, Forenede Stater, 23320
    - Cancer Specialists of Tidewater Limited
  - Fairfax, Virginia, Forenede Stater, 22031
    - Inova Schar Cancer Institute
  - Falls Church, Virginia, Forenede Stater, 22042
    - INOVA Fairfax Hospital
  - Gloucester, Virginia, Forenede Stater, 23061
    - Peninsula Cancer Institute-Gloucester
  - Martinsville, Virginia, Forenede Stater, 24115
    - Sovah Health Martinsville
  - Mechanicsville, Virginia, Forenede Stater, 23116
    - Bon Secours Memorial Regional Medical Center
  - Midlothian, Virginia, Forenede Stater, 23114
    - Bon Secours Saint Francis Medical Center
  - Midlothian, Virginia, Forenede Stater, 23113
    - Bon Secours Westchester Emergency Center
  - Newport News, Virginia, Forenede Stater, 23601
    - Peninsula Cancer Institute-Newport News
  - Norfolk, Virginia, Forenede Stater, 23505
    - Bon Secours DePaul Medical Center
  - Norton, Virginia, Forenede Stater, 24273
    - Southwest VA Regional Cancer Center
  - Onancock, Virginia, Forenede Stater, 23417
    - Riverside Shore Cancer Center
  - Portsmouth, Virginia, Forenede Stater, 23707
    - Bon Secours Maryview Medical Center
  - Richmond, Virginia, Forenede Stater, 23298
    - Virginia Commonwealth University/Massey Cancer Center
  - Richmond, Virginia, Forenede Stater, 23229
    - Virginia Cancer Institute
  - Richmond, Virginia, Forenede Stater, 23226
    - Bon Secours Saint Mary's Hospital
  - Richmond, Virginia, Forenede Stater, 23230
    - Bon Secours Cancer Institute at Reynolds Crossing
  - Richmond, Virginia, Forenede Stater, 23223
    - Bon Secours Richmond Community Hospital
  - South Hill, Virginia, Forenede Stater, 23970
    - VCU Community Memorial Health Center
  - Suffolk, Virginia, Forenede Stater, 23435
    - Cancer Specialists of Tidewater-Suffolk
  - Suffolk, Virginia, Forenede Stater, 23435
    - Bon Secours Health Center at Harbour View
  - Virginia Beach, Virginia, Forenede Stater, 23454
    - Peninsula Cancer Institute-Cancer Specialists of Tidewater
  - Williamsburg, Virginia, Forenede Stater, 23185
    - Peninsula Cancer Institute-Williamsburg
  - Winchester, Virginia, Forenede Stater, 22601
    - Valley Health / Winchester Medical Center
- Washington
  - Aberdeen, Washington, Forenede Stater, 98520
    - Providence Regional Cancer System-Aberdeen
  - Bellevue, Washington, Forenede Stater, 98004
    - Overlake Medical Center
  - Bellevue, Washington, Forenede Stater, 98004
    - FHCC Overlake
  - Bellingham, Washington, Forenede Stater, 98225
    - PeaceHealth Saint Joseph Medical Center
  - Bremerton, Washington, Forenede Stater, 98310
    - Harrison HealthPartners Hematology and Oncology-Bremerton
  - Bremerton, Washington, Forenede Stater, 98310
    - Harrison Medical Center
  - Burien, Washington, Forenede Stater, 98166
    - Highline Medical Center-Main Campus
  - Centralia, Washington, Forenede Stater, 98531
    - Providence Regional Cancer System-Centralia
  - Edmonds, Washington, Forenede Stater, 98026
    - Swedish Cancer Institute-Edmonds
  - Enumclaw, Washington, Forenede Stater, 98022
    - Saint Elizabeth Hospital
  - Everett, Washington, Forenede Stater, 98201
    - Providence Regional Cancer Partnership
  - Federal Way, Washington, Forenede Stater, 98003
    - Saint Francis Hospital
  - Issaquah, Washington, Forenede Stater, 98029
    - Swedish Cancer Institute-Issaquah
  - Kennewick, Washington, Forenede Stater, 99336
    - Kadlec Clinic Hematology and Oncology
  - Kirkland, Washington, Forenede Stater, 98034
    - Seattle Cancer Care Alliance at EvergreenHealth
  - Lacey, Washington, Forenede Stater, 98503
    - Providence Regional Cancer System-Lacey
  - Lakewood, Washington, Forenede Stater, 98499
    - Saint Clare Hospital
  - Longview, Washington, Forenede Stater, 98632
    - PeaceHealth Saint John Medical Center
  - Poulsbo, Washington, Forenede Stater, 98370
    - Harrison HealthPartners Hematology and Oncology-Poulsbo
  - Renton, Washington, Forenede Stater, 98055
    - Valley Medical Center
  - Seattle, Washington, Forenede Stater, 98109
    - Fred Hutchinson Cancer Research Center
  - Seattle, Washington, Forenede Stater, 98107
    - Swedish Medical Center-Ballard Campus
  - Seattle, Washington, Forenede Stater, 98122
    - Swedish Medical Center-First Hill
  - Seattle, Washington, Forenede Stater, 98195
    - University of Washington Medical Center - Montlake
  - Seattle, Washington, Forenede Stater, 98109
    - FHCC South Lake Union
  - Seattle, Washington, Forenede Stater, 98104
    - Pacific Gynecology Specialists
  - Seattle, Washington, Forenede Stater, 98122-5711
    - Swedish Medical Center-Cherry Hill
  - Seattle, Washington, Forenede Stater, 98133
    - FHCC at Northwest Hospital
  - Sedro-Woolley, Washington, Forenede Stater, 98284
    - PeaceHealth United General Medical Center
  - Shelton, Washington, Forenede Stater, 98584
    - Providence Regional Cancer System-Shelton
  - Tacoma, Washington, Forenede Stater, 98405
    - Northwest Medical Specialties PLLC
  - Tacoma, Washington, Forenede Stater, 98405
    - Franciscan Research Center-Northwest Medical Plaza
  - Vancouver, Washington, Forenede Stater, 98664
    - PeaceHealth Southwest Medical Center
  - Walla Walla, Washington, Forenede Stater, 99362
    - Providence Saint Mary Regional Cancer Center
  - Yakima, Washington, Forenede Stater, 98902
    - North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
  - Yelm, Washington, Forenede Stater, 98597
    - Providence Regional Cancer System-Yelm
- West Virginia
  - Charleston, West Virginia, Forenede Stater, 25304
    - West Virginia University Charleston Division
- Wisconsin
  - Antigo, Wisconsin, Forenede Stater, 54409
    - Langlade Hospital and Cancer Center
  - Appleton, Wisconsin, Forenede Stater, 54911
    - ThedaCare Regional Cancer Center
  - Ashland, Wisconsin, Forenede Stater, 54806
    - Duluth Clinic Ashland
  - Ashland, Wisconsin, Forenede Stater, 54806
    - Northwest Wisconsin Cancer Center
  - Eau Claire, Wisconsin, Forenede Stater, 54701
    - Marshfield Medical Center-EC Cancer Center
  - Eau Claire, Wisconsin, Forenede Stater, 54701
    - HSHS Sacred Heart Hospital
  - Green Bay, Wisconsin, Forenede Stater, 54301
    - Saint Vincent Hospital Cancer Center Green Bay
  - Green Bay, Wisconsin, Forenede Stater, 54303
    - Saint Vincent Hospital Cancer Center at Saint Mary's
  - Hayward, Wisconsin, Forenede Stater, 54843
    - Essentia Health-Hayward Clinic
  - Johnson Creek, Wisconsin, Forenede Stater, 53038
    - UW Cancer Center Johnson Creek
  - La Crosse, Wisconsin, Forenede Stater, 54601
    - Gundersen Lutheran Medical Center
  - Madison, Wisconsin, Forenede Stater, 53792
    - University of Wisconsin Carbone Cancer Center
  - Marshfield, Wisconsin, Forenede Stater, 54449
    - Marshfield Medical Center-Marshfield
  - Medford, Wisconsin, Forenede Stater, 54451
    - Aspirus Medford Hospital
  - Menomonee Falls, Wisconsin, Forenede Stater, 53051
    - Froedtert Menomonee Falls Hospital
  - Milwaukee, Wisconsin, Forenede Stater, 53226
    - Medical College of Wisconsin
  - Minocqua, Wisconsin, Forenede Stater, 54548
    - Marshfield Clinic-Minocqua Center
  - Mukwonago, Wisconsin, Forenede Stater, 53149
    - ProHealth D N Greenwald Center
  - New Richmond, Wisconsin, Forenede Stater, 54017
    - Cancer Center of Western Wisconsin
  - Oak Creek, Wisconsin, Forenede Stater, 53154
    - Drexel Town Square Health Center
  - Oconomowoc, Wisconsin, Forenede Stater, 53066
    - ProHealth Oconomowoc Memorial Hospital
  - Oconto Falls, Wisconsin, Forenede Stater, 54154
    - Saint Vincent Hospital Cancer Center at Oconto Falls
  - Rice Lake, Wisconsin, Forenede Stater, 54868
    - Marshfield Medical Center-Rice Lake
  - Sheboygan, Wisconsin, Forenede Stater, 53081
    - Saint Vincent Hospital Cancer Center at Sheboygan
  - Spooner, Wisconsin, Forenede Stater, 54801
    - Essentia Health-Spooner Clinic
  - Stevens Point, Wisconsin, Forenede Stater, 54481
    - Ascension Saint Michael's Hospital
  - Stevens Point, Wisconsin, Forenede Stater, 54482
    - Marshfield Medical Center-River Region at Stevens Point
  - Sturgeon Bay, Wisconsin, Forenede Stater, 54235-1495
    - Saint Vincent Hospital Cancer Center at Sturgeon Bay
  - Superior, Wisconsin, Forenede Stater, 54880
    - Essentia Health Saint Mary's Hospital - Superior
  - Waukesha, Wisconsin, Forenede Stater, 53188
    - UW Cancer Center at ProHealth Care
  - Waukesha, Wisconsin, Forenede Stater, 53188
    - ProHealth Waukesha Memorial Hospital
  - Wausau, Wisconsin, Forenede Stater, 54401
    - Aspirus Regional Cancer Center
  - West Bend, Wisconsin, Forenede Stater, 53095
    - Froedtert West Bend Hospital/Kraemer Cancer Center
  - Weston, Wisconsin, Forenede Stater, 54476
    - Marshfield Medical Center - Weston
  - Wisconsin Rapids, Wisconsin, Forenede Stater, 54494
    - Aspirus Cancer Care - Wisconsin Rapids
- Wyoming
  - Cody, Wyoming, Forenede Stater, 82414
    - Billings Clinic-Cody
  - Sheridan, Wyoming, Forenede Stater, 82801
    - Welch Cancer Center

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

70 år og ældre (Ældre voksen)

Tager imod sunde frivillige

Ingen

Beskrivelse

Inklusionskriterier:

Nydiagnosticeret ubehandlet metastatisk adenokarcinom i bugspytkirtlen. Tidligere operationer, adjuverende kemoterapi og/eller strålebehandling vil dog være tilladt, forudsat at strålebehandling er afsluttet mindst 2 uger før registrering, og adjuverende terapi blev administreret mere end 6 måneder før registrering. Patienter med følgende histologi er udelukket: acinær celle; adenosquamøst carcinom
Eastern Cooperative Oncology Group (ECOG) præstationsstatus 0-2
Patienten er en engelsktalende med evnen til at forstå og udfylde det informerede samtykke og spørgeskemaer
Leukocytter >= 3.000/mcL (opnået inden for 4 uger efter registrering)
Absolut neutrofiltal >= 1.500/mcL (opnået inden for 4 uger efter registrering)
Blodplader >= 100.000/mcL (opnået inden for 4 uger efter registrering)
Total bilirubin =< institutionel øvre normalgrænse (ULN) (opnået inden for 4 uger efter registrering)
Aspartataminotransferase (AST) (serumglutamin-oxaloeddikesyretransaminase [SGOT])/alaninaminotransferase (ALT) (serumglutamatpyruvattransaminase [SGPT]) =< 2,5 x institutionel ULN (opnået inden for 4 uger efter registrering)
Kreatinin =< institutionel ULN, medmindre der findes data, der understøtter sikker brug ved lavere nyrefunktionsværdier, ikke lavere end 30 ml/min/1,73 m^2 (opnået inden for 4 uger efter registrering)
Glomerulær filtrationshastighed (GFR) >= 40 ml/min/1,73 m^2, medmindre der findes data, der understøtter sikker brug ved lavere nyrefunktionsværdier, ikke lavere end 30 ml/min/1,73 m^2 (opnået inden for 4 uger efter registrering)
Human immundefektvirus (HIV)-inficerede patienter i effektiv antiretroviral behandling med upåviselig viral belastning inden for 6 måneder efter registrering er berettiget til denne protokol. HIV-positive (+) patienter, der er på ritonavir eller/og cobicistat-baseret regime, skal skiftes til alternativ antiretroviral behandling (ART)
For patienter med tegn på kronisk hepatitis B-virus (HBV)-infektion, skal HBV-virusmængden være uopdagelig ved suppressiv behandling, hvis indiceret
Patienter med en historie med hepatitis C-virus (HCV)-infektion skal være blevet behandlet og helbredt. For patienter med HCV-infektion, som i øjeblikket er i behandling, er de berettigede, hvis de har en upåviselig HCV-virusbelastning
Mandlige patienter skal acceptere ikke at blive far til børn under undersøgelsen
Patienter med kendt anamnese eller aktuelle symptomer på hjertesygdom, eller historie med behandling med kardiotoksiske midler, bør have en klinisk risikovurdering af hjertefunktionen ved hjælp af New York Heart Associations funktionelle klassifikation. For at være berettiget til denne protokol skal patienter være klasse 2B eller bedre
Patienter skal have målbar sygdom, og scanninger skal foretages inden for 4 uger efter registrering
Patienter, der er klassificeret til at have milde-moderate abnormiteter i et hvilket som helst af domænerne, der blev evalueret i den geriatriske screeningsvurdering og er klassificeret som "sårbare", er kvalificerede. Patienter klassificeret uden abnormiteter ("tilpasning") eller med alvorlig kognitiv/funktionel svækkelse eller høj co-morbiditetsscore ("svage") på den geriatriske screeningsvurdering er ikke kvalificerede
Patienter skal acceptere ikke at tage medicin eller stoffer, der er stærke hæmmere eller inducere af CYP3A4. De, der er randomiseret til liposomal irinotecan-behandlingsarm, bør undgå lægemidler, der er UGT1A1-hæmmere

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Primært formål: Behandling
Tildeling: Randomiseret
Interventionel model: Parallel tildeling
Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm Deltagergruppe / Arm En gruppe eller undergruppe af deltagere i et klinisk forsøg, der modtager en specifik intervention/behandling eller ingen intervention i henhold til forsøgets protokol.	Intervention / Behandling Intervention / Behandling En proces eller handling, der er i fokus for en klinisk undersøgelse. Interventioner omfatter lægemidler, medicinsk udstyr, procedurer, vacciner og andre produkter, der enten er til undersøgelse eller allerede er tilgængelige. Interventioner kan også omfatte ikke-invasive tilgange, såsom uddannelse eller ændring af kost og motion.
Eksperimentel: Arm A (gemcitabin, nab-paclitaxel) Patienterne får gemcitabin IV over 30 minutter og nab-paclitaxel IV over 30 minutter på dag 1. Cykler gentages hver 14. dag i fravær af sygdomsprogression eller uacceptabel toksicitet.	Andet: Livskvalitetsvurdering Hjælpestudier Andre navne: Livskvalitetsvurdering Andet: Spørgeskemaadministration Hjælpestudier Medicin: Gemcitabin Givet IV Andre navne: dFdCyd dFdC Difluordeoxycytidin Medicin: Nab-paclitaxel Givet IV Andre navne: ABI-007 Abraxane Albumin-bundet Paclitaxel ABI 007 Albumin-stabiliseret nanopartikel Paclitaxel Nanopartikel Albumin-bundet Paclitaxel Nanopartikel Paclitaxel Paclitaxel Albumin paclitaxel albumin-stabiliseret nanopartikelformulering proteinbundet paclitaxel Medicin: Gemcitabinhydrochlorid Givet IV Andre navne: Gemzar dFdCyd Difluordeoxycytidin hydrochlorid FF 10832 FF-10832 FF10832 Gemcitabin HCI LY-188011 LY188011
Eksperimentel: Arm B (fluorouracil, leucovorin, liposomalt irinotecan) Patienter får fluorouracil IV over 46 timer fra dag 1. Patienter får også leucovorin IV over 90-120 minutter og liposomal irinotecan IV over 90 minutter på dag 1. Cykler gentages hver 14. dag i fravær af sygdomsprogression eller uacceptabel toksicitet.	Andet: Livskvalitetsvurdering Hjælpestudier Andre navne: Livskvalitetsvurdering Andet: Spørgeskemaadministration Hjælpestudier Medicin: Fluorouracil Givet IV Andre navne: 5-FU 5-Fluracil Fluracil 5 Fluorouracil 5 Fluorouracilum 5 FU 5-fluor-2,4(1H,3H)-pyrimidindion 5-Fluorouracil 5FU AccuSite Carac Fluor Uracil Fluouracil Flurablastin Fluracedyl Fluril Fluroblastin Ribofluor Ro 2-9757 Ro-2-9757 Medicin: Leucovorin Givet IV Andre navne: Folinsyre Medicin: Leucovorin Calcium Givet IV Andre navne: Wellcovorin folinsyre Adinepar Calcifolin Calcium (6S)-folinat Calciumfolinat Calcium Leucovorin Calfolex Calinat Cehafolin Citofolin Citrec Citrovorum faktor Cromatonbic Folinico Dalisol Disintox Divical Ecofol Emovis Faktor, Citrovorum Flynoken A Folaren Folaxin FOLI-celle Foliben Folidan Folidar Folinac Folinat Calcium Folinsyre Calcium Salt Pentahydrat Folinoral Folinvit Foliplus Folix Imo Lederfolat Lederfolin Leucosar leukovorin Rescufolin Rescuvolin Tonofolin Medicin: Liposomal irinotecan Givet IV Andre navne: Onivyde MM-398 PEP02 Irinotecan liposom nal-IRI Nanoliposomal irinotecan Nanopartikel liposomformulering af irinotecan

Deltagergruppe / Arm

Intervention / Behandling

Eksperimentel: Arm A (gemcitabin, nab-paclitaxel)

Patienterne får gemcitabin IV over 30 minutter og nab-paclitaxel IV over 30 minutter på dag 1. Cykler gentages hver 14. dag i fravær af sygdomsprogression eller uacceptabel toksicitet.

Andet: Livskvalitetsvurdering

Hjælpestudier

Andre navne:

Livskvalitetsvurdering

Andet: Spørgeskemaadministration

Hjælpestudier

Medicin: Gemcitabin

Givet IV

Andre navne:

dFdCyd
dFdC
Difluordeoxycytidin

Medicin: Nab-paclitaxel

Givet IV

Andre navne:

ABI-007
Abraxane
Albumin-bundet Paclitaxel
ABI 007
Albumin-stabiliseret nanopartikel Paclitaxel
Nanopartikel Albumin-bundet Paclitaxel
Nanopartikel Paclitaxel
Paclitaxel Albumin
paclitaxel albumin-stabiliseret nanopartikelformulering
proteinbundet paclitaxel

Medicin: Gemcitabinhydrochlorid

Givet IV

Andre navne:

Gemzar
dFdCyd
Difluordeoxycytidin hydrochlorid
FF 10832
FF-10832
FF10832
Gemcitabin HCI
LY-188011
LY188011

Eksperimentel: Arm B (fluorouracil, leucovorin, liposomalt irinotecan)

Patienter får fluorouracil IV over 46 timer fra dag 1. Patienter får også leucovorin IV over 90-120 minutter og liposomal irinotecan IV over 90 minutter på dag 1. Cykler gentages hver 14. dag i fravær af sygdomsprogression eller uacceptabel toksicitet.

Andet: Livskvalitetsvurdering

Hjælpestudier

Andre navne:

Livskvalitetsvurdering

Andet: Spørgeskemaadministration

Hjælpestudier

Medicin: Fluorouracil

Givet IV

Andre navne:

5-FU
5-Fluracil
Fluracil
5 Fluorouracil
5 Fluorouracilum
5 FU
5-fluor-2,4(1H,3H)-pyrimidindion
5-Fluorouracil
5FU
AccuSite
Carac
Fluor Uracil
Fluouracil
Flurablastin
Fluracedyl
Fluril
Fluroblastin
Ribofluor
Ro 2-9757
Ro-2-9757

Medicin: Leucovorin

Givet IV

Andre navne:

Folinsyre

Medicin: Leucovorin Calcium

Givet IV

Andre navne:

Wellcovorin
folinsyre
Adinepar
Calcifolin
Calcium (6S)-folinat
Calciumfolinat
Calcium Leucovorin
Calfolex
Calinat
Cehafolin
Citofolin
Citrec
Citrovorum faktor
Cromatonbic Folinico
Dalisol
Disintox
Divical
Ecofol
Emovis
Faktor, Citrovorum
Flynoken A
Folaren
Folaxin
FOLI-celle
Foliben
Folidan
Folidar
Folinac
Folinat Calcium
Folinsyre Calcium Salt Pentahydrat
Folinoral
Folinvit
Foliplus
Folix
Imo
Lederfolat
Lederfolin
Leucosar
leukovorin
Rescufolin
Rescuvolin
Tonofolin

Medicin: Liposomal irinotecan

Givet IV

Andre navne:

Onivyde
MM-398
PEP02
Irinotecan liposom
nal-IRI
Nanoliposomal irinotecan
Nanopartikel liposomformulering af irinotecan

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål	Foranstaltningsbeskrivelse	Tidsramme
Samlet overlevelse (OS) Tidsramme: Op til 2 år efter behandling	Vil bruge en stratificeret log-rangtest med ensidig alfa på 0,05 og 90 % effekt. En trunkeret O'Brien-Fleming-grænse vil blive brugt til at kontrollere type I-fejl til effektivitetstestning, og gentagne konfidensintervalmetoder på OS-fareforholdet vil blive brugt til nytteløshedsanalyser	Op til 2 år efter behandling

Sekundære resultatmål

Resultatmål	Foranstaltningsbeskrivelse	Tidsramme
Instrumental Activities of Daily Living (IADL) Tidsramme: Op til 2 år efter behandling	Vil evaluere sammenhængen mellem funktionel status som registreret af IADL-vurderingsværktøjet og rater af grad 3 eller højere kemoterapitoksicitet inden for behandlingsarmen. Vil bruge logistisk regression og en 0,025 niveau ensidig test for odds ratio.	Op til 2 år efter behandling

Andre resultatmål

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

ECOG-ACRIN Cancer Research Group

Samarbejdspartnere

National Cancer Institute (NCI)

Efterforskere

Ledende efterforsker: Efrat Dotan, ECOG-ACRIN Cancer Research Group

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Dotan E, Catalano P, Lenchik L, Boutin R, Yao X, Marques HS, Ioffe D, Zhen DB, Li D, Wagner LI, Simon MA, Wong TZ, O'Dwyer PJ. The GIANT trial (ECOG-ACRIN EA2186) methods paper: A randomized phase II study of gemcitabine and nab-paclitaxel compared with 5-fluorouracil, leucovorin, and liposomal irinotecan in older patients with treatment-naive metastatic pancreatic cancer - defining a new treatment option for older vulnerable patients. J Geriatr Oncol. 2023 Apr;14(3):101474. doi: 10.1016/j.jgo.2023.101474. Epub 2023 Mar 22.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

26. august 2020

Primær færdiggørelse (Faktiske)

2. marts 2026

Studieafslutning (Anslået)

31. december 2026

Datoer for studieregistrering

Først indsendt

16. januar 2020

Først indsendt, der opfyldte QC-kriterier

16. januar 2020

Først opslået (Faktiske)

18. januar 2020

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

10. juli 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

9. juli 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

EA2186 (Anden identifikator: CTEP)
U10CA180820 (U.S. NIH-bevilling/kontrakt)
NCI-2019-08286 (Registry Identifier: CTRP (Clinical Trial Reporting Program))

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

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Ingen

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

Resultatmål	Foranstaltningsbeskrivelse	Tidsramme
Progressionsfri overlevelse (PFS) Tidsramme: Op til 2 år efter behandling		Op til 2 år efter behandling
Objektiv tumorrespons Tidsramme: Op til 2 år efter behandling		Op til 2 år efter behandling
Komorbiditeter som en forudsigelse for kemoterapitolerance Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år		Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Depression som en prædiktor for kemoterapitolerance Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år		Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Ernæring som en prædiktor for kemoterapitolerance Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år		Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Kognition som en prædiktor for kemoterapitolerance Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år		Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Ændring i funktionsstatus Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem ændringer i funktionel status ved hjælp af en geriatrisk vurdering, som vil omfatte antallet af fald, kumulativ sygdomsvurderingsskala, body mass index, vægttab og scores, såsom den geriatriske depressionsskala, og den velsignede orienteringshukommelseskoncentrationstest . Disse vil blive behandlet som kontinuerlige mål som prædiktorer for kemoterapitolerance og vil blive vurderet ved hjælp af en parret t-test. Longitudinelle analyser vil blive udført for at evaluere banen for patientrapporterede resultater over tid for hver arm og for at sammenligne på tværs af armene. Vil undersøge muligheden for, at geriatriske vurderinger ved baseline, der er prognostiske for efterfølgende uønskede hændelser af interesse, og vil udføre regressionsmodeller for vigtige uønskede hændelser (logistisk, Poisson eller lineær regression efter behov) for at vurdere den relative forudsigelsesevne af de foreslåede geriatriske vurderinger over dem, der traditionelt bruges til at identificere patienter i risikozonen.	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Comprehensive Geriatric Assessment (CGA) domæner Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem CGA-domæner og samlet overlevelse efter behandlingsarm.	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Livskvalitetsscore Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil blive vurderet som en kontinuert variabel af Functional Assessment of Cancer Treatment - Hepatitis version 4 mellem baseline mål og vurdering under behandlingsforløb af behandlingsarme.	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Forekomst af toksicitet hos ældre patienter Tidsramme: Op til 2 år efter behandling	Vil omfatte perifer neuropati grad 2 eller højere, træthedsgrad 3 eller højere, fald, skadestuebesøg, hospitalsindlæggelse, behandlingsændring og seponering. Disse data vil blive indhentet og registreret af undersøgelsessygeplejersken, mens patientens toksicitetsevaluering udføres ved hjælp af National Cancer Institute Common Terminology Criteria for Adverse Events.	Op til 2 år efter behandling
Hyppighed af grad 3 eller højere kemoterapitoksicitet oplevet under behandling Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem skeletmuskelindeks (SMI) og intermuskulært fedtvæv (IMAT) og rate af grad 3 eller højere kemoterapitoksicitet. I en foreløbig analyse vil det longitudinelle forløb af SMI og IMAT blive undersøgt grafisk og bruge longitudinel regressionsmodellering til at redegøre for sammenhænge på grund af de gentagne vurderinger. Hovedanalysen vil anvende logistisk regressionsmodellering. Modeller vil først blive udstyret med kun basisværdierne for SMI og IMAT og vil efterfølgende blive uddybet til at inkludere både baseline og ændring fra baseline. Modellerne vil kontrollere for sociodemografiske og kliniske statusmålinger ved baseline og vil også overveje interaktioner mellem de to billeddannelsesbaserede markører	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
OS Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem SMI og IMAT og OS. I en foreløbig analyse vil det longitudinelle forløb af SMI og IMAT blive undersøgt grafisk og bruge Cox regressionsmodellering til at redegøre for korrelationer på grund af de gentagne vurderinger. Hovedanalysen vil anvende logistisk regressionsmodellering. Modeller vil først blive udstyret med kun basisværdierne for SMI og IMAT og vil efterfølgende blive uddybet til at inkludere både baseline og ændring fra baseline. Modellerne vil kontrollere for sociodemografiske og kliniske statusmålinger ved baseline og vil også overveje interaktioner mellem de to billeddannelsesbaserede markører.	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Geriatriske vurderingsresultater Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem skeletmuskelindeks (SMI) og intermuskulært fedtvæv (IMAT) og geriatriske vurderingsscore, der evaluerer funktionel status. I en foreløbig analyse vil det longitudinelle forløb af SMI og IMAT blive undersøgt grafisk og lineær regressionsmodellering for at tage højde for korrelationer på grund af de gentagne vurderinger. Hovedanalysen vil anvende logistisk regressionsmodellering. Modeller vil først blive udstyret med kun basisværdierne for SMI og IMAT og vil efterfølgende blive uddybet til at inkludere både baseline og ændring fra baseline. Modellerne vil kontrollere for sociodemografiske og kliniske statusmålinger ved baseline og vil også overveje interaktioner mellem de to billeddannelsesbaserede markører	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Toksicitet og biomarkører for aldring (CRP og IL-6) Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem biomarkører for aldring (CRP og IL-6) og rater af grad 3 eller højere kemoterapitoksicitet. Vil blive analyseret som kontinuerlige variable og korreleret med kliniske resultater. Analyse af interaktion med behandlingsarm vil blive udført, men effekten for disse effekter er lavere, da undersøgelsen ikke er designet til at detektere interaktioner. Logistisk regression vil blive brugt til at bestemme, om niveauer af disse biomarkører tjener som forudsigere for toksicitet eller binære mål for effektivitet (respons).	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Ændringer i niveauer af CRP og IL-6 og toksicitet Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem ændringer i niveauer af CRP og IL-6 og rater for grad 3 kemoterapi toksicitet. Vil blive analyseret som kontinuerlige variable og korreleret med kliniske resultater. Analyse af interaktion med behandlingsarm vil blive udført, men effekten for disse effekter er lavere, da undersøgelsen ikke er designet til at detektere interaktioner. Logistisk regression vil blive brugt til at bestemme, om niveauer af disse biomarkører tjener som forudsigere for toksicitet eller binære mål for effektivitet (respons).	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
OS og biomarkører for aldring (CRP og IL-6) Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem ændringer i niveauer af CRP og IL-6 og den samlede overlevelse. Vil blive analyseret som kontinuerlige variable og korreleret med kliniske resultater. Analyse af interaktion med behandlingsarm vil blive udført, men effekten for disse effekter er lavere, da undersøgelsen ikke er designet til at detektere interaktioner. Standard tid til hændelsesanalyser (Kaplan-Meier-kurver og Cox-modeller) vil blive brugt til at bestemme sammenhængen mellem biomarkører med PFS og OS.	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år
Geriatriske vurderingsscore og biomarkører for aldring (CRP og IL-6) Tidsramme: Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år	Vil evaluere sammenhængen mellem niveauer af CRP og IL-6 og geriatriske vurderinger scorer evaluering funktionel status. Vil blive analyseret som kontinuerlige variable og korreleret med kliniske resultater. Analyse af interaktion med behandlingsarm vil blive udført, men effekten for disse effekter er lavere, da undersøgelsen ikke er designet til at detektere interaktioner. Logistisk regression vil blive brugt til at bestemme, om niveauer af disse biomarkører tjener som forudsigere for toksicitet eller binære mål for effektivitet (respons).	Baseline op til tidspunktet for sygdomsevaluering, vurderet op til 2 år

Sammenligning af to behandlingskombinationer, Gemcitabin og Nab-Paclitaxel med 5-Fluorouracil, Leucovorin og Liposomal Irinotecan for ældre patienter med kræft i bugspytkirtlen, der har spredt sig

Et randomiseret fase II-studie af gemcitabin og Nab-Paclitaxel sammenlignet med 5-fluorouracil, leucovorin og liposomal irinotecan hos ældre patienter med behandlingsnaive metastatisk bugspytkirtelkræft (GIANT)

Studieoversigt

Status

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Undersøgelsestype

Tilmelding (Faktiske)

Fase

Kontakter og lokationer

Studiekontakt

Studiesteder

Deltagelseskriterier

Berettigelseskriterier

Aldre berettiget til at studere

Tager imod sunde frivillige

Beskrivelse

Studieplan

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Antal våben

Våben og indgreb

Deltagergruppe / Arm

Intervention / Behandling

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål

Foranstaltningsbeskrivelse

Tidsramme

Sekundære resultatmål

Resultatmål

Foranstaltningsbeskrivelse

Tidsramme

Andre resultatmål

Resultatmål

Foranstaltningsbeskrivelse

Tidsramme

Samarbejdspartnere og efterforskere

Sponsor

Samarbejdspartnere

Efterforskere

Publikationer og nyttige links

Generelle publikationer

Datoer for undersøgelser

Studer store datoer

Studiestart (Faktiske)

Primær færdiggørelse (Faktiske)

Studieafslutning (Anslået)

Datoer for studieregistrering

Først indsendt

Først indsendt, der opfyldte QC-kriterier

Først opslået (Faktiske)

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

Sidst verificeret

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Studerer et amerikansk FDA-reguleret enhedsprodukt

produkt fremstillet i og eksporteret fra U.S.A.