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

3 april 2020 bijgewerkt door: Southwest Oncology Group

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

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

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

PRIMARY OBJECTIVES:

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

SECONDARY OBJECTIVES:

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

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

TERTIARY OBJECTIVES:

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

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

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

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

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

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

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

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

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

Studietype

Ingrijpend

Inschrijving (Werkelijk)

143

Fase

  • Fase 2

Contacten en locaties

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Studie Locaties

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

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

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

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

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

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

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

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Crossover-opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Arm I (dexamethasone, low-dose carfilzomib)
Patients receive dexamethasone IV and low-dose carfilzomib IV over 2-10 minutes on days 1, 2, 8, 9, 15, and 16. (Note that course 1 is given at a reduced dose.) Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Patients with progression cross-over to Arm II.
Ander: Laboratorium Biomarker Analyse
Correlatieve studies
Geneesmiddel: Carfilzomib
IV gegeven
Andere namen:
  • Kyprolis
  • PR-171
Geneesmiddel: Dexamethason
IV gegeven
Andere namen:
  • Decadron
  • Aacidexamen
  • Adexon
  • Aknichthol Dexa
  • Alba-Dex
  • Aline
  • Alin depot
  • Alin Oftalmico
  • Amplidermis
  • Anemul mono
  • Auricularum
  • Hulp
  • Baycuten
  • Baycuten N
  • Cortidexason
  • Cortisumman
  • Deccort
  • Decadrol
  • Decalix
  • Decameth
  • Decasone R.p.
  • Dectancyl
  • Dekacort
  • Deltafluoreen
  • Deronil
  • Desamethason
  • Desameton
  • Dexa-Mamallet
  • Dexa-Rhinosan
  • Dexa-Scheroson
  • Dexa-sinus
  • Dexacortaal
  • Dexacortine
  • Dexafarma
  • Dexafluoreen
  • Dexaal lokaal
  • Dexamecortine
  • Dexameth
  • Dexamethasonum
  • Dexamonozon
  • Dexapos
  • Dexinoraal
  • Dexon
  • Dinormon
  • Fluorodelta
  • Fortecortin
  • Gammacorten
  • Hexadecadrol
  • Hexadrol
  • Lokalison-F
  • Loverine
  • Methylfluorprednisolon
  • Millicorten
  • Mymethason
  • Orgadrone
  • Spersadex
  • Visumetazon
Experimenteel: Arm II (dexamethasone, high-dose carfilzomib)
Patients receive dexamethasone IV and high-dose carfilzomib IV over 30 minutes on days 1, 2, 8, 9, 15, and 16. (Note that course 1 is given at a reduced dose over 2-10 minutes.) Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
Ander: Laboratorium Biomarker Analyse
Correlatieve studies
Geneesmiddel: Carfilzomib
IV gegeven
Andere namen:
  • Kyprolis
  • PR-171
Geneesmiddel: Dexamethason
IV gegeven
Andere namen:
  • Decadron
  • Aacidexamen
  • Adexon
  • Aknichthol Dexa
  • Alba-Dex
  • Aline
  • Alin depot
  • Alin Oftalmico
  • Amplidermis
  • Anemul mono
  • Auricularum
  • Hulp
  • Baycuten
  • Baycuten N
  • Cortidexason
  • Cortisumman
  • Deccort
  • Decadrol
  • Decalix
  • Decameth
  • Decasone R.p.
  • Dectancyl
  • Dekacort
  • Deltafluoreen
  • Deronil
  • Desamethason
  • Desameton
  • Dexa-Mamallet
  • Dexa-Rhinosan
  • Dexa-Scheroson
  • Dexa-sinus
  • Dexacortaal
  • Dexacortine
  • Dexafarma
  • Dexafluoreen
  • Dexaal lokaal
  • Dexamecortine
  • Dexameth
  • Dexamethasonum
  • Dexamonozon
  • Dexapos
  • Dexinoraal
  • Dexon
  • Dinormon
  • Fluorodelta
  • Fortecortin
  • Gammacorten
  • Hexadecadrol
  • Hexadrol
  • Lokalison-F
  • Loverine
  • Methylfluorprednisolon
  • Millicorten
  • Mymethason
  • Orgadrone
  • Spersadex
  • Visumetazon

Wat meet het onderzoek?

Primaire uitkomstmaten

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

Secundaire uitkomstmaten

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

Andere uitkomstmaten

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

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Southwest Oncology Group

Medewerkers

National Cancer Institute (NCI)

Onderzoekers

  • Hoofdonderzoeker: Sikander Ailawadhi, Southwest Oncology Group

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 oktober 2013

Primaire voltooiing (Werkelijk)

1 november 2017

Studie voltooiing (Werkelijk)

7 maart 2019

Studieregistratiedata

Eerst ingediend

16 juli 2013

Eerst ingediend dat voldeed aan de QC-criteria

16 juli 2013

Eerst geplaatst (Schatting)

19 juli 2013

Updates van studierecords

Laatste update geplaatst (Werkelijk)

14 april 2020

Laatste update ingediend die voldeed aan QC-criteria

3 april 2020

Laatst geverifieerd

1 april 2020

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • S1304 (Andere identificatie: CTEP)
  • U10CA032102 (Subsidie/contract van de Amerikaanse NIH)
  • U10CA180888 (Subsidie/contract van de Amerikaanse NIH)
  • NCI-2013-00796 (Register-ID: CTRP (Clinical Trial Reporting Program))
  • PS1304_A07PAMDREVW01
  • SWOG-S1304

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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