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Et fase II/III-forsøg med Nivolumab, Ipilimumab og GM-CSF hos patienter med avanceret melanom

27. august 2026 opdateret af: National Cancer Institute (NCI)

Randomiseret fase II/III-undersøgelse af Nivolumab Plus Ipilimumab Plus Sargramostim versus Nivolumab Plus Ipilimumab hos patienter med uoperabelt trin III eller trin IV melanom

Denne fase II/III-undersøgelse studerer bivirkningerne af nivolumab og ipilimumab, når de gives sammen med eller uden sargramostim, og for at se, hvor godt de virker ved behandling af patienter med stadium III-IV melanom, som ikke kan fjernes ved kirurgi (ikke-opererbart). Immunterapi med monoklonale antistoffer, såsom ipilimumab og nivolumab, kan hjælpe kroppens immunsystem til at angribe kræften og kan forstyrre tumorcellernes evne til at vokse og sprede sig. Kolonistimulerende faktorer, såsom sargramostim, kan øge produktionen af hvide blodlegemer. Det vides endnu ikke, om nivolumab og ipilimumab er mere effektive med eller uden sargramostim til behandling af patienter med melanom.

Studieoversigt

Status

Aktiv, ikke rekrutterende

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

PRIMÆR MÅL:

I. At sammenligne den samlede overlevelse (OS) af nivolumab/ipilimumab/sargramostim (GM-CSF) versus nivolumab/ipilimumab.

SEKUNDÆRE MÅL:

I. At evaluere progressionsfri overlevelse (PFS) hos patienter behandlet med nivolumab/ipilimumab/GM-CSF versus nivolumab/ipilimumab.

II. At vurdere for forskelle i tolerabilitet, specifikt graden af grad III eller højere bivirkninger, mellem nivolumab/ipilimumab/GM-CSF versus nivolumab/ipilimumab.

III. At evaluere immunrelateret responsrate (baseret på immunrelaterede responskriterier) og responsrate (baseret på Respons Evaluation Criteria in Solid Tumors [RECIST] kriterier) og sammenligne dem.

UNDERSØGENDE MÅL FOR TOBAKSBRUG:

I. At bestemme virkningerne af tobak, operationaliseret som brændbar tobak (1a), andre former for tobak (1b) og miljømæssig tobakseksponering (ETS) (1c) på udbyder-rapporteret toksicitet for cancerbehandling (uønskede hændelser [både kliniske og hæmatologiske] og dosisændringer).

II. At bestemme virkningerne af tobak på patientrapporterede fysiske symptomer og psykologiske symptomer.

III. At undersøge ophørsadfærd og adfærdsrådgivning/støtte og brug af ophør af medicin.

IV. At udforske effekten af tobaksbrug og eksponering på behandlingsvarighed, relativ dosisintensitet og terapeutisk fordel.

OVERSIGT: Patienterne randomiseres til 1 ud af 2 behandlingsarme.

ARM A: INDUKTIONSTERAPI: Patienterne får nivolumab intravenøst (IV) over 30 minutter på dag 1, ipilimumab IV over 30 minutter på dag 1 og sargramostim subkutant (SC) på dag 1-14. Behandlingen gentages hver 21. dag i 4 cyklusser i fravær af sygdomsprogression eller uacceptabel toksicitet.

VEDLIGEHOLDELSESTERAPI: Patienterne får nivolumab og sargramostim som ved induktionsterapi. Patienter med partielt respons (PR), stabil sygdom (SD) eller komplet respons (CR) efter 24 uger kan fortsætte vedligeholdelsesbehandlingen i op til 2 år i fravær af sygdomsprogression eller uacceptabel toksicitet.

ARM B: INDUKTIONSTERAPI: Patienterne får nivolumab og ipilimumab som i arm I. Behandlingen gentages hver 21. dag i 4 cyklusser i fravær af sygdomsprogression eller uacceptabel toksicitet.

VEDLIGEHOLDELSESTERAPI: Patienterne får nivolumab som ved induktionsterapi. Patienter med PR, SD eller CR efter 24 uger kan fortsætte vedligeholdelsesbehandlingen i op til 2 år i fravær af sygdomsprogression eller uacceptabel toksicitet.

Efter afsluttet undersøgelsesbehandling følges patienterne hver 3. måned i 2 år og derefter hver 6. måned i 3 år.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

600

Fase

Fase 2
Fase 3

Kontakter og lokationer

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

Studiesteder

Forenede Stater
- Alabama
  - Birmingham, Alabama, Forenede Stater, 35233
    - University of Alabama at Birmingham Cancer Center
- Arizona
  - Kingman, Arizona, Forenede Stater, 86401
    - Kingman Regional Medical Center
- Arkansas
  - Little Rock, Arkansas, Forenede Stater, 72205
    - Carti Cancer Center
  - Little Rock, Arkansas, Forenede Stater, 72205
    - John L McClellan Memorial Veterans Hospital
- California
  - Anaheim, California, Forenede Stater, 92806
    - Kaiser Permanente-Anaheim
  - Antioch, California, Forenede Stater, 94531
    - Kaiser Permanente-Deer Valley Medical Center
  - Arroyo Grande, California, Forenede Stater, 93420
    - PCR Oncology
  - Auburn, California, Forenede Stater, 95602
    - Sutter Auburn Faith Hospital
  - Auburn, California, Forenede Stater, 95603
    - Sutter Cancer Centers Radiation Oncology Services-Auburn
  - Baldwin Park, California, Forenede Stater, 91706
    - Kaiser Permanente-Baldwin Park
  - Bellflower, California, Forenede Stater, 90706
    - Kaiser Permanente-Bellflower
  - Berkeley, California, Forenede Stater, 94704
    - Alta Bates Summit Medical Center-Herrick Campus
  - Burlingame, California, Forenede Stater, 94010
    - Mills-Peninsula Medical Center
  - Cameron Park, California, Forenede Stater, 95682
    - Sutter Cancer Centers Radiation Oncology Services-Cameron Park
  - Castro Valley, California, Forenede Stater, 94546
    - Eden Hospital Medical Center
  - Davis, California, Forenede Stater, 95616
    - Sutter Davis Hospital
  - Duarte, California, Forenede Stater, 91010
    - City of Hope Comprehensive Cancer Center
  - Dublin, California, Forenede Stater, 94568
    - Kaiser Permanente Dublin
  - Fontana, California, Forenede Stater, 92335
    - Kaiser Permanente-Fontana
  - Fremont, California, Forenede Stater, 94538
    - Kaiser Permanente-Fremont
  - Fremont, California, Forenede Stater, 94538
    - Palo Alto Medical Foundation-Fremont
  - Fresno, California, Forenede Stater, 93720
    - Kaiser Permanente-Fresno
  - Fresno, California, Forenede Stater, 93720
    - Kaiser Permanente Fresno Orchard Plaza
  - Harbor City, California, Forenede Stater, 90710
    - Kaiser Permanente South Bay
  - Irvine, California, Forenede Stater, 92618
    - Kaiser Permanente-Irvine
  - Irvine, California, Forenede Stater, 92612
    - UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
  - Los Angeles, California, Forenede Stater, 90027
    - Kaiser Permanente Los Angeles Medical Center
  - Los Angeles, California, Forenede Stater, 90034
    - Kaiser Permanente West Los Angeles
  - Modesto, California, Forenede Stater, 95355
    - Memorial Medical Center
  - Modesto, California, Forenede Stater, 95356
    - Kaiser Permanente-Modesto
  - Mountain View, California, Forenede Stater, 94040
    - Palo Alto Medical Foundation-Camino Division
  - Mountain View, California, Forenede Stater, 94040
    - Palo Alto Medical Foundation-Gynecologic Oncology
  - Novato, California, Forenede Stater, 94945
    - Sutter Cancer Research Consortium
  - Oakland, California, Forenede Stater, 94611
    - Kaiser Permanente-Oakland
  - Ontario, California, Forenede Stater, 91761
    - Kaiser Permanente-Ontario
  - Orange, California, Forenede Stater, 92868
    - UC Irvine Health/Chao Family Comprehensive Cancer Center
  - Orange, California, Forenede Stater, 92868
    - Saint Joseph Hospital - Orange
  - Palo Alto, California, Forenede Stater, 94304
    - Stanford Cancer Institute Palo Alto
  - Palo Alto, California, Forenede Stater, 94301
    - Palo Alto Medical Foundation Health Care
  - Panorama City, California, Forenede Stater, 91402
    - Kaiser Permanente - Panorama City
  - Redwood City, California, Forenede Stater, 94063
    - Kaiser Permanente-Redwood City
  - Redwood City, California, Forenede Stater, 94063
    - Kaiser Permanente- Marshall Medical Offices
  - Richmond, California, Forenede Stater, 94801
    - Kaiser Permanente-Richmond
  - Riverside, California, Forenede Stater, 92505
    - Kaiser Permanente-Riverside
  - Roseville, California, Forenede Stater, 95661
    - Kaiser Permanente-Roseville
  - Roseville, California, Forenede Stater, 95661
    - Sutter Cancer Centers Radiation Oncology Services-Roseville
  - Roseville, California, Forenede Stater, 95661
    - Sutter Roseville Medical Center
  - Sacramento, California, Forenede Stater, 95816
    - Sutter Medical Center Sacramento
  - Sacramento, California, Forenede Stater, 95814
    - Kaiser Permanente Downtown Commons
  - Sacramento, California, Forenede Stater, 95823
    - Kaiser Permanente-South Sacramento
  - Sacramento, California, Forenede Stater, 95825
    - Kaiser Permanente Sacramento Medical Center
  - San Diego, California, Forenede Stater, 92120
    - Kaiser Permanente-San Diego Zion
  - San Diego, California, Forenede Stater, 92134
    - Naval Medical Center -San Diego
  - San Diego, California, Forenede Stater, 92108
    - Kaiser Permanente-Rio San Diego
  - San Francisco, California, Forenede Stater, 94115
    - Kaiser Permanente-San Francisco
  - San Francisco, California, Forenede Stater, 94115
    - California Pacific Medical Center-Pacific Campus
  - San Jose, California, Forenede Stater, 95119
    - Kaiser Permanente-Santa Teresa-San Jose
  - San Leandro, California, Forenede Stater, 94577
    - Kaiser Permanente San Leandro
  - San Marcos, California, Forenede Stater, 92078
    - Kaiser Permanente-San Marcos
  - San Mateo, California, Forenede Stater, 94401
    - Mills Health Center
  - San Rafael, California, Forenede Stater, 94903
    - Kaiser San Rafael-Gallinas
  - San Rafael, California, Forenede Stater, 94903
    - Kaiser Permanente-San Rafael
  - Santa Barbara, California, Forenede Stater, 93105
    - Ridley-Tree Cancer Center
  - Santa Clara, California, Forenede Stater, 95051
    - Kaiser Permanente Medical Center - Santa Clara
  - Santa Cruz, California, Forenede Stater, 95065
    - Palo Alto Medical Foundation-Santa Cruz
  - Santa Cruz, California, Forenede Stater, 95065
    - Santa Cruz Radiation Oncology Medical Group
  - Santa Rosa, California, Forenede Stater, 95403
    - Kaiser Permanente-Santa Rosa
  - Santa Rosa, California, Forenede Stater, 95403
    - Sutter Pacific Medical Foundation
  - South San Francisco, California, Forenede Stater, 94080
    - Kaiser Permanente-South San Francisco
  - Stockton, California, Forenede Stater, 95210
    - Kaiser Permanente-Stockton
  - Sunnyvale, California, Forenede Stater, 94086
    - Palo Alto Medical Foundation-Sunnyvale
  - Upland, California, Forenede Stater, 91786
    - City of Hope Upland
  - Vacaville, California, Forenede Stater, 95688
    - Kaiser Permanente Medical Center-Vacaville
  - Vallejo, California, Forenede Stater, 94589
    - Kaiser Permanente-Vallejo
  - Vallejo, California, Forenede Stater, 94589
    - Sutter Solano Medical Center/Cancer Center
  - Walnut Creek, California, Forenede Stater, 94596
    - Kaiser Permanente-Walnut Creek
  - Woodland Hills, California, Forenede Stater, 91367
    - Kaiser Permanente-Woodland Hills
- Colorado
  - Aurora, Colorado, Forenede Stater, 80012
    - The Medical Center of Aurora
  - Boulder, Colorado, Forenede Stater, 80303
    - Boulder Community Foothills Hospital
  - Boulder, Colorado, Forenede Stater, 80304
    - Rocky Mountain Cancer Centers-Boulder
  - Colorado Springs, Colorado, Forenede Stater, 80907
    - Penrose-Saint Francis Healthcare
  - Colorado Springs, Colorado, Forenede Stater, 80907
    - Rocky Mountain Cancer Centers-Penrose
  - Colorado Springs, Colorado, Forenede Stater, 80923
    - Saint Francis Cancer Center
  - Denver, Colorado, Forenede Stater, 80205
    - Kaiser Permanente-Franklin
  - Denver, Colorado, Forenede Stater, 80218
    - Presbyterian - Saint Lukes Medical Center - Health One
  - Denver, Colorado, Forenede Stater, 80220
    - Rose Medical Center
  - Denver, Colorado, Forenede Stater, 80218
    - Saint Joseph Hospital - Cancer Centers of Colorado
  - Denver, Colorado, Forenede Stater, 80210
    - AdventHealth Porter
  - Durango, Colorado, Forenede Stater, 81301
    - Mercy Medical Center
  - Durango, Colorado, Forenede Stater, 81301
    - CommonSpirit Cancer Center Mercy
  - Englewood, Colorado, Forenede Stater, 80113
    - Mountain Blue Cancer Care Center - Swedish
  - Englewood, Colorado, Forenede Stater, 80113
    - Swedish Medical Center
  - Englewood, Colorado, Forenede Stater, 80113
    - Rocky Mountain Cancer Centers - Swedish
  - Englewood, Colorado, Forenede Stater, 80113
    - The Melanoma and Skin Cancer Institute
  - Greeley, Colorado, Forenede Stater, 80631
    - Banner North Colorado Medical Center
  - Lafayette, Colorado, Forenede Stater, 80026
    - Kaiser Permanente-Rock Creek
  - Lakewood, Colorado, Forenede Stater, 80228
    - CommonSpirit Saint Anthony Hospital Cancer Center
  - Lone Tree, Colorado, Forenede Stater, 80124
    - Kaiser Permanente-Lone Tree
  - Lone Tree, Colorado, Forenede Stater, 80124
    - Sky Ridge Medical Center
  - Longmont, Colorado, Forenede Stater, 80501
    - Longmont United Hospital
  - Loveland, Colorado, Forenede Stater, 80539
    - Banner North Colorado Medical Center - Loveland Campus
  - Parker, Colorado, Forenede Stater, 80138
    - AdventHealth Parker
  - Pueblo, Colorado, Forenede Stater, 81004
    - Saint Mary Corwin Medical Center
  - Wheat Ridge, Colorado, Forenede Stater, 80401
    - Intermountain Health Lutheran Hospital
- Connecticut
  - Glastonbury, Connecticut, Forenede Stater, 06033
    - Smilow Cancer Hospital Care Center at Glastonbury
  - Guilford, Connecticut, Forenede Stater, 06437
    - Smilow Cancer Hospital Care Center - Guilford
  - Hartford, Connecticut, Forenede Stater, 06105
    - Smilow Cancer Hospital Care Center at Saint Francis
  - New Haven, Connecticut, Forenede Stater, 06520
    - Yale University
  - New Haven, Connecticut, Forenede Stater, 06510
    - Smilow Cancer Center/Yale-New Haven Hospital
  - Trumbull, Connecticut, Forenede Stater, 06611
    - Smilow Cancer Hospital Care Center-Trumbull
  - Waterbury, Connecticut, Forenede Stater, 06708
    - Smilow Cancer Hospital-Waterbury Care Center
  - Waterford, Connecticut, Forenede Stater, 06385
    - Smilow Cancer Hospital Care Center - Waterford
- District of Columbia
  - Washington D.C., District of Columbia, Forenede Stater, 20010
    - MedStar Washington Hospital Center
  - Washington D.C., District of Columbia, Forenede Stater, 20007
    - Medstar Georgetown University Hospital
- Florida
  - Aventura, Florida, Forenede Stater, 33180
    - UM Sylvester Comprehensive Cancer Center at Aventura
  - Coral Gables, Florida, Forenede Stater, 33146
    - UM Sylvester Comprehensive Cancer Center at Coral Gables
  - Deerfield Beach, Florida, Forenede Stater, 33442
    - UM Sylvester Comprehensive Cancer Center at Deerfield Beach
  - Fort Lauderdale, Florida, Forenede Stater, 33308
    - Holy Cross Hospital
  - Miami, Florida, Forenede Stater, 33136
    - University of Miami Miller School of Medicine-Sylvester Cancer Center
  - Miami, Florida, Forenede Stater, 33176
    - UM Sylvester Comprehensive Cancer Center at Kendall
  - North Miami, Florida, Forenede Stater, 33181
    - University of Miami Sylvester Comprehensive Cancer Center at Sole Mia
  - Plantation, Florida, Forenede Stater, 33324
    - UM Sylvester Comprehensive Cancer Center at Plantation
  - 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
- Georgia
  - Athens, Georgia, Forenede Stater, 30607
    - University Cancer and Blood Center LLC
  - Atlanta, Georgia, Forenede Stater, 30322
    - Emory University Hospital/Winship Cancer Institute
  - Atlanta, Georgia, Forenede Stater, 30342
    - Northside Hospital
  - Augusta, Georgia, Forenede Stater, 30912
    - Augusta University Medical Center
  - Cumming, Georgia, Forenede Stater, 30041
    - Northside Hospital-Forsyth
  - Decatur, Georgia, Forenede Stater, 30033
    - Emory Decatur Hospital
  - Duluth, Georgia, Forenede Stater, 30096
    - Northside Hospital - Duluth
  - Lawrenceville, Georgia, Forenede Stater, 30046
    - Northside Hospital - Gwinnett
  - Savannah, Georgia, Forenede Stater, 31405
    - Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
  - Savannah, Georgia, Forenede Stater, 31405
    - Summit Cancer Care-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
  - Honolulu, Hawaii, Forenede Stater, 96819
    - Kaiser Permanente Moanalua Medical Center
  - Honolulu, Hawaii, Forenede Stater, 96817
    - Hawaii Diagnostic Radiology Services LLC
  - Kahului, Hawaii, Forenede Stater, 96732
    - Straub Medical Center - Kahului Clinic
  - Kailua, Hawaii, Forenede Stater, 96734
    - Castle Medical Center
  - 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
  - ‘Aiea, Hawaii, Forenede Stater, 96701
    - Straub Pearlridge Clinic
  - ‘Ewa Beach, Hawaii, Forenede Stater, 96706
    - The Queen's Medical Center - West Oahu
- Idaho
  - Boise, Idaho, Forenede Stater, 83706
    - Saint Alphonsus Cancer Care Center-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
  - Meridian, Idaho, Forenede Stater, 83642
    - Idaho Urologic Institute-Meridian
  - 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 Clinic Cancer Services - Sandpoint
- Illinois
  - Aurora, Illinois, Forenede Stater, 60504
    - Rush-Copley Medical Center
  - Aurora, Illinois, Forenede Stater, 60506
    - Advocate Outpatient Center - Aurora
  - Barrington, Illinois, Forenede Stater, 60010
    - Advocate Good Shepherd Hospital
  - Bloomington, Illinois, Forenede Stater, 61704
    - Illinois CancerCare-Bloomington
  - Bloomington, Illinois, Forenede Stater, 61701
    - OSF Saint Joseph Medical Center
  - 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
  - Chicago, Illinois, Forenede Stater, 60611
    - Northwestern University
  - Chicago, Illinois, Forenede Stater, 60625
    - Swedish Covenant Hospital
  - Chicago, Illinois, Forenede Stater, 60657
    - Advocate Illinois Masonic Medical Center
  - Crystal Lake, Illinois, Forenede Stater, 60014
    - AMG Crystal Lake - Oncology
  - Danville, Illinois, Forenede Stater, 61832
    - Carle at The Riverfront
  - 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
  - Downers Grove, Illinois, Forenede Stater, 60515
    - Advocate Good Samaritan Hospital
  - Effingham, Illinois, Forenede Stater, 62401
    - Crossroads Cancer Center
  - Effingham, Illinois, Forenede Stater, 62401
    - Carle Physician Group-Effingham
  - Elgin, Illinois, Forenede Stater, 60123
    - Advocate Sherman Hospital
  - Eureka, Illinois, Forenede Stater, 61530
    - Illinois CancerCare-Eureka
  - Evanston, Illinois, Forenede Stater, 60201
    - NorthShore University HealthSystem-Evanston Hospital
  - 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
  - Glenview, Illinois, Forenede Stater, 60026
    - NorthShore University HealthSystem-Glenbrook Hospital
  - Glenview, Illinois, Forenede Stater, 60026
    - Northwestern Medicine Glenview Outpatient Center
  - Grayslake, Illinois, Forenede Stater, 60030
    - Northwestern Medicine Grayslake Outpatient Center
  - Hazel Crest, Illinois, Forenede Stater, 60429
    - Advocate South Suburban Hospital
  - Highland Park, Illinois, Forenede Stater, 60035
    - NorthShore University HealthSystem-Highland Park Hospital
  - Kewanee, Illinois, Forenede Stater, 61443
    - Illinois CancerCare-Kewanee Clinic
  - Lake Forest, Illinois, Forenede Stater, 60045
    - Northwestern Medicine Lake Forest Hospital
  - Libertyville, Illinois, Forenede Stater, 60048
    - Condell Memorial Hospital
  - Libertyville, Illinois, Forenede Stater, 60048
    - AMG Libertyville - Oncology
  - Macomb, Illinois, Forenede Stater, 61455
    - Illinois CancerCare-Macomb
  - Mattoon, Illinois, Forenede Stater, 61938
    - Carle Physician Group-Mattoon/Charleston
  - O'Fallon, Illinois, Forenede Stater, 62269
    - Cancer Care Center of O'Fallon
  - O'Fallon, Illinois, Forenede Stater, 62269
    - HSHS Saint Elizabeth's Hospital
  - Oak Lawn, Illinois, Forenede Stater, 60453-2699
    - Advocate Christ Medical Center
  - Oak Lawn, Illinois, Forenede Stater, 60453
    - Advocate Outpatient Center - Oak Lawn
  - Orland Park, Illinois, Forenede Stater, 60462
    - Northwestern Medicine Orland Park
  - Ottawa, Illinois, Forenede Stater, 61350
    - Illinois CancerCare-Ottawa Clinic
  - Palos Heights, Illinois, Forenede Stater, 60463
    - Advocate High Tech Medical Park
  - Park Ridge, Illinois, Forenede Stater, 60068
    - Advocate Lutheran General Hospital
  - Pekin, Illinois, Forenede Stater, 61554
    - Illinois CancerCare-Pekin
  - Pekin, Illinois, Forenede Stater, 61554
    - OSF Saint Francis Radiation Oncology at Pekin
  - Peoria, Illinois, Forenede Stater, 61636
    - Methodist Medical Center of Illinois
  - Peoria, Illinois, Forenede Stater, 61637
    - Osf Saint Francis Medical Center
  - Peoria, Illinois, Forenede Stater, 61615
    - Illinois CancerCare-Peoria
  - Peoria, Illinois, Forenede Stater, 61615
    - OSF Saint Francis Radiation Oncology at Peoria Cancer Center
  - 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, 62702
    - Southern Illinois University School of Medicine
  - Springfield, Illinois, Forenede Stater, 62702
    - Springfield Clinic
  - Springfield, Illinois, Forenede Stater, 62781
    - Springfield Memorial Hospital
  - 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
  - Evansville, Indiana, Forenede Stater, 47713
    - Deaconess Clinic Downtown
  - Indianapolis, Indiana, Forenede Stater, 46237
    - Franciscan Health Indianapolis
  - Indianapolis, Indiana, Forenede Stater, 46202
    - Indiana University/Melvin and Bren Simon Cancer Center
  - Michigan City, Indiana, Forenede Stater, 46360
    - Franciscan Saint Anthony Health-Michigan City
  - Michigan City, Indiana, Forenede Stater, 46360
    - Woodland Cancer Care Center
  - Mooresville, Indiana, Forenede Stater, 46158
    - Franciscan Health Mooresville
  - Newburgh, Indiana, Forenede Stater, 47630
    - Chancellor Center for Oncology
  - Richmond, Indiana, Forenede Stater, 47374
    - Reid Health
- Iowa
  - Ames, Iowa, Forenede Stater, 50010
    - Mary Greeley Medical Center
  - Ames, Iowa, Forenede Stater, 50010
    - McFarland Clinic - Ames
  - Boone, Iowa, Forenede Stater, 50036
    - McFarland Clinic - Boone
  - Council Bluffs, Iowa, Forenede Stater, 51503
    - Alegent Health Mercy Hospital
  - Council Bluffs, Iowa, Forenede Stater, 51503
    - Heartland Oncology and Hematology LLP
  - Council Bluffs, Iowa, Forenede Stater, 51503
    - Methodist Jennie Edmundson Hospital
  - Council Bluffs, Iowa, Forenede Stater, 51503
    - Nebraska Cancer Specialists/Oncology Hematology West PC - MEJ
  - Fort Dodge, Iowa, Forenede Stater, 50501
    - McFarland Clinic - Trinity Cancer Center
  - Jefferson, Iowa, Forenede Stater, 50129
    - McFarland Clinic - Jefferson
  - Marshalltown, Iowa, Forenede Stater, 50158
    - McFarland Clinic - Marshalltown
  - Sioux City, Iowa, Forenede Stater, 51101
    - Siouxland Regional Cancer Center
- Kansas
  - Chanute, Kansas, Forenede Stater, 66720
    - Cancer Center of Kansas - Chanute
  - Dodge City, Kansas, Forenede Stater, 67801
    - Cancer Center of Kansas - Dodge City
  - El Dorado, Kansas, Forenede Stater, 67042
    - Cancer Center of Kansas - El Dorado
  - Fort Scott, Kansas, Forenede Stater, 66701
    - Cancer Center of Kansas - Fort Scott
  - Hays, Kansas, Forenede Stater, 67601
    - HaysMed
  - Independence, Kansas, Forenede Stater, 67301
    - Cancer Center of Kansas-Independence
  - Kansas City, Kansas, Forenede Stater, 66160
    - University of Kansas Cancer Center
  - Kingman, Kansas, Forenede Stater, 67068
    - Cancer Center of Kansas-Kingman
  - Lawrence, Kansas, Forenede Stater, 66044
    - Lawrence Memorial Hospital
  - Liberal, Kansas, Forenede Stater, 67905
    - Cancer Center of Kansas-Liberal
  - Manhattan, Kansas, Forenede Stater, 66502
    - Cancer Center of Kansas-Manhattan
  - McPherson, Kansas, Forenede Stater, 67460
    - Cancer Center of Kansas - McPherson
  - Newton, Kansas, Forenede Stater, 67114
    - Cancer Center of Kansas - Newton
  - Olathe, Kansas, Forenede Stater, 66061
    - The University of Kansas Cancer Center - Olathe
  - Overland Park, Kansas, Forenede Stater, 66210
    - University of Kansas Cancer Center-Overland Park
  - Overland Park, Kansas, Forenede Stater, 66211
    - University of Kansas Hospital-Indian Creek Campus
  - Parsons, Kansas, Forenede Stater, 67357
    - Cancer Center of Kansas - Parsons
  - Pittsburg, Kansas, Forenede Stater, 66762
    - Freeman Physician Group of Pittsburg
  - Pratt, Kansas, Forenede Stater, 67124
    - Cancer Center of Kansas - Pratt
  - Salina, Kansas, Forenede Stater, 67401
    - Salina Regional Health Center
  - Salina, Kansas, Forenede Stater, 67401
    - Cancer Center of Kansas - Salina
  - Topeka, Kansas, Forenede Stater, 66606
    - University of Kansas Health System Saint Francis Campus
  - Topeka, Kansas, Forenede Stater, 66606
    - Cotton O'Neil Cancer Center / Stormont Vail Health
  - Wellington, Kansas, Forenede Stater, 67152
    - Cancer Center of Kansas - Wellington
  - Westwood, Kansas, Forenede Stater, 66205
    - University of Kansas Hospital-Westwood Cancer Center
  - Wichita, Kansas, Forenede Stater, 67214
    - Ascension Via Christi Hospitals Wichita
  - Wichita, Kansas, Forenede Stater, 67208
    - Cancer Center of Kansas-Wichita Medical Arts Tower
  - Wichita, Kansas, Forenede Stater, 67214
    - Cancer Center of Kansas - Wichita
  - Wichita, Kansas, Forenede Stater, 67208
    - Associates In Womens Health
  - Winfield, Kansas, Forenede Stater, 67156
    - Cancer Center of Kansas - Winfield
- Kentucky
  - Crestview Hills, Kentucky, Forenede Stater, 41017
    - Oncology Hematology Care Inc-Crestview
  - Louisville, Kentucky, Forenede Stater, 40202
    - The James Graham Brown Cancer Center at University of Louisville
  - Louisville, Kentucky, Forenede Stater, 40245
    - UofL Health Medical Center Northeast
- 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
    - Ochsner Health Center-Summa
  - Baton Rouge, Louisiana, Forenede Stater, 70816
    - Medical Center of Baton Rouge
  - Baton Rouge, Louisiana, Forenede Stater, 70836
    - Ochsner High Grove
  - Baton Rouge, Louisiana, Forenede Stater, 70808
    - Our Lady of The Lake
  - Baton Rouge, Louisiana, Forenede Stater, 70808
    - Our Lady of the Lake Physician Group
  - Covington, Louisiana, Forenede Stater, 70433
    - Mary Bird Perkins Cancer Center - Covington
  - Covington, Louisiana, Forenede Stater, 70433
    - Northshore Oncology Associates-Covington
  - Houma, Louisiana, Forenede Stater, 70360
    - Mary Bird Perkins Cancer Center - Houma
  - Houma, Louisiana, Forenede Stater, 70360
    - Oncology Center of The South Incorporated
  - Kenner, Louisiana, Forenede Stater, 70065
    - Ochsner Medical Center Kenner
  - Monroe, Louisiana, Forenede Stater, 71202
    - Ochsner LSU Health Monroe Medical Center
  - New Orleans, Louisiana, Forenede Stater, 70121
    - Ochsner Medical Center Jefferson
  - New Orleans, Louisiana, Forenede Stater, 70112
    - University Medical Center New Orleans
  - New Orleans, Louisiana, Forenede Stater, 70112
    - Louisiana State University Health Science Center
  - Shreveport, Louisiana, Forenede Stater, 71103
    - LSU Health Sciences Center at Shreveport
  - Shreveport, Louisiana, Forenede Stater, 71105
    - CHRISTUS Highland Medical Center
- Maine
  - Augusta, Maine, Forenede Stater, 04330
    - Harold Alfond Center for Cancer Care
  - Bangor, Maine, Forenede Stater, 04401
    - Eastern Maine Medical Center
  - Brewer, Maine, Forenede Stater, 04412
    - Lafayette Family Cancer Center-EMMC
  - Kennebunk, Maine, Forenede Stater, 04043
    - New England Cancer Specialists - Kennebunk
  - Westbrook, Maine, Forenede Stater, 04092
    - New England Cancer Specialists
- Maryland
  - Baltimore, Maryland, Forenede Stater, 21237
    - MedStar Franklin Square Medical Center/Weinberg Cancer Institute
  - Baltimore, Maryland, Forenede Stater, 21215
    - Sinai Hospital of Baltimore
  - Baltimore, Maryland, Forenede Stater, 21204
    - Greater Baltimore Medical Center
  - Baltimore, Maryland, Forenede Stater, 21229
    - Saint Agnes Hospital
  - Cumberland, Maryland, Forenede Stater, 21502
    - UPMC Western Maryland
  - Randallstown, Maryland, Forenede Stater, 21133
    - Northwest Hospital Center
- Massachusetts
  - Boston, Massachusetts, Forenede Stater, 02215
    - Beth Israel Deaconess Medical Center
  - Boston, Massachusetts, Forenede Stater, 02215
    - Dana-Farber Cancer Institute
  - Boston, Massachusetts, Forenede Stater, 02114
    - Massachusetts General Hospital Cancer Center
  - Springfield, Massachusetts, Forenede Stater, 01199
    - Baystate Medical Center
  - Worcester, Massachusetts, Forenede Stater, 01655
    - UMass Memorial Medical Center - University Campus
- Michigan
  - Adrian, Michigan, Forenede Stater, 49221
    - Hickman Cancer Center
  - Alma, Michigan, Forenede Stater, 48801
    - MyMichigan Medical Center Gratiot
  - Alpena, Michigan, Forenede Stater, 49707
    - MyMichigan Medical Center Alpena
  - Ann Arbor, Michigan, Forenede Stater, 48109
    - University of Michigan Rogel Cancer Center
  - Ann Arbor, Michigan, Forenede Stater, 48106
    - Trinity Health Saint Joseph Mercy Hospital Ann Arbor
  - Battle Creek, Michigan, Forenede Stater, 49017
    - Bronson Battle Creek
  - Brighton, Michigan, Forenede Stater, 48114
    - Trinity Health IHA Medical Group Hematology Oncology - Brighton
  - Brighton, Michigan, Forenede Stater, 48116
    - University of Michigan - Brighton Center for Specialty Care
  - Brighton, Michigan, Forenede Stater, 48114
    - Trinity Health Medical Center - Brighton
  - Canton, Michigan, Forenede Stater, 48188
    - Trinity Health IHA Medical Group Hematology Oncology - Canton
  - Canton, Michigan, Forenede Stater, 48188
    - Trinity Health Medical Center - Canton
  - Caro, Michigan, Forenede Stater, 48723
    - Caro Cancer Center
  - Chelsea, Michigan, Forenede Stater, 48118
    - Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
  - Chelsea, Michigan, Forenede Stater, 48118
    - Chelsea Hospital
  - Clarkston, Michigan, Forenede Stater, 48346
    - Hematology Oncology Consultants-Clarkston
  - Clarkston, Michigan, Forenede Stater, 48346
    - Newland Medical Associates-Clarkston
  - Dearborn, Michigan, Forenede Stater, 48124
    - Corewell Health Dearborn Hospital
  - Detroit, Michigan, Forenede Stater, 48236
    - Henry Ford Health Saint John Hospital
  - East China Township, Michigan, Forenede Stater, 48054
    - Henry Ford River District Hospital
  - Flint, Michigan, Forenede Stater, 48503
    - Hurley Medical Center
  - Flint, Michigan, Forenede Stater, 48503
    - Genesee Hematology Oncology PC
  - Flint, Michigan, Forenede Stater, 48503
    - Genesys Hurley Cancer Institute
  - Flint, Michigan, Forenede Stater, 48503
    - Cancer Hematology Centers - Flint
  - Gladwin, Michigan, Forenede Stater, 48624
    - MyMichigan Medical Center Gladwin
  - Grand Rapids, Michigan, Forenede Stater, 49503
    - Trinity Health Grand Rapids Hospital
  - Grand Rapids, Michigan, Forenede Stater, 49503
    - Corewell Health Grand Rapids Hospitals - Butterworth Hospital
  - Grosse Pointe Woods, Michigan, Forenede Stater, 48236
    - Henry Ford Saint John Hospital - Academic
  - Grosse Pointe Woods, Michigan, Forenede Stater, 48236
    - Henry Ford Saint John Hospital - Breast
  - Grosse Pointe Woods, Michigan, Forenede Stater, 48236
    - Henry Ford Saint John Hospital - Van Elslander
  - Jackson, Michigan, Forenede Stater, 49201
    - Allegiance Health
  - Kalamazoo, Michigan, Forenede Stater, 49007
    - West Michigan Cancer Center
  - Kalamazoo, Michigan, Forenede Stater, 49007
    - Bronson Methodist Hospital
  - Kalamazoo, Michigan, Forenede Stater, 49009
    - Beacon Kalamazoo Cancer Center
  - Kalamazoo, Michigan, Forenede Stater, 49048
    - Beacon Kalamazoo
  - Lansing, Michigan, Forenede Stater, 48912
    - University of Michigan Health - Sparrow Lansing
  - 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
    - Henry Ford Warren Hospital - Breast Macomb
  - Macomb, Michigan, Forenede Stater, 48044
    - Henry Ford Saint John Hospital - Macomb Medical
  - Marlette, Michigan, Forenede Stater, 48453
    - Saint Mary's Oncology/Hematology Associates of Marlette
  - Midland, Michigan, Forenede Stater, 48670
    - MyMichigan Medical Center Midland
  - Monroe, Michigan, Forenede Stater, 48162
    - Toledo Clinic Cancer Centers-Monroe
  - Mount Pleasant, Michigan, Forenede Stater, 48858
    - MyMichigan Medical Center Mount Pleasant
  - Muskegon, Michigan, Forenede Stater, 49444
    - Trinity Health Muskegon Hospital
  - Norton Shores, Michigan, Forenede Stater, 49444
    - Cancer and Hematology Centers of Western Michigan - Norton Shores
  - Pontiac, Michigan, Forenede Stater, 48341
    - Hope Cancer Center
  - Pontiac, Michigan, Forenede Stater, 48341
    - Newland Medical Associates-Pontiac
  - Pontiac, Michigan, Forenede Stater, 48341
    - Trinity Health Saint Joseph Mercy Oakland Hospital
  - Pontiac, Michigan, Forenede Stater, 48341
    - Michigan Healthcare Professionals Pontiac
  - Reed City, Michigan, Forenede Stater, 49677
    - Corewell Health Reed City Hospital
  - Rochester Hills, Michigan, Forenede Stater, 48309
    - Henry Ford Rochester Hospital
  - Royal Oak, Michigan, Forenede Stater, 48073
    - Corewell Health William Beaumont University Hospital
  - Saginaw, Michigan, Forenede Stater, 48604
    - Oncology Hematology Associates of Saginaw Valley PC
  - Saginaw, Michigan, Forenede Stater, 48601
    - MyMichigan Medical Center Saginaw
  - Southfield, Michigan, Forenede Stater, 48075
    - Henry Ford Health Providence Southfield Hospital
  - Sterling Heights, Michigan, Forenede Stater, 48312
    - Bhadresh Nayak MD PC-Sterling Heights
  - Tawas City, Michigan, Forenede Stater, 48764
    - MyMichigan Medical Center Tawas
  - Traverse City, Michigan, Forenede Stater, 49684
    - Munson Medical Center
  - Troy, Michigan, Forenede Stater, 48085
    - Corewell Health Beaumont Troy Hospital
  - Warren, Michigan, Forenede Stater, 48088
    - Advanced Breast Care Center PLLC
  - Warren, Michigan, Forenede Stater, 48093
    - Macomb Hematology Oncology PC
  - Warren, Michigan, Forenede Stater, 48093
    - Henry Ford Madison Heights Hospital - Breast
  - Warren, Michigan, Forenede Stater, 48093
    - Henry Ford Health Warren Hospital
  - Warren, Michigan, Forenede Stater, 48093
    - Henry Ford Warren Hospital - GLCMS
  - West Branch, Michigan, Forenede Stater, 48661
    - Saint Mary's Oncology/Hematology Associates of West Branch
  - Wyoming, Michigan, Forenede Stater, 49519
    - University of Michigan Health - West
  - 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
  - Crosslake, Minnesota, Forenede Stater, 56442
    - Essentia Health - Saint Joseph's Crosslake Clinic
  - 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
  - Pequot Lakes, Minnesota, Forenede Stater, 56472
    - Essentia Health - Saint Joseph's Pequot Lakes Clinic
  - Pine River, Minnesota, Forenede Stater, 56474
    - Essentia Health - Saint Joseph's Pine River Clinic
  - 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
  - Staples, Minnesota, Forenede Stater, 56479
    - Essentia Health - Saint Joseph's Staples Clinic
  - 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
  - Jackson, Mississippi, Forenede Stater, 39216
    - University of Mississippi Medical Center
- Missouri
  - Bonne Terre, Missouri, Forenede Stater, 63628
    - Parkland Health Center-Bonne Terre
  - Cape Girardeau, Missouri, Forenede Stater, 63703
    - Saint Francis Medical Center
  - Cape Girardeau, Missouri, Forenede Stater, 63703
    - Mercy Cancer Center - Cape Girardeau
  - Chesterfield, Missouri, Forenede Stater, 63017
    - Saint Luke's Hospital
  - Farmington, Missouri, Forenede Stater, 63640
    - Parkland Health Center - Farmington
  - Jefferson City, Missouri, Forenede Stater, 65109
    - MU Health Care Goldschmidt Cancer Center
  - Kansas City, Missouri, Forenede Stater, 64154
    - University of Kansas Cancer Center - North
  - Kansas City, Missouri, Forenede Stater, 64108
    - University Health Truman Medical Center
  - Kansas City, Missouri, Forenede Stater, 64116
    - University of Kansas Cancer Center - Briarcliff
  - Lee's Summit, Missouri, Forenede Stater, 64064
    - University of Kansas Cancer Center - Lee's Summit
  - North Kansas City, Missouri, Forenede Stater, 64116
    - University of Kansas Cancer Center at North Kansas City Hospital
  - 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, 63131
    - Missouri Baptist Medical Center
  - Sullivan, Missouri, Forenede Stater, 63080
    - Missouri Baptist Sullivan Hospital
- 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 Health Deaconess Hospital
  - Butte, Montana, Forenede Stater, 59701
    - Saint James Community Hospital and Cancer Treatment Center
  - Great Falls, Montana, Forenede Stater, 59405
    - Benefis Sletten Cancer Institute
  - Havre, Montana, Forenede Stater, 59501
    - Hi-Line Sletten Cancer Center
  - Helena, Montana, Forenede Stater, 59601
    - Saint Peter's Community Hospital
  - Kalispell, Montana, Forenede Stater, 59901
    - Logan Health Medical Center
- Nebraska
  - Lincoln, Nebraska, Forenede Stater, 68510
    - Saint Elizabeth Regional Medical Center
  - North Platte, Nebraska, Forenede Stater, 69101
    - Great Plains Health Callahan Cancer Center
  - 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, 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
    - 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, 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
  - Henderson, Nevada, Forenede Stater, 89074
    - Oncology Las Vegas - Henderson
  - 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, 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, 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, 89106
    - Cancer and Blood Specialists-Shadow
  - Las Vegas, Nevada, Forenede Stater, 89109
    - HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
  - Las Vegas, Nevada, Forenede Stater, 89113
    - HealthCare Partners Medical Group Oncology/Hematology-San Martin
  - Las Vegas, Nevada, Forenede Stater, 89128
    - Cancer and Blood Specialists-Tenaya
  - Las Vegas, Nevada, Forenede Stater, 89128
    - HealthCare Partners Medical Group Oncology/Hematology-Tenaya
  - Las Vegas, Nevada, Forenede Stater, 89148-2405
    - Las Vegas Cancer Center-Medical Center
  - Las Vegas, Nevada, Forenede Stater, 89149
    - HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
  - 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
  - Las Vegas, Nevada, Forenede Stater, 89128
    - Oncology Las Vegas - Tenaya
  - Las Vegas, Nevada, Forenede Stater, 89183
    - OptumCare Cancer Care at Fort Apache
  - 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 Hampshire
  - Lebanon, New Hampshire, Forenede Stater, 03756
    - Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
- New Jersey
  - Basking Ridge, New Jersey, Forenede Stater, 07920
    - Memorial Sloan Kettering Basking Ridge
  - Hackensack, New Jersey, Forenede Stater, 07601
    - Hackensack University Medical Center
  - Neptune City, New Jersey, Forenede Stater, 07753
    - Jersey Shore Medical Center
  - Paramus, New Jersey, Forenede Stater, 07652
    - John Theurer Cancer Center at From Road
  - Red Bank, New Jersey, Forenede Stater, 07701
    - Riverview Medical Center/Booker Cancer Center
- New Mexico
  - Albuquerque, New Mexico, Forenede Stater, 87102
    - Lovelace Medical Center-Saint Joseph Square
  - Albuquerque, New Mexico, Forenede Stater, 87109
    - New Mexico Oncology Hematology Consultants
  - Albuquerque, New Mexico, Forenede Stater, 87106
    - University of New Mexico Cancer Center
  - Albuquerque, New Mexico, Forenede Stater, 87110
    - Presbyterian Kaseman Hospital
  - Rio Rancho, New Mexico, Forenede Stater, 87124
    - Presbyterian Rust Medical Center/Jorgensen Cancer Center
  - Santa Fe, New Mexico, Forenede Stater, 87505
    - Christus Saint Vincent Regional Cancer Center
- New York
  - Buffalo, New York, Forenede Stater, 14263
    - Roswell Park Cancer Institute
  - Commack, New York, Forenede Stater, 11725
    - Memorial Sloan Kettering Commack
  - Cooperstown, New York, Forenede Stater, 13326
    - Mary Imogene Bassett Hospital
  - Harrison, New York, Forenede Stater, 10604
    - Memorial Sloan Kettering Westchester
  - New York, New York, Forenede Stater, 10065
    - Memorial Sloan Kettering Cancer Center
  - New York, New York, Forenede Stater, 10065
    - NYP/Weill Cornell Medical Center
  - Rochester, New York, Forenede Stater, 14642
    - University of Rochester
- North Carolina
  - Asheville, North Carolina, Forenede Stater, 28803
    - AdventHealth Infusion Center Asheville
  - Clinton, North Carolina, Forenede Stater, 28328
    - Southeastern Medical Oncology Center-Clinton
  - Goldsboro, North Carolina, Forenede Stater, 27534
    - Southeastern Medical Oncology Center-Goldsboro
  - Goldsboro, North Carolina, Forenede Stater, 27534
    - Wayne Memorial Hospital
  - Hendersonville, North Carolina, Forenede Stater, 28791
    - Margaret R Pardee Memorial Hospital
  - Jacksonville, North Carolina, Forenede Stater, 28546
    - Southeastern Medical Oncology Center-Jacksonville
  - Jacksonville, North Carolina, Forenede Stater, 28546
    - Onslow Memorial Hospital
  - Kenansville, North Carolina, Forenede Stater, 28349
    - ECU Health Oncology Kenansville
  - Kinston, North Carolina, Forenede Stater, 28501
    - ECU Health Oncology Kinston
  - Richlands, North Carolina, Forenede Stater, 28574
    - ECU Health Oncology Richlands
- 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
  - Jamestown, North Dakota, Forenede Stater, 58401
    - Essentia Health - Jamestown Clinic
- Ohio
  - Avon, Ohio, Forenede Stater, 44011
    - UH Seidman Cancer Center at UH Avon Health Center
  - Beachwood, Ohio, Forenede Stater, 44122
    - UHHS-Chagrin Highlands Medical Center
  - 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
  - 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, 45219
    - University of Cincinnati Cancer Center-UC Medical Center
  - Cincinnati, Ohio, Forenede Stater, 45242
    - Oncology Hematology Care Inc-Blue Ash
  - Cincinnati, Ohio, Forenede Stater, 45202
    - Oncology Hematology Care Inc-Eden Park
  - Cincinnati, Ohio, Forenede Stater, 45211
    - Oncology Hematology Care Inc-Mercy West
  - Cincinnati, Ohio, Forenede Stater, 45230
    - Oncology Hematology Care Inc-Anderson
  - Cincinnati, Ohio, Forenede Stater, 45236
    - Oncology Hematology Care Inc-Kenwood
  - Cleveland, Ohio, Forenede Stater, 44106
    - Case Western Reserve University
  - Cleveland, Ohio, Forenede Stater, 44109
    - MetroHealth Medical Center
  - 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, 45406
    - Good Samaritan Hospital - Dayton
  - Dayton, Ohio, Forenede Stater, 45409
    - Miami Valley Hospital
  - Dayton, Ohio, Forenede Stater, 45415
    - Miami Valley Hospital North
  - Dayton, Ohio, Forenede Stater, 45415
    - Dayton Physician LLC - Englewood
  - Dayton, Ohio, Forenede Stater, 45409
    - Premier 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
  - Fairfield, Ohio, Forenede Stater, 45014
    - Oncology Hematology Care Inc-Healthplex
  - 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
  - Greenville, Ohio, Forenede Stater, 45331
    - Wayne Hospital
  - Greenville, Ohio, Forenede Stater, 45331
    - Dayton Physicians LLC-Wayne
  - Greenville, Ohio, Forenede Stater, 45331
    - Miami Valley Cancer Care and Infusion
  - Grove City, Ohio, Forenede Stater, 43123
    - Mount Carmel Grove City Hospital
  - Grove City, Ohio, Forenede Stater, 43123
    - Zangmeister Center Grove City
  - Kettering, Ohio, Forenede Stater, 45429
    - Kettering Medical Center
  - Kettering, Ohio, Forenede Stater, 45409
    - Greater Dayton Cancer Center
  - Lancaster, Ohio, Forenede Stater, 43130
    - Fairfield Medical Center
  - Lima, Ohio, Forenede Stater, 45801
    - Saint Rita's Medical Center
  - 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
  - Marysville, Ohio, Forenede Stater, 43040
    - Memorial Hospital
  - Maumee, Ohio, Forenede Stater, 43537
    - Toledo Clinic Cancer Centers-Maumee
  - Maumee, Ohio, Forenede Stater, 43537
    - Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
  - Mentor, Ohio, Forenede Stater, 44060
    - UH Seidman Cancer Center at Lake Health Mentor Campus
  - Middletown, Ohio, Forenede Stater, 45042
    - Dayton Physicians LLC-Signal Point
  - Mount Vernon, Ohio, Forenede Stater, 43050
    - Knox Community Hospital
  - New Albany, Ohio, Forenede Stater, 43054
    - Mount Carmel New Albany Surgical Hospital
  - Newark, Ohio, Forenede Stater, 43055
    - Licking Memorial Hospital
  - Newark, Ohio, Forenede Stater, 43055
    - Newark Radiation Oncology
  - Oregon, Ohio, Forenede Stater, 43616
    - Saint Charles Hospital
  - Perrysburg, Ohio, Forenede Stater, 43551
    - Mercy Health - Perrysburg Hospital
  - Portsmouth, Ohio, Forenede Stater, 45662
    - Southern Ohio Medical Center
  - Sandusky, Ohio, Forenede Stater, 44870
    - UH Seidman Cancer Center at Firelands Regional Medical Center
  - Sidney, Ohio, Forenede Stater, 45365
    - Dayton Physicians LLC-Wilson
  - Springfield, Ohio, Forenede Stater, 45504
    - Springfield Regional Cancer Center
  - Springfield, Ohio, Forenede Stater, 45504
    - Springfield Regional Medical Center
  - 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, 43623
    - Mercy Health - Saint Anne Hospital
  - Toledo, Ohio, Forenede Stater, 43623
    - Toledo Clinic Cancer Centers-Toledo
  - Toledo, Ohio, Forenede Stater, 43608
    - Mercy Health - Saint Vincent Hospital
  - Toledo, Ohio, Forenede Stater, 43623
    - Mercy Health Sylvania Radiation Oncology Center
  - 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
  - West Chester, Ohio, Forenede Stater, 45069
    - University of Cincinnati Cancer Center-West Chester
  - Westerville, Ohio, Forenede Stater, 43081
    - Saint Ann's Hospital
  - Westlake, Ohio, Forenede Stater, 44145
    - UH Seidman Cancer Center at Saint John Medical Center
  - Wilmington, Ohio, Forenede Stater, 45177
    - Clinton Memorial Hospital/Foster J Boyd Regional Cancer 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
- Oregon
  - Baker City, Oregon, Forenede Stater, 97814
    - Saint Alphonsus Cancer Care Center-Baker City
  - Ontario, Oregon, Forenede Stater, 97914
    - Saint Alphonsus Cancer Care Center-Ontario
- Pennsylvania
  - Allentown, Pennsylvania, Forenede Stater, 18103
    - Lehigh Valley Hospital-Cedar Crest
  - Allentown, Pennsylvania, Forenede Stater, 18104
    - Saint Luke's Cancer Center - Allentown
  - Allentown, Pennsylvania, Forenede Stater, 18104
    - Saint Luke's Hospital-Allentown Campus
  - Beaver, Pennsylvania, Forenede Stater, 15009
    - UPMC-Heritage Valley Health System Beaver
  - Bethlehem, Pennsylvania, Forenede Stater, 18017
    - Lehigh Valley Hospital - Muhlenberg
  - Bethlehem, Pennsylvania, Forenede Stater, 18015
    - Saint Luke's University Hospital-Bethlehem Campus
  - Coaldale, Pennsylvania, Forenede Stater, 18218
    - Saint Luke's Hospital-Miners Campus
  - 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
  - Erie, Pennsylvania, Forenede Stater, 16505
    - UPMC Hillman Cancer Center Erie
  - Greensburg, Pennsylvania, Forenede Stater, 15601
    - UPMC Cancer Centers - Arnold Palmer Pavilion
  - 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
  - Johnstown, Pennsylvania, Forenede Stater, 15901
    - UPMC-Johnstown/John P. Murtha Regional Cancer Center
  - Lewisburg, Pennsylvania, Forenede Stater, 17837
    - Geisinger Medical Oncology-Lewisburg
  - Lewistown, Pennsylvania, Forenede Stater, 17044
    - Lewistown Hospital
  - McKeesport, Pennsylvania, Forenede Stater, 15132
    - UPMC Cancer Center at UPMC McKeesport
  - Mechanicsburg, Pennsylvania, Forenede Stater, 17050
    - UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
  - Monroeville, Pennsylvania, Forenede Stater, 15146
    - UPMC Hillman Cancer Center - Monroeville
  - Moon Township, Pennsylvania, Forenede Stater, 15108
    - UPMC Hillman Cancer Center in Coraopolis
  - Pittsburgh, Pennsylvania, Forenede Stater, 15232
    - UPMC Hillman Cancer Center
  - Pittsburgh, Pennsylvania, Forenede Stater, 15213
    - UPMC-Magee Womens Hospital
  - Pittsburgh, Pennsylvania, Forenede Stater, 15232
    - UPMC-Shadyside Hospital
  - Pittsburgh, Pennsylvania, Forenede Stater, 15213
    - UPMC-Presbyterian Hospital
  - Pittsburgh, Pennsylvania, Forenede Stater, 15215
    - UPMC-Saint Margaret
  - Pittsburgh, Pennsylvania, Forenede Stater, 15237
    - UPMC-Passavant Hospital
  - 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 - Upper Bucks Campus
  - Sayre, Pennsylvania, Forenede Stater, 18840
    - Guthrie Medical Group PC-Robert Packer Hospital
  - 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
  - State College, Pennsylvania, Forenede Stater, 16801
    - Geisinger Medical Group
  - Stroudsburg, Pennsylvania, Forenede Stater, 18360
    - Saint Luke's Hospital - Monroe Campus
  - Uniontown, Pennsylvania, Forenede Stater, 15401
    - UPMC Uniontown Hospital Radiation Oncology
  - Washington, Pennsylvania, Forenede Stater, 15301
    - UPMC Washington Hospital Radiation Oncology
  - Washington, Pennsylvania, Forenede Stater, 15301
    - UPMC Cancer Center-Washington
  - West Reading, Pennsylvania, Forenede Stater, 19611
    - Reading Hospital
  - Wilkes-Barre, Pennsylvania, Forenede Stater, 18711
    - Geisinger Wyoming Valley/Henry Cancer Center
  - Williamsport, Pennsylvania, Forenede Stater, 17701
    - UPMC Susquehanna
- Rhode Island
  - Westerly, Rhode Island, Forenede Stater, 02891
    - Smilow Cancer Hospital Care Center - Westerly
- South Carolina
  - Bluffton, South Carolina, Forenede Stater, 29910
    - Saint Joseph's/Candler - Bluffton Campus
  - Greenville, South Carolina, Forenede Stater, 29607
    - Saint Francis Cancer Center
  - Greenville, South Carolina, Forenede Stater, 29601
    - Saint Francis Hospital
  - Hilton Head Island, South Carolina, Forenede Stater, 29926-3827
    - South Carolina Cancer Specialists PC
- 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
  - Franklin, Tennessee, Forenede Stater, 37067
    - Vanderbilt-Ingram Cancer Center Cool Springs
  - Knoxville, Tennessee, Forenede Stater, 37916
    - Covenant Health Cancer Centers
  - Knoxville, Tennessee, Forenede Stater, 37932
    - Covenant Health Cancer Centers - West
  - Maryville, Tennessee, Forenede Stater, 37804
    - Covenant Health Oncology Group - Maryville
  - Nashville, Tennessee, Forenede Stater, 37232
    - Vanderbilt University/Ingram Cancer Center
  - Nashville, Tennessee, Forenede Stater, 37204
    - Vanderbilt Breast Center at One Hundred Oaks
  - Oak Ridge, Tennessee, Forenede Stater, 37830
    - Covenant Health Oncology Group - Oak Ridge
- Texas
  - Dallas, Texas, Forenede Stater, 75235
    - Parkland Memorial Hospital
  - Dallas, Texas, Forenede Stater, 75390
    - UT Southwestern/Simmons Cancer Center-Dallas
- Utah
  - Farmington, Utah, Forenede Stater, 84025
    - Farmington Health Center
  - Salt Lake City, Utah, Forenede Stater, 84112
    - Huntsman Cancer Institute/University of Utah
  - South Jordan, Utah, Forenede Stater, 84009
    - South Jordan Health Center
- Vermont
  - Burlington, Vermont, Forenede Stater, 05401
    - University of Vermont Medical Center
  - Burlington, Vermont, Forenede Stater, 05405
    - University of Vermont and State Agricultural College
- Virginia
  - Charlottesville, Virginia, Forenede Stater, 22908
    - University of Virginia Cancer Center
  - Fredericksburg, Virginia, Forenede Stater, 22408
    - Hematology Oncology Associates of Fredericksburg Inc
  - Lynchburg, Virginia, Forenede Stater, 24501
    - Centra Alan B Pearson Regional Cancer Center
  - Richmond, Virginia, Forenede Stater, 23229
    - Virginia Cancer Institute
  - Richmond, Virginia, Forenede Stater, 23298
    - VCU Massey Comprehensive Cancer Center
  - Winchester, Virginia, Forenede Stater, 22601
    - Shenandoah Oncology PC
- Washington
  - Bellevue, Washington, Forenede Stater, 98004
    - Overlake Medical Center
  - Port Townsend, Washington, Forenede Stater, 98368
    - Jefferson Healthcare
  - Renton, Washington, Forenede Stater, 98055
    - Valley Medical Center
  - Yakima, Washington, Forenede Stater, 98902
    - North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
- West Virginia
  - Charleston, West Virginia, Forenede Stater, 25304
    - West Virginia University Charleston Division
  - Huntington, West Virginia, Forenede Stater, 25701
    - Edwards Comprehensive Cancer Center
- Wisconsin
  - Antigo, Wisconsin, Forenede Stater, 54409
    - Aspirus Cancer Care-Antigo-Volm Cancer Center
  - Ashland, Wisconsin, Forenede Stater, 54806
    - Duluth Clinic Ashland
  - Ashland, Wisconsin, Forenede Stater, 54806
    - Northwest Wisconsin Cancer Center
  - Burlington, Wisconsin, Forenede Stater, 53105
    - Aurora Cancer Care-Southern Lakes VLCC
  - Chippewa Falls, Wisconsin, Forenede Stater, 54729
    - Marshfield Clinic-Chippewa Center
  - Cudahy, Wisconsin, Forenede Stater, 53110
    - Aurora Saint Luke's South Shore
  - Eau Claire, Wisconsin, Forenede Stater, 54701
    - Marshfield Medical Center-EC Cancer Center
  - Eau Claire, Wisconsin, Forenede Stater, 54701
    - Marshfield Clinic Cancer Center at Sacred Heart
  - Fond du Lac, Wisconsin, Forenede Stater, 54937
    - Aurora Health Center-Fond du Lac
  - Germantown, Wisconsin, Forenede Stater, 53022
    - Aurora Health Care Germantown Health Center
  - Grafton, Wisconsin, Forenede Stater, 53024
    - Aurora Cancer Care-Grafton
  - Green Bay, Wisconsin, Forenede Stater, 54311
    - Aurora BayCare Medical Center
  - Green Bay, Wisconsin, Forenede Stater, 54301
    - Bellin Memorial Hospital
  - Hayward, Wisconsin, Forenede Stater, 54843
    - Tamarack Health Hayward Medical Center
  - Johnson Creek, Wisconsin, Forenede Stater, 53038
    - University of Wisconsin Carbone Cancer Center - Johnson Creek
  - Kenosha, Wisconsin, Forenede Stater, 53142
    - Aurora Cancer Care-Kenosha South
  - La Crosse, Wisconsin, Forenede Stater, 54601
    - Gundersen Lutheran Medical Center
  - Madison, Wisconsin, Forenede Stater, 53792
    - University of Wisconsin Carbone Cancer Center - University Hospital
  - Madison, Wisconsin, Forenede Stater, 53718
    - University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
  - Marinette, Wisconsin, Forenede Stater, 54143
    - Aurora Bay Area Medical Group-Marinette
  - Marshfield, Wisconsin, Forenede Stater, 54449
    - Marshfield Medical Center-Marshfield
  - Medford, Wisconsin, Forenede Stater, 54451
    - Aspirus Medford Hospital
  - Milwaukee, Wisconsin, Forenede Stater, 53226
    - Medical College of Wisconsin
  - Milwaukee, Wisconsin, Forenede Stater, 53209
    - Aurora Cancer Care-Milwaukee
  - Milwaukee, Wisconsin, Forenede Stater, 53215
    - Aurora Saint Luke's Medical Center
  - Milwaukee, Wisconsin, Forenede Stater, 53233
    - Aurora Sinai Medical Center
  - Minocqua, Wisconsin, Forenede Stater, 54548
    - Marshfield Medical Center - Minocqua
  - Mukwonago, Wisconsin, Forenede Stater, 53149
    - ProHealth D N Greenwald Center
  - New Richmond, Wisconsin, Forenede Stater, 54017
    - Cancer Center of Western Wisconsin
  - Oconomowoc, Wisconsin, Forenede Stater, 53066
    - ProHealth Oconomowoc Memorial Hospital
  - Oshkosh, Wisconsin, Forenede Stater, 54904
    - Vince Lombardi Cancer Clinic - Oshkosh
  - Racine, Wisconsin, Forenede Stater, 53406
    - Aurora Cancer Care-Racine
  - Rhinelander, Wisconsin, Forenede Stater, 54501
    - Aspirus Cancer Care-Rhinelander-James Beck Cancer Center
  - Rice Lake, Wisconsin, Forenede Stater, 54868
    - Marshfield Medical Center-Rice Lake
  - Rice Lake, Wisconsin, Forenede Stater, 54868
    - Lakeview Medical Center-Marshfield Clinic
  - Sheboygan, Wisconsin, Forenede Stater, 53081
    - Vince Lombardi Cancer Clinic-Sheboygan
  - Stevens Point, Wisconsin, Forenede Stater, 54482
    - Marshfield Medical Center-River Region at Stevens Point
  - Stevens Point, Wisconsin, Forenede Stater, 54481
    - Aspirus Cancer Care - Stevens Point
  - Summit, Wisconsin, Forenede Stater, 53066
    - Aurora Medical Center in Summit
  - Two Rivers, Wisconsin, Forenede Stater, 54241
    - Vince Lombardi Cancer Clinic-Two Rivers
  - Waukesha, Wisconsin, Forenede Stater, 53188
    - UW Cancer Center at ProHealth Care
  - Waukesha, Wisconsin, Forenede Stater, 53188
    - ProHealth Waukesha Memorial Hospital
  - Waukesha, Wisconsin, Forenede Stater, 53188
    - Aurora Cancer Care-Waukesha
  - Wausau, Wisconsin, Forenede Stater, 54401
    - Marshfield Clinic-Wausau Center
  - Wausau, Wisconsin, Forenede Stater, 54401
    - Aspirus Cancer Care-Wausau
  - Wauwatosa, Wisconsin, Forenede Stater, 53226
    - Aurora Cancer Care-Milwaukee West
  - West Allis, Wisconsin, Forenede Stater, 53227
    - Aurora West Allis Medical Center
  - Weston, Wisconsin, Forenede Stater, 54476
    - Marshfield Medical Center - Weston
  - Wisconsin Rapids, Wisconsin, Forenede Stater, 54494
    - Aspirus Cancer Care - Wisconsin Rapids
  - Wisconsin Rapids, Wisconsin, Forenede Stater, 54494
    - Marshfield Clinic - Wisconsin Rapids 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

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Beskrivelse

Inklusionskriterier:

Alle patienter skal være >= 18 år
Eastern Cooperative Oncology Group (ECOG) præstationsstatus: 0 eller 1
Patienter skal have kendt BRAF-mutationsstatus for tumor; vildtype (WT) eller muteret, før randomisering
Patienter skal have inoperabelt stadium III eller stadium IV melanom ifølge American Joint Committee on Cancer (AJCC) version (v)7; patienter skal have histologisk eller cytologisk bekræftelse af melanom, der er metastatisk eller ikke-opererbart og klart progressivt
Patienter skal have målbar sygdom i henhold til RECIST 1.1-kriterier; alle sygdomssteder skal evalueres inden for 4 uger før randomisering
Patienter kan have haft tidligere systemisk behandling i adjuverende omgivelser (f. interferon-, BRAF- eller MEK-midler). Patienter kan have haft tidligere anti-CTLA-4 i adjuverende indstilling, hvis der er gået mindst et år fra sidste dosis af behandling, før behandlingen påbegyndes. Patienter kan have haft et hvilket som helst tidligere programmeret celledød (PD)-1/PD-ligand (PD-L)1-middel i adjuverende indstilling, hvis der er gået mindst et år fra sidste dosis af behandling, før behandlingen påbegyndes
Patienter skal have ophørt med kemoterapi, immunterapi eller andre forsøgsmidler, der anvendes i adjuverende omgivelser >= 4 uger før randomisering og er kommet sig over bivirkninger på grund af disse midler; mitomycin og nitrosoureas skal være seponeret mindst 6 uger før indtræden i undersøgelsen; patienter skal have afbrudt strålebehandling >= 2 uger før indtræden i undersøgelsen og komme sig fra eventuelle bivirkninger forbundet med behandlingen; forudgående operation skal være >= 4 uger fra randomisering, og patienter skal være fuldt restituerede fra post-kirurgiske komplikationer
Hvidt blodtal >= 3.000/uL (opnået inden for 4 uger før randomisering)
Absolut neutrofiltal (ANC) >= 1.500/uL (opnået inden for 4 uger før randomisering)
Blodpladetal >= 100.000/uL (opnået inden for 4 uger før randomisering)
Hæmoglobin >= 9 g/dL (opnået inden for 4 uger før randomisering)
Serumkreatinin =< 1,5 x øvre grænse for normal (ULN) eller serumkreatininclearance (CrCl) >= 40 ml/min (opnået inden for 4 uger før randomisering)
Aspartataminotransferase (AST) og alaninaminotransferase (ALT) =< 3 x ULN (=< 5 x ULN for patienter med dokumenterede levermetastaser) (opnået inden for 4 uger før randomisering)
Alkalisk fosfatase =< 2 x ULN (=< 5 x ULN for patienter med kendt leverpåvirkning og =< 7 x ULN for patienter med kendt knoglepåvirkning) (opnået inden for 4 uger før randomisering)
Total bilirubin =< 1,5 x ULN undtagen forsøgspersoner med normalt direkte bilirubin eller dem med kendt Gilberts syndrom (opnået inden for 4 uger før randomisering)
Serum lactat dehydrogenase (LDH) =< 10 X ULN (opnået inden for 4 uger før randomisering)
Patienter med autoimmun hypothyroid sygdom eller type I diabetes i erstatningsbehandling er berettiget

Ekskluderingskriterier:

Patienter må ikke være gravide eller amme på grund af brug af cytotoksisk immunterapi og risiko for teratogene bivirkninger; alle patienter i den fødedygtige alder skal have en blodprøve eller urinundersøgelse inden for 2 uger før randomisering for at udelukke graviditet; en patient i den fødedygtige alder er enhver, uanset seksuel orientering eller om de har gennemgået tubal ligering, som opfylder følgende kriterier: 1) ikke har gennemgået en hysterektomi eller bilateral ooforektomi; eller 2) ikke har været naturligt postmenopausal i mindst 24 på hinanden følgende måneder (dvs. har haft menstruation på noget tidspunkt i de foregående 24 på hinanden følgende måneder)
Patienter må ikke blive gravide eller få børn ved at bruge accepterede og effektive præventionsmetoder eller ved at afholde sig fra samleje fra tidspunktet for undersøgelsens registrering og fortsætte (for patienter i den fødedygtige alder) i mindst 5 måneder efter den sidste dosis af protokol behandling; patienter i den fødedygtige alder må heller ikke donere æg i samme tidsrum
Patienter har muligvis ikke tidligere haft ipilimumab og/eller anti-PD-1/PD-L1-middel i metastaserende omgivelser
Patienter må ikke modtage andre forsøgsmidler, mens de er i undersøgelse eller inden for fire uger før randomisering
Patienten må ikke have modtaget nogen levende vaccine inden for 30 dage før randomisering, mens han deltog i undersøgelsen, og i 4 uger (28 dage) efter den sidste dosis af protokolbehandling; levende vacciner omfatter, men er ikke begrænset til, følgende: mæslinger, fåresyge, røde hunde, skoldkopper, gul feber, rabies, bacillus Calmette-Guerin (BCG) og tyfus (oral) vaccinepatienter har tilladelse til at modtage inaktiverede vacciner og alle ikke-levende vacciner, inklusive dem til sæsonbestemt influenza og coronavirus sygdom 19 (COVID-19) (Bemærk: intranasale influenzavacciner, såsom Flu-Mist er levende svækkede vacciner og er ikke tilladt); hvis det er muligt, anbefales det at adskille undersøgelseslægemiddeladministration fra vaccineadministration med ca. en uge (primært for at minimere en overlapning af uønskede hændelser)
Patienter er ikke kvalificerede, hvis de har nogen aktuelt aktive metastaser i centralnervesystemet (CNS); patienter, der har behandlet hjernemetastaser (med enten kirurgisk resektion eller stereotaktisk radiokirurgi), som har været stabile på hovedmagnetisk resonansbilleddannelse (MRI) eller kontrastcomputertomografi (CT) scanning i mindst 4 uger efter behandling og inden for 4 uger før randomisering, er berettiget; patienter må ikke have taget nogen steroider =< 14 dage før randomisering med det formål at håndtere deres hjernemetastaser; patienter med kun helhjernebestråling til behandling af CNS-metastaser vil være udelukket
Patienter må ikke have andre aktuelle maligniteter, bortset fra basalcellehudkræft, planocellulær hudcancer, in situ livmoderhalskræft, duktalt eller lobulært karcinom in situ i brystet; patienter med andre maligniteter er berettigede, hvis de har været kontinuerligt sygdomsfri i > 3 år forud for randomiseringstidspunktet
Patienter må ikke have nogen alvorlige eller ustabile allerede eksisterende medicinske tilstande (bortset fra malignitets-undtagelser specificeret ovenfor), inklusive, men ikke begrænset til, igangværende eller aktiv infektion, der kræver parenterale antibiotika på dag 1, anamnese med blødende diatese eller behov for samtidig antikoagulering (internationalt normaliseret ratio [INR] =< 1,5 og delvis tromboplastintid [PTT] inden for 1,1 x ULN), eller psykiatrisk sygdom/sociale situationer, der ville begrænse overholdelse af undersøgelseskrav, forstyrre forsøgspersonens sikkerhed eller indhente informeret samtykke
Patienter med human immundefektvirus (HIV) infektion er ikke kvalificerede; på grund af virkningsmekanismen for ipilimumab og GM-CSF er aktivitet og bivirkninger hos en immunkompromitteret patient ukendt
Patienter med tegn på aktiv hepatitis B-virus (HBV) eller hepatitis C-virus (HCV)-infektion er ikke kvalificerede; patienter med clearet HBV og HCV (0 viral load) infektion vil være tilladt
Patienter må ikke have autoimmune lidelser eller tilstande med immunsuppression, der kræver igangværende behandling med systemiske kortikosteroider (eller andre systemiske immunsuppressiva), herunder orale steroider (f.eks. prednison, dexamethason) eller kontinuerlig brug af topiske steroidcremer eller -salver eller oftalmologiske steroider; en historie med lejlighedsvis (men ikke kontinuerlig) brug af steroidinhalatorer er tilladt; erstatningsdoser af steroider til patienter med binyrebarkinsufficiens er tilladt; patienter, der ophører med at bruge disse klasser af medicin i mindst 2 uger før randomisering, er berettigede, hvis det efter den behandlende læges efterforskers vurdering ikke er sandsynligt, at patienten vil kræve genoptagelse af behandlingen med disse klasser af lægemidler under undersøgelsen
Udelukkelse fra denne undersøgelse omfatter også patienter med en historie med symptomatisk autoimmun sygdom (fx rheumatoid arthritis, systemisk progressiv sklerose [skleroderma], systemisk lupus erythematosus, Sjogrens syndrom, autoimmun vaskulitis [fx Wegeners granulomatose]); motorisk neuropati betragtet som af autoimmun oprindelse (f.eks. Guillain-Barre syndrom og myasthenia gravis); anden CNS-autoimmun sygdom (f.eks. multipel sklerose)
Patienter må ikke have en historie med inflammatorisk tarmsygdom eller divertikulitis (historie med divertikulose er tilladt)
Patienter må ikke have andre væsentlige medicinske, kirurgiske eller psykiatriske tilstande eller kræve nogen form for medicin eller behandling, der efter investigatorens mening kan forstyrre compliance, gøre administrationen af undersøgelseslægemidlerne farlige eller skjule fortolkningen af uønskede hændelser (AE'er), såsom en tilstand forbundet med hyppig diarré; patienter må ikke have en aktiv infektion, der kræver aktuel behandling med parenterale antibiotika

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)

Antal våben

Våben og indgreb

Deltagergruppe / Arm	Intervention / Behandling
Eksperimentel: Arm A (nivolumab, ipilimumab, sargramostim) INDUKTIONSTERAPI: Patienterne får nivolumab IV over 30 minutter på dag 1 i hver cyklus, ipilimumab IV over 30 minutter på dag 1 i hver cyklus og sargramostim SC på dag 1-14 i hver cyklus. Behandlingen gentages hver 21. dag i 4 cyklusser i fravær af sygdomsprogression eller uacceptabel toksicitet. VEDLIGEHOLDELSESTERAPI: Patienterne får nivolumab og sargramostim som ved induktionsterapi. Patienter med PR, SC eller CR efter 24 uger kan fortsætte vedligeholdelsesbehandlingen i op til 2 år i fravær af sygdomsprogression eller uacceptabel toksicitet. Patienterne gennemgår MRI, CT-scanning og blodprøvetagning under hele undersøgelsen. Patienter kan også gennemgå en MUGA under screening, såvel som en ECHO under hele forsøget som klinisk indiceret.	Biologisk: Nivolumab Givet IV Andre navne: BMS-936558 MDX-1106 NIVO ONO-4538 Opdivo CMAB819 Nivolumab Biosimilar CMAB819 MDX 1106 MDX1106 BMS 936558 ABP 206 Nivolumab Biosimilar ABP 206 BCD-263 Nivolumab Biosimilar BCD-263 BMS936558 ONO 4538 ONO4538 Biologisk: Ipilimumab Givet IV Andre navne: Anti-cytotoksisk T-lymfocyt-associeret antigen-4 monoklonalt antistof BMS-734016 Ipilimumab Biosimilar CS1002 MDX-010 MDX-CTLA4 Yervoy MDX010 BMS734016 BMS 734016 MDX 010 Biologisk: Sargramostim Givet SC Andre navne: 23-L-Leucinkoloni-stimulerende faktor 2 DRG-0012 Leukin Prokine rhu GM-CFS Sagramostim Sargramostatin Procedure: Bioprøvesamling Gennemgå blodprøvetagning Andre navne: Biologisk prøvesamling Bioprøve indsamlet Prøvesamling Prøvekollektion Procedure: Computertomografi Gennemgå CT-scanning Andre navne: CT KAT CAT-scanning Beregnet aksial tomografi Computerstyret aksial tomografi Computerstyret tomografi CT-scanning tomografi Computerstyret aksial tomografi (procedure) Computerstyret tomografi (CT) scanning Diagnostisk CAT -scanning Diagnostic CAT Scan Service Type Procedure: Multigated Acquisition Scan Gennemgå MUGA Andre navne: Blood Pool Scan Ligevægtsradionuklidangiografi Gated Blood Pool Imaging MUGA Radionuklid ventrikulografi RNVG SYMA-scanning Synkroniseret Multigated Acquisition Scanning MUGA Scan Multi-Gated Acquisition Scan Radionuklid Ventrikulogram Scan Gated Heart Pool Scan RNV Scan Procedure: Magnetisk resonans elastografi Gennemgå MR Andre navne: MRE Procedure: Ekkokardiografitest Gennemgå Echo Andre navne: Ekkokardiografi EC
Eksperimentel: Arm B (nivolumab, ipilimumab) INDUKTIONSTERAPI: Patienterne får nivolumab og ipilimumab som i arm I. Behandlingen gentages hver 21. dag i 4 cyklusser i fravær af sygdomsprogression eller uacceptabel toksicitet. VEDLIGEHOLDELSESTERAPI: Patienter får nivolumab som ved induktionsterapi. Patienter med PR, SD eller CR efter 24 uger kan fortsætte vedligeholdelsesbehandlingen i op til 2 år i fravær af sygdomsprogression eller uacceptabel toksicitet. Patienterne gennemgår MRI, CT-scanning og blodprøvetagning under hele undersøgelsen. Patienter kan også gennemgå en MUGA under screening, såvel som en ECHO under hele forsøget som klinisk indiceret.	Biologisk: Nivolumab Givet IV Andre navne: BMS-936558 MDX-1106 NIVO ONO-4538 Opdivo CMAB819 Nivolumab Biosimilar CMAB819 MDX 1106 MDX1106 BMS 936558 ABP 206 Nivolumab Biosimilar ABP 206 BCD-263 Nivolumab Biosimilar BCD-263 BMS936558 ONO 4538 ONO4538 Biologisk: Ipilimumab Givet IV Andre navne: Anti-cytotoksisk T-lymfocyt-associeret antigen-4 monoklonalt antistof BMS-734016 Ipilimumab Biosimilar CS1002 MDX-010 MDX-CTLA4 Yervoy MDX010 BMS734016 BMS 734016 MDX 010 Procedure: Bioprøvesamling Gennemgå blodprøvetagning Andre navne: Biologisk prøvesamling Bioprøve indsamlet Prøvesamling Prøvekollektion Procedure: Computertomografi Gennemgå CT-scanning Andre navne: CT KAT CAT-scanning Beregnet aksial tomografi Computerstyret aksial tomografi Computerstyret tomografi CT-scanning tomografi Computerstyret aksial tomografi (procedure) Computerstyret tomografi (CT) scanning Diagnostisk CAT -scanning Diagnostic CAT Scan Service Type Procedure: Multigated Acquisition Scan Gennemgå MUGA Andre navne: Blood Pool Scan Ligevægtsradionuklidangiografi Gated Blood Pool Imaging MUGA Radionuklid ventrikulografi RNVG SYMA-scanning Synkroniseret Multigated Acquisition Scanning MUGA Scan Multi-Gated Acquisition Scan Radionuklid Ventrikulogram Scan Gated Heart Pool Scan RNV Scan Procedure: Magnetisk resonans elastografi Gennemgå MR Andre navne: MRE Procedure: Ekkokardiografitest Gennemgå Echo Andre navne: Ekkokardiografi EC

Deltagergruppe / Arm

Intervention / Behandling

Eksperimentel: Arm A (nivolumab, ipilimumab, sargramostim)

INDUKTIONSTERAPI: Patienterne får nivolumab IV over 30 minutter på dag 1 i hver cyklus, ipilimumab IV over 30 minutter på dag 1 i hver cyklus og sargramostim SC på dag 1-14 i hver cyklus. Behandlingen gentages hver 21. dag i 4 cyklusser i fravær af sygdomsprogression eller uacceptabel toksicitet.

VEDLIGEHOLDELSESTERAPI: Patienterne får nivolumab og sargramostim som ved induktionsterapi. Patienter med PR, SC eller CR efter 24 uger kan fortsætte vedligeholdelsesbehandlingen i op til 2 år i fravær af sygdomsprogression eller uacceptabel toksicitet. Patienterne gennemgår MRI, CT-scanning og blodprøvetagning under hele undersøgelsen. Patienter kan også gennemgå en MUGA under screening, såvel som en ECHO under hele forsøget som klinisk indiceret.

Biologisk: Nivolumab

Givet IV

Andre navne:

BMS-936558
MDX-1106
NIVO
ONO-4538
Opdivo
CMAB819
Nivolumab Biosimilar CMAB819
MDX 1106
MDX1106
BMS 936558
ABP 206
Nivolumab Biosimilar ABP 206
BCD-263
Nivolumab Biosimilar BCD-263
BMS936558
ONO 4538
ONO4538

Biologisk: Ipilimumab

Givet IV

Andre navne:

Anti-cytotoksisk T-lymfocyt-associeret antigen-4 monoklonalt antistof
BMS-734016
Ipilimumab Biosimilar CS1002
MDX-010
MDX-CTLA4
Yervoy
MDX010
BMS734016
BMS 734016
MDX 010

Biologisk: Sargramostim

Givet SC

Andre navne:

23-L-Leucinkoloni-stimulerende faktor 2
DRG-0012
Leukin
Prokine
rhu GM-CFS
Sagramostim
Sargramostatin

Procedure: Bioprøvesamling

Gennemgå blodprøvetagning

Andre navne:

Biologisk prøvesamling
Bioprøve indsamlet
Prøvesamling
Prøvekollektion

Procedure: Computertomografi

Gennemgå CT-scanning

Andre navne:

CT
KAT
CAT-scanning
Beregnet aksial tomografi
Computerstyret aksial tomografi
Computerstyret tomografi
CT-scanning
tomografi
Computerstyret aksial tomografi (procedure)
Computerstyret tomografi (CT) scanning
Diagnostisk CAT -scanning
Diagnostic CAT Scan Service Type

Procedure: Multigated Acquisition Scan

Gennemgå MUGA

Andre navne:

Blood Pool Scan
Ligevægtsradionuklidangiografi
Gated Blood Pool Imaging
MUGA
Radionuklid ventrikulografi
RNVG
SYMA-scanning
Synkroniseret Multigated Acquisition Scanning
MUGA Scan
Multi-Gated Acquisition Scan
Radionuklid Ventrikulogram Scan
Gated Heart Pool Scan
RNV Scan

Procedure: Magnetisk resonans elastografi

Gennemgå MR

Andre navne:

Procedure: Ekkokardiografitest

Gennemgå Echo

Andre navne:

Ekkokardiografi
EC

Eksperimentel: Arm B (nivolumab, ipilimumab)

INDUKTIONSTERAPI: Patienterne får nivolumab og ipilimumab som i arm I. Behandlingen gentages hver 21. dag i 4 cyklusser i fravær af sygdomsprogression eller uacceptabel toksicitet.

VEDLIGEHOLDELSESTERAPI: Patienter får nivolumab som ved induktionsterapi. Patienter med PR, SD eller CR efter 24 uger kan fortsætte vedligeholdelsesbehandlingen i op til 2 år i fravær af sygdomsprogression eller uacceptabel toksicitet. Patienterne gennemgår MRI, CT-scanning og blodprøvetagning under hele undersøgelsen. Patienter kan også gennemgå en MUGA under screening, såvel som en ECHO under hele forsøget som klinisk indiceret.

Biologisk: Nivolumab

Givet IV

Andre navne:

BMS-936558
MDX-1106
NIVO
ONO-4538
Opdivo
CMAB819
Nivolumab Biosimilar CMAB819
MDX 1106
MDX1106
BMS 936558
ABP 206
Nivolumab Biosimilar ABP 206
BCD-263
Nivolumab Biosimilar BCD-263
BMS936558
ONO 4538
ONO4538

Biologisk: Ipilimumab

Givet IV

Andre navne:

Anti-cytotoksisk T-lymfocyt-associeret antigen-4 monoklonalt antistof
BMS-734016
Ipilimumab Biosimilar CS1002
MDX-010
MDX-CTLA4
Yervoy
MDX010
BMS734016
BMS 734016
MDX 010

Procedure: Bioprøvesamling

Gennemgå blodprøvetagning

Andre navne:

Biologisk prøvesamling
Bioprøve indsamlet
Prøvesamling
Prøvekollektion

Procedure: Computertomografi

Gennemgå CT-scanning

Andre navne:

CT
KAT
CAT-scanning
Beregnet aksial tomografi
Computerstyret aksial tomografi
Computerstyret tomografi
CT-scanning
tomografi
Computerstyret aksial tomografi (procedure)
Computerstyret tomografi (CT) scanning
Diagnostisk CAT -scanning
Diagnostic CAT Scan Service Type

Procedure: Multigated Acquisition Scan

Gennemgå MUGA

Andre navne:

Blood Pool Scan
Ligevægtsradionuklidangiografi
Gated Blood Pool Imaging
MUGA
Radionuklid ventrikulografi
RNVG
SYMA-scanning
Synkroniseret Multigated Acquisition Scanning
MUGA Scan
Multi-Gated Acquisition Scan
Radionuklid Ventrikulogram Scan
Gated Heart Pool Scan
RNV Scan

Procedure: Magnetisk resonans elastografi

Gennemgå MR

Andre navne:

Procedure: Ekkokardiografitest

Gennemgå Echo

Andre navne:

Ekkokardiografi
EC

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål	Foranstaltningsbeskrivelse	Tidsramme
Samlet overlevelse Tidsramme: Tid fra randomisering til død uanset årsag, vurderet op til 5 år	Samlet overlevelse mellem de to arme vil blive sammenlignet ved hjælp af den stratificerede log-rank test. Ensidig type I fejlrate på 0,2 vil blive brugt. Kaplan-Meier plot vil blive genereret og to-sidede p-værdier vil blive rapporteret. Denne analyse vil blive opsummeret ved hjælp af skovparcellerne med fareforhold og 95 % konfidensintervaller. Cox multivariate modeller vil blive udviklet til overordnet overlevelse.	Tid fra randomisering til død uanset årsag, vurderet op til 5 år

Sekundære resultatmål

Resultatmål	Foranstaltningsbeskrivelse	Tidsramme
Progressionsfri overlevelse Tidsramme: Tid fra randomisering til sygdomsprogression eller død (alt efter hvad der indtræffer først), vurderet op til 5 år	Evalueret baseret på internationale kriterier foreslået af den reviderede Response Evaluation Criteria in Solid Tumors guideline (version 1.1). Denne analyse vil blive opsummeret ved hjælp af skovparcellerne med fareforhold og 95 % konfidensintervaller. Cox multivariate modeller vil blive udviklet til progressionsfri overlevelse.	Tid fra randomisering til sygdomsprogression eller død (alt efter hvad der indtræffer først), vurderet op til 5 år
Forekomst af toksiciteter Tidsramme: Op til 90 dage efter den sidste undersøgelseslægemiddeladministration	Defineret ved hjælp af de fælles terminologikriterier for uønskede hændelser version 4.0-kriterierne. Individuel toksicitetstype bivirkning og kategoriserede bivirkningsdata (efter autoimmune lidelser, endokrine, gastrointestinale, lever, nervesystem, bugspytkirtel, psykiatriske lidelser, hud, tromboemboliske lidelser) vil blive opsummeret efter grad og behandlingsgruppe. Procentdelen af patienter, der oplever den værste grad af toksicitet (højeste grad af hændelse pr. bivirkningstype pr. patient) vil blive evalueret, og fordelingen af den værste grad af toksicitet vil blive sammenlignet mellem behandlingsarmene. Andelen af patienter med værste grad af toksicitet med 3 eller højere vil blive opsummeret og sammenlignet blandt behandlingsarmene.	Op til 90 dage efter den sidste undersøgelseslægemiddeladministration
Immunrespons Tidsramme: Op til 5 år	Vurderet ved hjælp af anvendeligheden af immunrelaterede responskriterier. De immunrelaterede responskriterier og responsevalueringskriterierne i solide tumorer-baserede kliniske responsdata vil blive sammenlignet mellem de to behandlingsarme ved hjælp af Fishers eksakte test. Tosidede p-værdier vil blive rapporteret. Endvidere vil immunrelaterede responskriteriedata blive forbundet med responsevalueringskriterierne i solide tumorer-baseret klinisk respons. Kappa-statistikken, som måler graden af overensstemmelse mellem responsevalueringskriterierne i solide tumorer-baseret respons og immunrelaterede responskriterier vil blive estimeret. McNemars test vil blive brugt til at evaluere overensstemmelsen mellem immunrelaterede responskriterier og responsevalueringskriterier i solide tumorer-baseret klinisk respons.	Op til 5 år
Klinisk respons Tidsramme: Op til 5 år	Vurderet ved hjælp af anvendeligheden af immunrelaterede responskriterier. Standard responskriterier (baseret på responsevalueringskriterierne i solide tumorer) vil blive anvendt til at vurdere klinisk respons. De immunrelaterede responskriterier og responsevalueringskriterierne i solide tumorer-baserede kliniske responsdata vil blive sammenlignet mellem de to behandlingsarme ved hjælp af Fishers eksakte test. Tosidede p-værdier vil blive rapporteret. Endvidere vil immunrelaterede responskriteriedata blive forbundet med responsevalueringskriterierne i solide tumorer-baseret klinisk respons. Kappa-statistikken, som måler graden af overensstemmelse mellem responsevalueringskriterierne i solide tumorer-baseret respons og immunrelaterede responskriterier vil blive estimeret. McNemars test vil blive brugt til at evaluere overensstemmelsen mellem immunrelaterede responskriterier og responsevalueringskriterier i solide tumorer-baseret klinisk respons.	Op til 5 år

Samarbejdspartnere og efterforskere

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

Sponsor

National Cancer Institute (NCI)

Efterforskere

Ledende efterforsker: Frank S Hodi, ECOG-ACRIN Cancer Research Group

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)

23. november 2015

Primær færdiggørelse (Anslået)

30. juni 2033

Studieafslutning (Anslået)

30. juni 2033

Datoer for studieregistrering

Først indsendt

12. januar 2015

Først indsendt, der opfyldte QC-kriterier

12. januar 2015

Først opslået (Anslået)

15. januar 2015

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

28. august 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

27. august 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

NCI-2014-02674 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
EA6141 (Anden identifikator: CTEP)
U10CA180820 (U.S. NIH-bevilling/kontrakt)
U24CA196172 (U.S. NIH-bevilling/kontrakt)

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

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

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 .

Et fase II/III-forsøg med Nivolumab, Ipilimumab og GM-CSF hos patienter med avanceret melanom

Randomiseret fase II/III-undersøgelse af Nivolumab Plus Ipilimumab Plus Sargramostim versus Nivolumab Plus Ipilimumab hos patienter med uoperabelt trin III eller trin IV melanom

Studieoversigt

Status

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Undersøgelsestype

Tilmelding (Anslået)

Fase

Kontakter og lokationer

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

Samarbejdspartnere og efterforskere

Sponsor

Efterforskere

Datoer for undersøgelser

Studer store datoer

Studiestart (Faktiske)

Primær færdiggørelse (Anslået)

Studieafslutning (Anslået)

Datoer for studieregistrering

Først indsendt

Først indsendt, der opfyldte QC-kriterier

Først opslået (Anslået)

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

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