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Test af immunterapi versus observation hos patienter med HPV-halskræft

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

En fase III randomiseret undersøgelse af vedligeholdelsesnivolumab versus observation hos patienter med lokalt avanceret, mellemrisiko HPV positiv OPSCC

Disse fase III-forsøg undersøger, om vedligeholdelsesimmunterapi (nivolumab) efter endelig behandling med strålebehandling og kemoterapi (cisplatin) resulterer i signifikant forbedring af den samlede overlevelse (time being alive) og progressionsfri overlevelse (time being i live uden cancer) for patienter med mellemliggende risiko. human papillomavirus (HPV) positiv oropharynx cancer (halskræft), der har spredt sig til nærliggende væv eller lymfeknuder. Lægemidler brugt i kemoterapi såsom cisplatin virker på forskellige måder for at stoppe væksten af tumorceller, enten ved at dræbe cellerne, ved at stoppe dem i at dele sig eller ved at stoppe dem i at sprede sig. Strålebehandling bruger højenergistråler til at dræbe tumorceller og skrumpe tumorer. Immunterapi med monoklonale antistoffer, såsom nivolumab, kan hjælpe kroppens immunsystem med at angribe kræften og kan forstyrre tumorcellernes evne til at vokse og sprede sig. Det vides endnu ikke, om kemoterapi og strålebehandling efterfulgt af vedligeholdelses-nivolumab-behandling virker bedre end kemoterapi og strålebehandling alene til behandling af patienter med HPV-positiv orofarynxcancer.

Studieoversigt

Status

Aktiv, ikke rekrutterende

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

PRIMÆR MÅL:

I. At vurdere effektiviteten af samtidig definitiv behandling efterfulgt af nivolumab sammenlignet med samtidig definitiv behandling efterfulgt af observation med hensyn til total overlevelse (OS).

SEKUNDÆRE MÅL:

I. For yderligere at vurdere effektiviteten af nivolumab sammenlignet med observation i form af:

Ia. At evaluere behandlingseffekt inden for undergruppen af patienter testet som PD-L1+.

Ib. At evaluere den prognostiske effekt af baseline spyt og/eller plasma HPV status.

Ic. At evaluere den prognostiske effekt af mutationsbyrde blandt patienter på nivolumab-armen.

Id. For at evaluere sammenhængen mellem 12 ugers post-terapi fludeoxyglucose F-18 (FDG) positronemissionstomografi (PET)/computertomografi (CT) OS og progressionsfri overlevelse (PFS).

dvs. At etablere den prognostiske værdi af standardiseret optagelsesværdi (SUV) max for primær tumor eller nakkeknudemetastase af baseline FDG PET/CT for OS (og/eller PFS).

Hvis. At korrelere SUV max for primær tumor eller nodal metastasering af baseline FDG PET/CT med PD-L1 ekspression (positiv versus [vs.] negativ).

Ig. At sammenligne den PET-baserede behandlingsresponsvurdering (Hopkins-kriterier) med responsevalueringskriterierne i solide tumorer (RECIST) 1.1-vurdering 12 uger efter kemoradiationsbehandling for patienter, der har en PET/CT-scanning efter 12 uger.

II. At vurdere effektiviteten af samtidig definitiv behandling efterfulgt af nivolumab med hensyn til progressionsfri overlevelse (PFS).

OVERSIGT: Patienter randomiseres til arm A eller arm B. Patienter i arm B kan krydse over til arm C med klart dokumenteret sygdomsprogression.

ARM A: Patienter modtager cisplatin intravenøst (IV) over 60 minutter ugentligt og intensitetsmoduleret strålebehandling (IMRT) 5 dage om ugen i 7 uger i i alt 35 fraktioner. Inden for 4 uger efter afslutning af samtidig behandling får patienterne nivolumab IV én gang ugentligt over 30 minutter hver 4. uge i 12 måneder i fravær af sygdomsprogression eller uacceptabel toksicitet.

ARM B: Patienterne får cisplatin IV over 60 minutter ugentligt og IMRT 5 dage om ugen i 7 uger i i alt 35 fraktioner og går derefter til observation. Patienter vil blive tilbudt muligheden for at gå over til arm C, hvis de har klart dokumenteret progression inden for 12 måneder fra afslutningen af cisplatin/strålebehandling.

ARM C: Patienter får nivolumab IV over 30 minutter hver 4. uge i 12 måneder i fravær af sygdomsprogression eller uacceptabel toksicitet.

Efter afsluttet undersøgelsesbehandling følges patienterne hver 3.-6. måned i 3 år og derefter årligt i i alt 10 år.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

636

Fase

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
  - Fairhope, Alabama, Forenede Stater, 36532
    - Thomas Hospital
  - Mobile, Alabama, Forenede Stater, 36607
    - Mobile Infirmary Medical Center
- Alaska
  - Anchorage, Alaska, Forenede Stater, 98508
    - Anchorage Associates in Radiation Medicine
  - Anchorage, Alaska, Forenede Stater, 99508
    - Alaska Breast Care and Surgery LLC
  - Anchorage, Alaska, Forenede Stater, 99508
    - Alaska Oncology and Hematology LLC
  - Anchorage, Alaska, Forenede Stater, 99508
    - Alaska Women's Cancer Care
  - Anchorage, Alaska, Forenede Stater, 99508
    - Anchorage Oncology Centre
  - Anchorage, Alaska, Forenede Stater, 99508
    - Katmai Oncology Group
  - Anchorage, Alaska, Forenede Stater, 99508
    - Providence Alaska Medical Center
  - Anchorage, Alaska, Forenede Stater, 99504
    - Anchorage Radiation Therapy Center
  - Fairbanks, Alaska, Forenede Stater, 99701
    - Fairbanks Memorial Hospital
- Arizona
  - Goodyear, Arizona, Forenede Stater, 85338
    - CTCA at Western Regional Medical Center
  - Kingman, Arizona, Forenede Stater, 86401
    - Kingman Regional Medical Center
  - Phoenix, Arizona, Forenede Stater, 85004
    - Cancer Center at Saint Joseph's
- Arkansas
  - Fort Smith, Arkansas, Forenede Stater, 72903
    - Mercy Hospital Fort Smith
  - Hot Springs, Arkansas, Forenede Stater, 71913
    - CHI Saint Vincent Cancer Center Hot Springs
- California
  - Antioch, California, Forenede Stater, 94531
    - Kaiser Permanente-Deer Valley Medical Center
  - Arroyo Grande, California, Forenede Stater, 93420
    - PCR Oncology
  - Arroyo Grande, California, Forenede Stater, 93420
    - Mission Hope Medical Oncology - Arroyo Grande
  - Burbank, California, Forenede Stater, 91505
    - Providence Saint Joseph Medical Center/Disney Family Cancer Center
  - Carmichael, California, Forenede Stater, 95608
    - Mercy San Juan Medical Center
  - Carmichael, California, Forenede Stater, 95608
    - Mercy Cancer Center - Carmichael
  - Dublin, California, Forenede Stater, 94568
    - Kaiser Permanente Dublin
  - Dublin, California, Forenede Stater, 94568
    - Epic Care-Dublin
  - Elk Grove, California, Forenede Stater, 95758
    - Mercy Cancer Center - Elk Grove
  - Emeryville, California, Forenede Stater, 94608
    - Bay Area Breast Surgeons Inc
  - Emeryville, California, Forenede Stater, 94608
    - Epic Care Partners in Cancer Care
  - Fremont, California, Forenede Stater, 94538
    - Kaiser Permanente-Fremont
  - Fresno, California, Forenede Stater, 93720
    - Kaiser Permanente-Fresno
  - Fresno, California, Forenede Stater, 93720
    - Fresno Cancer Center
  - Long Beach, California, Forenede Stater, 90822
    - Tibor Rubin VA Medical Center
  - Martinez, California, Forenede Stater, 94553-3156
    - Contra Costa Regional Medical Center
  - Merced, California, Forenede Stater, 95340
    - Mercy Cancer Center
  - Modesto, California, Forenede Stater, 95356
    - Kaiser Permanente-Modesto
  - Napa, California, Forenede Stater, 94558
    - Providence Queen of The Valley
  - Oakland, California, Forenede Stater, 94611
    - Kaiser Permanente-Oakland
  - Oakland, California, Forenede Stater, 94611
    - Kaiser Permanente Oakland-Broadway
  - Oakland, California, Forenede Stater, 94609
    - Alta Bates Summit Medical Center - Summit Campus
  - Oakland, California, Forenede Stater, 94609
    - Bay Area Tumor Institute
  - Palo Alto, California, Forenede Stater, 94304
    - VA Palo Alto Health Care System
  - Rancho Cordova, California, Forenede Stater, 95670
    - Kaiser Permanente-Rancho Cordova Cancer Center
  - Redwood City, California, Forenede Stater, 94063
    - Kaiser Permanente-Redwood City
  - Richmond, California, Forenede Stater, 94801
    - Kaiser Permanente-Richmond
  - Rocklin, California, Forenede Stater, 95765
    - Mercy Cancer Center - Rocklin
  - Rohnert Park, California, Forenede Stater, 94928
    - Rohnert Park Cancer Center
  - Roseville, California, Forenede Stater, 95678
    - The Permanente Medical Group-Roseville Radiation Oncology
  - Roseville, California, Forenede Stater, 95661
    - Kaiser Permanente-Roseville
  - Sacramento, California, Forenede Stater, 95814
    - Kaiser Permanente Downtown Commons
  - Sacramento, California, Forenede Stater, 95823
    - South Sacramento Cancer Center
  - Sacramento, California, Forenede Stater, 95816
    - Mercy Cancer Center - Sacramento
  - Salinas, California, Forenede Stater, 93901
    - Salinas Valley Memorial
  - San Diego, California, Forenede Stater, 92134
    - Naval Medical Center -San Diego
  - San Diego, California, Forenede Stater, 92103
    - UC San Diego Medical Center - Hillcrest
  - San Francisco, California, Forenede Stater, 94115
    - Kaiser Permanente-San Francisco
  - San Jose, California, Forenede Stater, 95119
    - Kaiser Permanente-Santa Teresa-San Jose
  - San Leandro, California, Forenede Stater, 94577
    - Kaiser Permanente San Leandro
  - San Luis Obispo, California, Forenede Stater, 93401
    - Pacific Central Coast Health Center-San Luis Obispo
  - San Rafael, California, Forenede Stater, 94903
    - Kaiser San Rafael-Gallinas
  - Santa Clara, California, Forenede Stater, 95051
    - Kaiser Permanente Medical Center - Santa Clara
  - Santa Maria, California, Forenede Stater, 93444
    - Mission Hope Medical Oncology - Santa Maria
  - Santa Rosa, California, Forenede Stater, 95403
    - Kaiser Permanente-Santa Rosa
  - Santa Rosa, California, Forenede Stater, 95403
    - Providence Medical Foundation - Santa Rosa
  - South San Francisco, California, Forenede Stater, 94080
    - Kaiser Permanente Cancer Treatment Center
  - South San Francisco, California, Forenede Stater, 94080
    - Kaiser Permanente-South San Francisco
  - Stockton, California, Forenede Stater, 95210
    - Kaiser Permanente-Stockton
  - Vacaville, California, Forenede Stater, 95688
    - Kaiser Permanente Medical Center-Vacaville
  - Vallejo, California, Forenede Stater, 94589
    - Kaiser Permanente-Vallejo
  - Walnut Creek, California, Forenede Stater, 94596
    - Kaiser Permanente-Walnut Creek
  - Walnut Creek, California, Forenede Stater, 94597
    - Epic Care Cyberknife Center
  - Woodland, California, Forenede Stater, 95695
    - Woodland Memorial Hospital
- Colorado
  - Aurora, Colorado, Forenede Stater, 80012
    - Rocky Mountain Cancer Centers-Aurora
  - Aurora, Colorado, Forenede Stater, 80012
    - The Medical Center of Aurora
  - Aurora, Colorado, Forenede Stater, 80045
    - UCHealth University of Colorado Hospital
  - Boulder, Colorado, Forenede Stater, 80303
    - Boulder Community Foothills Hospital
  - Boulder, Colorado, Forenede Stater, 80304
    - Rocky Mountain Cancer Centers-Boulder
  - Centennial, Colorado, Forenede Stater, 80112
    - Rocky Mountain Cancer Centers - Centennial
  - Colorado Springs, Colorado, Forenede Stater, 80907
    - Penrose-Saint Francis Healthcare
  - Colorado Springs, Colorado, Forenede Stater, 80909
    - UCHealth Memorial Hospital Central
  - Colorado Springs, Colorado, Forenede Stater, 80907
    - Rocky Mountain Cancer Centers-Penrose
  - Colorado Springs, Colorado, Forenede Stater, 80920
    - Memorial Hospital North
  - Colorado Springs, Colorado, Forenede Stater, 80923
    - Saint Francis Cancer Center
  - Denver, Colorado, Forenede Stater, 80218
    - Presbyterian - Saint Lukes Medical Center - Health One
  - Denver, Colorado, Forenede Stater, 80220
    - Rose Medical Center
  - Denver, Colorado, Forenede Stater, 80218
    - Rocky Mountain Cancer Centers-Midtown
  - Denver, Colorado, Forenede Stater, 80220
    - Rocky Mountain Cancer Centers-Rose
  - Denver, Colorado, Forenede Stater, 80218
    - Colorado Blood Cancer Institute
  - Denver, Colorado, Forenede Stater, 80204
    - Cancer Center of Colorado at Sloan's Lake
  - Denver, Colorado, Forenede Stater, 80209
    - The Women's Imaging Center
  - Denver, Colorado, Forenede Stater, 80206
    - National Jewish Health-Main Campus
  - Denver, Colorado, Forenede Stater, 80220
    - Western Surgical Care
  - 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
  - Fort Collins, Colorado, Forenede Stater, 80524
    - Poudre Valley Hospital
  - Fort Collins, Colorado, Forenede Stater, 80528
    - Cancer Care and Hematology-Fort Collins
  - Golden, Colorado, Forenede Stater, 80401
    - National Jewish Health-Western Hematology Oncology
  - Grand Junction, Colorado, Forenede Stater, 81501
    - Saint Mary's Hospital and Regional Medical Center
  - Greeley, Colorado, Forenede Stater, 80631
    - UCHealth Greeley Hospital
  - Greeley, Colorado, Forenede Stater, 80631
    - Banner North Colorado Medical Center
  - Lafayette, Colorado, Forenede Stater, 80026
    - Good Samaritan Hospital - Cancer Centers of Colorado
  - Lakewood, Colorado, Forenede Stater, 80228
    - Rocky Mountain Cancer Centers-Lakewood
  - Lakewood, Colorado, Forenede Stater, 80228
    - CommonSpirit Saint Anthony Hospital Cancer Center
  - Littleton, Colorado, Forenede Stater, 80120
    - Rocky Mountain Cancer Centers-Littleton
  - Littleton, Colorado, Forenede Stater, 80122
    - AdventHealth Littleton
  - Lone Tree, Colorado, Forenede Stater, 80124
    - Sky Ridge Medical Center
  - Lone Tree, Colorado, Forenede Stater, 80124
    - Rocky Mountain Cancer Centers-Sky Ridge
  - Longmont, Colorado, Forenede Stater, 80501
    - Longmont United Hospital
  - Longmont, Colorado, Forenede Stater, 80501
    - Rocky Mountain Cancer Centers-Longmont
  - Loveland, Colorado, Forenede Stater, 80538
    - Medical Center of the Rockies
  - 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
  - Thornton, Colorado, Forenede Stater, 80260
    - Rocky Mountain Cancer Centers-Thornton
  - Thornton, Colorado, Forenede Stater, 80260
    - National Jewish Health-Northern Hematology Oncology
  - Wheat Ridge, Colorado, Forenede Stater, 80401
    - Intermountain Health Lutheran Hospital
- Connecticut
  - Greenwich, Connecticut, Forenede Stater, 06830
    - Smilow Cancer Hospital Care Center at Greenwich
  - Guilford, Connecticut, Forenede Stater, 06437
    - Smilow Cancer Hospital Care Center - Guilford
  - New Haven, Connecticut, Forenede Stater, 06520
    - Yale University
  - New Haven, Connecticut, Forenede Stater, 06510
    - Smilow Cancer Center/Yale-New Haven Hospital
  - North Haven, Connecticut, Forenede Stater, 06473
    - Yale-New Haven Hospital North Haven Medical Center
  - Orange, Connecticut, Forenede Stater, 06477
    - Smilow Cancer Hospital-Orange Care Center
  - Trumbull, Connecticut, Forenede Stater, 06611
    - Smilow Cancer Hospital Care Center-Trumbull
  - Waterford, Connecticut, Forenede Stater, 06385
    - Smilow Cancer Hospital Care Center - Waterford
- Delaware
  - Lewes, Delaware, Forenede Stater, 19958
    - Beebe Medical Center
  - Millville, Delaware, Forenede Stater, 19967
    - Beebe South Coastal Health Campus
  - Newark, Delaware, Forenede Stater, 19713
    - Helen F Graham Cancer Center
  - Newark, Delaware, Forenede Stater, 19713
    - Delaware Clinical and Laboratory Physicians PA
  - Newark, Delaware, Forenede Stater, 19713
    - Medical Oncology Hematology Consultants PA
  - Newark, Delaware, Forenede Stater, 19718
    - Christiana Care Health System-Christiana Hospital
  - Rehoboth Beach, Delaware, Forenede Stater, 19971
    - Beebe Health Campus
- District of Columbia
  - Washington D.C., District of Columbia, Forenede Stater, 20037
    - George Washington University Medical Center
- Florida
  - Deerfield Beach, Florida, Forenede Stater, 33064
    - Broward Health North
  - Fort Lauderdale, Florida, Forenede Stater, 33316
    - Broward Health Medical Center
  - Fort Lauderdale, Florida, Forenede Stater, 33308
    - Holy Cross Hospital
  - Lakeland, Florida, Forenede Stater, 33805
    - The Watson Clinic
  - Tampa, Florida, Forenede Stater, 33612
    - Moffitt Cancer Center
  - Tampa, Florida, Forenede Stater, 33607
    - Moffitt Cancer Center-International Plaza
  - Tampa, Florida, Forenede Stater, 33612
    - Moffitt Cancer Center - McKinley Campus
  - Wesley Chapel, Florida, Forenede Stater, 33544
    - Moffitt Cancer Center at Wesley Chapel
- Georgia
  - Atlanta, Georgia, Forenede Stater, 30308
    - Emory University Hospital Midtown
  - Atlanta, Georgia, Forenede Stater, 30322
    - Emory University Hospital/Winship Cancer Institute
  - Decatur, Georgia, Forenede Stater, 30033
    - Atlanta VA Medical Center
  - Savannah, Georgia, Forenede Stater, 31405
    - Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
  - Valdosta, Georgia, Forenede Stater, 31602
    - South Georgia Medical Center/Pearlman Cancer Center
- 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
    - 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, 96819
    - Kaiser Permanente Moanalua 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
- Idaho
  - Boise, Idaho, Forenede Stater, 83706
    - Saint Alphonsus Cancer Care Center-Boise
  - Boise, Idaho, Forenede Stater, 83712
    - Saint Luke's Cancer Institute - Boise
  - Caldwell, Idaho, Forenede Stater, 83605
    - Saint Alphonsus Cancer Care Center-Caldwell
  - Coeur d'Alene, Idaho, Forenede Stater, 83814
    - Kootenai Health - Coeur d'Alene
  - Emmett, Idaho, Forenede Stater, 83617
    - Walter Knox Memorial Hospital
  - Fruitland, Idaho, Forenede Stater, 83619
    - Saint Luke's Cancer Institute - Fruitland
  - Meridian, Idaho, Forenede Stater, 83642
    - Idaho Urologic Institute-Meridian
  - Meridian, Idaho, Forenede Stater, 83642
    - Saint Luke's Cancer Institute - Meridian
  - Nampa, Idaho, Forenede Stater, 83687
    - Saint Alphonsus Cancer Care Center-Nampa
  - Nampa, Idaho, Forenede Stater, 83687
    - Saint Luke's Cancer Institute - Nampa
  - Post Falls, Idaho, Forenede Stater, 83854
    - Kootenai Clinic Cancer Services - Post Falls
  - Sandpoint, Idaho, Forenede Stater, 83864
    - Kootenai Clinic Cancer Services - Sandpoint
  - Twin Falls, Idaho, Forenede Stater, 83301
    - Saint Luke's Cancer Institute - Twin Falls
- Illinois
  - Alton, Illinois, Forenede Stater, 62002
    - OSF Saint Anthony's Health Center
  - Aurora, Illinois, Forenede Stater, 60504
    - Rush-Copley Medical Center
  - Barrington, Illinois, Forenede Stater, 60010
    - Advocate Good Shepherd Hospital
  - Bloomington, Illinois, Forenede Stater, 61704
    - Illinois CancerCare-Bloomington
  - Canton, Illinois, Forenede Stater, 61520
    - Illinois CancerCare-Canton
  - Carbondale, Illinois, Forenede Stater, 62902
    - Memorial Hospital of Carbondale
  - Carterville, Illinois, Forenede Stater, 62918
    - SIH Cancer Institute
  - Carthage, Illinois, Forenede Stater, 62321
    - Illinois CancerCare-Carthage
  - Centralia, Illinois, Forenede Stater, 62801
    - Centralia Oncology Clinic
  - Centralia, Illinois, Forenede Stater, 62801
    - Saint Mary's Hospital
  - Chicago, Illinois, Forenede Stater, 60611
    - Northwestern University
  - Chicago, Illinois, Forenede Stater, 60612
    - University of Illinois
  - Chicago, Illinois, Forenede Stater, 60612
    - John H Stroger Jr Hospital of Cook County
  - 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
  - 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
  - Galesburg, Illinois, Forenede Stater, 61401
    - Western Illinois Cancer Treatment Center
  - Galesburg, Illinois, Forenede Stater, 61401
    - Illinois CancerCare-Galesburg
  - Hazel Crest, Illinois, Forenede Stater, 60429
    - Advocate South Suburban Hospital
  - Hinsdale, Illinois, Forenede Stater, 60521
    - UChicago Medicine AdventHealth Cancer Institute Hinsdale
  - 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
  - Mount Vernon, Illinois, Forenede Stater, 62864
    - SSM Health Good Samaritan
  - 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
  - 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
  - Washington, Illinois, Forenede Stater, 61571
    - Illinois CancerCare - Washington
  - Yorkville, Illinois, Forenede Stater, 60560
    - Rush-Copley Healthcare Center
- Indiana
  - Fort Wayne, Indiana, Forenede Stater, 46845
    - Parkview Regional Medical Center
  - Indianapolis, Indiana, Forenede Stater, 46237
    - Franciscan Health Indianapolis
  - Indianapolis, Indiana, Forenede Stater, 46219
    - Community Cancer Center East
  - Indianapolis, Indiana, Forenede Stater, 46227
    - Community Cancer Center South
  - Indianapolis, Indiana, Forenede Stater, 46256
    - Community Cancer Center North
  - Kokomo, Indiana, Forenede Stater, 46904
    - Community Howard Regional Health
  - Michigan City, Indiana, Forenede Stater, 46360
    - Woodland Cancer Care Center
  - Mooresville, Indiana, Forenede Stater, 46158
    - Franciscan Health Mooresville
  - Terre Haute, Indiana, Forenede Stater, 47804
    - Union Hospital
- Iowa
  - Ames, Iowa, Forenede Stater, 50010
    - Mary Greeley Medical Center
  - Ames, Iowa, Forenede Stater, 50010
    - McFarland Clinic - Ames
  - Ankeny, Iowa, Forenede Stater, 50023
    - UI Health Care Mission Cancer and Blood - Ankeny Clinic
  - Boone, Iowa, Forenede Stater, 50036
    - McFarland Clinic - Boone
  - Carroll, Iowa, Forenede Stater, 51401
    - Saint Anthony Regional Hospital
  - Clive, Iowa, Forenede Stater, 50325
    - Mercy Cancer Center-West Lakes
  - Clive, Iowa, Forenede Stater, 50325
    - UI Health Care Mission Cancer and Blood - West Des Moines Clinic
  - Council Bluffs, Iowa, Forenede Stater, 51503
    - Alegent Health Mercy Hospital
  - Creston, Iowa, Forenede Stater, 50801
    - Greater Regional Medical Center
  - Des Moines, Iowa, Forenede Stater, 50309
    - Iowa Methodist Medical Center
  - Des Moines, Iowa, Forenede Stater, 50314
    - Mercy Medical Center - Des Moines
  - Des Moines, Iowa, Forenede Stater, 50314
    - Broadlawns Medical Center
  - Des Moines, Iowa, Forenede Stater, 50316
    - Iowa Lutheran Hospital
  - Des Moines, Iowa, Forenede Stater, 50309
    - UI Health Care Mission Cancer and Blood - Des Moines Clinic
  - Des Moines, Iowa, Forenede Stater, 50314
    - UI Health Care Mission Cancer and Blood - Laurel Clinic
  - Fort Dodge, Iowa, Forenede Stater, 50501
    - McFarland Clinic - Trinity Cancer Center
  - Fort Dodge, Iowa, Forenede Stater, 50501
    - UI Healthcare Mission Cancer and Blood - Fort Dodge
  - Jefferson, Iowa, Forenede Stater, 50129
    - McFarland Clinic - Jefferson
  - Marshalltown, Iowa, Forenede Stater, 50158
    - McFarland Clinic - Marshalltown
  - West Des Moines, Iowa, Forenede Stater, 50266-7700
    - Methodist West Hospital
  - West Des Moines, Iowa, Forenede Stater, 50266
    - Mercy Medical Center-West Lakes
- Kansas
  - Garden City, Kansas, Forenede Stater, 67846
    - Central Care Cancer Center - Garden City
  - Great Bend, Kansas, Forenede Stater, 67530
    - Central Care Cancer Center - Great Bend
- Kentucky
  - Bardstown, Kentucky, Forenede Stater, 40004
    - CommonSpirit Saint Joseph Hospital - Bardstown
  - Corbin, Kentucky, Forenede Stater, 40701
    - Commonwealth Cancer Center-Corbin
  - Lexington, Kentucky, Forenede Stater, 40504
    - Saint Joseph Radiation Oncology Resource Center
  - Lexington, Kentucky, Forenede Stater, 40509
    - CommonSpirit Saint Joseph Medical Center - East Lexington
  - Lexington, Kentucky, Forenede Stater, 40504
    - CommonSpirit Saint Joseph Hospital - Lexington
  - London, Kentucky, Forenede Stater, 40741
    - CommonSpirit Saint Joseph Hospital London
  - Louisville, Kentucky, Forenede Stater, 40202
    - The James Graham Brown Cancer Center at University of Louisville
  - Louisville, Kentucky, Forenede Stater, 40202
    - Jewish Hospital
  - Louisville, Kentucky, Forenede Stater, 40245
    - UofL Health Medical Center Northeast
  - Louisville, Kentucky, Forenede Stater, 40215
    - Saints Mary and Elizabeth Hospital
  - Shepherdsville, Kentucky, Forenede Stater, 40165
    - Jewish Hospital Medical Center South
- Louisiana
  - Baton Rouge, Louisiana, Forenede Stater, 70805
    - LSU Health Baton Rouge-North Clinic
  - Baton Rouge, Louisiana, Forenede Stater, 70809
    - Louisiana Hematology Oncology Associates LLC
  - Baton Rouge, Louisiana, Forenede Stater, 70809
    - Mary Bird Perkins Cancer Center
  - Baton Rouge, Louisiana, Forenede Stater, 70808
    - Our Lady of The Lake
  - Baton Rouge, Louisiana, Forenede Stater, 70808
    - Our Lady of the Lake Physician Group
  - New Orleans, Louisiana, Forenede Stater, 70112
    - University Medical Center New Orleans
  - New Orleans, Louisiana, Forenede Stater, 70112
    - Louisiana State University Health Science Center
- Maryland
  - Baltimore, Maryland, Forenede Stater, 21204
    - Greater Baltimore Medical Center
  - Baltimore, Maryland, Forenede Stater, 21201
    - University of Maryland/Greenebaum Cancer Center
  - Bel Air, Maryland, Forenede Stater, 21014
    - UM Upper Chesapeake Medical Center
- Massachusetts
  - Boston, Massachusetts, Forenede Stater, 02111
    - Tufts Medical Center
  - Lowell, Massachusetts, Forenede Stater, 01854
    - Lowell General Hospital
  - Springfield, Massachusetts, Forenede Stater, 01104
    - Mercy Medical Center
  - Worcester, Massachusetts, Forenede Stater, 01655
    - UMass Memorial Medical Center - University Campus
- Michigan
  - Ann Arbor, Michigan, Forenede Stater, 48106
    - Trinity Health Saint Joseph Mercy Hospital Ann Arbor
  - Battle Creek, Michigan, Forenede Stater, 49017
    - Bronson Battle Creek
  - Bay City, Michigan, Forenede Stater, 48706
    - McLaren Cancer Institute-Bay City
  - Brighton, Michigan, Forenede Stater, 48114
    - Trinity Health IHA Medical Group Hematology Oncology - Brighton
  - 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
    - McLaren Cancer Institute-Clarkston
  - Clarkston, Michigan, Forenede Stater, 48346
    - Hematology Oncology Consultants-Clarkston
  - Clarkston, Michigan, Forenede Stater, 48346
    - Newland Medical Associates-Clarkston
  - Detroit, Michigan, Forenede Stater, 48201
    - Wayne State University/Karmanos Cancer Institute
  - Detroit, Michigan, Forenede Stater, 48236
    - Henry Ford Health Saint John Hospital
  - East China Township, Michigan, Forenede Stater, 48054
    - Henry Ford River District Hospital
  - Farmington Hills, Michigan, Forenede Stater, 48334
    - Weisberg Cancer Treatment Center
  - Flint, Michigan, Forenede Stater, 48532
    - McLaren Cancer Institute-Flint
  - Flint, Michigan, Forenede Stater, 48532
    - Singh and Arora Hematology Oncology PC
  - 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
  - Grand Rapids, Michigan, Forenede Stater, 49503
    - Trinity Health Grand Rapids Hospital
  - Grand Rapids, Michigan, Forenede Stater, 49503
    - Corewell Health Grand Rapids Hospitals - Butterworth Hospital
  - Grand Rapids, Michigan, Forenede Stater, 49503
    - Corewell Health Grand Rapids Hospitals - Helen DeVos Children's 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
  - 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
    - Mid-Michigan Physicians-Lansing
  - Lansing, Michigan, Forenede Stater, 48910
    - Karmanos Cancer Institute at McLaren Greater Lansing
  - Lansing, Michigan, Forenede Stater, 48912
    - University of Michigan Health - Sparrow Lansing
  - Lapeer, Michigan, Forenede Stater, 48446
    - McLaren Cancer Institute-Lapeer Region
  - 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
  - Mount Clemens, Michigan, Forenede Stater, 48043
    - McLaren Cancer Institute-Macomb
  - Mount Pleasant, Michigan, Forenede Stater, 48858
    - McLaren Cancer Institute-Central Michigan
  - Muskegon, Michigan, Forenede Stater, 49444
    - Trinity Health Muskegon Hospital
  - Niles, Michigan, Forenede Stater, 49120
    - Corewell Health Lakeland Hospitals - Niles Hospital
  - Norton Shores, Michigan, Forenede Stater, 49444
    - Cancer and Hematology Centers of Western Michigan - Norton Shores
  - Petoskey, Michigan, Forenede Stater, 49770
    - McLaren Cancer Institute-Northern Michigan
  - 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
  - Port Huron, Michigan, Forenede Stater, 48060
    - McLaren-Port Huron
  - Reed City, Michigan, Forenede Stater, 49677
    - Corewell Health Reed City Hospital
  - Rochester Hills, Michigan, Forenede Stater, 48309
    - Henry Ford Rochester Hospital
  - Saginaw, Michigan, Forenede Stater, 48604
    - Oncology Hematology Associates of Saginaw Valley PC
  - Saginaw, Michigan, Forenede Stater, 48601
    - MyMichigan Medical Center Saginaw
  - Saint Joseph, Michigan, Forenede Stater, 49085
    - Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
  - Saint Joseph, Michigan, Forenede Stater, 49085
    - Corewell Health Lakeland Hospitals - Saint Joseph 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
  - 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
  - Bemidji, Minnesota, Forenede Stater, 56601
    - Sanford Joe Lueken Cancer 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
  - Edina, Minnesota, Forenede Stater, 55435
    - Fairview Southdale Hospital
  - Fridley, Minnesota, Forenede Stater, 55432
    - Unity Hospital
  - 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
  - Minneapolis, Minnesota, Forenede Stater, 55417
    - Minneapolis VA Medical Center
  - Monticello, Minnesota, Forenede Stater, 55362
    - Monticello Cancer Center
  - New Ulm, Minnesota, Forenede Stater, 56073
    - New Ulm Medical Center
  - 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
  - Shakopee, Minnesota, Forenede Stater, 55379
    - Saint Francis Regional Medical Center
  - Stillwater, Minnesota, Forenede Stater, 55082
    - Lakeview Hospital
  - Thief River Falls, Minnesota, Forenede Stater, 56701
    - Sanford Thief River Falls Medical Center
  - 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
- Missouri
  - Ballwin, Missouri, Forenede Stater, 63011
    - Mercy Oncology and Hematology - Clayton-Clarkson
  - Bolivar, Missouri, Forenede Stater, 65613
    - Central Care Cancer Center - Bolivar
  - Bonne Terre, Missouri, Forenede Stater, 63628
    - Parkland Health Center-Bonne Terre
  - Branson, Missouri, Forenede Stater, 65616
    - Cox Cancer Center Branson
  - Cape Girardeau, Missouri, Forenede Stater, 63703
    - Saint Francis Medical Center
  - Cape Girardeau, Missouri, Forenede Stater, 63703
    - Mercy Cancer Center - Cape Girardeau
  - Jefferson City, Missouri, Forenede Stater, 65109
    - MU Health Care Goldschmidt Cancer Center
  - Joplin, Missouri, Forenede Stater, 64804
    - Freeman Health System
  - Joplin, Missouri, Forenede Stater, 64804
    - Mercy Hospital Joplin
  - Rolla, Missouri, Forenede Stater, 65401
    - Mercy Clinic-Rolla-Cancer and Hematology
  - Rolla, Missouri, Forenede Stater, 65401
    - Phelps Health Delbert Day Cancer Institute
  - 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
  - St Louis, Missouri, Forenede Stater, 63109
    - Mercy Infusion Center - Chippewa
  - St Louis, Missouri, Forenede Stater, 63141
    - Mercy Hospital Saint Louis
  - St Louis, Missouri, Forenede Stater, 63128
    - Mercy Hospital South
  - Sullivan, Missouri, Forenede Stater, 63080
    - Missouri Baptist Sullivan Hospital
  - Washington, Missouri, Forenede Stater, 63090
    - Mercy Hospital Washington
- Montana
  - Anaconda, Montana, Forenede Stater, 59711
    - Community Hospital of Anaconda
  - Billings, Montana, Forenede Stater, 59101
    - Billings Clinic Cancer Center
  - Billings, Montana, Forenede Stater, 59101
    - Saint Vincent Healthcare
  - Billings, Montana, Forenede Stater, 59102
    - Saint Vincent Frontier 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
    - Great Falls Clinic
  - Great Falls, Montana, Forenede Stater, 59405
    - Benefis Sletten Cancer Institute
  - Helena, Montana, Forenede Stater, 59601
    - Saint Peter's Community Hospital
  - Kalispell, Montana, Forenede Stater, 59901
    - Logan Health Medical Center
  - Missoula, Montana, Forenede Stater, 59802
    - Saint Patrick Hospital - Community Hospital
  - Missoula, Montana, Forenede Stater, 59804
    - Community Medical Center
- Nebraska
  - Bellevue, Nebraska, Forenede Stater, 68123
    - Nebraska Medicine-Bellevue
  - Grand Island, Nebraska, Forenede Stater, 68803
    - Nebraska Cancer Specialists/Oncology Hematology West PC
  - Kearney, Nebraska, Forenede Stater, 68847
    - CHI Health Good Samaritan
  - Lincoln, Nebraska, Forenede Stater, 68510
    - Saint Elizabeth Regional Medical Center
  - Omaha, Nebraska, Forenede Stater, 68198
    - University of Nebraska Medical Center
  - Omaha, Nebraska, Forenede Stater, 68124
    - Alegent Health Bergan Mercy Medical Center
  - Omaha, Nebraska, Forenede Stater, 68118
    - Nebraska Medicine-Village Pointe
  - Omaha, Nebraska, Forenede Stater, 68122
    - Alegent Health Immanuel Medical Center
  - Omaha, Nebraska, Forenede Stater, 68130
    - Alegent Health Lakeside Hospital
  - 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
  - Cape May Court House, New Jersey, Forenede Stater, 08210
    - AtlantiCare Health Park-Cape May Court House
  - Egg Harbor, New Jersey, Forenede Stater, 08234
    - AtlantiCare Surgery Center
  - Hamilton, New Jersey, Forenede Stater, 08690
    - The Cancer Institute of New Jersey Hamilton
  - Jersey City, New Jersey, Forenede Stater, 07302
    - Jersey City Medical Center
  - Livingston, New Jersey, Forenede Stater, 07039
    - Cooperman Barnabas Medical Center
  - Moorestown, New Jersey, Forenede Stater, 08057
    - Virtua Samson Cancer Center
  - Morristown, New Jersey, Forenede Stater, 07960
    - Morristown Medical Center
  - Mount Holly, New Jersey, Forenede Stater, 08060
    - Virtua Memorial
  - New Brunswick, New Jersey, Forenede Stater, 08903
    - Rutgers Cancer Institute of New Jersey
  - Newark, New Jersey, Forenede Stater, 07101
    - Rutgers New Jersey Medical School
  - Summit, New Jersey, Forenede Stater, 07902
    - Overlook Hospital
  - Voorhees Township, New Jersey, Forenede Stater, 08043
    - Virtua Voorhees
- New Mexico
  - Albuquerque, New Mexico, Forenede Stater, 87106
    - University of New Mexico Cancer Center
- New York
  - Brooklyn, New York, Forenede Stater, 11215
    - New York-Presbyterian/Brooklyn Methodist Hospital
  - Buffalo, New York, Forenede Stater, 14263
    - Roswell Park Cancer Institute
  - New York, New York, Forenede Stater, 10065
    - NYP/Weill Cornell Medical Center
  - Rochester, New York, Forenede Stater, 14642
    - University of Rochester
  - Stony Brook, New York, Forenede Stater, 11794
    - Stony Brook University Medical Center
  - Syracuse, New York, Forenede Stater, 13210
    - State University of New York Upstate Medical University
  - Syracuse, New York, Forenede Stater, 13215
    - SUNY Upstate Medical Center-Community Campus
  - The Bronx, New York, Forenede Stater, 10461
    - Montefiore Medical Center-Einstein Campus
  - The Bronx, New York, Forenede Stater, 10467
    - Montefiore Medical Center - Moses Campus
  - The Bronx, New York, Forenede Stater, 10461
    - Montefiore Medical Center-Weiler Hospital
- North Carolina
  - Asheville, North Carolina, Forenede Stater, 28803
    - AdventHealth Infusion Center Asheville
  - Charlotte, North Carolina, Forenede Stater, 28204
    - Novant Health Presbyterian Medical Center
  - Clyde, North Carolina, Forenede Stater, 28721
    - AdventHealth Infusion Center Haywood
  - Gastonia, North Carolina, Forenede Stater, 28054
    - CaroMont Regional Medical Center
  - Greenville, North Carolina, Forenede Stater, 27834
    - East Carolina University
  - Hendersonville, North Carolina, Forenede Stater, 28792
    - AdventHealth Hendersonville
  - Huntersville, North Carolina, Forenede Stater, 28078
    - Novant Health Cancer Institute - Huntersville
  - Huntersville, North Carolina, Forenede Stater, 28078
    - Novant Health Presbyterian Medical Center Huntersville
  - Kernersville, North Carolina, Forenede Stater, 27284
    - Novant Health Cancer Institute - Kernersville
  - Matthews, North Carolina, Forenede Stater, 28105
    - Novant Health Cancer Institute - Matthews
  - Mooresville, North Carolina, Forenede Stater, 28117
    - Novant Health Cancer Institute - Mooresville
  - Mount Airy, North Carolina, Forenede Stater, 27030
    - Novant Health Cancer Institute - Mount Airy
  - New Bern, North Carolina, Forenede Stater, 28561
    - CarolinaEast Medical Center
  - North Wilkesboro, North Carolina, Forenede Stater, 28659
    - Novant Health Cancer Institute - Wilkesboro
  - Statesville, North Carolina, Forenede Stater, 28625
    - Novant Health Cancer Institute - Statesville
  - Thomasville, North Carolina, Forenede Stater, 27360
    - Novant Health Cancer Institute - Thomasville
  - Weaverville, North Carolina, Forenede Stater, 28787
    - AdventHealth Infusion Center Weaverville
  - Winston-Salem, North Carolina, Forenede Stater, 27103
    - Novant Health Forsyth Medical Center
- 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, 58122
    - Sanford Broadway Medical Center
  - Fargo, North Dakota, Forenede Stater, 58103
    - Sanford South University Medical Center
  - Fargo, North Dakota, Forenede Stater, 58103
    - Southpointe-Sanford Medical Center Fargo
  - Fargo, North Dakota, Forenede Stater, 58104
    - Sanford Medical Center Fargo
- Ohio
  - Akron, Ohio, Forenede Stater, 44304
    - Summa Health System - Akron Campus
  - Avon, Ohio, Forenede Stater, 44011
    - UH Seidman Cancer Center at UH Avon Health Center
  - Barberton, Ohio, Forenede Stater, 44203
    - Summa Health System - Barberton Campus
  - Beachwood, Ohio, Forenede Stater, 44122
    - UHHS-Chagrin Highlands Medical Center
  - Canton, Ohio, Forenede Stater, 44708
    - Cleveland Clinic Mercy Hospital
  - Centerville, Ohio, Forenede Stater, 45459
    - Miami Valley Hospital South
  - Chardon, Ohio, Forenede Stater, 44024
    - Geauga Hospital
  - Cincinnati, Ohio, Forenede Stater, 45220
    - Good Samaritan Hospital - Cincinnati
  - Cincinnati, Ohio, Forenede Stater, 45242
    - Bethesda North Hospital
  - Cincinnati, Ohio, Forenede Stater, 45247
    - TriHealth Cancer Institute-Westside
  - Cincinnati, Ohio, Forenede Stater, 45255
    - TriHealth Cancer Institute-Anderson
  - Cleveland, Ohio, Forenede Stater, 44106
    - Case Western Reserve University
  - Cleveland, Ohio, Forenede Stater, 44109
    - MetroHealth Medical Center
  - Cleveland, Ohio, Forenede Stater, 44195
    - Cleveland Clinic Foundation
  - Cleveland, Ohio, Forenede Stater, 44111
    - Cleveland Clinic Cancer Center/Fairview Hospital
  - Columbus, Ohio, Forenede Stater, 43210
    - Ohio State University Comprehensive Cancer Center
  - Dayton, Ohio, Forenede Stater, 45409
    - Miami Valley Hospital
  - Dayton, Ohio, Forenede Stater, 45415
    - Miami Valley Hospital North
  - Dayton, Ohio, Forenede Stater, 45409
    - Premier Blood and Cancer Center
  - Elyria, Ohio, Forenede Stater, 44035
    - Mercy Cancer Center-Elyria
  - Franklin, Ohio, Forenede Stater, 45005-1066
    - Atrium Medical Center-Middletown Regional Hospital
  - Greenville, Ohio, Forenede Stater, 45331
    - Miami Valley Cancer Care and Infusion
  - Mansfield, Ohio, Forenede Stater, 44906
    - Cleveland Clinic Cancer Center Mansfield
  - Mayfield Heights, Ohio, Forenede Stater, 44124
    - Hillcrest Hospital Cancer Center
  - Medina, Ohio, Forenede Stater, 44256
    - Summa Health Medina Medical Center
  - Mentor, Ohio, Forenede Stater, 44060
    - UH Seidman Cancer Center at Lake Health Mentor Campus
  - Middleburg Heights, Ohio, Forenede Stater, 44130
    - UH Seidman Cancer Center at Southwest General Hospital
  - Parma, Ohio, Forenede Stater, 44129
    - University Hospitals Parma Medical Center
  - Ravenna, Ohio, Forenede Stater, 44266
    - University Hospitals Portage Medical Center
  - Sandusky, Ohio, Forenede Stater, 44870
    - North Coast Cancer Care
  - Strongsville, Ohio, Forenede Stater, 44136
    - Cleveland Clinic Cancer Center Strongsville
  - Troy, Ohio, Forenede Stater, 45373
    - Upper Valley Medical Center
  - Westlake, Ohio, Forenede Stater, 44145
    - UH Seidman Cancer Center at Saint John Medical Center
  - Westlake, Ohio, Forenede Stater, 44145
    - UHHS-Westlake Medical Center
- Oklahoma
  - Lawton, Oklahoma, Forenede Stater, 73505
    - Cancer Centers of Southwest Oklahoma Research
  - Oklahoma City, Oklahoma, Forenede Stater, 73104
    - University of Oklahoma Health Sciences Center
  - Oklahoma City, Oklahoma, Forenede Stater, 73120
    - Mercy Hospital Oklahoma City
  - Tulsa, Oklahoma, Forenede Stater, 74146
    - Oklahoma Cancer Specialists and Research Institute-Tulsa
- Oregon
  - Baker City, Oregon, Forenede Stater, 97814
    - Saint Alphonsus Cancer Care Center-Baker City
  - Bend, Oregon, Forenede Stater, 97701
    - Saint Charles Health System
  - Clackamas, Oregon, Forenede Stater, 97015
    - Clackamas Radiation Oncology Center
  - Clackamas, Oregon, Forenede Stater, 97015
    - Providence Cancer Institute Clackamas Clinic
  - Coos Bay, Oregon, Forenede Stater, 97420
    - Bay Area Hospital
  - Newberg, Oregon, Forenede Stater, 97132
    - Providence Newberg Medical Center
  - Ontario, Oregon, Forenede Stater, 97914
    - Saint Alphonsus Cancer Care Center-Ontario
  - Oregon City, Oregon, Forenede Stater, 97045
    - Providence Willamette Falls Medical Center
  - Portland, Oregon, Forenede Stater, 97213
    - Providence Portland Medical Center
  - Portland, Oregon, Forenede Stater, 97225
    - Providence Saint Vincent Medical Center
  - Redmond, Oregon, Forenede Stater, 97756
    - Saint Charles Health System-Redmond
- Pennsylvania
  - Allentown, Pennsylvania, Forenede Stater, 18103
    - Lehigh Valley Hospital-Cedar Crest
  - Bethlehem, Pennsylvania, Forenede Stater, 18017
    - Lehigh Valley Hospital - Muhlenberg
  - Chadds Ford, Pennsylvania, Forenede Stater, 19317
    - Christiana Care Health System-Concord Health Center
  - Danville, Pennsylvania, Forenede Stater, 17822
    - Geisinger Medical Center
  - East Stroudsburg, Pennsylvania, Forenede Stater, 18301
    - Pocono Medical Center
  - Erie, Pennsylvania, Forenede Stater, 16505
    - UPMC Hillman Cancer Center Erie
  - Farrell, Pennsylvania, Forenede Stater, 16121
    - UPMC Cancer Center at UPMC Horizon
  - Hazleton, Pennsylvania, Forenede Stater, 18201
    - Geisinger Medical Center-Cancer Center Hazleton
  - Hazleton, Pennsylvania, Forenede Stater, 18201
    - Lehigh Valley Hospital-Hazleton
  - Hershey, Pennsylvania, Forenede Stater, 17033-0850
    - Penn State Milton S Hershey Medical Center
  - Lewisburg, Pennsylvania, Forenede Stater, 17837
    - Geisinger Medical Oncology-Lewisburg
  - Lewistown, Pennsylvania, Forenede Stater, 17044
    - Lewistown Hospital
  - Monroeville, Pennsylvania, Forenede Stater, 15146
    - UPMC Hillman Cancer Center - Monroeville
  - Monroeville, Pennsylvania, Forenede Stater, 15146
    - UPMC Cancer Center - Monroeville
  - Philadelphia, Pennsylvania, Forenede Stater, 19107
    - Thomas Jefferson University Hospital
  - Philadelphia, Pennsylvania, Forenede Stater, 19114
    - Jefferson Torresdale Hospital
  - Pittsburgh, Pennsylvania, Forenede Stater, 15232
    - UPMC Hillman Cancer Center
  - Pittsburgh, Pennsylvania, Forenede Stater, 15232
    - UPMC-Shadyside Hospital
  - 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
  - Scranton, Pennsylvania, Forenede Stater, 18510
    - Community Medical Center
  - West Reading, Pennsylvania, Forenede Stater, 19611
    - Reading Hospital
  - Wilkes-Barre, Pennsylvania, Forenede Stater, 18711
    - Geisinger Wyoming Valley/Henry Cancer Center
  - Willow Grove, Pennsylvania, Forenede Stater, 19090
    - Asplundh Cancer Pavilion
- South Carolina
  - Boiling Springs, South Carolina, Forenede Stater, 29316
    - Prisma Health Cancer Institute - Spartanburg
  - Charleston, South Carolina, Forenede Stater, 29425
    - Medical University of South Carolina
  - Easley, South Carolina, Forenede Stater, 29640
    - Prisma Health Cancer Institute - Easley
  - Gaffney, South Carolina, Forenede Stater, 29341
    - Gibbs Cancer Center-Gaffney
  - Greenville, South Carolina, Forenede Stater, 29605
    - Prisma Health Cancer Institute - Faris
  - Greenville, South Carolina, Forenede Stater, 29607
    - Saint Francis Cancer Center
  - Greenville, South Carolina, Forenede Stater, 29615
    - Prisma Health Cancer Institute - Eastside
  - Greenville, South Carolina, Forenede Stater, 29605
    - Prisma Health Cancer Institute - Butternut
  - Greenville, South Carolina, Forenede Stater, 29601
    - Saint Francis Hospital
  - Greer, South Carolina, Forenede Stater, 29650
    - Prisma Health Cancer Institute - Greer
  - Greer, South Carolina, Forenede Stater, 29651
    - Gibbs Cancer Center-Pelham
  - Seneca, South Carolina, Forenede Stater, 29672
    - Prisma Health Cancer Institute - Seneca
  - Spartanburg, South Carolina, Forenede Stater, 29303
    - Spartanburg Medical Center
  - Union, South Carolina, Forenede Stater, 29379
    - SMC Center for Hematology Oncology Union
- South Dakota
  - Aberdeen, South Dakota, Forenede Stater, 57401
    - Avera Cancer Institute-Aberdeen
  - Sioux Falls, South Dakota, Forenede Stater, 57105
    - Avera Cancer Institute
  - 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
  - Nashville, Tennessee, Forenede Stater, 37232
    - Vanderbilt University/Ingram Cancer Center
- Texas
  - Amarillo, Texas, Forenede Stater, 79106
    - The Don and Sybil Harrington Cancer Center
  - Austin, Texas, Forenede Stater, 78712
    - University of Texas at Austin
  - Austin, Texas, Forenede Stater, 78701
    - Dell Seton Medical Center at The University of Texas
  - Bryan, Texas, Forenede Stater, 77802
    - Saint Joseph Regional Cancer Center
  - Dallas, Texas, Forenede Stater, 75235
    - Parkland Memorial Hospital
  - Dallas, Texas, Forenede Stater, 75390
    - UT Southwestern/Simmons Cancer Center-Dallas
  - Houston, Texas, Forenede Stater, 77030
    - Memorial Hermann Texas Medical Center
  - Humble, Texas, Forenede Stater, 77338
    - Memorial Hermann Northeast Hospital
- Utah
  - American Fork, Utah, Forenede Stater, 84003
    - American Fork Hospital / Huntsman Intermountain Cancer Center
  - Cedar City, Utah, Forenede Stater, 84720
    - Sandra L Maxwell Cancer Center
  - Logan, Utah, Forenede Stater, 84321
    - Logan Regional Hospital
  - Murray, Utah, Forenede Stater, 84107
    - Intermountain Medical Center
  - Ogden, Utah, Forenede Stater, 84403
    - McKay-Dee Hospital Center
  - Provo, Utah, Forenede Stater, 84604
    - Utah Valley Regional Medical Center
  - Riverton, Utah, Forenede Stater, 84065
    - Riverton Hospital
  - Salt Lake City, Utah, Forenede Stater, 84106
    - Utah Cancer Specialists-Salt Lake City
  - Salt Lake City, Utah, Forenede Stater, 84143
    - LDS Hospital
  - St. George, Utah, Forenede Stater, 84770
    - Saint George Regional Medical Center
- Vermont
  - Saint Johnsbury, Vermont, Forenede Stater, 05819
    - Dartmouth Cancer Center - North
- Virginia
  - Richmond, Virginia, Forenede Stater, 23235
    - VCU Massey Cancer Center at Stony Point
  - Richmond, Virginia, Forenede Stater, 23298
    - VCU Massey Comprehensive Cancer Center
- Washington
  - Aberdeen, Washington, Forenede Stater, 98520
    - Providence Regional Cancer System-Aberdeen
  - Auburn, Washington, Forenede Stater, 98001
    - MultiCare Auburn Medical Center
  - Bellevue, Washington, Forenede Stater, 98004
    - Overlake Medical Center
  - Bellingham, Washington, Forenede Stater, 98225
    - PeaceHealth Saint Joseph Medical Center
  - Burien, Washington, Forenede Stater, 98166
    - Highline Medical Center-Main Campus
  - Centralia, Washington, Forenede Stater, 98531
    - Providence Regional Cancer System-Centralia
  - Edmonds, Washington, Forenede Stater, 98026
    - Swedish Cancer Institute-Edmonds
  - Enumclaw, Washington, Forenede Stater, 98022
    - Saint Elizabeth Hospital
  - Everett, Washington, Forenede Stater, 98201
    - Providence Regional Cancer Partnership
  - Federal Way, Washington, Forenede Stater, 98003
    - Saint Francis Hospital
  - Gig Harbor, Washington, Forenede Stater, 98335
    - MultiCare Gig Harbor Medical Park
  - Issaquah, Washington, Forenede Stater, 98029
    - Swedish Cancer Institute-Issaquah
  - Kennewick, Washington, Forenede Stater, 99336
    - Kadlec Clinic Hematology and Oncology
  - Lacey, Washington, Forenede Stater, 98503
    - Providence Regional Cancer System-Lacey
  - Lakewood, Washington, Forenede Stater, 98499
    - Saint Clare Hospital
  - Longview, Washington, Forenede Stater, 98632
    - PeaceHealth Saint John Medical Center
  - Mount Vernon, Washington, Forenede Stater, 98274
    - Skagit Regional Health Cancer Care Center
  - Port Townsend, Washington, Forenede Stater, 98368
    - Jefferson Healthcare
  - Poulsbo, Washington, Forenede Stater, 98370
    - Harrison HealthPartners Hematology and Oncology-Poulsbo
  - Puyallup, Washington, Forenede Stater, 98372
    - MultiCare Good Samaritan Hospital
  - Renton, Washington, Forenede Stater, 98055
    - Valley Medical Center
  - Seattle, Washington, Forenede Stater, 98107
    - Swedish Medical Center-Ballard Campus
  - Seattle, Washington, Forenede Stater, 98122
    - Swedish Medical Center-First Hill
  - Seattle, Washington, Forenede Stater, 98104
    - Pacific Gynecology Specialists
  - Seattle, Washington, Forenede Stater, 98122-5711
    - Swedish Medical Center-Cherry Hill
  - Sedro-Woolley, Washington, Forenede Stater, 98284
    - PeaceHealth United General Medical Center
  - Shelton, Washington, Forenede Stater, 98584
    - Providence Regional Cancer System-Shelton
  - Silverdale, Washington, Forenede Stater, 98383
    - Saint Joseph Medical Center Hematology and Oncology - Silverdale
  - Spokane, Washington, Forenede Stater, 99204
    - MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
  - Spokane, Washington, Forenede Stater, 99218
    - MultiCare Deaconess Cancer and Blood Specialty Center - North
  - Spokane Valley, Washington, Forenede Stater, 99216
    - MultiCare Deaconess Cancer and Blood Specialty Center - Valley
  - Tacoma, Washington, Forenede Stater, 98405
    - Mary Bridge Children's Hospital and Health Center
  - Tacoma, Washington, Forenede Stater, 98405
    - Northwest Medical Specialties PLLC
  - Tacoma, Washington, Forenede Stater, 98405
    - MultiCare Tacoma General Hospital
  - Tacoma, Washington, Forenede Stater, 98405
    - Franciscan Research Center-Northwest Medical Plaza
  - Vancouver, Washington, Forenede Stater, 98664
    - PeaceHealth Southwest Medical Center
  - Walla Walla, Washington, Forenede Stater, 99362
    - Providence Saint Mary Regional Cancer Center
  - Yakima, Washington, Forenede Stater, 98902
    - North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
  - Yelm, Washington, Forenede Stater, 98597
    - Providence Regional Cancer System-Yelm
- Wisconsin
  - Appleton, Wisconsin, Forenede Stater, 54911
    - ThedaCare Regional Cancer Center
  - Burlington, Wisconsin, Forenede Stater, 53105
    - Aurora Cancer Care-Southern Lakes VLCC
  - Eau Claire, Wisconsin, Forenede Stater, 54701
    - Marshfield Medical Center-EC Cancer Center
  - Eau Claire, Wisconsin, Forenede Stater, 54701
    - HSHS Sacred Heart Hospital
  - 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
    - Saint Vincent Hospital Cancer Center Green Bay
  - Green Bay, Wisconsin, Forenede Stater, 54303
    - Saint Vincent Hospital Cancer Center at Saint Mary's
  - Kenosha, Wisconsin, Forenede Stater, 53142
    - Aurora Cancer Care-Kenosha South
  - La Crosse, Wisconsin, Forenede Stater, 54601
    - Gundersen Lutheran Medical Center
  - Manitowoc, Wisconsin, Forenede Stater, 54221
    - Holy Family Memorial Hospital
  - Marinette, Wisconsin, Forenede Stater, 54143
    - Aurora Bay Area Medical Group-Marinette
  - Marshfield, Wisconsin, Forenede Stater, 54449
    - Marshfield Medical Center-Marshfield
  - Menomonee Falls, Wisconsin, Forenede Stater, 53051
    - Froedtert Menomonee Falls 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
  - Oak Creek, Wisconsin, Forenede Stater, 53154
    - Drexel Town Square Health Center
  - Oconomowoc, Wisconsin, Forenede Stater, 53066
    - ProHealth Oconomowoc Memorial Hospital
  - Oconto Falls, Wisconsin, Forenede Stater, 54154
    - Saint Vincent Hospital Cancer Center at Oconto Falls
  - Oshkosh, Wisconsin, Forenede Stater, 54904
    - Vince Lombardi Cancer Clinic - Oshkosh
  - Racine, Wisconsin, Forenede Stater, 53406
    - Aurora Cancer Care-Racine
  - Rice Lake, Wisconsin, Forenede Stater, 54868
    - Marshfield Medical Center-Rice Lake
  - Sheboygan, Wisconsin, Forenede Stater, 53081
    - Vince Lombardi Cancer Clinic-Sheboygan
  - Sheboygan, Wisconsin, Forenede Stater, 53081
    - HSHS Saint Nicholas Hospital
  - Stevens Point, Wisconsin, Forenede Stater, 54482
    - Marshfield Medical Center-River Region at Stevens Point
  - Sturgeon Bay, Wisconsin, Forenede Stater, 54235-1495
    - Saint Vincent Hospital Cancer Center at Sturgeon Bay
  - 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
  - Wauwatosa, Wisconsin, Forenede Stater, 53226
    - Aurora Cancer Care-Milwaukee West
  - West Allis, Wisconsin, Forenede Stater, 53227
    - Aurora West Allis Medical Center
  - West Bend, Wisconsin, Forenede Stater, 53095
    - Froedtert West Bend Hospital/Kraemer Cancer Center
  - Weston, Wisconsin, Forenede Stater, 54476
    - Marshfield Medical Center - Weston
- Wyoming
  - Cheyenne, Wyoming, Forenede Stater, 82001
    - Cheyenne Regional Medical Center-West
  - Cody, Wyoming, Forenede Stater, 82414
    - Billings Clinic-Cody
  - Sheridan, Wyoming, Forenede Stater, 82801
    - Welch Cancer Center

Deltagelseskriterier

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

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Beskrivelse

Inklusionskriterier:

TRIN 1: Alder >= 18 år
TRIN 1: Eastern Cooperative Oncology Group (ECOG) præstationsstatus på 0 eller 1.
TRIN 1: Patienter skal have oropharynx cancer (American Joint Committee on Cancer [AJCC] 8), der er p16-positiv ved immunhistokemi ELLER p16 tvetydig af IHC og HPV-positiv ved in situ hybridisering med følgende kriterier: >= 10 pakkeår, trin T1-2N2-N3 eller T3-4N0-3 (mindre end 10 pakkeår betragtes som en ikke-ryger) ELLER < 10 pakkeår, trin T4N0-N3 eller T1-3N2-3
TRIN 1: Patienter må ikke have kendt overfølsomhed over for nivolumab eller forbindelser med lignende kemisk eller biologisk sammensætning.
TRIN 1: Patienter med en anamnese med allergiske reaktioner tilskrevet platinbaserede kemoterapimidler er udelukket.
TRIN 1: Patienter må ikke have haft forudgående systemisk terapi, strålebehandling eller operation for p16-positivt oropharyngealt pladecellekarcinom (OPSCC).
- BEMÆRK: Patienter, der havde resektion af T1- eller T2-karcinom uden stråling eller kemoterapi, er berettigede, hvis operationen blev udført 5 år før indskrivning
TRIN 1: Patienter må ikke have modtaget tidligere bestråling for hoved- og halstumorer, kraniebase eller hjernetumorer.
TRIN 1: Patienter må ikke modtage forsøgsmidler inden for 4 uger efter tilmelding eller på noget tidspunkt under undersøgelsen.
TRIN 1: Patienter med tegn på fjernmetastaser eller leptomeningeal sygdom (LMD) er udelukket.
TRIN 1: Patienter med ukontrollerede interkurrente sygdomme, som efter investigators opfattelse vil forstyrre evnen til at gennemgå terapi inklusive kemoterapi, er udelukket.
TRIN 1: Patienter med tidligere eller anden malignitet er udelukket, med undtagelse af kurativt behandlet ikke-melanom hudkræft eller kurativt behandlet livmoderhalskræft; desuden er patienter, der behandles kurativt for malignitet, og som forbliver sygdomsfrie efter > 2 års opfølgning, ikke udelukket.
TRIN 1: Absolut neutrofiltal (ANC) >= 1500/mm^3 (skal opnås =< 2 uger før randomisering).
TRIN 1: Hæmoglobin (Hgb) >= 8,0 g/dL (skal opnås =< 2 uger før randomisering).
TRIN 1: Blodpladetal >= 100.000/mm^3 (skal opnås =< 2 uger før randomisering).
TRIN 1: Kreatininclearance på >= 60 ml/min (skal opnås =< 2 uger før randomisering). Kreatininclearance kan måles eller beregnes. Hvis du beregner kreatininclearance, skal du bruge Cockcroft-Gault-formlen.
TRIN 1: Total bilirubin inden for 1,5 gange de normale grænser (skal opnås =< 2 uger før randomisering).
TRIN 1: Serumglutamin-oxaloeddikesyretransaminase (SGOT) (aspartataminotransferase [AST]) eller serumglutamatpyruvattransaminase (SGPT) (alaninaminotransferase [ALT]) inden for 2,0 gange de normale grænser (skal opnås =< 2 uger før randomisering) .
TRIN 1: Alkalisk fosfatase inden for 2,0 gange de normale grænser (skal opnås =< 2 uger før randomisering).
TRIN 1: Patienter må ikke være gravide eller ammende, da kemoterapi, stråling og immunterapi kan have mulige teratogenicitetseffekter; desuden kan komplikationer fra graviditeten forstyrre patienters evne til at få en uafbrudt behandling. 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 kvinde, uanset seksuel orientering eller om de har gennemgået tubal ligering, som opfylder følgende kriterier: 1) har opnået menarche på et tidspunkt, 2) ikke har gennemgået en hysterektomi eller bilateral oophorektomi eller 3) har ikke været naturligt postmenopausal (amenoré efter cancerbehandling udelukker ikke den fødedygtige alder) i mindst 24 på hinanden følgende måneder (dvs. har haft menstruation på noget tidspunkt i de foregående 24 på hinanden følgende måneder).
TRIN 1: Patienter i den fødedygtige alder skal bruge en accepteret og effektiv præventionsmetode eller afholde sig fra samleje i mindst en uge før behandlingsstart og fortsætte i 5 måneder efter den sidste dosis af protokolbehandlingen. Patienter må heller ikke donere æg i samme tidsrum.
TRIN 1: Patienter skal have målbar sygdom
TRIN 1: Patienterne skal have tumormålinger med CT af halsen og CT af brystet (eller CT af halsen og FDG PET/CT hvis standardbehandling) inden for 4 uger før trin 1 randomisering.
TRIN 1: Patienter med aktiv autoimmun sygdom eller historie med autoimmun sygdom, som kan opstå igen, som kan påvirke vitale organers funktion eller kræver immunsuppressiv behandling inklusive systemiske kortikosteroider, bør udelukkes. Disse omfatter, men er ikke begrænset til, patienter med en historie med immunrelateret neurologisk sygdom, multipel sklerose, autoimmun (demyeliniserende) neuropati, Guillain-Barre syndrom, myasthenia gravis; systemisk autoimmun sygdom, såsom systemisk lupus erythematosus (SLE), bindevævssygdom, sklerodermi, inflammatorisk tarmsygdom (IBD), Crohns, ulcerøs colitis, hepatitis; og patienter med en historie med toksisk epidermal nekrolyse (TEN), Stevens-Johnsons syndrom eller fosfolipidsyndrom bør udelukkes på grund af risikoen for tilbagefald eller forværring af sygdommen. Patienter med vitiligo, endokrine mangler inklusive thyroiditis behandlet med erstatningshormoner inklusive fysiologiske kortikosteroider er kvalificerede. Patienter med leddegigt og andre artropatier, Sjogrens syndrom og psoriasis kontrolleret med topisk medicin og patienter med positiv serologi, såsom antinukleære antistoffer (ANA), anti-thyreoidea-antistoffer bør evalueres for tilstedeværelsen af målorganinvolvering og potentielt behov for systemisk behandling men skulle ellers være berettiget.
TRIN 1: Patienter har tilladelse til at tilmelde sig, hvis de har vitiligo, type I diabetes mellitus, resterende hypothyroidisme på grund af autoimmun tilstand, der kun kræver hormonudskiftning, psoriasis, der ikke kræver systemisk behandling, eller tilstande, der ikke forventes at gentage sig i fravær af en ekstern trigger (udløser begivenhed).
TRIN 1: Patienter må ikke have en tilstand, der kræver systemisk behandling med hverken kortikosteroider (>10 mg/dag prednisonækvivalenter) eller anden immunsuppressiv medicin, som forventes at fortsætte under nivolumab-administration. Inhalerede eller topikale steroider og binyreerstatningsdoser > 10 mg/dag prednisonækvivalenter er tilladt i fravær af aktiv autoimmun sygdom
TRIN 1: Patienter med tegn på kronisk hepatitis B-virus (HBV)-infektion, HBV-virusmængden skal være uopdagelig ved suppressiv terapi, hvis indiceret
TRIN 1: Patienter med en historie med hepatitis C-virus (HCV)-infektion skal være blevet behandlet og helbredt. For patienter med HCV-infektion, som i øjeblikket er i behandling, er de berettigede, hvis de har en upåviselig HCV-virusbelastning
TRIN 1: Patienter med en kendt historie om at være testet positive for humant immundefektvirus (HIV) eller kendt erhvervet immundefektsyndrom (AIDS) må ikke have nogen påviselig viral belastning på et stabilt antiviralt regime
TRIN 1: Patienter må ikke modtage andre forsøgsmidler.
TRIN 1: Patienten må ikke have et klinisk signifikant høretab ved baseline, hvilket efter investigators mening vil udelukke brugen af cisplatin
TRIN 2: Patienter skal have progression i henhold til RECIST-kriterier OG vævsdokumenteret progression på arm B-behandling inden for 12 måneder efter afslutning af strålebehandling.
TRIN 2: ECOG-ydelsesstatus på 0 eller 1.
TRIN 2: Patienter må ikke have kendt overfølsomhed over for nivolumab eller forbindelser med lignende kemisk eller biologisk sammensætning.
TRIN 2: Patienter må ikke have modtaget non-protokol anti-cancer terapi efter afslutning af stråling og kemoterapi.
TRIN 2: ANC >= 1500/mm^3 (skal indhentes =< 2 uger før registrering).
TRIN 2: Hgb >= 8,0 g/dL (skal indhentes =< 2 uger før registrering).
TRIN 2: Blodpladetal >= 100.000/mm^3 (skal indhentes =< 2 uger før registrering).
TRIN 2: Kreatinin inden for institutionelle grænser af normale (skal indhentes =< 2 uger før registrering)
TRIN 2: Total bilirubin inden for 1,5 gange de normale grænser (skal indhentes =< 2 uger før registrering).
TRIN 2: SGOT (AST) eller SGPT (ALT) inden for 2,0 gange de normale grænser (skal indhentes =< 2 uger før registrering).
TRIN 2: Alkalisk fosfatase inden for 1,5 gange de normale grænser (skal opnås =< 2 uger før registrering).
TRIN 2: Patienter må ikke være gravide eller ammende, da kemoterapi, stråling og immunterapi kan have mulige teratogenicitetseffekter; desuden kan komplikationer fra graviditeten forstyrre patienters evne til at få en uafbrudt behandling. Alle kvinder i den fødedygtige alder skal have en blodprøve eller urinundersøgelse inden for 2 uger før registrering for at udelukke graviditet. En kvinde i den fødedygtige alder er enhver kvinde, uanset seksuel orientering eller om de har gennemgået tubal ligering, som opfylder følgende kriterier: 1) har opnået menarche på et tidspunkt, 2) ikke har gennemgået en hysterektomi eller bilateral ooforektomi eller 3) har ikke været naturligt postmenopausal (amenoré efter kræftbehandling udelukker ikke den fødedygtige alder) i mindst 24 på hinanden følgende måneder (dvs. har haft menstruation på noget tidspunkt i de foregående 24 på hinanden følgende måneder).
TRIN 2: Patienter i den fødedygtige alder skal bruge en accepteret og effektiv præventionsmetode eller afholde sig fra samleje i mindst en uge før behandlingsstart og fortsætte i 5 måneder efter den sidste dosis af protokolbehandlingen. Patienter må heller ikke donere æg i samme tidsrum.
TRIN 2: Patienter skal have målbar sygdom på tidspunktet for dokumenteret progression
- BEMÆRK: For patienter, der har gennemgået en bjærgningsoperation for tilbagefald af sygdom, er målbar sygdom ikke påkrævet på tidspunktet for registrering til trin 2
TRIN 2: Patienter skal have tumormålinger med CT af hals og CT af bryst (eller CT af hals og FDG PET/CT hvis standardbehandling) inden for 4 uger før trin 2 registrering
- BEMÆRK: Patienter, der har gennemgået en redningsoperation for tilbagefald af sygdom før trin 2, skal ikke have målbar sygdom efter resektion, men skal have CT af halsen og CT af brystet (eller CT af halsen og FDG PET/CT hvis standardbehandling ) efter bjærgningsoperation og inden for 4 uger før trin 2 registrering for at etablere en baseline før nivolumab

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: Crossover opgave
Maskning: Ingen (Åben etiket)

Antal våben

Våben og indgreb

Deltagergruppe / Arm	Intervention / Behandling
Eksperimentel: Arm A (cisplatin, IMRT, nivolumab) Patienterne får cisplatin IV over 60 minutter ugentligt og IMRT 5 dage om ugen i 7 uger for i alt 35 fraktioner. Inden for 4 uger efter afslutning af samtidig behandling får patienterne nivolumab IV én gang ugentligt over 30 minutter hver 4. uge i 12 måneder i fravær af sygdomsprogression eller uacceptabel toksicitet. Patienterne gennemgår CT- eller FDG PET/CT-scanninger under hele forsøget. Patienter kan gennemgå ECHO som klinisk indiceret. Derudover gennemgår patienter blodprøvetagning under screening.	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 Medicin: Cisplatin Givet IV Andre navne: CDDP Cis-diammindichloridoplatin Cismaplat Cisplatin Neoplatin Platinol Abiplatin Blastolem Briplatin Cis-diammin-dichlorplatin Cis-diammindichlor platin (II) Cis-diamindichlorplatin Cis-dichloramin Platin (II) Cis-platinøst diamin dichlorid Cis-platin Cis-platin II Cis-platin II diamin dichlorid Cisplatina Cisplatyl Citoplatino Citosin Cysplatyna DDP Lederplatin Metaplatin Peyrones klorid Peyrones salt Placis Plastistil Platamin Platiblastin Platiblastin-S Platinex Platinol-AQ Platinol-AQ VHA Plus Platinoxan Platin Platindiaminodichlorid Platiran Platistin Platosin Procedure: Bioprøvesamling Gennemgå blodprøvetagning Andre navne: Biologisk prøvesamling Bioprøve indsamlet Prøvesamling Prøvekollektion Stråling: Intensitetsmoduleret strålebehandling Gennemgå IMRT Andre navne: IMRT Intensitetsmoduleret RT Intensitetsmoduleret strålebehandling Stråling, intensitetsmoduleret strålebehandling Intensitetsmoduleret strålebehandling (procedure) Procedure: Positron emissionstomografi Gennemgå PET/CT Andre navne: Medicinsk billeddannelse, Positron Emission Tomografi KÆLEDYR PET-scanning Positron Emission Tomografi Scan Positron-emissionstomografi PT Positron emissionstomografi (procedure) Procedure: Computertomografi Gennemgå CT eller PET/CT 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 Andet: Fludeoxyglucose F-18 Modtag FDG Andre navne: 18FDG FDG fludeoxyglucose F 18 Fludeoxyglucose (18F) Fludeoxyglucose F18 Fluor-18 2-Fluor-2-deoxy-D-Glucose Fluorodeoxyglucose F18 Procedure: Ekkokardiografitest Gennemgå Echo Andre navne: Ekkokardiografi EC
Aktiv komparator: Arm B (cisplatin, IMRT, observation) Patienterne får cisplatin IV over 60 minutter ugentligt og IMRT 5 dage om ugen i 7 uger for i alt 35 fraktioner og går derefter til observation. Patienter vil blive tilbudt muligheden for at gå over til arm C, hvis de har klart dokumenteret progression inden for 12 måneder fra afslutningen af cisplatin/strålebehandling. Patienterne gennemgår CT- eller FDG PET/CT-scanninger under hele forsøget. Patienter kan gennemgå ECHO som klinisk indiceret. Derudover gennemgår patienter blodprøvetagning under screening.	Medicin: Cisplatin Givet IV Andre navne: CDDP Cis-diammindichloridoplatin Cismaplat Cisplatin Neoplatin Platinol Abiplatin Blastolem Briplatin Cis-diammin-dichlorplatin Cis-diammindichlor platin (II) Cis-diamindichlorplatin Cis-dichloramin Platin (II) Cis-platinøst diamin dichlorid Cis-platin Cis-platin II Cis-platin II diamin dichlorid Cisplatina Cisplatyl Citoplatino Citosin Cysplatyna DDP Lederplatin Metaplatin Peyrones klorid Peyrones salt Placis Plastistil Platamin Platiblastin Platiblastin-S Platinex Platinol-AQ Platinol-AQ VHA Plus Platinoxan Platin Platindiaminodichlorid Platiran Platistin Platosin Procedure: Bioprøvesamling Gennemgå blodprøvetagning Andre navne: Biologisk prøvesamling Bioprøve indsamlet Prøvesamling Prøvekollektion Stråling: Intensitetsmoduleret strålebehandling Gennemgå IMRT Andre navne: IMRT Intensitetsmoduleret RT Intensitetsmoduleret strålebehandling Stråling, intensitetsmoduleret strålebehandling Intensitetsmoduleret strålebehandling (procedure) Andet: Patientobservation Gennemgå observation Andre navne: Observation Aktiv overvågning udskudt terapi forventningsfuld ledelse Vagtende venter Procedure: Positron emissionstomografi Gennemgå PET/CT Andre navne: Medicinsk billeddannelse, Positron Emission Tomografi KÆLEDYR PET-scanning Positron Emission Tomografi Scan Positron-emissionstomografi PT Positron emissionstomografi (procedure) Procedure: Computertomografi Gennemgå CT eller PET/CT 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 Andet: Fludeoxyglucose F-18 Modtag FDG Andre navne: 18FDG FDG fludeoxyglucose F 18 Fludeoxyglucose (18F) Fludeoxyglucose F18 Fluor-18 2-Fluor-2-deoxy-D-Glucose Fluorodeoxyglucose F18 Procedure: Ekkokardiografitest Gennemgå Echo Andre navne: Ekkokardiografi EC
Eksperimentel: Arm C (nivolumab) Patienter får nivolumab IV over 30 minutter hver 4. uge i 12 måneder i fravær af sygdomsprogression eller uacceptabel toksicitet. Patienterne gennemgår CT- eller FDG PET/CT-scanninger under hele forsøget. Patienter kan gennemgå ECHO som klinisk indiceret. Derudover gennemgår patienter blodprøvetagning under screening.	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 Procedure: Bioprøvesamling Gennemgå blodprøvetagning Andre navne: Biologisk prøvesamling Bioprøve indsamlet Prøvesamling Prøvekollektion Procedure: Positron emissionstomografi Gennemgå PET/CT Andre navne: Medicinsk billeddannelse, Positron Emission Tomografi KÆLEDYR PET-scanning Positron Emission Tomografi Scan Positron-emissionstomografi PT Positron emissionstomografi (procedure) Procedure: Computertomografi Gennemgå CT eller PET/CT 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 Andet: Fludeoxyglucose F-18 Modtag FDG Andre navne: 18FDG FDG fludeoxyglucose F 18 Fludeoxyglucose (18F) Fludeoxyglucose F18 Fluor-18 2-Fluor-2-deoxy-D-Glucose Fluorodeoxyglucose F18 Procedure: Ekkokardiografitest Gennemgå Echo Andre navne: Ekkokardiografi EC

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål	Foranstaltningsbeskrivelse	Tidsramme
Samlet overlevelse (OS) Tidsramme: Fra randomisering til død, vurderet op til 10 år	Log rank test vil blive brugt til at sammenligne OS. Da patienter i observationsarmen får lov til at krydse over til nivolumab-armen efter progression, vil en samlet overlevelsesanalyse ved hjælp af omvendte sandsynlighedscensurvægte (IPCW, Robins et. al, 2000) vil også blive overvejet. Kaplan-Meier-metoden og Cox-regression vil blive brugt til analyserne af overlevelsesresultater.	Fra randomisering til død, vurderet op til 10 år
Negativ (standardiseret kvalitativ) 12 uger efter behandling (cisplatin + strålebehandling [RT]) FDG positronemissionstomografi/computertomografi (PET/CT) forbundet med OS for patienter, der har en PET/CT Tidsramme: 12 uger efter behandling	Logrank-test og input-farehastigheder vil blive brugt.	12 uger efter behandling
Negativ (standardiseret kvalitativ) 12 uger efter behandling (cisplatin + RT) FDG PET/CT forbundet med PFS for patienter, der har en PET/CT Tidsramme: 12 uger efter behandling	Logrank-test og input-farehastigheder vil blive brugt.	12 uger efter behandling

Sekundære resultatmål

Resultatmål	Foranstaltningsbeskrivelse	Tidsramme
Progressionsfri overlevelse (PFS) Tidsramme: Fra randomisering til dato for progression, anden primær tumor fra hoved- og halsregionen eller død, vurderet op til 10 år	Progression vil blive defineret ved hjælp af responsevalueringskriterier i solide tumorer (RECIST) 1.1-kriterier. Sammenligningen af PFS vil bruge stratificeret log rank test og vil være intention-to-treat analyser.	Fra randomisering til dato for progression, anden primær tumor fra hoved- og halsregionen eller død, vurderet op til 10 år
Prognostisk effekt af baseline PD-L1-ekspression (positiv versus [vs.] negativ) på OS og PFS Tidsramme: Baseline op til 10 år	Chi-square test eller Pearson korrelationstest vil blive brugt til de sekundære korrelationsanalyser.	Baseline op til 10 år
Prognostisk effekt af baseline spyt og/eller plasma human papillomavirus (HPV) status (positiv vs. negativ) på OS og PFS Tidsramme: Baseline op til 10 år	Spyt- og plasma HPV-status 12 uger og 9 måneder efter afslutning af samtidig behandling vil også blive analyseret med hensyn til effekt på resultatet. Chi-square test eller Pearson korrelationstest vil blive brugt til de sekundære korrelationsanalyser.	Baseline op til 10 år
Prognostisk værdi af maksimal standardiseret optagelsesværdi (SUVmax) af primær tumor eller nakkeknudemetastase af baseline FDG PET/CT for OS Tidsramme: Baseline op til 10 år	Chi-square test eller Pearson korrelationstest vil blive brugt til de sekundære korrelationsanalyser.	Baseline op til 10 år
Prognostisk værdi af SUVmax for primær tumor eller nakke nodal metastase af baseline FDG PET/CT for PFS Tidsramme: Baseline op til 10 år	Chi-square test eller Pearson korrelationstest vil blive brugt til de sekundære korrelationsanalyser.	Baseline op til 10 år
SUVmax for primær tumor eller nodal metastase af baseline FDG PET/CT med PD-L1-ekspression (positiv vs. negativ) Tidsramme: Baseline op til 10 år	Chi-square test eller Pearson korrelationstest vil blive brugt til de sekundære korrelationsanalyser.	Baseline op til 10 år
Efter terapi (cisplatin + RT) FDG PET/CT med spyt- eller plasmaniveauer af HPV-deoxyribonukleinsyre (DNA) Tidsramme: Op til 9 måneder efter behandling	Chi-square test eller Pearson korrelationstest vil blive brugt til de sekundære korrelationsanalyser.	Op til 9 måneder efter behandling
PET-baseret behandlingsresponsvurdering sammenlignet med RECIST 1.1-vurdering for patienter, der har en PET/CT-scanning efter 12 uger Tidsramme: 12 uger efter kemoradiationsbehandling	Kappa-statistikker vil blive anvendt til at evaluere overensstemmelsen mellem PET-baseret behandlingsresponsvurdering (Hopkins-kriterier) og RECIST 1.1-vurdering 12 uger efter kemoradiationsterapi.	12 uger efter kemoradiationsbehandling

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: Nabil F Saba, 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)

16. august 2019

Primær færdiggørelse (Anslået)

1. januar 2027

Studieafslutning (Anslået)

1. januar 2027

Datoer for studieregistrering

Først indsendt

18. januar 2019

Først indsendt, der opfyldte QC-kriterier

18. januar 2019

Først opslået (Faktiske)

22. januar 2019

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

4. august 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

1. august 2026

Sidst verificeret

1. juli 2026

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

NCI-2019-00179 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
U10CA180820 (U.S. NIH-bevilling/kontrakt)
EA3161 (Anden identifikator: CTEP)

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

IPD-planbeskrivelse

NCI er forpligtet til at dele data i overensstemmelse med NIHs politik. For flere detaljer om, hvordan kliniske forsøgsdata deles, skal du gå til linket til NIH-siden for datadelingspolitik

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Studerer et amerikansk FDA-reguleret enhedsprodukt

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 .

Test af immunterapi versus observation hos patienter med HPV-halskræft

En fase III randomiseret undersøgelse af vedligeholdelsesnivolumab versus observation hos patienter med lokalt avanceret, mellemrisiko HPV positiv OPSCC

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 (Faktiske)

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

Sidst verificeret

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

IPD-planbeskrivelse

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Studerer et amerikansk FDA-reguleret enhedsprodukt