Kombinationschemotherapie mit oder ohne Temsirolimus bei der Behandlung von Patienten mit Rhabdomyosarkom mit mittlerem Risiko
Eine randomisierte Phase-3-Studie mit Vincristin, Dactinomycin, Cyclophosphamid (VAC) im Wechsel mit Vincristin und Irinotecan (VI) im Vergleich zu VAC/VI plus Temsirolimus (TORI, Torisel, NSC# 683864) bei Patienten mit Rhabdomyosarkom (RMS) mit mittlerem Risiko (IR)
This randomized phase III trial studies how well combination chemotherapy (vincristine sulfate, dactinomycin, cyclophosphamide alternated with vincristine sulfate and irinotecan hydrochloride or vinorelbine) works compared to combination chemotherapy plus temsirolimus in treating patients with rhabdomyosarcoma (cancer that forms in the soft tissues, such as muscle), and has an intermediate chance of coming back after treatment (intermediate risk). Drugs used work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Combination chemotherapy and temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether chemotherapy plus temsirolimus is more effective than chemotherapy alone in treating patients with intermediate-risk rhabdomyosarcoma.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
PRIMARY OBJECTIVE:
I. To compare the event-free survival (EFS) of patients with intermediate-risk (IR) rhabdomyosarcoma (RMS) treated with surgery, radiotherapy, and vincristine (vincristine sulfate), dactinomycin, and cyclophosphamide (VAC) alternating with vincristine and irinotecan (irinotecan hydrochloride) (VI) (VAC/VI) with maintenance to that of patients treated with surgery, radiotherapy and VAC/VI plus temsirolimus with maintenance.
SECONDARY OBJECTIVE:
I. To compare the overall survival (OS) of patients with IR RMS treated with surgery, radiotherapy, and VAC alternating with VI with maintenance to that of patients treated with surgery, radiotherapy and VAC/VI plus temsirolimus with maintenance.
EXPLORATORY OBJECTIVES:
I. To compare the outcome of patients based on their FOXO1 fusion gene partner, by evaluating PAX3 versus (vs) PAX7 in all patients found to be FOXO1 fusion positive.
II. To compare the outcome of patients based on their [F18]-fluorodeoxy-D-glucose-positron emission tomography (FDG-PET) response at week 9 (positive or negative), as assessed by Deauville criteria (5-point).
III. To estimate the frequency of patients with circulating tumor deoxyribonucleic acid (DNA) (ctDNA) at diagnosis and subsequent time-points, and explore whether tumor-specific somatic variants are detectable in the ctDNA.
IV. To compare the outcome of patients (VAC/VI with or without temsirolimus) who have received maintenance therapy on ARST1431 to those who received VAC/VI on ARST0531.
OUTLINE:
FEASIBILITY PHASE (THE FEASIBILITY PHASE IS COMPLETE, EFFECTIVE WITH AMENDMENT #1A): (< 21 years old): This is a dose-escalation study of temsirolimus.
Patients receive vincristine sulfate intravenously (IV) over 1 minute on day 1 of weeks 1-13, 16, 17, 19, 20, 22-26, 28, 31-34, 37, 38, and 40, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 4, 10, 16, 19, 25, 31, and 37, and temsirolimus IV over 30-60 minutes on days 1, 8, and 15. Patients also undergo radiation therapy (RT) beginning week 13 for up to 6.5 weeks. Courses with temsirolimus repeat every 21 days for 12 weeks in the absence of disease progression or unacceptable toxicity.
EFFICACY PHASE: Patients are randomized to Regimen A or B. Patients with disease that is ARMS FOXO1 fusion negative (stage I, group I/II, stage 1, group III [orbit] or stage II, group I/II) are assigned to Regimen C.
REGIMEN A (VAC/VI): Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-13, 16, 17, 19, 20, 22-26, 28, 31-34, 37, 38, and 40, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 4, 10, 16, 19, 25, 31, and 37. Patients also undergo primary site RT beginning at week 13 or metastatic site RT beginning at week 43 for up to 6.5 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients then receive vinorelbine IV over 6-10 minutes on days 1, 8, and 15 and cyclophosphamide orally (PO) once daily (QD) on days 1-28. Cycles repeats every 28 days for 24 weeks in the absence of disease progression or unacceptable toxicity.
REGIMEN B (VAC/VI TEMSIROLIMUS): Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-13, 16, 17, 19, 20, 22-26, 28, 31-34, 37, 38, and 40, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 4, 10, 16, 19, 25, 31, and 37 and temsirolimus IV over 30-60 minutes on day 1 of weeks 1-12 and 21-42. Patients also undergo RT as in Regimen A. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients then receive vinorelbine IV over 6-10 minutes on days 1, 8, and 15 and cyclophosphamide PO QD on days 1-28. Cycles repeats every 28 days for 24 weeks in the absence of disease progression or unacceptable toxicity.
MAINTENANCE PHASE (Patients in Regimen A or Regimen B): Patients receive vinorelbine IV over 6-10 minutes on days 1, 8, and 15 and cyclophosphamide orally (PO) once daily (QD) on days 1-28. Treatment repeats every 28 days for up to 6 cycles.
REGIMEN C (FOXO1 FUSION NEGATIVE): Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-10 and 13-22, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 4, 7, 10, 13, 16, 19, and 22, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 4, 7, and 10. Patients undergo RT beginning at week 13 for up to 6.5 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 1 year, every 4 months for 2 years, every 6 months for 1 year, and then annually for up to 10 years.
Studientyp
Studientyp
Einschreibung (Tatsächlich)
Einschreibung
Phase
Phase
- Phase 3
Kontakte und Standorte
Studienorte
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New South Wales
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Hunter Regional Mail Centre, New South Wales, Australien, 2310
- John Hunter Children's Hospital
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Randwick, New South Wales, Australien, 2031
- Sydney Children's Hospital
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Westmead, New South Wales, Australien, 2145
- The Children's Hospital at Westmead
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Queensland
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South Brisbane, Queensland, Australien, 4101
- Queensland Children's Hospital
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Western Australia
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Perth, Western Australia, Australien, 6008
- Princess Margaret Hospital for Children
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Perth, Western Australia, Australien, 6009
- Perth Children's Hospital
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-
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-
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Québec, Kanada, G1V 4G2
- CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)
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Alberta
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Calgary, Alberta, Kanada, T3B 6A8
- Alberta Children's Hospital
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Edmonton, Alberta, Kanada, T6G 2B7
- University of Alberta Hospital
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British Columbia
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Vancouver, British Columbia, Kanada, V6H 3V4
- British Columbia Children's Hospital
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Manitoba
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Winnipeg, Manitoba, Kanada, R3E 0V9
- CancerCare Manitoba
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Newfoundland and Labrador
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St. John's, Newfoundland and Labrador, Kanada, A1B 3V6
- Janeway Child Health Centre
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Nova Scotia
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Halifax, Nova Scotia, Kanada, B3K 6R8
- IWK Health Centre
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Ontario
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Hamilton, Ontario, Kanada, L8N 3Z5
- McMaster Children's Hospital at Hamilton Health Sciences
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Kingston, Ontario, Kanada, K7L 2V7
- Kingston Health Sciences Centre
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London, Ontario, Kanada, N6A 5W9
- Children's Hospital
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Ottawa, Ontario, Kanada, K1H 8L1
- Children's Hospital of Eastern Ontario
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Toronto, Ontario, Kanada, M5G 1X8
- Hospital for Sick Children
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Quebec
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Montreal, Quebec, Kanada, H3H 1P3
- The Montreal Children's Hospital of the MUHC
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Montreal, Quebec, Kanada, H3T 1C5
- Centre Hospitalier Universitaire Sainte-Justine
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Saskatchewan
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Saskatoon, Saskatchewan, Kanada, S7N 4H4
- Saskatoon Cancer Centre
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Saskatoon, Saskatchewan, Kanada, S7N 0W8
- Jim Pattison Children's Hospital
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-
-
-
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Christchurch, Neuseeland, 8011
- Christchurch Hospital
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Auckland
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Grafton, Auckland, Neuseeland, 1145
- Starship Children's Hospital
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-
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-
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Caguas, Puerto Rico, 00726
- HIMA San Pablo Oncologic Hospital
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San Juan, Puerto Rico, 00926
- University Pediatric Hospital
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San Juan, Puerto Rico, 00912
- San Jorge Children's Hospital
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Alabama
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Birmingham, Alabama, Vereinigte Staaten, 35233
- Children's Hospital of Alabama
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Mobile, Alabama, Vereinigte Staaten, 36604
- USA Health Strada Patient Care Center
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Alaska
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Anchorage, Alaska, Vereinigte Staaten, 98508
- Anchorage Associates in Radiation Medicine
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Anchorage, Alaska, Vereinigte Staaten, 99508
- Alaska Breast Care and Surgery LLC
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Anchorage, Alaska, Vereinigte Staaten, 99508
- Alaska Oncology and Hematology LLC
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Anchorage, Alaska, Vereinigte Staaten, 99508
- Alaska Women's Cancer Care
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Anchorage, Alaska, Vereinigte Staaten, 99508
- Anchorage Oncology Centre
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Anchorage, Alaska, Vereinigte Staaten, 99508
- Katmai Oncology Group
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Anchorage, Alaska, Vereinigte Staaten, 99508
- Providence Alaska Medical Center
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Anchorage, Alaska, Vereinigte Staaten, 99504
- Anchorage Radiation Therapy Center
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Arizona
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Kingman, Arizona, Vereinigte Staaten, 86401
- Kingman Regional Medical Center
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Mesa, Arizona, Vereinigte Staaten, 85202
- Banner Children's at Desert
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Phoenix, Arizona, Vereinigte Staaten, 85054
- Mayo Clinic Hospital in Arizona
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Phoenix, Arizona, Vereinigte Staaten, 85016
- Phoenix Childrens Hospital
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Scottsdale, Arizona, Vereinigte Staaten, 85259
- Mayo Clinic in Arizona
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Tucson, Arizona, Vereinigte Staaten, 85719
- Banner University Medical Center - Tucson
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Arkansas
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Little Rock, Arkansas, Vereinigte Staaten, 72202-3591
- Arkansas Children's Hospital
-
-
California
-
Anaheim, California, Vereinigte Staaten, 92806
- Kaiser Permanente-Anaheim
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Arroyo Grande, California, Vereinigte Staaten, 93420
- PCR Oncology
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Bellflower, California, Vereinigte Staaten, 90706
- Kaiser Permanente-Bellflower
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Burbank, California, Vereinigte Staaten, 91505
- Providence Saint Joseph Medical Center/Disney Family Cancer Center
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Downey, California, Vereinigte Staaten, 90242
- Kaiser Permanente Downey Medical Center
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Fontana, California, Vereinigte Staaten, 92335
- Kaiser Permanente-Fontana
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Loma Linda, California, Vereinigte Staaten, 92354
- Loma Linda University Medical Center
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Los Angeles, California, Vereinigte Staaten, 90027
- Children's Hospital Los Angeles
-
Los Angeles, California, Vereinigte Staaten, 90095
- UCLA / Jonsson Comprehensive Cancer Center
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Los Angeles, California, Vereinigte Staaten, 90027
- Kaiser Permanente Los Angeles Medical Center
-
Los Angeles, California, Vereinigte Staaten, 90095
- Mattel Children's Hospital UCLA
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Madera, California, Vereinigte Staaten, 93636
- Valley Children's Hospital
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Oakland, California, Vereinigte Staaten, 94609
- UCSF Benioff Children's Hospital Oakland
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Oakland, California, Vereinigte Staaten, 94611
- Kaiser Permanente-Oakland
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Orange, California, Vereinigte Staaten, 92868
- Children's Hospital of Orange County
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Palo Alto, California, Vereinigte Staaten, 94304
- Lucile Packard Children's Hospital Stanford University
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Roseville, California, Vereinigte Staaten, 95661
- Kaiser Permanente-Roseville
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Sacramento, California, Vereinigte Staaten, 95816
- Sutter Medical Center Sacramento
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Sacramento, California, Vereinigte Staaten, 95817
- University of California Davis Comprehensive Cancer Center
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San Diego, California, Vereinigte Staaten, 92123
- Rady Children's Hospital - San Diego
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San Diego, California, Vereinigte Staaten, 92134
- Naval Medical Center -San Diego
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San Diego, California, Vereinigte Staaten, 92108
- Kaiser Permanente-Rio San Diego
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San Francisco, California, Vereinigte Staaten, 94158
- UCSF Medical Center-Mission Bay
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Santa Clara, California, Vereinigte Staaten, 95051
- Kaiser Permanente Medical Center - Santa Clara
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Torrance, California, Vereinigte Staaten, 90502
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
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Colorado
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Aurora, Colorado, Vereinigte Staaten, 80045
- Children's Hospital Colorado
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Denver, Colorado, Vereinigte Staaten, 80218
- Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
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Connecticut
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Hartford, Connecticut, Vereinigte Staaten, 06106
- Connecticut Children's Medical Center
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New Haven, Connecticut, Vereinigte Staaten, 06520
- Yale University
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New Haven, Connecticut, Vereinigte Staaten, 06510
- Smilow Cancer Center/Yale-New Haven Hospital
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Trumbull, Connecticut, Vereinigte Staaten, 06611
- Smilow Cancer Hospital Care Center-Trumbull
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Delaware
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Wilmington, Delaware, Vereinigte Staaten, 19803
- Alfred I duPont Hospital for Children
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District of Columbia
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Washington D.C., District of Columbia, Vereinigte Staaten, 20010
- Children's National Medical Center
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Washington D.C., District of Columbia, Vereinigte Staaten, 20002
- Kaiser Permanente-Capitol Hill Medical Center
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Washington D.C., District of Columbia, Vereinigte Staaten, 20007
- MedStar Georgetown University Hospital
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Washington D.C., District of Columbia, Vereinigte Staaten, 20016
- Sibley Memorial Hospital
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Florida
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Fort Lauderdale, Florida, Vereinigte Staaten, 33316
- Broward Health Medical Center
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Fort Myers, Florida, Vereinigte Staaten, 33908
- Golisano Children's Hospital of Southwest Florida
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Gainesville, Florida, Vereinigte Staaten, 32610
- UF Health Cancer Institute - Gainesville
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Hollywood, Florida, Vereinigte Staaten, 33021
- Memorial Regional Hospital/Joe DiMaggio Children's Hospital
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Jacksonville, Florida, Vereinigte Staaten, 32207
- Nemours Children's Clinic-Jacksonville
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Loxahatchee Groves, Florida, Vereinigte Staaten, 33470
- Palms West Radiation Therapy
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Miami, Florida, Vereinigte Staaten, 33155
- Nicklaus Children's Hospital
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Miami, Florida, Vereinigte Staaten, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
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Miami, Florida, Vereinigte Staaten, 33176
- Miami Cancer Institute
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Orlando, Florida, Vereinigte Staaten, 32827
- Nemours Children's Hospital
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Orlando, Florida, Vereinigte Staaten, 32803
- AdventHealth Orlando
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Orlando, Florida, Vereinigte Staaten, 32806
- Arnold Palmer Hospital for Children
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Pensacola, Florida, Vereinigte Staaten, 32504
- Sacred Heart Hospital
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Pensacola, Florida, Vereinigte Staaten, 32504
- Nemours Children's Clinic - Pensacola
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St. Petersburg, Florida, Vereinigte Staaten, 33701
- Johns Hopkins All Children's Hospital
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Tampa, Florida, Vereinigte Staaten, 33606
- Tampa General Hospital
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Tampa, Florida, Vereinigte Staaten, 33607
- Saint Joseph's Hospital/Children's Hospital-Tampa
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West Palm Beach, Florida, Vereinigte Staaten, 33407
- Saint Mary's Medical Center
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Georgia
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Atlanta, Georgia, Vereinigte Staaten, 30329
- Children's Healthcare of Atlanta - Arthur M Blank Hospital
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Augusta, Georgia, Vereinigte Staaten, 30912
- Augusta University Medical Center
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Macon, Georgia, Vereinigte Staaten, 31201
- Atrium Health Navicent
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Savannah, Georgia, Vereinigte Staaten, 31404
- Memorial Health University Medical Center
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Hawaii
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Honolulu, Hawaii, Vereinigte Staaten, 96813
- Straub Clinic and Hospital
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Honolulu, Hawaii, Vereinigte Staaten, 96826
- Kapiolani Medical Center for Women and Children
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Honolulu, Hawaii, Vereinigte Staaten, 96819
- Kaiser Permanente Moanalua Medical Center
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Idaho
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Boise, Idaho, Vereinigte Staaten, 83712
- Saint Luke's Cancer Institute - Boise
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Fruitland, Idaho, Vereinigte Staaten, 83619
- Saint Luke's Cancer Institute - Fruitland
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Meridian, Idaho, Vereinigte Staaten, 83642
- Saint Luke's Cancer Institute - Meridian
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Nampa, Idaho, Vereinigte Staaten, 83687
- Saint Luke's Cancer Institute - Nampa
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Twin Falls, Idaho, Vereinigte Staaten, 83301
- Saint Luke's Cancer Institute - Twin Falls
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Illinois
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Chicago, Illinois, Vereinigte Staaten, 60637
- University of Chicago Comprehensive Cancer Center
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Chicago, Illinois, Vereinigte Staaten, 60612
- University of Illinois
-
Chicago, Illinois, Vereinigte Staaten, 60612
- John H Stroger Jr Hospital of Cook County
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Chicago, Illinois, Vereinigte Staaten, 60611
- Lurie Children's Hospital-Chicago
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Chicago, Illinois, Vereinigte Staaten, 60612
- Rush MD Anderson Cancer Center
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Maywood, Illinois, Vereinigte Staaten, 60153
- Loyola University Medical Center
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Oak Lawn, Illinois, Vereinigte Staaten, 60453
- Advocate Children's Hospital-Oak Lawn
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Park Ridge, Illinois, Vereinigte Staaten, 60068
- Advocate Children's Hospital-Park Ridge
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Peoria, Illinois, Vereinigte Staaten, 61637
- OSF Children's Hospital of Illinois
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Springfield, Illinois, Vereinigte Staaten, 62702
- Southern Illinois University School of Medicine
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Springfield, Illinois, Vereinigte Staaten, 62702
- Saint John's Hospital
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Springfield, Illinois, Vereinigte Staaten, 62781
- Springfield Memorial Hospital
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Indiana
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Indianapolis, Indiana, Vereinigte Staaten, 46202
- Riley Hospital for Children
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Indianapolis, Indiana, Vereinigte Staaten, 46260
- Ascension Saint Vincent Indianapolis Hospital
-
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Iowa
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Des Moines, Iowa, Vereinigte Staaten, 50309
- Iowa Methodist Medical Center
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Des Moines, Iowa, Vereinigte Staaten, 50309
- Blank Children's Hospital
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Des Moines, Iowa, Vereinigte Staaten, 50316
- Iowa Lutheran Hospital
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Iowa City, Iowa, Vereinigte Staaten, 52242
- University of Iowa/Holden Comprehensive Cancer Center
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Kentucky
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Lexington, Kentucky, Vereinigte Staaten, 40536
- University of Kentucky/Markey Cancer Center
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Louisville, Kentucky, Vereinigte Staaten, 40202
- Norton Children's Hospital
-
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Louisiana
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New Orleans, Louisiana, Vereinigte Staaten, 70121
- Ochsner Medical Center Jefferson
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New Orleans, Louisiana, Vereinigte Staaten, 70118
- Children's Hospital New Orleans
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Maine
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Bangor, Maine, Vereinigte Staaten, 04401
- Eastern Maine Medical Center
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Scarborough, Maine, Vereinigte Staaten, 04074
- Maine Children's Cancer Program
-
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Maryland
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Baltimore, Maryland, Vereinigte Staaten, 21287
- Johns Hopkins University/Sidney Kimmel Cancer Center
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Baltimore, Maryland, Vereinigte Staaten, 21215
- Sinai Hospital of Baltimore
-
Baltimore, Maryland, Vereinigte Staaten, 21201
- University of Maryland/Greenebaum Cancer Center
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Bethesda, Maryland, Vereinigte Staaten, 20889-5600
- Walter Reed National Military Medical Center
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Massachusetts
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Boston, Massachusetts, Vereinigte Staaten, 02215
- Dana-Farber Cancer Institute
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Boston, Massachusetts, Vereinigte Staaten, 02114
- Massachusetts General Hospital Cancer Center
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Boston, Massachusetts, Vereinigte Staaten, 02111
- Tufts Children's Hospital
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Worcester, Massachusetts, Vereinigte Staaten, 01655
- UMass Memorial Medical Center - University Campus
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Michigan
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Ann Arbor, Michigan, Vereinigte Staaten, 48109
- C S Mott Children's Hospital
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Ann Arbor, Michigan, Vereinigte Staaten, 48109
- University of Michigan Rogel Cancer Center
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Battle Creek, Michigan, Vereinigte Staaten, 49017
- Bronson Battle Creek
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Detroit, Michigan, Vereinigte Staaten, 48201
- Wayne State University/Karmanos Cancer Institute
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Detroit, Michigan, Vereinigte Staaten, 48236
- Henry Ford Health Saint John Hospital
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East Lansing, Michigan, Vereinigte Staaten, 48823
- Michigan State University
-
Flint, Michigan, Vereinigte Staaten, 48503
- Hurley Medical Center
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Grand Rapids, Michigan, Vereinigte Staaten, 49503
- Trinity Health Grand Rapids Hospital
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Grand Rapids, Michigan, Vereinigte Staaten, 49503
- Corewell Health Grand Rapids Hospitals - Butterworth Hospital
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Grand Rapids, Michigan, Vereinigte Staaten, 49503
- Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
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Kalamazoo, Michigan, Vereinigte Staaten, 49007
- West Michigan Cancer Center
-
Kalamazoo, Michigan, Vereinigte Staaten, 49007
- Bronson Methodist Hospital
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Kalamazoo, Michigan, Vereinigte Staaten, 49048
- Beacon Kalamazoo
-
Lansing, Michigan, Vereinigte Staaten, 48912
- University of Michigan Health - Sparrow Lansing
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Muskegon, Michigan, Vereinigte Staaten, 49444
- Trinity Health Muskegon Hospital
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Niles, Michigan, Vereinigte Staaten, 49120
- Corewell Health Lakeland Hospitals - Niles Hospital
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Port Huron, Michigan, Vereinigte Staaten, 48060
- Lake Huron Medical Center
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Port Huron, Michigan, Vereinigte Staaten, 48060
- Huron Medical Center PC
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Reed City, Michigan, Vereinigte Staaten, 49677
- Corewell Health Reed City Hospital
-
Royal Oak, Michigan, Vereinigte Staaten, 48073
- Corewell Health Children's
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Saint Joseph, Michigan, Vereinigte Staaten, 49085
- Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
-
Saint Joseph, Michigan, Vereinigte Staaten, 49085
- Corewell Health Lakeland Hospitals - Saint Joseph Hospital
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Traverse City, Michigan, Vereinigte Staaten, 49684
- Munson Medical Center
-
Wyoming, Michigan, Vereinigte Staaten, 49519
- University of Michigan Health - West
-
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Minnesota
-
Duluth, Minnesota, Vereinigte Staaten, 55805
- Essentia Health Cancer Center
-
Minneapolis, Minnesota, Vereinigte Staaten, 55404
- Children's Hospitals and Clinics of Minnesota - Minneapolis
-
Minneapolis, Minnesota, Vereinigte Staaten, 55455
- University of Minnesota/Masonic Cancer Center
-
Rochester, Minnesota, Vereinigte Staaten, 55905
- Mayo Clinic in Rochester
-
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Mississippi
-
Jackson, Mississippi, Vereinigte Staaten, 39216
- University of Mississippi Medical Center
-
-
Missouri
-
City of Saint Peters, Missouri, Vereinigte Staaten, 63376
- Siteman Cancer Center at Saint Peters Hospital
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Columbia, Missouri, Vereinigte Staaten, 65212
- University of Missouri Children's Hospital
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Creve Coeur, Missouri, Vereinigte Staaten, 63141
- Siteman Cancer Center at West County Hospital
-
Kansas City, Missouri, Vereinigte Staaten, 64108
- Children's Mercy Hospitals and Clinics
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St Louis, Missouri, Vereinigte Staaten, 63110
- Barnes-Jewish Hospital
-
St Louis, Missouri, Vereinigte Staaten, 63110
- Washington University School of Medicine
-
St Louis, Missouri, Vereinigte Staaten, 63141
- Mercy Hospital Saint Louis
-
St Louis, Missouri, Vereinigte Staaten, 63104
- Cardinal Glennon Children's Medical Center
-
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Montana
-
Missoula, Montana, Vereinigte Staaten, 59802
- Saint Patrick Hospital - Community Hospital
-
-
Nebraska
-
Omaha, Nebraska, Vereinigte Staaten, 68198
- University of Nebraska Medical Center
-
Omaha, Nebraska, Vereinigte Staaten, 68114
- Children's Hospital and Medical Center of Omaha
-
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Nevada
-
Carson City, Nevada, Vereinigte Staaten, 89703
- Carson Tahoe Regional Medical Center
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Henderson, Nevada, Vereinigte Staaten, 89052
- Comprehensive Cancer Centers of Nevada - Henderson
-
Henderson, Nevada, Vereinigte Staaten, 89052
- Cancer and Blood Specialists-Henderson
-
Henderson, Nevada, Vereinigte Staaten, 89052
- Las Vegas Cancer Center-Henderson
-
Henderson, Nevada, Vereinigte Staaten, 89074
- Comprehensive Cancer Centers of Nevada-Southeast Henderson
-
Henderson, Nevada, Vereinigte Staaten, 89052
- Comprehensive Cancer Centers of Nevada-Horizon Ridge
-
Henderson, Nevada, Vereinigte Staaten, 89074
- Las Vegas Urology - Green Valley
-
Henderson, Nevada, Vereinigte Staaten, 89074
- Las Vegas Urology - Pebble
-
Henderson, Nevada, Vereinigte Staaten, 89074
- Urology Specialists of Nevada - Green Valley
-
Henderson, Nevada, Vereinigte Staaten, 89074
- Oncology Las Vegas - Henderson
-
Las Vegas, Nevada, Vereinigte Staaten, 89144
- Summerlin Hospital Medical Center
-
Las Vegas, Nevada, Vereinigte Staaten, 89109
- Sunrise Hospital and Medical Center
-
Las Vegas, Nevada, Vereinigte Staaten, 89102
- OptumCare Cancer Care at Charleston
-
Las Vegas, Nevada, Vereinigte Staaten, 89106
- Radiation Oncology Centers of Nevada Central
-
Las Vegas, Nevada, Vereinigte Staaten, 89119
- Radiation Oncology Centers of Nevada Southeast
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- Comprehensive Cancer Centers of Nevada - Northwest
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- OptumCare Cancer Care at MountainView
-
Las Vegas, Nevada, Vereinigte Staaten, 89135
- Alliance for Childhood Diseases/Cure 4 the Kids Foundation
-
Las Vegas, Nevada, Vereinigte Staaten, 89144
- Comprehensive Cancer Centers of Nevada - Town Center
-
Las Vegas, Nevada, Vereinigte Staaten, 89144
- Comprehensive Cancer Centers of Nevada-Summerlin
-
Las Vegas, Nevada, Vereinigte Staaten, 89148
- Comprehensive Cancer Centers of Nevada
-
Las Vegas, Nevada, Vereinigte Staaten, 89169
- Comprehensive Cancer Centers of Nevada - Central Valley
-
Las Vegas, Nevada, Vereinigte Staaten, 89102
- University Medical Center of Southern Nevada
-
Las Vegas, Nevada, Vereinigte Staaten, 89106
- Cancer and Blood Specialists-Shadow
-
Las Vegas, Nevada, Vereinigte Staaten, 89109
- HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
-
Las Vegas, Nevada, Vereinigte Staaten, 89113
- HealthCare Partners Medical Group Oncology/Hematology-San Martin
-
Las Vegas, Nevada, Vereinigte Staaten, 89121
- Cancer Therapy and Integrative Medicine
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- Cancer and Blood Specialists-Tenaya
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- HealthCare Partners Medical Group Oncology/Hematology-Tenaya
-
Las Vegas, Nevada, Vereinigte Staaten, 89148-2405
- Las Vegas Cancer Center-Medical Center
-
Las Vegas, Nevada, Vereinigte Staaten, 89149
- HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- Ann M Wierman MD LTD
-
Las Vegas, Nevada, Vereinigte Staaten, 89074
- Las Vegas Urology - Pecos
-
Las Vegas, Nevada, Vereinigte Staaten, 89102
- Desert West Surgery
-
Las Vegas, Nevada, Vereinigte Staaten, 89106
- Urology Specialists of Nevada - Central
-
Las Vegas, Nevada, Vereinigte Staaten, 89113
- Las Vegas Urology - Sunset
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- Las Vegas Urology - Cathedral Rock
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- Las Vegas Urology - Smoke Ranch
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- Urology Specialists of Nevada - Northwest
-
Las Vegas, Nevada, Vereinigte Staaten, 89169
- University Cancer Center
-
Las Vegas, Nevada, Vereinigte Staaten, 89113
- Urology Specialists of Nevada - Southwest
-
Las Vegas, Nevada, Vereinigte Staaten, 89128
- Oncology Las Vegas - Tenaya
-
Las Vegas, Nevada, Vereinigte Staaten, 89183
- OptumCare Cancer Care at Fort Apache
-
Pahrump, Nevada, Vereinigte Staaten, 89048
- Hope Cancer Care of Nevada-Pahrump
-
Reno, Nevada, Vereinigte Staaten, 89502
- Renown Regional Medical Center
-
Reno, Nevada, Vereinigte Staaten, 89503
- Saint Mary's Regional Medical Center
-
Reno, Nevada, Vereinigte Staaten, 89509
- Radiation Oncology Associates
-
-
New Hampshire
-
Lebanon, New Hampshire, Vereinigte Staaten, 03756
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
-
-
New Jersey
-
Hackensack, New Jersey, Vereinigte Staaten, 07601
- Hackensack University Medical Center
-
Morristown, New Jersey, Vereinigte Staaten, 07960
- Morristown Medical Center
-
New Brunswick, New Jersey, Vereinigte Staaten, 08903
- Rutgers Cancer Institute of New Jersey
-
New Brunswick, New Jersey, Vereinigte Staaten, 08901
- Saint Peter's University Hospital
-
New Brunswick, New Jersey, Vereinigte Staaten, 08903
- Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
-
Newark, New Jersey, Vereinigte Staaten, 07112
- Newark Beth Israel Medical Center
-
Paterson, New Jersey, Vereinigte Staaten, 07503
- Saint Joseph's Regional Medical Center
-
-
New Mexico
-
Albuquerque, New Mexico, Vereinigte Staaten, 87106
- Presbyterian Hospital
-
-
New York
-
Albany, New York, Vereinigte Staaten, 12208
- Albany Medical Center
-
Brooklyn, New York, Vereinigte Staaten, 11219
- Maimonides Medical Center
-
Buffalo, New York, Vereinigte Staaten, 14263
- Roswell Park Cancer Institute
-
Glens Falls, New York, Vereinigte Staaten, 12801
- Glens Falls Hospital
-
Mineola, New York, Vereinigte Staaten, 11501
- NYU Langone Hospital - Long Island
-
New Hyde Park, New York, Vereinigte Staaten, 11040
- The Steven and Alexandra Cohen Children's Medical Center of New York
-
New York, New York, Vereinigte Staaten, 10065
- Memorial Sloan Kettering Cancer Center
-
New York, New York, Vereinigte Staaten, 10029
- Mount Sinai Hospital
-
New York, New York, Vereinigte Staaten, 10032
- NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
-
New York, New York, Vereinigte Staaten, 10016
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
-
Rochester, New York, Vereinigte Staaten, 14642
- University of Rochester
-
Stony Brook, New York, Vereinigte Staaten, 11794
- Stony Brook University Medical Center
-
Syracuse, New York, Vereinigte Staaten, 13210
- State University of New York Upstate Medical University
-
The Bronx, New York, Vereinigte Staaten, 10461
- Montefiore Medical Center-Einstein Campus
-
The Bronx, New York, Vereinigte Staaten, 10467
- Children's Hospital at Montefiore
-
The Bronx, New York, Vereinigte Staaten, 10467
- Montefiore Medical Center - Moses Campus
-
The Bronx, New York, Vereinigte Staaten, 10461
- Montefiore Medical Center-Weiler Hospital
-
Valhalla, New York, Vereinigte Staaten, 10595
- New York Medical College
-
Valhalla, New York, Vereinigte Staaten, 10595
- Westchester Medical Center
-
-
North Carolina
-
Asheville, North Carolina, Vereinigte Staaten, 28801
- Mission Hospital
-
Chapel Hill, North Carolina, Vereinigte Staaten, 27599
- UNC Lineberger Comprehensive Cancer Center
-
Charlotte, North Carolina, Vereinigte Staaten, 28203
- Carolinas Medical Center/Levine Cancer Institute
-
Charlotte, North Carolina, Vereinigte Staaten, 28204
- Novant Health Presbyterian Medical Center
-
Charlotte, North Carolina, Vereinigte Staaten, 28207
- Oncology Specialists of Charlotte
-
Charlotte, North Carolina, Vereinigte Staaten, 28262
- Southern Oncology Specialists-Charlotte
-
Charlotte, North Carolina, Vereinigte Staaten, 28207
- Novant Health Carolina Surgical - Randolph
-
Durham, North Carolina, Vereinigte Staaten, 27710
- Duke University Medical Center
-
Greenville, North Carolina, Vereinigte Staaten, 27834
- East Carolina University
-
Huntersville, North Carolina, Vereinigte Staaten, 28078
- Novant Health Cancer Institute - Huntersville
-
Huntersville, North Carolina, Vereinigte Staaten, 28078
- Southern Oncology Specialists-Huntersville
-
Huntersville, North Carolina, Vereinigte Staaten, 28078
- Novant Health Presbyterian Medical Center Huntersville
-
Matthews, North Carolina, Vereinigte Staaten, 28105
- Matthews Radiation Oncology Center
-
Matthews, North Carolina, Vereinigte Staaten, 28105
- Novant Health Cancer Institute - Matthews
-
Mooresville, North Carolina, Vereinigte Staaten, 28117
- Novant Health Cancer Institute - Mooresville
-
Salisbury, North Carolina, Vereinigte Staaten, 28144
- Novant Health Cancer Institute - Rowan
-
Salisbury, North Carolina, Vereinigte Staaten, 28144
- Rowan Regional Medical Center
-
Winston-Salem, North Carolina, Vereinigte Staaten, 27157
- Wake Forest University Health Sciences
-
-
North Dakota
-
Fargo, North Dakota, Vereinigte Staaten, 58122
- Sanford Broadway Medical Center
-
-
Ohio
-
Akron, Ohio, Vereinigte Staaten, 44308
- Children's Hospital Medical Center of Akron
-
Cincinnati, Ohio, Vereinigte Staaten, 45229
- Cincinnati Children's Hospital Medical Center
-
Cleveland, Ohio, Vereinigte Staaten, 44195
- Cleveland Clinic Foundation
-
Cleveland, Ohio, Vereinigte Staaten, 44106
- Rainbow Babies and Childrens Hospital
-
Columbus, Ohio, Vereinigte Staaten, 43205
- Nationwide Children's Hospital
-
Dayton, Ohio, Vereinigte Staaten, 45404
- Dayton Children's Hospital
-
Sylvania, Ohio, Vereinigte Staaten, 43560
- ProMedica Flower Hospital
-
Toledo, Ohio, Vereinigte Staaten, 43606
- ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
-
-
Oklahoma
-
Oklahoma City, Oklahoma, Vereinigte Staaten, 73104
- University of Oklahoma Health Sciences Center
-
-
Oregon
-
Bend, Oregon, Vereinigte Staaten, 97701
- Saint Charles Health System
-
Clackamas, Oregon, Vereinigte Staaten, 97015
- Clackamas Radiation Oncology Center
-
Clackamas, Oregon, Vereinigte Staaten, 97015
- Providence Cancer Institute Clackamas Clinic
-
Coos Bay, Oregon, Vereinigte Staaten, 97420
- Bay Area Hospital
-
Newberg, Oregon, Vereinigte Staaten, 97132
- Providence Newberg Medical Center
-
Portland, Oregon, Vereinigte Staaten, 97239
- Oregon Health and Science University
-
Portland, Oregon, Vereinigte Staaten, 97213
- Providence Portland Medical Center
-
Portland, Oregon, Vereinigte Staaten, 97225
- Providence Saint Vincent Medical Center
-
Portland, Oregon, Vereinigte Staaten, 97227
- Legacy Emanuel Children's Hospital
-
-
Pennsylvania
-
Allentown, Pennsylvania, Vereinigte Staaten, 18103
- Lehigh Valley Hospital-Cedar Crest
-
Bethlehem, Pennsylvania, Vereinigte Staaten, 18017
- Lehigh Valley Hospital - Muhlenberg
-
Danville, Pennsylvania, Vereinigte Staaten, 17822
- Geisinger Medical Center
-
Hershey, Pennsylvania, Vereinigte Staaten, 17033
- Penn State Children's Hospital
-
Philadelphia, Pennsylvania, Vereinigte Staaten, 19104
- Children's Hospital of Philadelphia
-
Philadelphia, Pennsylvania, Vereinigte Staaten, 19134
- Saint Christopher's Hospital for Children
-
Pittsburgh, Pennsylvania, Vereinigte Staaten, 15224
- Children's Hospital of Pittsburgh of UPMC
-
-
Rhode Island
-
Providence, Rhode Island, Vereinigte Staaten, 02903
- Rhode Island Hospital
-
-
South Carolina
-
Boiling Springs, South Carolina, Vereinigte Staaten, 29316
- Prisma Health Cancer Institute - Spartanburg
-
Charleston, South Carolina, Vereinigte Staaten, 29425
- Medical University of South Carolina
-
Clinton, South Carolina, Vereinigte Staaten, 29325
- Prisma Health Cancer Institute - Laurens
-
Columbia, South Carolina, Vereinigte Staaten, 29203
- Prisma Health Richland Hospital
-
Easley, South Carolina, Vereinigte Staaten, 29640
- Prisma Health Cancer Institute - Easley
-
Greenville, South Carolina, Vereinigte Staaten, 29605
- Prisma Health Cancer Institute - Faris
-
Greenville, South Carolina, Vereinigte Staaten, 29607
- Saint Francis Cancer Center
-
Greenville, South Carolina, Vereinigte Staaten, 29615
- Prisma Health Cancer Institute - Eastside
-
Greenville, South Carolina, Vereinigte Staaten, 29605
- Prisma Health Cancer Institute - Butternut
-
Greenville, South Carolina, Vereinigte Staaten, 29601
- Saint Francis Hospital
-
Greenville, South Carolina, Vereinigte Staaten, 29605
- BI-LO Charities Children's Cancer Center
-
Greer, South Carolina, Vereinigte Staaten, 29650
- Prisma Health Cancer Institute - Greer
-
Seneca, South Carolina, Vereinigte Staaten, 29672
- Prisma Health Cancer Institute - Seneca
-
-
South Dakota
-
Sioux Falls, South Dakota, Vereinigte Staaten, 57117-5134
- Sanford USD Medical Center - Sioux Falls
-
-
Tennessee
-
Chattanooga, Tennessee, Vereinigte Staaten, 37403
- T C Thompson Children's Hospital
-
Knoxville, Tennessee, Vereinigte Staaten, 37916
- East Tennessee Childrens Hospital
-
Nashville, Tennessee, Vereinigte Staaten, 37232
- Vanderbilt University/Ingram Cancer Center
-
Nashville, Tennessee, Vereinigte Staaten, 37203
- The Children's Hospital at TriStar Centennial
-
-
Texas
-
Amarillo, Texas, Vereinigte Staaten, 79106
- Texas Tech University Health Sciences Center-Amarillo
-
Austin, Texas, Vereinigte Staaten, 78723
- Dell Children's Medical Center of Central Texas
-
Corpus Christi, Texas, Vereinigte Staaten, 78411
- Driscoll Children's Hospital
-
Dallas, Texas, Vereinigte Staaten, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
-
Dallas, Texas, Vereinigte Staaten, 75230
- Medical City Dallas Hospital
-
El Paso, Texas, Vereinigte Staaten, 79905
- El Paso Children's Hospital
-
Houston, Texas, Vereinigte Staaten, 77030
- UT MD Anderson Cancer Center
-
Houston, Texas, Vereinigte Staaten, 77030
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
-
Lubbock, Texas, Vereinigte Staaten, 79410
- Covenant Children's Hospital
-
Lubbock, Texas, Vereinigte Staaten, 79415
- UMC Cancer Center / UMC Health System
-
Lubbock, Texas, Vereinigte Staaten, 79430
- Texas Tech University Health Sciences Center-Lubbock
-
San Antonio, Texas, Vereinigte Staaten, 78229
- University Hospital
-
San Antonio, Texas, Vereinigte Staaten, 78229
- University of Texas Health Science Center at San Antonio
-
San Antonio, Texas, Vereinigte Staaten, 78207
- Children's Hospital of San Antonio
-
San Antonio, Texas, Vereinigte Staaten, 78229
- Methodist Children's Hospital of South Texas
-
Temple, Texas, Vereinigte Staaten, 76508
- Scott and White Memorial Hospital
-
-
Utah
-
Salt Lake City, Utah, Vereinigte Staaten, 84113
- Primary Children's Hospital
-
-
Vermont
-
Berlin Corners, Vermont, Vereinigte Staaten, 05602
- Central Vermont Medical Center/National Life Cancer Treatment
-
Burlington, Vermont, Vereinigte Staaten, 05401
- University of Vermont Medical Center
-
Burlington, Vermont, Vereinigte Staaten, 05405
- University of Vermont and State Agricultural College
-
-
Virginia
-
Charlottesville, Virginia, Vereinigte Staaten, 22908
- University of Virginia Cancer Center
-
Falls Church, Virginia, Vereinigte Staaten, 22042
- Inova Fairfax Hospital
-
Norfolk, Virginia, Vereinigte Staaten, 23507
- Children's Hospital of The King's Daughters
-
Portsmouth, Virginia, Vereinigte Staaten, 23708-2197
- Naval Medical Center - Portsmouth
-
Richmond, Virginia, Vereinigte Staaten, 23298
- VCU Massey Comprehensive Cancer Center
-
-
Washington
-
Aberdeen, Washington, Vereinigte Staaten, 98520
- Providence Regional Cancer System-Aberdeen
-
Bellevue, Washington, Vereinigte Staaten, 98004
- Overlake Medical Center
-
Bellingham, Washington, Vereinigte Staaten, 98225
- PeaceHealth Saint Joseph Medical Center
-
Centralia, Washington, Vereinigte Staaten, 98531
- Providence Regional Cancer System-Centralia
-
Edmonds, Washington, Vereinigte Staaten, 98026
- Swedish Cancer Institute-Edmonds
-
Everett, Washington, Vereinigte Staaten, 98201
- Providence Regional Cancer Partnership
-
Issaquah, Washington, Vereinigte Staaten, 98029
- Swedish Cancer Institute-Issaquah
-
Kennewick, Washington, Vereinigte Staaten, 99336
- Kadlec Clinic Hematology and Oncology
-
Lacey, Washington, Vereinigte Staaten, 98503
- Providence Regional Cancer System-Lacey
-
Longview, Washington, Vereinigte Staaten, 98632
- PeaceHealth Saint John Medical Center
-
Seattle, Washington, Vereinigte Staaten, 98105
- Seattle Children's Hospital
-
Seattle, Washington, Vereinigte Staaten, 98107
- Swedish Medical Center-Ballard Campus
-
Seattle, Washington, Vereinigte Staaten, 98122
- Swedish Medical Center-First Hill
-
Seattle, Washington, Vereinigte Staaten, 98195
- University of Washington Medical Center - Montlake
-
Seattle, Washington, Vereinigte Staaten, 98112
- Kaiser Permanente Washington
-
Seattle, Washington, Vereinigte Staaten, 98104
- Pacific Gynecology Specialists
-
Seattle, Washington, Vereinigte Staaten, 98122-5711
- Swedish Medical Center-Cherry Hill
-
Shelton, Washington, Vereinigte Staaten, 98584
- Providence Regional Cancer System-Shelton
-
Spokane, Washington, Vereinigte Staaten, 99204
- Providence Sacred Heart Medical Center and Children's Hospital
-
Spokane, Washington, Vereinigte Staaten, 99204
- MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
-
Spokane, Washington, Vereinigte Staaten, 99218
- MultiCare Deaconess Cancer and Blood Specialty Center - North
-
Spokane Valley, Washington, Vereinigte Staaten, 99216
- MultiCare Deaconess Cancer and Blood Specialty Center - Valley
-
Tacoma, Washington, Vereinigte Staaten, 98405
- Mary Bridge Children's Hospital and Health Center
-
Tacoma, Washington, Vereinigte Staaten, 98431
- Madigan Army Medical Center
-
Vancouver, Washington, Vereinigte Staaten, 98664
- PeaceHealth Southwest Medical Center
-
Walla Walla, Washington, Vereinigte Staaten, 99362
- Providence Saint Mary Regional Cancer Center
-
Yakima, Washington, Vereinigte Staaten, 98902
- North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
-
Yelm, Washington, Vereinigte Staaten, 98597
- Providence Regional Cancer System-Yelm
-
-
West Virginia
-
Bridgeport, West Virginia, Vereinigte Staaten, 26330
- United Hospital Center
-
Charleston, West Virginia, Vereinigte Staaten, 25304
- Vandalia Health/CAMC Institute for Academic Medicine
-
Martinsburg, West Virginia, Vereinigte Staaten, 25401
- WVUH-Berkely Medical Center
-
Morgantown, West Virginia, Vereinigte Staaten, 26506
- West Virginia University Healthcare
-
Parkersburg, West Virginia, Vereinigte Staaten, 26101
- Camden Clark Medical Center
-
-
Wisconsin
-
La Crosse, Wisconsin, Vereinigte Staaten, 54601
- Gundersen Lutheran Medical Center
-
Madison, Wisconsin, Vereinigte Staaten, 53792
- University of Wisconsin Carbone Cancer Center - University Hospital
-
Marshfield, Wisconsin, Vereinigte Staaten, 54449
- Marshfield Medical Center-Marshfield
-
Milwaukee, Wisconsin, Vereinigte Staaten, 53226
- Children's Hospital of Wisconsin
-
-
Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
Inclusion Criteria:
-
Feasibility Phase: Patients must be < 21 years of age at the time of enrollment; please note: the feasibility phase is complete, effective with amendment #1
-
Efficacy Phase: Patients must be =< 40 years of age at the time of enrollment
-
Patients with newly diagnosed RMS of any subtype, except adult-type pleomorphic, based upon institutional histopathologic classification, are eligible to enroll on the study based upon stage, group, and age, as below
-
RMS types included under embryonal rhabdomyosarcoma (ERMS) include those classified in the 1995 International Classification of Rhabdomyosarcoma (ICR) as ERMS (classic, spindle cell, and botryoid variants), which are reclassified in the 2013 World Health Organization (WHO) classification as ERMS (classic, dense and botryoid variants) and spindle cell/sclerosing RMS (encompassing the historical spindle cell ERMS variant and the newly recognized sclerosing RMS variant); classification of alveolar rhabdomyosarcoma (ARMS) in the 2013 WHO classification is the same as in the ICR and includes classic and solid variants
-
ERMS
- Stage 1, group III (non-orbit)
- Stage 3, group I/II
- Stage 2/3, group III
- Stage 4, group IV, < 10 years old
-
ARMS:
- Stages 1-3, groups I-III
-
-
Specimen Submission: Patients must have sufficient tissue available for the required biology study
-
Lansky performance status score >= 50 for patients =< 16 years of age; Karnofsky performance status score >= 50 for patients > 16 years of age
-
Peripheral absolute neutrophil count (ANC) >= 750/uL
-
Platelet count >= 75,000/uL
-
Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:
- 1 month to < 6 months old: 0.4 mg/dl (male), 0.4 mg/dl (female)
- 6 months to < 1 year old: 0.5 mg/dl (male), 0.5 mg/dl (female)
- 1 to < 2 years old: 0.6 mg/dl (male), 0.6 mg/dl (female)
- 2 to < 6 years old: 0.8 mg/dl (male), 0.8 mg/dl (female)
- 6 to < 10 years old: 1 mg/dl (male), 1 mg/dl (female)
- 10 to < 13 years old: 1.2 mg/dl (male), 1.2 mg/dl (female)
- 13 to < 16 years old: 1.5 mg/dl (male), 1.4 mg/dl (female)
- >= 16 years old: 1.7 mg/dl (male), 1.4 mg/dl (female)
- Patients with an elevated serum creatinine due to obstructive hydronephrosis secondary to tumor are still eligible; however, patients with urinary tract obstruction by tumor must have unimpeded urinary flow established via diversion (i.e. percutaneous nephrostomies or ureteric stents) of the urinary tract
-
Total bilirubin =< 1.5 x upper limit of normal (ULN) for age
-
All patients and/or their parents or legal guardians must sign a written informed consent.
-
All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met.
Exclusion Criteria:
- Patients who have previously received temsirolimus, another mTOR inhibitor, or any other investigational agent
- Patients who have received any chemotherapy (excluding steroids) and/or RT prior to this enrollment
- Patients with uncontrolled hyperglycemia
- Patients with uncontrolled hyperlipidemia
- Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of their study participation and for at least 3 months after treatment is completed
- Female patients who are pregnant are not eligible since fetal toxicities or teratogenic effects have been noted for several of the study drugs; Note: A pregnancy test is required for female patients of childbearing potential prior to study entry
- Lactating females who plan to breastfeed their infants are not eligible
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Keine (Offenes Etikett)
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Experimental: Regimen A (VAC/VI)
Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-13, 16, 17, 19, 20, 22-26, 28, 31-34, 37, 38, and 40, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 4, 10, 16, 19, 25, 31, and 37. Patients also undergo primary site RT beginning at week 13 or metastatic site RT beginning at week 43 for up to 6.5 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients then receive vinorelbine IV over 6-10 minutes on days 1, 8, and 15 and cyclophosphamide PO QD on days 1-28. Cycles repeats every 28 days for 24 weeks in the absence of disease progression or unacceptable toxicity. |
Correlative studies Given IV
Andere Namen:
Ancillary studies Given IV and PO
Andere Namen:
Given IV
Andere Namen:
Given IV
Andere Namen:
Undergo RT
Andere Namen:
|
|
Experimental: Regimen B (VAC/VI/temsirolimus)
Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-13, 16, 17, 19, 20, 22-26, 28, 31-34, 37, 38, and 40, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 7, 13, 22, 28, 34, and 40, irinotecan hydrochloride IV over 90 minutes on days 1-5 of weeks 4, 10, 16, 19, 25, 31, and 37 and temsirolimus IV over 30-60 minutes on day 1 of weeks 1-12 and 21-42. Patients also undergo RT as in Regimen A. Treatment continues in the absence of disease progression or unacceptable toxicity. Patients then receive vinorelbine IV over 6-10 minutes on days 1, 8, and 15 and cyclophosphamide PO QD on days 1-28. Cycles repeats every 28 days for 24 weeks in the absence of disease progression or unacceptable toxicity. |
Correlative studies Given IV
Andere Namen:
Ancillary studies Given IV
Andere Namen:
Given IV and PO
Andere Namen:
Given IV
Andere Namen:
Given IV
Andere Namen:
Undergo RT
Andere Namen:
Given IV
Andere Namen:
|
|
Experimental: Regimen C (FOXO1 fusion negative, VAC/VA)
Patients receive vincristine sulfate IV over 1 minute on day 1 of weeks 1-10 and 13-22, dactinomycin IV over 1-5 or 10-15 minutes on day 1 of weeks 1, 4, 7, 10, 13, 16, 19, and 22, cyclophosphamide IV over 60 minutes on day 1 of weeks 1, 4, 7, and 10. Patients undergo RT beginning at week 13 for up to 6.5 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity. |
Correlative studies Given IV
Andere Namen:
Ancillary studies Given IV and PO
Andere Namen:
Given IV
Andere Namen:
Undergo RT
Andere Namen:
|
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Event-free Survival (EFS)
Zeitfenster: Up to 3 years from study entry
|
The Kaplan-Meier method will used to estimate 3-year EFS between the randomized treatment groups (Regimen A (VAC/VI) vs. Regimen B (VAC/VI/Temsirolimus)) using the log-rank test. EFS event is defined as the time from study entry until first occurrence of progression, relapse, second malignancy, or death. |
Up to 3 years from study entry
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Overall Survival (OS)
Zeitfenster: Up to 3 years from study entry
|
The Kaplan-Meier method will used to estimate 3-year OS between the randomized treatment groups (Regimen A (VAC/VI) vs. Regimen B (VAC/VI/Temsirolimus)) using the log-rank test. OS event is defined as the time from study entry until death. |
Up to 3 years from study entry
|
Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Patientenergebnis basierend auf ihrem Forkhead-Box-O1-Protein (FOXO1)-Partner, durch Bewertung von PAX3 vs. PAX7 bei allen Patienten, bei denen festgestellt wurde, dass sie FOXO1-Fusion-positiv sind
Zeitfenster: Bis zu 10 Jahre
|
Bis zu 10 Jahre
|
|
|
Frequency of Circulating Tumor DNA (ctDNA) at Diagnosis and Subsequent Time-points
Zeitfenster: Up to 10 years
|
Will determine the frequency with which of ctDNA is detected in patients with intermediate-risk (IR) rhabdomyosarcoma (RMS) at diagnosis and how these levels change over time with. In addition, the level of ctDNA as a percent of total cell-free DNA will be summarized by reporting the median and range. Since no prior data are available on the rate of positivity nor the change over time, the analysis will be purely descriptive. Changes over time will be plotted to visually determine and compare the trajectories of ctDNA during the early and late stages of therapy. |
Up to 10 years
|
|
Patient Outcome Based on Their [F18]-Fluorodeoxy-D-glucose-positron Emission Tomography (FDG-positron Emission Tomography [PET]) Response
Zeitfenster: At week 9
|
Assessed by Deauville Criteria (5-point). |
At week 9
|
|
Patient Outcomes Based on (Vincristine, Dactinomycin, and Cyclophosphamide [VAC]/Vincristine and Irinotecan [VI] With or Without Temsirolimus) Who Have Received Maintenance Therapy on ARST1431 to Those Who Received VAC/VI on ARST0531
Zeitfenster: Up to 10 years
|
The two-sample log-rank test will be performed. |
Up to 10 years
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Ermittler
Ermittler
- Hauptermittler: Abha A Gupta, Children's Oncology Group
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Gupta AA, Xue W, Harrison DJ, Hawkins DS, Dasgupta R, Wolden S, Shulkin B, Qumseya A, Routh JC, MacDonald T, Feinberg S, Crompton B, Rudzinski ER, Arnold M, Venkatramani R. Addition of temsirolimus to chemotherapy in children, adolescents, and young adults with intermediate-risk rhabdomyosarcoma (ARST1431): a randomised, open-label, phase 3 trial from the Children's Oncology Group. Lancet Oncol. 2024 Jul;25(7):912-921. doi: 10.1016/S1470-2045(24)00255-9.
- Winsnes K, Bradley JA, Gao Z, Gupta AA, Rothstein DH, Shenoy A, Venkatramani R, Xue W, Arndt C. Intermediate Risk Rhabdomyosarcoma in Very Young Children (Less Than or Equal to 24 Months) Treated on the Prior Children's Oncology Group Protocol ARST1431. Pediatr Blood Cancer. 2026 Jun;73(6):e70293. doi: 10.1002/1545-5017.70293. Epub 2026 Mar 31.
- de Traux de Wardin H, Dermawan JK, Vanoli F, Jiang SC, Singer S, Chi P, Tap W, Wexler LH, Antonescu CR. NF1-Driven Rhabdomyosarcoma Phenotypes: A Comparative Clinical and Molecular Study of NF1-Mutant Rhabdomyosarcoma and NF1-Associated Malignant Triton Tumor. JCO Precis Oncol. 2024 Apr;8:e2300597. doi: 10.1200/PO.23.00597.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Tatsächlich)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Geschätzt)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Zusätzliche relevante MeSH-Bedingungen
- Neubildungen
- Neubildungen nach histologischem Typ
- Sarkom
- Neubildungen, Binde- und Weichgewebe
- Neubildungen, Muskelgewebe
- Myosarkom
- Rhabdomyosarkom
- Rhabdomyosarkom, embryonal
- Rhabdomyosarkom, Alveolar
- Peptide
- Aminosäuren, Peptide und Proteine
- Organische Chemikalien
- Heterocyclische Verbindungen
- Heterocyclische Verbindungen, 2-Ring
- Heterocyclische Verbindungen, Fusionsring
- Therapeutika
- Kohlenwasserstoffe
- Physikalische Phänomene
- Camptothecin
- Alkaloide
- Polycyclische Verbindungen
- Indolen
- Makroliden
- Laktone
- Phosphoramid -Senf
- Stickstoffsenfverbindungen
- Senfverbindungen
- Kohlenwasserstoffe, halogeniert
- Phosphoramide
- Organophosphorverbindungen
- Vinca -Alkaloide
- Secologanin Tryptaminalkaloide
- Indolalkaloide
- Indolizidine
- Indoliziner
- Makrocyclische Verbindungen
- Peptide, zyklisch
- Heterocyclische Verbindungen, 3-Ring
- Irinotecan
- Vinorelbin
- Sirolimus
- Cyclophosphamid
- Vincristin
- Dactinomycin
- Strahlentherapie
- Strahlung
- temsirolimus
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- NCI-2015-01644
- U10CA180886 (US NIH Stipendium/Vertrag)
- NCI-2015-01644 (Registrierungskennung: CTRP (Clinical Trial Reporting Program))
- ARST1431 (Andere Kennung: CTEP)
- ARST1431
- ARST1431 (Andere Kennung: Children's Oncology Group)
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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