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Testen van immunotherapie versus observatie bij patiënten met HPV-keelkanker

23 oktober 2026 bijgewerkt door: National Cancer Institute (NCI)

Een gerandomiseerde fase III-studie van onderhoudsbehandeling met nivolumab versus observatie bij patiënten met HPV-positieve OPSCC met lokaal gevorderd, gemiddeld risico

This phase III trials studies whether maintenance immunotherapy (nivolumab) following definitive treatment with radiation and chemotherapy (cisplatin) result in significant improvement in overall survival (time being alive) and progression-free survival (time being alive without cancer) for patients with intermediate risk human papillomavirus (HPV) positive oropharynx cancer (throat cancer) that has spread to nearby tissue or lymph nodes. Drugs used in chemotherapy such as cisplatin 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. Radiation therapy uses high energy rays to kill tumor cells and shrink tumors. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. It is not yet known whether chemotherapy and radiation therapy followed by maintenance nivolumab therapy works better than chemotherapy and radiation therapy alone in treating patients with HPV positive oropharyngeal cancer.

Studie Overzicht

Toestand

Actief, niet wervend

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

PRIMARY OBJECTIVE:

I. To assess the efficacy of concurrent definitive therapy followed by nivolumab compared with concurrent definitive therapy followed by observation in terms of overall survival (OS).

SECONDARY OBJECTIVES:

I. To further assess the efficacy of nivolumab compared with observation in terms of:

Ia. To evaluate treatment effect within the subset of patients tested as PD-L1+ .

Ib. To evaluate the prognostic effect of baseline saliva and/or plasma HPV status .

Ic. To evaluate the prognostic effect of mutation burden among patients on the nivolumab arm.

Id. To evaluate the association of 12-week post therapy fludeoxyglucose F-18 (FDG) positron emission tomography(PET)/computed tomography (CT) OS and progression free survival (PFS).

Ie. To establish the prognostic value of standardized uptake value (SUV) max of primary tumor or neck nodal metastasis of baseline FDG PET/CT for OS (and/or PFS).

If. To correlate SUV max of primary tumor or nodal metastasis of baseline FDG PET/CT with PD-L1 expression (positive versus [vs.] negative).

Ig. To compare the PET based therapy response assessment (Hopkins criteria) to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 assessment at 12 week post chemoradiation therapy, for patients who have a PET/CT scan at 12 weeks.

II. To assess the efficacy of concurrent definitive therapy followed by nivolumab in terms of progression free survival (PFS).

OUTLINE: Patients are randomized to Arm A or Arm B. Patients in Arm B may cross-over to Arm C with clearly documented disease progression.

ARM A: Patients receive cisplatin intravenously (IV) over 60 minutes weekly and intensity modulated radiation therapy (IMRT) 5 days a week for 7 weeks for a total of 35 fractions. Within 4 weeks after completion of concurrent therapy, patients receive nivolumab IV once weekly over 30 minutes every 4 weeks for 12 months in the absence of disease progression or unacceptable toxicity.

ARM B: Patients receive cisplatin IV over 60 minutes weekly and IMRT 5 days a week for 7 weeks for a total of 35 fractions, and then go on observation. Patients will be offered the option to cross-over to Arm C if they have clearly documented progression within 12 months from the end of cisplatin/radiation therapy.

ARM C: Patients receive nivolumab IV over 30 minutes every 4 weeks for 12 months in the absence of disease progression or unacceptable toxicity.

All patients undergo computed tomography (CT) or Fludeoxyglucose F-18 (FDG) positron emission tomography (PET)/CT scans throughout the trial. Patients may undergo echocardiography (ECHO) as clinically indicated. Additionally, patients undergo blood sample collection during screening.

After completion of study treatment, patients are followed up every 3-6 months for 3 years and then annually for a total of 10 years.

Studietype

Ingrijpend

Inschrijving (Geschat)

636

Fase

Fase 3

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

Verenigde Staten
- Alabama
  - Fairhope, Alabama, Verenigde Staten, 36532
    - Thomas Hospital
  - Mobile, Alabama, Verenigde Staten, 36607
    - Mobile Infirmary Medical Center
- Alaska
  - Anchorage, Alaska, Verenigde Staten, 98508
    - Anchorage Associates in Radiation Medicine
  - Anchorage, Alaska, Verenigde Staten, 99508
    - Alaska Breast Care and Surgery LLC
  - Anchorage, Alaska, Verenigde Staten, 99508
    - Alaska Oncology and Hematology LLC
  - Anchorage, Alaska, Verenigde Staten, 99508
    - Alaska Women's Cancer Care
  - Anchorage, Alaska, Verenigde Staten, 99508
    - Anchorage Oncology Centre
  - Anchorage, Alaska, Verenigde Staten, 99508
    - Katmai Oncology Group
  - Anchorage, Alaska, Verenigde Staten, 99508
    - Providence Alaska Medical Center
  - Anchorage, Alaska, Verenigde Staten, 99504
    - Anchorage Radiation Therapy Center
  - Fairbanks, Alaska, Verenigde Staten, 99701
    - Fairbanks Memorial Hospital
- Arizona
  - Goodyear, Arizona, Verenigde Staten, 85338
    - CTCA at Western Regional Medical Center
  - Kingman, Arizona, Verenigde Staten, 86401
    - Kingman Regional Medical Center
  - Phoenix, Arizona, Verenigde Staten, 85004
    - Cancer Center at Saint Joseph's
- Arkansas
  - Fort Smith, Arkansas, Verenigde Staten, 72903
    - Mercy Hospital Fort Smith
  - Hot Springs, Arkansas, Verenigde Staten, 71913
    - CHI Saint Vincent Cancer Center Hot Springs
- California
  - Antioch, California, Verenigde Staten, 94531
    - Kaiser Permanente-Deer Valley Medical Center
  - Arroyo Grande, California, Verenigde Staten, 93420
    - PCR Oncology
  - Arroyo Grande, California, Verenigde Staten, 93420
    - Mission Hope Medical Oncology - Arroyo Grande
  - Burbank, California, Verenigde Staten, 91505
    - Providence Saint Joseph Medical Center/Disney Family Cancer Center
  - Carmichael, California, Verenigde Staten, 95608
    - Mercy San Juan Medical Center
  - Carmichael, California, Verenigde Staten, 95608
    - Mercy Cancer Center - Carmichael
  - Dublin, California, Verenigde Staten, 94568
    - Kaiser Permanente Dublin
  - Dublin, California, Verenigde Staten, 94568
    - Epic Care-Dublin
  - Elk Grove, California, Verenigde Staten, 95758
    - Mercy Cancer Center - Elk Grove
  - Emeryville, California, Verenigde Staten, 94608
    - Bay Area Breast Surgeons Inc
  - Emeryville, California, Verenigde Staten, 94608
    - Epic Care Partners in Cancer Care
  - Fremont, California, Verenigde Staten, 94538
    - Kaiser Permanente-Fremont
  - Fresno, California, Verenigde Staten, 93720
    - Kaiser Permanente-Fresno
  - Fresno, California, Verenigde Staten, 93720
    - Fresno Cancer Center
  - Long Beach, California, Verenigde Staten, 90822
    - Tibor Rubin VA Medical Center
  - Martinez, California, Verenigde Staten, 94553-3156
    - Contra Costa Regional Medical Center
  - Merced, California, Verenigde Staten, 95340
    - Mercy Cancer Center
  - Modesto, California, Verenigde Staten, 95356
    - Kaiser Permanente-Modesto
  - Napa, California, Verenigde Staten, 94558
    - Providence Queen of The Valley
  - Oakland, California, Verenigde Staten, 94611
    - Kaiser Permanente-Oakland
  - Oakland, California, Verenigde Staten, 94611
    - Kaiser Permanente Oakland-Broadway
  - Oakland, California, Verenigde Staten, 94609
    - Alta Bates Summit Medical Center - Summit Campus
  - Oakland, California, Verenigde Staten, 94609
    - Bay Area Tumor Institute
  - Palo Alto, California, Verenigde Staten, 94304
    - VA Palo Alto Health Care System
  - Rancho Cordova, California, Verenigde Staten, 95670
    - Kaiser Permanente-Rancho Cordova Cancer Center
  - Redwood City, California, Verenigde Staten, 94063
    - Kaiser Permanente-Redwood City
  - Richmond, California, Verenigde Staten, 94801
    - Kaiser Permanente-Richmond
  - Rocklin, California, Verenigde Staten, 95765
    - Mercy Cancer Center - Rocklin
  - Rohnert Park, California, Verenigde Staten, 94928
    - Rohnert Park Cancer Center
  - Roseville, California, Verenigde Staten, 95678
    - The Permanente Medical Group-Roseville Radiation Oncology
  - Roseville, California, Verenigde Staten, 95661
    - Kaiser Permanente-Roseville
  - Sacramento, California, Verenigde Staten, 95814
    - Kaiser Permanente Downtown Commons
  - Sacramento, California, Verenigde Staten, 95823
    - South Sacramento Cancer Center
  - Sacramento, California, Verenigde Staten, 95816
    - Mercy Cancer Center - Sacramento
  - Salinas, California, Verenigde Staten, 93901
    - Salinas Valley Memorial
  - San Diego, California, Verenigde Staten, 92134
    - Naval Medical Center -San Diego
  - San Diego, California, Verenigde Staten, 92103
    - UC San Diego Medical Center - Hillcrest
  - San Francisco, California, Verenigde Staten, 94115
    - Kaiser Permanente-San Francisco
  - San Jose, California, Verenigde Staten, 95119
    - Kaiser Permanente-Santa Teresa-San Jose
  - San Leandro, California, Verenigde Staten, 94577
    - Kaiser Permanente San Leandro
  - San Luis Obispo, California, Verenigde Staten, 93401
    - Pacific Central Coast Health Center-San Luis Obispo
  - San Rafael, California, Verenigde Staten, 94903
    - Kaiser San Rafael-Gallinas
  - Santa Clara, California, Verenigde Staten, 95051
    - Kaiser Permanente Medical Center - Santa Clara
  - Santa Maria, California, Verenigde Staten, 93444
    - Mission Hope Medical Oncology - Santa Maria
  - Santa Rosa, California, Verenigde Staten, 95403
    - Kaiser Permanente-Santa Rosa
  - Santa Rosa, California, Verenigde Staten, 95403
    - Providence Medical Foundation - Santa Rosa
  - South San Francisco, California, Verenigde Staten, 94080
    - Kaiser Permanente Cancer Treatment Center
  - South San Francisco, California, Verenigde Staten, 94080
    - Kaiser Permanente-South San Francisco
  - Stockton, California, Verenigde Staten, 95210
    - Kaiser Permanente-Stockton
  - Vacaville, California, Verenigde Staten, 95688
    - Kaiser Permanente Medical Center-Vacaville
  - Vallejo, California, Verenigde Staten, 94589
    - Kaiser Permanente-Vallejo
  - Walnut Creek, California, Verenigde Staten, 94596
    - Kaiser Permanente-Walnut Creek
  - Walnut Creek, California, Verenigde Staten, 94597
    - Epic Care Cyberknife Center
  - Woodland, California, Verenigde Staten, 95695
    - Woodland Memorial Hospital
- Colorado
  - Aurora, Colorado, Verenigde Staten, 80012
    - Rocky Mountain Cancer Centers-Aurora
  - Aurora, Colorado, Verenigde Staten, 80012
    - The Medical Center of Aurora
  - Aurora, Colorado, Verenigde Staten, 80045
    - UCHealth University of Colorado Hospital
  - Boulder, Colorado, Verenigde Staten, 80303
    - Boulder Community Foothills Hospital
  - Boulder, Colorado, Verenigde Staten, 80304
    - Rocky Mountain Cancer Centers-Boulder
  - Centennial, Colorado, Verenigde Staten, 80112
    - Rocky Mountain Cancer Centers - Centennial
  - Colorado Springs, Colorado, Verenigde Staten, 80907
    - Penrose-Saint Francis Healthcare
  - Colorado Springs, Colorado, Verenigde Staten, 80909
    - UCHealth Memorial Hospital Central
  - Colorado Springs, Colorado, Verenigde Staten, 80907
    - Rocky Mountain Cancer Centers-Penrose
  - Colorado Springs, Colorado, Verenigde Staten, 80920
    - Memorial Hospital North
  - Colorado Springs, Colorado, Verenigde Staten, 80923
    - Saint Francis Cancer Center
  - Denver, Colorado, Verenigde Staten, 80218
    - Presbyterian - Saint Lukes Medical Center - Health One
  - Denver, Colorado, Verenigde Staten, 80220
    - Rose Medical Center
  - Denver, Colorado, Verenigde Staten, 80218
    - Rocky Mountain Cancer Centers-Midtown
  - Denver, Colorado, Verenigde Staten, 80220
    - Rocky Mountain Cancer Centers-Rose
  - Denver, Colorado, Verenigde Staten, 80218
    - Colorado Blood Cancer Institute
  - Denver, Colorado, Verenigde Staten, 80204
    - Cancer Center of Colorado at Sloan's Lake
  - Denver, Colorado, Verenigde Staten, 80209
    - The Women's Imaging Center
  - Denver, Colorado, Verenigde Staten, 80206
    - National Jewish Health-Main Campus
  - Denver, Colorado, Verenigde Staten, 80220
    - Western Surgical Care
  - Denver, Colorado, Verenigde Staten, 80218
    - Saint Joseph Hospital - Cancer Centers of Colorado
  - Denver, Colorado, Verenigde Staten, 80210
    - AdventHealth Porter
  - Durango, Colorado, Verenigde Staten, 81301
    - Mercy Medical Center
  - Durango, Colorado, Verenigde Staten, 81301
    - CommonSpirit Cancer Center Mercy
  - Englewood, Colorado, Verenigde Staten, 80113
    - Mountain Blue Cancer Care Center - Swedish
  - Englewood, Colorado, Verenigde Staten, 80113
    - Swedish Medical Center
  - Englewood, Colorado, Verenigde Staten, 80113
    - Rocky Mountain Cancer Centers - Swedish
  - Englewood, Colorado, Verenigde Staten, 80113
    - The Melanoma and Skin Cancer Institute
  - Fort Collins, Colorado, Verenigde Staten, 80524
    - Poudre Valley Hospital
  - Fort Collins, Colorado, Verenigde Staten, 80528
    - Cancer Care and Hematology-Fort Collins
  - Golden, Colorado, Verenigde Staten, 80401
    - National Jewish Health-Western Hematology Oncology
  - Grand Junction, Colorado, Verenigde Staten, 81501
    - Saint Mary's Hospital and Regional Medical Center
  - Greeley, Colorado, Verenigde Staten, 80631
    - UCHealth Greeley Hospital
  - Greeley, Colorado, Verenigde Staten, 80631
    - Banner North Colorado Medical Center
  - Lafayette, Colorado, Verenigde Staten, 80026
    - Good Samaritan Hospital - Cancer Centers of Colorado
  - Lakewood, Colorado, Verenigde Staten, 80228
    - Rocky Mountain Cancer Centers-Lakewood
  - Lakewood, Colorado, Verenigde Staten, 80228
    - CommonSpirit Saint Anthony Hospital Cancer Center
  - Littleton, Colorado, Verenigde Staten, 80120
    - Rocky Mountain Cancer Centers-Littleton
  - Littleton, Colorado, Verenigde Staten, 80122
    - AdventHealth Littleton
  - Lone Tree, Colorado, Verenigde Staten, 80124
    - Sky Ridge Medical Center
  - Lone Tree, Colorado, Verenigde Staten, 80124
    - Rocky Mountain Cancer Centers-Sky Ridge
  - Longmont, Colorado, Verenigde Staten, 80501
    - Longmont United Hospital
  - Longmont, Colorado, Verenigde Staten, 80501
    - Rocky Mountain Cancer Centers-Longmont
  - Loveland, Colorado, Verenigde Staten, 80538
    - Medical Center of the Rockies
  - Loveland, Colorado, Verenigde Staten, 80539
    - Banner North Colorado Medical Center - Loveland Campus
  - Parker, Colorado, Verenigde Staten, 80138
    - AdventHealth Parker
  - Pueblo, Colorado, Verenigde Staten, 81004
    - Saint Mary Corwin Medical Center
  - Thornton, Colorado, Verenigde Staten, 80260
    - Rocky Mountain Cancer Centers-Thornton
  - Thornton, Colorado, Verenigde Staten, 80260
    - National Jewish Health-Northern Hematology Oncology
  - Wheat Ridge, Colorado, Verenigde Staten, 80401
    - Intermountain Health Lutheran Hospital
- Connecticut
  - Greenwich, Connecticut, Verenigde Staten, 06830
    - Smilow Cancer Hospital Care Center at Greenwich
  - Guilford, Connecticut, Verenigde Staten, 06437
    - Smilow Cancer Hospital Care Center - Guilford
  - New Haven, Connecticut, Verenigde Staten, 06520
    - Yale University
  - New Haven, Connecticut, Verenigde Staten, 06510
    - Smilow Cancer Center/Yale-New Haven Hospital
  - 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
  - Trumbull, Connecticut, Verenigde Staten, 06611
    - Smilow Cancer Hospital Care Center-Trumbull
  - Waterford, Connecticut, Verenigde Staten, 06385
    - Smilow Cancer Hospital Care Center - Waterford
- Delaware
  - Lewes, Delaware, Verenigde Staten, 19958
    - Beebe Medical Center
  - Millville, Delaware, Verenigde Staten, 19967
    - Beebe South Coastal Health Campus
  - 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
  - Rehoboth Beach, Delaware, Verenigde Staten, 19971
    - Beebe Health Campus
- District of Columbia
  - Washington D.C., District of Columbia, Verenigde Staten, 20037
    - George Washington University Medical Center
- Florida
  - Deerfield Beach, Florida, Verenigde Staten, 33064
    - Broward Health North
  - Fort Lauderdale, Florida, Verenigde Staten, 33316
    - Broward Health Medical Center
  - Fort Lauderdale, Florida, Verenigde Staten, 33308
    - Holy Cross Hospital
  - Lakeland, Florida, Verenigde Staten, 33805
    - The Watson Clinic
  - Tampa, Florida, Verenigde Staten, 33612
    - Moffitt Cancer Center
  - Tampa, Florida, Verenigde Staten, 33607
    - Moffitt Cancer Center-International Plaza
  - Tampa, Florida, Verenigde Staten, 33612
    - Moffitt Cancer Center - McKinley Campus
  - Wesley Chapel, Florida, Verenigde Staten, 33544
    - Moffitt Cancer Center at Wesley Chapel
- Georgia
  - Atlanta, Georgia, Verenigde Staten, 30308
    - Emory University Hospital Midtown
  - Atlanta, Georgia, Verenigde Staten, 30322
    - Emory University Hospital/Winship Cancer Institute
  - Decatur, Georgia, Verenigde Staten, 30033
    - Atlanta VA Medical Center
  - Savannah, Georgia, Verenigde Staten, 31405
    - Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
  - Valdosta, Georgia, Verenigde Staten, 31602
    - South Georgia Medical Center/Pearlman Cancer Center
- Hawaii
  - Honolulu, Hawaii, Verenigde Staten, 96813
    - Queen's Medical Center
  - Honolulu, Hawaii, Verenigde Staten, 96817
    - The Cancer Center of Hawaii-Liliha
  - Honolulu, Hawaii, Verenigde Staten, 96813
    - Hawaii Cancer Care Inc - Waterfront Plaza
  - Honolulu, Hawaii, Verenigde Staten, 96813
    - Queen's Cancer Cenrer - POB I
  - Honolulu, Hawaii, Verenigde Staten, 96813
    - Straub Clinic and Hospital
  - Honolulu, Hawaii, Verenigde Staten, 96813
    - University of Hawaii Cancer Center
  - Honolulu, Hawaii, Verenigde Staten, 96817
    - Kuakini Medical Center
  - Honolulu, Hawaii, Verenigde Staten, 96817
    - Queen's Cancer Center - Kuakini
  - Honolulu, Hawaii, Verenigde Staten, 96826
    - Kapiolani Medical Center for Women and Children
  - Honolulu, Hawaii, Verenigde Staten, 96819
    - Kaiser Permanente Moanalua Medical Center
  - Lihue, Hawaii, Verenigde Staten, 96766
    - Wilcox Memorial Hospital and Kauai Medical Clinic
  - ‘Aiea, Hawaii, Verenigde Staten, 96701
    - Hawaii Cancer Care - Westridge
  - ‘Aiea, Hawaii, Verenigde Staten, 96701
    - Pali Momi Medical Center
  - ‘Aiea, Hawaii, Verenigde Staten, 96701
    - Queen's Cancer Center - Pearlridge
  - ‘Aiea, Hawaii, Verenigde Staten, 96701
    - The Cancer Center of Hawaii-Pali Momi
- Idaho
  - Boise, Idaho, Verenigde Staten, 83706
    - Saint Alphonsus Cancer Care Center-Boise
  - Boise, Idaho, Verenigde Staten, 83712
    - Saint Luke's Cancer Institute - Boise
  - Caldwell, Idaho, Verenigde Staten, 83605
    - Saint Alphonsus Cancer Care Center-Caldwell
  - Coeur d'Alene, Idaho, Verenigde Staten, 83814
    - Kootenai Health - Coeur d'Alene
  - Emmett, Idaho, Verenigde Staten, 83617
    - Walter Knox Memorial Hospital
  - Fruitland, Idaho, Verenigde Staten, 83619
    - Saint Luke's Cancer Institute - Fruitland
  - Meridian, Idaho, Verenigde Staten, 83642
    - Idaho Urologic Institute-Meridian
  - Meridian, Idaho, Verenigde Staten, 83642
    - Saint Luke's Cancer Institute - Meridian
  - Nampa, Idaho, Verenigde Staten, 83687
    - Saint Alphonsus Cancer Care Center-Nampa
  - Nampa, Idaho, Verenigde Staten, 83687
    - Saint Luke's Cancer Institute - Nampa
  - Post Falls, Idaho, Verenigde Staten, 83854
    - Kootenai Clinic Cancer Services - Post Falls
  - Sandpoint, Idaho, Verenigde Staten, 83864
    - Kootenai Clinic Cancer Services - Sandpoint
  - Twin Falls, Idaho, Verenigde Staten, 83301
    - Saint Luke's Cancer Institute - Twin Falls
- Illinois
  - Alton, Illinois, Verenigde Staten, 62002
    - OSF Saint Anthony's Health Center
  - Aurora, Illinois, Verenigde Staten, 60504
    - Rush-Copley Medical Center
  - Barrington, Illinois, Verenigde Staten, 60010
    - Advocate Good Shepherd Hospital
  - Bloomington, Illinois, Verenigde Staten, 61704
    - Illinois CancerCare-Bloomington
  - Canton, Illinois, Verenigde Staten, 61520
    - Illinois CancerCare-Canton
  - Carbondale, Illinois, Verenigde Staten, 62902
    - Memorial Hospital of Carbondale
  - Carterville, Illinois, Verenigde Staten, 62918
    - SIH Cancer Institute
  - Carthage, Illinois, Verenigde Staten, 62321
    - Illinois CancerCare-Carthage
  - Centralia, Illinois, Verenigde Staten, 62801
    - Centralia Oncology Clinic
  - Centralia, Illinois, Verenigde Staten, 62801
    - Saint Mary's Hospital
  - Chicago, Illinois, Verenigde Staten, 60611
    - Northwestern University
  - Chicago, Illinois, Verenigde Staten, 60612
    - University of Illinois
  - Chicago, Illinois, Verenigde Staten, 60612
    - John H Stroger Jr Hospital of Cook County
  - Chicago, Illinois, Verenigde Staten, 60657
    - Advocate Illinois Masonic Medical Center
  - Crystal Lake, Illinois, Verenigde Staten, 60014
    - AMG Crystal Lake - Oncology
  - Danville, Illinois, Verenigde Staten, 61832
    - Carle at The Riverfront
  - Decatur, Illinois, Verenigde Staten, 62526
    - Decatur Memorial Hospital
  - Decatur, Illinois, Verenigde Staten, 62526
    - Cancer Care Specialists of Illinois - Decatur
  - Dixon, Illinois, Verenigde Staten, 61021
    - Illinois CancerCare-Dixon
  - Downers Grove, Illinois, Verenigde Staten, 60515
    - Advocate Good Samaritan Hospital
  - Effingham, Illinois, Verenigde Staten, 62401
    - Crossroads Cancer Center
  - Effingham, Illinois, Verenigde Staten, 62401
    - Carle Physician Group-Effingham
  - Elgin, Illinois, Verenigde Staten, 60123
    - Advocate Sherman Hospital
  - 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
  - Hazel Crest, Illinois, Verenigde Staten, 60429
    - Advocate South Suburban Hospital
  - Hinsdale, Illinois, Verenigde Staten, 60521
    - UChicago Medicine AdventHealth Cancer Institute Hinsdale
  - Kewanee, Illinois, Verenigde Staten, 61443
    - Illinois CancerCare-Kewanee Clinic
  - Lake Forest, Illinois, Verenigde Staten, 60045
    - Northwestern Medicine Lake Forest Hospital
  - Libertyville, Illinois, Verenigde Staten, 60048
    - Condell Memorial Hospital
  - Libertyville, Illinois, Verenigde Staten, 60048
    - AMG Libertyville - Oncology
  - Macomb, Illinois, Verenigde Staten, 61455
    - Illinois CancerCare-Macomb
  - Mattoon, Illinois, Verenigde Staten, 61938
    - Carle Physician Group-Mattoon/Charleston
  - Mount Vernon, Illinois, Verenigde Staten, 62864
    - SSM Health Good Samaritan
  - O'Fallon, Illinois, Verenigde Staten, 62269
    - Cancer Care Center of O'Fallon
  - O'Fallon, Illinois, Verenigde Staten, 62269
    - HSHS Saint Elizabeth's Hospital
  - Oak Lawn, Illinois, Verenigde Staten, 60453-2699
    - Advocate Christ Medical Center
  - Ottawa, Illinois, Verenigde Staten, 61350
    - Illinois CancerCare-Ottawa Clinic
  - Palos Heights, Illinois, Verenigde Staten, 60463
    - Advocate High Tech Medical Park
  - Park Ridge, Illinois, Verenigde Staten, 60068
    - Advocate Lutheran General Hospital
  - Pekin, Illinois, Verenigde Staten, 61554
    - Illinois CancerCare-Pekin
  - Pekin, Illinois, Verenigde Staten, 61554
    - OSF Saint Francis Radiation Oncology at Pekin
  - Peoria, Illinois, Verenigde Staten, 61636
    - Methodist Medical Center of Illinois
  - 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
  - Peru, Illinois, Verenigde Staten, 61354
    - Illinois CancerCare-Peru
  - Peru, Illinois, Verenigde Staten, 61354
    - Valley Radiation Oncology
  - Princeton, Illinois, Verenigde Staten, 61356
    - Illinois CancerCare-Princeton
  - Springfield, Illinois, Verenigde Staten, 62702
    - Southern Illinois University School of Medicine
  - Springfield, Illinois, Verenigde Staten, 62702
    - Springfield Clinic
  - Springfield, Illinois, Verenigde Staten, 62781
    - Springfield Memorial Hospital
  - Swansea, Illinois, Verenigde Staten, 62226
    - Southwest Illinois Health Services LLP
  - Urbana, Illinois, Verenigde Staten, 61801
    - Carle Cancer Center
  - Urbana, Illinois, Verenigde Staten, 61801
    - The Carle Foundation Hospital
  - Washington, Illinois, Verenigde Staten, 61571
    - Illinois CancerCare - Washington
  - Yorkville, Illinois, Verenigde Staten, 60560
    - Rush-Copley Healthcare Center
- Indiana
  - Fort Wayne, Indiana, Verenigde Staten, 46845
    - Parkview Regional Medical Center
  - Indianapolis, Indiana, Verenigde Staten, 46237
    - Franciscan Health Indianapolis
  - Indianapolis, Indiana, Verenigde Staten, 46219
    - Community Cancer Center East
  - Indianapolis, Indiana, Verenigde Staten, 46227
    - Community Cancer Center South
  - Indianapolis, Indiana, Verenigde Staten, 46256
    - Community Cancer Center North
  - Kokomo, Indiana, Verenigde Staten, 46904
    - Community Howard Regional Health
  - Michigan City, Indiana, Verenigde Staten, 46360
    - Woodland Cancer Care Center
  - Mooresville, Indiana, Verenigde Staten, 46158
    - Franciscan Health Mooresville
  - Terre Haute, Indiana, Verenigde Staten, 47804
    - Union Hospital
- Iowa
  - Ames, Iowa, Verenigde Staten, 50010
    - Mary Greeley Medical Center
  - Ames, Iowa, Verenigde Staten, 50010
    - McFarland Clinic - Ames
  - Ankeny, Iowa, Verenigde Staten, 50023
    - UI Health Care Mission Cancer and Blood - Ankeny Clinic
  - Boone, Iowa, Verenigde Staten, 50036
    - McFarland Clinic - Boone
  - Carroll, Iowa, Verenigde Staten, 51401
    - Saint Anthony Regional Hospital
  - Clive, Iowa, Verenigde Staten, 50325
    - Mercy Cancer Center-West Lakes
  - Clive, Iowa, Verenigde Staten, 50325
    - UI Health Care Mission Cancer and Blood - West Des Moines Clinic
  - Council Bluffs, Iowa, Verenigde Staten, 51503
    - Alegent Health Mercy Hospital
  - Creston, Iowa, Verenigde Staten, 50801
    - Greater Regional Medical Center
  - 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, 50314
    - Broadlawns Medical Center
  - Des Moines, Iowa, Verenigde Staten, 50316
    - Iowa Lutheran Hospital
  - Des Moines, Iowa, Verenigde Staten, 50309
    - UI Health Care Mission Cancer and Blood - Des Moines Clinic
  - Des Moines, Iowa, Verenigde Staten, 50314
    - UI Health Care Mission Cancer and Blood - Laurel Clinic
  - Fort Dodge, Iowa, Verenigde Staten, 50501
    - McFarland Clinic - Trinity Cancer Center
  - Fort Dodge, Iowa, Verenigde Staten, 50501
    - UI Healthcare Mission Cancer and Blood - Fort Dodge
  - Jefferson, Iowa, Verenigde Staten, 50129
    - McFarland Clinic - Jefferson
  - Marshalltown, Iowa, Verenigde Staten, 50158
    - McFarland Clinic - Marshalltown
  - West Des Moines, Iowa, Verenigde Staten, 50266-7700
    - Methodist West Hospital
  - West Des Moines, Iowa, Verenigde Staten, 50266
    - Mercy Medical Center-West Lakes
- Kansas
  - Garden City, Kansas, Verenigde Staten, 67846
    - Central Care Cancer Center - Garden City
  - Great Bend, Kansas, Verenigde Staten, 67530
    - Central Care Cancer Center - Great Bend
- Kentucky
  - Bardstown, Kentucky, Verenigde Staten, 40004
    - CommonSpirit Saint Joseph Hospital - Bardstown
  - Corbin, Kentucky, Verenigde Staten, 40701
    - Commonwealth Cancer Center-Corbin
  - Lexington, Kentucky, Verenigde Staten, 40504
    - Saint Joseph Radiation Oncology Resource Center
  - Lexington, Kentucky, Verenigde Staten, 40509
    - CommonSpirit Saint Joseph Medical Center - East Lexington
  - Lexington, Kentucky, Verenigde Staten, 40504
    - CommonSpirit Saint Joseph Hospital - Lexington
  - London, Kentucky, Verenigde Staten, 40741
    - CommonSpirit Saint Joseph Hospital London
  - Louisville, Kentucky, Verenigde Staten, 40202
    - The James Graham Brown Cancer Center at University of Louisville
  - Louisville, Kentucky, Verenigde Staten, 40202
    - Jewish Hospital
  - Louisville, Kentucky, Verenigde Staten, 40245
    - UofL Health Medical Center Northeast
  - Louisville, Kentucky, Verenigde Staten, 40215
    - Saints Mary and Elizabeth Hospital
  - Shepherdsville, Kentucky, Verenigde Staten, 40165
    - Jewish Hospital Medical Center South
- 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, 70808
    - Our Lady of The Lake
  - Baton Rouge, Louisiana, Verenigde Staten, 70808
    - Our Lady of the Lake Physician Group
  - New Orleans, Louisiana, Verenigde Staten, 70112
    - University Medical Center New Orleans
  - New Orleans, Louisiana, Verenigde Staten, 70112
    - Louisiana State University Health Science Center
- Maryland
  - Baltimore, Maryland, Verenigde Staten, 21204
    - Greater Baltimore Medical Center
  - Baltimore, Maryland, Verenigde Staten, 21201
    - University of Maryland/Greenebaum Cancer Center
  - Bel Air, Maryland, Verenigde Staten, 21014
    - UM Upper Chesapeake Medical Center
- Massachusetts
  - Boston, Massachusetts, Verenigde Staten, 02111
    - Tufts Medical Center
  - Lowell, Massachusetts, Verenigde Staten, 01854
    - Lowell General Hospital
  - Springfield, Massachusetts, Verenigde Staten, 01104
    - Mercy Medical Center
  - Worcester, Massachusetts, Verenigde Staten, 01655
    - UMass Memorial Medical Center - University Campus
- Michigan
  - Ann Arbor, Michigan, Verenigde Staten, 48106
    - Trinity Health Saint Joseph Mercy Hospital Ann Arbor
  - Battle Creek, Michigan, Verenigde Staten, 49017
    - Bronson Battle Creek
  - Bay City, Michigan, Verenigde Staten, 48706
    - McLaren Cancer Institute-Bay City
  - Brighton, Michigan, Verenigde Staten, 48114
    - Trinity Health IHA Medical Group Hematology Oncology - Brighton
  - Brighton, Michigan, Verenigde Staten, 48114
    - Trinity Health Medical Center - Brighton
  - Canton, Michigan, Verenigde Staten, 48188
    - Trinity Health IHA Medical Group Hematology Oncology - Canton
  - Canton, Michigan, Verenigde Staten, 48188
    - Trinity Health Medical Center - Canton
  - Caro, Michigan, Verenigde Staten, 48723
    - Caro Cancer Center
  - Chelsea, Michigan, Verenigde Staten, 48118
    - Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
  - Chelsea, Michigan, Verenigde Staten, 48118
    - Chelsea Hospital
  - Clarkston, Michigan, Verenigde Staten, 48346
    - McLaren Cancer Institute-Clarkston
  - Clarkston, Michigan, Verenigde Staten, 48346
    - Hematology Oncology Consultants-Clarkston
  - Clarkston, Michigan, Verenigde Staten, 48346
    - Newland Medical Associates-Clarkston
  - Detroit, Michigan, Verenigde Staten, 48201
    - Wayne State University/Karmanos Cancer Institute
  - Detroit, Michigan, Verenigde Staten, 48236
    - Henry Ford Health Saint John Hospital
  - East China Township, Michigan, Verenigde Staten, 48054
    - Henry Ford River District Hospital
  - Farmington Hills, Michigan, Verenigde Staten, 48334
    - Weisberg Cancer Treatment Center
  - Flint, Michigan, Verenigde Staten, 48532
    - McLaren Cancer Institute-Flint
  - Flint, Michigan, Verenigde Staten, 48532
    - Singh and Arora Hematology Oncology PC
  - Flint, Michigan, Verenigde Staten, 48503
    - Hurley Medical Center
  - Flint, Michigan, Verenigde Staten, 48503
    - Genesee Hematology Oncology PC
  - Flint, Michigan, Verenigde Staten, 48503
    - Genesys Hurley Cancer Institute
  - Flint, Michigan, Verenigde Staten, 48503
    - Cancer Hematology Centers - Flint
  - Grand Rapids, Michigan, Verenigde Staten, 49503
    - Trinity Health Grand Rapids Hospital
  - Grand Rapids, Michigan, Verenigde Staten, 49503
    - Corewell Health Grand Rapids Hospitals - Butterworth Hospital
  - Grand Rapids, Michigan, Verenigde Staten, 49503
    - Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
  - Grosse Pointe Woods, Michigan, Verenigde Staten, 48236
    - Henry Ford Saint John Hospital - Academic
  - Grosse Pointe Woods, Michigan, Verenigde Staten, 48236
    - Henry Ford Saint John Hospital - Breast
  - Grosse Pointe Woods, Michigan, Verenigde Staten, 48236
    - Henry Ford Saint John Hospital - Van Elslander
  - Kalamazoo, Michigan, Verenigde Staten, 49007
    - West Michigan Cancer Center
  - Kalamazoo, Michigan, Verenigde Staten, 49007
    - Bronson Methodist Hospital
  - Kalamazoo, Michigan, Verenigde Staten, 49009
    - Beacon Kalamazoo Cancer Center
  - Kalamazoo, Michigan, Verenigde Staten, 49048
    - Beacon Kalamazoo
  - Lansing, Michigan, Verenigde Staten, 48912
    - Mid-Michigan Physicians-Lansing
  - Lansing, Michigan, Verenigde Staten, 48910
    - Karmanos Cancer Institute at McLaren Greater Lansing
  - Lansing, Michigan, Verenigde Staten, 48912
    - University of Michigan Health - Sparrow Lansing
  - Lapeer, Michigan, Verenigde Staten, 48446
    - McLaren Cancer Institute-Lapeer Region
  - Livonia, Michigan, Verenigde Staten, 48154
    - Trinity Health Saint Mary Mercy Livonia Hospital
  - Livonia, Michigan, Verenigde Staten, 48154
    - Hope Cancer Clinic
  - Macomb, Michigan, Verenigde Staten, 48044
    - Henry Ford Warren Hospital - Breast Macomb
  - Macomb, Michigan, Verenigde Staten, 48044
    - Henry Ford Saint John Hospital - Macomb Medical
  - Marlette, Michigan, Verenigde Staten, 48453
    - Saint Mary's Oncology/Hematology Associates of Marlette
  - Mount Clemens, Michigan, Verenigde Staten, 48043
    - McLaren Cancer Institute-Macomb
  - Mount Pleasant, Michigan, Verenigde Staten, 48858
    - McLaren Cancer Institute-Central Michigan
  - Muskegon, Michigan, Verenigde Staten, 49444
    - Trinity Health Muskegon Hospital
  - Niles, Michigan, Verenigde Staten, 49120
    - Corewell Health Lakeland Hospitals - Niles Hospital
  - Norton Shores, Michigan, Verenigde Staten, 49444
    - Cancer and Hematology Centers of Western Michigan - Norton Shores
  - Petoskey, Michigan, Verenigde Staten, 49770
    - McLaren Cancer Institute-Northern Michigan
  - Pontiac, Michigan, Verenigde Staten, 48341
    - Hope Cancer Center
  - Pontiac, Michigan, Verenigde Staten, 48341
    - Trinity Health Saint Joseph Mercy Oakland Hospital
  - Pontiac, Michigan, Verenigde Staten, 48341
    - Michigan Healthcare Professionals Pontiac
  - Pontiac, Michigan, Verenigde Staten, 48341
    - Trinity Health IHA Medical Group-Alice Gustafson Center
  - Port Huron, Michigan, Verenigde Staten, 48060
    - McLaren-Port Huron
  - Reed City, Michigan, Verenigde Staten, 49677
    - Corewell Health Reed City Hospital
  - Rochester Hills, Michigan, Verenigde Staten, 48309
    - Henry Ford Rochester Hospital
  - Saginaw, Michigan, Verenigde Staten, 48604
    - Oncology Hematology Associates of Saginaw Valley PC
  - Saginaw, Michigan, Verenigde Staten, 48601
    - MyMichigan Medical Center Saginaw
  - Saint Joseph, Michigan, Verenigde Staten, 49085
    - Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
  - Saint Joseph, Michigan, Verenigde Staten, 49085
    - Corewell Health Lakeland Hospitals - Saint Joseph Hospital
  - Sterling Heights, Michigan, Verenigde Staten, 48312
    - Bhadresh Nayak MD PC-Sterling Heights
  - Tawas City, Michigan, Verenigde Staten, 48764
    - MyMichigan Medical Center Tawas
  - Traverse City, Michigan, Verenigde Staten, 49684
    - Munson Medical Center
  - Warren, Michigan, Verenigde Staten, 48088
    - Advanced Breast Care Center PLLC
  - Warren, Michigan, Verenigde Staten, 48093
    - Macomb Hematology Oncology PC
  - Warren, Michigan, Verenigde Staten, 48093
    - Henry Ford Madison Heights Hospital - Breast
  - Warren, Michigan, Verenigde Staten, 48093
    - Henry Ford Health Warren Hospital
  - Warren, Michigan, Verenigde Staten, 48093
    - Henry Ford Warren Hospital - GLCMS
  - West Branch, Michigan, Verenigde Staten, 48661
    - Saint Mary's Oncology/Hematology Associates of West Branch
  - Wyoming, Michigan, Verenigde Staten, 49519
    - University of Michigan Health - West
  - Ypsilanti, Michigan, Verenigde Staten, 48197
    - Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
  - Ypsilanti, Michigan, Verenigde Staten, 48106
    - Huron Gastroenterology PC
- Minnesota
  - Bemidji, Minnesota, Verenigde Staten, 56601
    - Sanford Joe Lueken Cancer Center
  - Burnsville, Minnesota, Verenigde Staten, 55337
    - Fairview Ridges Hospital
  - Burnsville, Minnesota, Verenigde Staten, 55337
    - Minnesota Oncology - Burnsville
  - Cambridge, Minnesota, Verenigde Staten, 55008
    - Cambridge Medical Center
  - Coon Rapids, Minnesota, Verenigde Staten, 55433
    - Mercy Hospital
  - Edina, Minnesota, Verenigde Staten, 55435
    - Fairview Southdale Hospital
  - Fridley, Minnesota, Verenigde Staten, 55432
    - Unity Hospital
  - Maple Grove, Minnesota, Verenigde Staten, 55369
    - Fairview Clinics and Surgery Center Maple Grove
  - 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
  - Minneapolis, Minnesota, Verenigde Staten, 55417
    - Minneapolis VA Medical Center
  - Monticello, Minnesota, Verenigde Staten, 55362
    - Monticello Cancer Center
  - New Ulm, Minnesota, Verenigde Staten, 56073
    - New Ulm Medical Center
  - Princeton, Minnesota, Verenigde Staten, 55371
    - Fairview Northland Medical Center
  - Robbinsdale, Minnesota, Verenigde Staten, 55422
    - North Memorial Medical Health Center
  - Saint Louis Park, Minnesota, Verenigde Staten, 55416
    - Park Nicollet Clinic - Saint Louis Park
  - 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
  - Thief River Falls, Minnesota, Verenigde Staten, 56701
    - Sanford Thief River Falls Medical Center
  - 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
  - Worthington, Minnesota, Verenigde Staten, 56187
    - Sanford Cancer Center Worthington
  - Wyoming, Minnesota, Verenigde Staten, 55092
    - Fairview Lakes Medical Center
- Missouri
  - Ballwin, Missouri, Verenigde Staten, 63011
    - Mercy Oncology and Hematology - Clayton-Clarkson
  - Bolivar, Missouri, Verenigde Staten, 65613
    - Central Care Cancer Center - Bolivar
  - Bonne Terre, Missouri, Verenigde Staten, 63628
    - Parkland Health Center-Bonne Terre
  - Branson, Missouri, Verenigde Staten, 65616
    - Cox Cancer Center Branson
  - Cape Girardeau, Missouri, Verenigde Staten, 63703
    - Saint Francis Medical Center
  - Cape Girardeau, Missouri, Verenigde Staten, 63703
    - Mercy Cancer Center - Cape Girardeau
  - Jefferson City, Missouri, Verenigde Staten, 65109
    - MU Health Care Goldschmidt Cancer Center
  - Joplin, Missouri, Verenigde Staten, 64804
    - Freeman Health System
  - Joplin, Missouri, Verenigde Staten, 64804
    - Mercy Hospital Joplin
  - Rolla, Missouri, Verenigde Staten, 65401
    - Mercy Clinic-Rolla-Cancer and Hematology
  - Rolla, Missouri, Verenigde Staten, 65401
    - Phelps Health Delbert Day Cancer Institute
  - Saint Joseph, Missouri, Verenigde Staten, 64506
    - Heartland Regional Medical Center
  - Sainte Genevieve, Missouri, Verenigde Staten, 63670
    - Sainte Genevieve County Memorial Hospital
  - Springfield, Missouri, Verenigde Staten, 65807
    - CoxHealth South Hospital
  - Springfield, Missouri, Verenigde Staten, 65804
    - Mercy Hospital Springfield
  - St Louis, Missouri, Verenigde Staten, 63131
    - Missouri Baptist Medical Center
  - St Louis, Missouri, Verenigde Staten, 63109
    - Mercy Infusion Center - Chippewa
  - St Louis, Missouri, Verenigde Staten, 63141
    - Mercy Hospital Saint Louis
  - St Louis, Missouri, Verenigde Staten, 63128
    - Mercy Hospital South
  - Sullivan, Missouri, Verenigde Staten, 63080
    - Missouri Baptist Sullivan Hospital
  - Washington, Missouri, Verenigde Staten, 63090
    - Mercy Hospital Washington
- Montana
  - Anaconda, Montana, Verenigde Staten, 59711
    - Community Hospital of Anaconda
  - Billings, Montana, Verenigde Staten, 59101
    - Billings Clinic Cancer Center
  - Billings, Montana, Verenigde Staten, 59101
    - Saint Vincent Healthcare
  - Billings, Montana, Verenigde Staten, 59102
    - Saint Vincent Frontier Cancer Center
  - Bozeman, Montana, Verenigde Staten, 59715
    - Bozeman Health Deaconess Hospital
  - Butte, Montana, Verenigde Staten, 59701
    - Saint James Community Hospital and Cancer Treatment Center
  - Great Falls, Montana, Verenigde Staten, 59405
    - Great Falls Clinic
  - Great Falls, Montana, Verenigde Staten, 59405
    - Benefis Sletten Cancer Institute
  - Helena, Montana, Verenigde Staten, 59601
    - Saint Peter's Community Hospital
  - Kalispell, Montana, Verenigde Staten, 59901
    - Logan Health Medical Center
  - Missoula, Montana, Verenigde Staten, 59802
    - Saint Patrick Hospital - Community Hospital
  - Missoula, Montana, Verenigde Staten, 59804
    - Community Medical Center
- Nebraska
  - Bellevue, Nebraska, Verenigde Staten, 68123
    - Nebraska Medicine-Bellevue
  - Grand Island, Nebraska, Verenigde Staten, 68803
    - Nebraska Cancer Specialists/Oncology Hematology West PC
  - Kearney, Nebraska, Verenigde Staten, 68847
    - CHI Health Good Samaritan
  - Lincoln, Nebraska, Verenigde Staten, 68510
    - Saint Elizabeth Regional Medical Center
  - Omaha, Nebraska, Verenigde Staten, 68198
    - University of Nebraska Medical Center
  - Omaha, Nebraska, Verenigde Staten, 68124
    - Alegent Health Bergan Mercy Medical Center
  - Omaha, Nebraska, Verenigde Staten, 68118
    - Nebraska Medicine-Village Pointe
  - Omaha, Nebraska, Verenigde Staten, 68122
    - Alegent Health Immanuel Medical Center
  - Omaha, Nebraska, Verenigde Staten, 68130
    - Alegent Health Lakeside Hospital
  - Papillion, Nebraska, Verenigde Staten, 68046
    - Midlands Community Hospital
- Nevada
  - Carson City, Nevada, Verenigde Staten, 89703
    - Carson Tahoe Regional Medical Center
  - 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, 89052
    - Comprehensive Cancer Centers of Nevada-Horizon Ridge
  - Henderson, Nevada, Verenigde Staten, 89074
    - Las Vegas Urology - Green Valley
  - Henderson, Nevada, Verenigde Staten, 89074
    - Las Vegas Urology - Pebble
  - Henderson, Nevada, Verenigde Staten, 89074
    - Urology Specialists of Nevada - Green Valley
  - Henderson, Nevada, Verenigde Staten, 89074
    - Oncology Las Vegas - Henderson
  - Las Vegas, Nevada, Verenigde Staten, 89144
    - Summerlin Hospital Medical Center
  - Las Vegas, Nevada, Verenigde Staten, 89109
    - Sunrise Hospital and Medical Center
  - Las Vegas, Nevada, Verenigde Staten, 89102
    - OptumCare Cancer Care at Charleston
  - 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, 89128
    - OptumCare Cancer Care at MountainView
  - Las Vegas, Nevada, Verenigde Staten, 89135
    - Alliance for Childhood Diseases/Cure 4 the Kids Foundation
  - Las Vegas, Nevada, Verenigde Staten, 89144
    - Comprehensive Cancer Centers of Nevada - Town Center
  - 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, 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, 89128
    - Ann M Wierman MD LTD
  - Las Vegas, Nevada, Verenigde Staten, 89074
    - Las Vegas Urology - Pecos
  - Las Vegas, Nevada, Verenigde Staten, 89102
    - Desert West Surgery
  - Las Vegas, Nevada, Verenigde Staten, 89103
    - Hope Cancer Care of Nevada
  - Las Vegas, Nevada, Verenigde Staten, 89106
    - Urology Specialists of Nevada - Central
  - Las Vegas, Nevada, Verenigde Staten, 89113
    - Las Vegas Prostate Cancer Center
  - Las Vegas, Nevada, Verenigde Staten, 89113
    - Las Vegas Urology - Sunset
  - Las Vegas, Nevada, Verenigde Staten, 89128
    - Las Vegas Urology - Cathedral Rock
  - Las Vegas, Nevada, Verenigde Staten, 89128
    - Las Vegas Urology - Smoke Ranch
  - Las Vegas, Nevada, Verenigde Staten, 89128
    - Urology Specialists of Nevada - Northwest
  - Las Vegas, Nevada, Verenigde Staten, 89169
    - University Cancer Center
  - Las Vegas, Nevada, Verenigde Staten, 89113
    - Urology Specialists of Nevada - Southwest
  - Las Vegas, Nevada, Verenigde Staten, 89128
    - Oncology Las Vegas - Tenaya
  - Las Vegas, Nevada, Verenigde Staten, 89183
    - OptumCare Cancer Care at Fort Apache
  - Pahrump, Nevada, Verenigde Staten, 89048
    - Hope Cancer Care of Nevada-Pahrump
  - Reno, Nevada, Verenigde Staten, 89502
    - Renown Regional Medical Center
  - Reno, Nevada, Verenigde Staten, 89503
    - Saint Mary's Regional Medical Center
  - Reno, Nevada, Verenigde Staten, 89509
    - Radiation Oncology Associates
- New Hampshire
  - Lebanon, New Hampshire, Verenigde Staten, 03756
    - Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
- New Jersey
  - Cape May Court House, New Jersey, Verenigde Staten, 08210
    - AtlantiCare Health Park-Cape May Court House
  - Egg Harbor, New Jersey, Verenigde Staten, 08234
    - AtlantiCare Surgery Center
  - Hamilton, New Jersey, Verenigde Staten, 08690
    - The Cancer Institute of New Jersey Hamilton
  - Jersey City, New Jersey, Verenigde Staten, 07302
    - Jersey City Medical Center
  - Livingston, New Jersey, Verenigde Staten, 07039
    - Cooperman Barnabas Medical Center
  - Moorestown, New Jersey, Verenigde Staten, 08057
    - Virtua Samson Cancer Center
  - Morristown, New Jersey, Verenigde Staten, 07960
    - Morristown Medical Center
  - Mount Holly, New Jersey, Verenigde Staten, 08060
    - Virtua Memorial
  - New Brunswick, New Jersey, Verenigde Staten, 08903
    - Rutgers Cancer Institute of New Jersey
  - Newark, New Jersey, Verenigde Staten, 07101
    - Rutgers New Jersey Medical School
  - Summit, New Jersey, Verenigde Staten, 07902
    - Overlook Hospital
  - Voorhees Township, New Jersey, Verenigde Staten, 08043
    - Virtua Voorhees
- New Mexico
  - Albuquerque, New Mexico, Verenigde Staten, 87106
    - University of New Mexico Cancer Center
- New York
  - Brooklyn, New York, Verenigde Staten, 11215
    - New York-Presbyterian/Brooklyn Methodist Hospital
  - Buffalo, New York, Verenigde Staten, 14263
    - Roswell Park Cancer Institute
  - New York, New York, Verenigde Staten, 10065
    - NYP/Weill Cornell Medical Center
  - Rochester, New York, Verenigde Staten, 14642
    - University of Rochester
  - Stony Brook, New York, Verenigde Staten, 11794
    - Stony Brook University Medical Center
  - Syracuse, New York, Verenigde Staten, 13210
    - State University of New York Upstate Medical University
  - Syracuse, New York, Verenigde Staten, 13215
    - SUNY Upstate Medical Center-Community Campus
  - The Bronx, New York, Verenigde Staten, 10461
    - Montefiore Medical Center-Einstein Campus
  - The Bronx, New York, Verenigde Staten, 10467
    - Montefiore Medical Center - Moses Campus
  - The Bronx, New York, Verenigde Staten, 10461
    - Montefiore Medical Center-Weiler Hospital
- North Carolina
  - Asheville, North Carolina, Verenigde Staten, 28803
    - AdventHealth Infusion Center Asheville
  - Charlotte, North Carolina, Verenigde Staten, 28204
    - Novant Health Presbyterian Medical Center
  - Clyde, North Carolina, Verenigde Staten, 28721
    - AdventHealth Infusion Center Haywood
  - Gastonia, North Carolina, Verenigde Staten, 28054
    - CaroMont Regional Medical Center
  - Greenville, North Carolina, Verenigde Staten, 27834
    - East Carolina University
  - Hendersonville, North Carolina, Verenigde Staten, 28792
    - AdventHealth Hendersonville
  - Huntersville, North Carolina, Verenigde Staten, 28078
    - Novant Health Cancer Institute - Huntersville
  - Huntersville, North Carolina, Verenigde Staten, 28078
    - Novant Health Presbyterian Medical Center Huntersville
  - Kernersville, North Carolina, Verenigde Staten, 27284
    - Novant Health Cancer Institute - Kernersville
  - Matthews, North Carolina, Verenigde Staten, 28105
    - Novant Health Cancer Institute - Matthews
  - Mooresville, North Carolina, Verenigde Staten, 28117
    - Novant Health Cancer Institute - Mooresville
  - Mount Airy, North Carolina, Verenigde Staten, 27030
    - Novant Health Cancer Institute - Mount Airy
  - New Bern, North Carolina, Verenigde Staten, 28561
    - CarolinaEast Medical Center
  - North Wilkesboro, North Carolina, Verenigde Staten, 28659
    - Novant Health Cancer Institute - Wilkesboro
  - Statesville, North Carolina, Verenigde Staten, 28625
    - Novant Health Cancer Institute - Statesville
  - Thomasville, North Carolina, Verenigde Staten, 27360
    - Novant Health Cancer Institute - Thomasville
  - Weaverville, North Carolina, Verenigde Staten, 28787
    - AdventHealth Infusion Center Weaverville
  - Winston-Salem, North Carolina, Verenigde Staten, 27103
    - Novant Health Forsyth Medical Center
- North Dakota
  - Bismarck, North Dakota, Verenigde Staten, 58501
    - Sanford Bismarck Medical Center
  - Fargo, North Dakota, Verenigde Staten, 58122
    - Sanford Roger Maris Cancer Center
  - Fargo, North Dakota, Verenigde Staten, 58122
    - Sanford Broadway Medical Center
  - Fargo, North Dakota, Verenigde Staten, 58103
    - Sanford South University Medical Center
  - Fargo, North Dakota, Verenigde Staten, 58103
    - Southpointe-Sanford Medical Center Fargo
  - Fargo, North Dakota, Verenigde Staten, 58104
    - Sanford Medical Center Fargo
- Ohio
  - Akron, Ohio, Verenigde Staten, 44304
    - Summa Health System - Akron Campus
  - Avon, Ohio, Verenigde Staten, 44011
    - UH Seidman Cancer Center at UH Avon Health Center
  - Barberton, Ohio, Verenigde Staten, 44203
    - Summa Health System - Barberton Campus
  - Beachwood, Ohio, Verenigde Staten, 44122
    - UHHS-Chagrin Highlands Medical Center
  - Canton, Ohio, Verenigde Staten, 44708
    - Cleveland Clinic Mercy Hospital
  - Centerville, Ohio, Verenigde Staten, 45459
    - Miami Valley Hospital South
  - Chardon, Ohio, Verenigde Staten, 44024
    - Geauga Hospital
  - Cincinnati, Ohio, Verenigde Staten, 45220
    - Good Samaritan Hospital - Cincinnati
  - Cincinnati, Ohio, Verenigde Staten, 45242
    - Bethesda North Hospital
  - Cincinnati, Ohio, Verenigde Staten, 45247
    - TriHealth Cancer Institute-Westside
  - Cincinnati, Ohio, Verenigde Staten, 45255
    - TriHealth Cancer Institute-Anderson
  - Cleveland, Ohio, Verenigde Staten, 44106
    - Case Western Reserve University
  - Cleveland, Ohio, Verenigde Staten, 44109
    - MetroHealth Medical Center
  - Cleveland, Ohio, Verenigde Staten, 44195
    - Cleveland Clinic Foundation
  - Cleveland, Ohio, Verenigde Staten, 44111
    - Cleveland Clinic Cancer Center/Fairview Hospital
  - Columbus, Ohio, Verenigde Staten, 43210
    - Ohio State University Comprehensive Cancer Center
  - Dayton, Ohio, Verenigde Staten, 45409
    - Miami Valley Hospital
  - Dayton, Ohio, Verenigde Staten, 45415
    - Miami Valley Hospital North
  - Dayton, Ohio, Verenigde Staten, 45409
    - Premier Blood and Cancer Center
  - Elyria, Ohio, Verenigde Staten, 44035
    - Mercy Cancer Center-Elyria
  - Franklin, Ohio, Verenigde Staten, 45005-1066
    - Atrium Medical Center-Middletown Regional Hospital
  - Greenville, Ohio, Verenigde Staten, 45331
    - Miami Valley Cancer Care and Infusion
  - Mansfield, Ohio, Verenigde Staten, 44906
    - Cleveland Clinic Cancer Center Mansfield
  - Mayfield Heights, Ohio, Verenigde Staten, 44124
    - Hillcrest Hospital Cancer Center
  - Medina, Ohio, Verenigde Staten, 44256
    - Summa Health Medina Medical Center
  - Mentor, Ohio, Verenigde Staten, 44060
    - UH Seidman Cancer Center at Lake Health Mentor Campus
  - Middleburg Heights, Ohio, Verenigde Staten, 44130
    - UH Seidman Cancer Center at Southwest General Hospital
  - Parma, Ohio, Verenigde Staten, 44129
    - University Hospitals Parma Medical Center
  - Ravenna, Ohio, Verenigde Staten, 44266
    - University Hospitals Portage Medical Center
  - Sandusky, Ohio, Verenigde Staten, 44870
    - North Coast Cancer Care
  - Strongsville, Ohio, Verenigde Staten, 44136
    - Cleveland Clinic Cancer Center Strongsville
  - Troy, Ohio, Verenigde Staten, 45373
    - Upper Valley Medical Center
  - Westlake, Ohio, Verenigde Staten, 44145
    - UH Seidman Cancer Center at Saint John Medical Center
  - Westlake, Ohio, Verenigde Staten, 44145
    - UHHS-Westlake Medical Center
- Oklahoma
  - Lawton, Oklahoma, Verenigde Staten, 73505
    - Cancer Centers of Southwest Oklahoma Research
  - Oklahoma City, Oklahoma, Verenigde Staten, 73104
    - University of Oklahoma Health Sciences Center
  - Oklahoma City, Oklahoma, Verenigde Staten, 73120
    - Mercy Hospital Oklahoma City
  - Tulsa, Oklahoma, Verenigde Staten, 74146
    - Oklahoma Cancer Specialists and Research Institute-Tulsa
- Oregon
  - Baker City, Oregon, Verenigde Staten, 97814
    - Saint Alphonsus Cancer Care Center-Baker City
  - Bend, Oregon, Verenigde Staten, 97701
    - Saint Charles Health System
  - Clackamas, Oregon, Verenigde Staten, 97015
    - Clackamas Radiation Oncology Center
  - Clackamas, Oregon, Verenigde Staten, 97015
    - Providence Cancer Institute Clackamas Clinic
  - Coos Bay, Oregon, Verenigde Staten, 97420
    - Bay Area Hospital
  - Newberg, Oregon, Verenigde Staten, 97132
    - Providence Newberg Medical Center
  - Ontario, Oregon, Verenigde Staten, 97914
    - Saint Alphonsus Cancer Care Center-Ontario
  - Oregon City, Oregon, Verenigde Staten, 97045
    - Providence Willamette Falls Medical Center
  - Portland, Oregon, Verenigde Staten, 97213
    - Providence Portland Medical Center
  - Portland, Oregon, Verenigde Staten, 97225
    - Providence Saint Vincent Medical Center
  - Redmond, Oregon, Verenigde Staten, 97756
    - Saint Charles Health System-Redmond
- Pennsylvania
  - Allentown, Pennsylvania, Verenigde Staten, 18103
    - Lehigh Valley Hospital-Cedar Crest
  - Bethlehem, Pennsylvania, Verenigde Staten, 18017
    - Lehigh Valley Hospital - Muhlenberg
  - Chadds Ford, Pennsylvania, Verenigde Staten, 19317
    - Christiana Care Health System-Concord Health Center
  - Danville, Pennsylvania, Verenigde Staten, 17822
    - Geisinger Medical Center
  - East Stroudsburg, Pennsylvania, Verenigde Staten, 18301
    - Pocono Medical Center
  - Erie, Pennsylvania, Verenigde Staten, 16505
    - UPMC Hillman Cancer Center Erie
  - Farrell, Pennsylvania, Verenigde Staten, 16121
    - UPMC Cancer Center at UPMC Horizon
  - Hazleton, Pennsylvania, Verenigde Staten, 18201
    - Geisinger Medical Center-Cancer Center Hazleton
  - Hazleton, Pennsylvania, Verenigde Staten, 18201
    - Lehigh Valley Hospital-Hazleton
  - Hershey, Pennsylvania, Verenigde Staten, 17033-0850
    - Penn State Milton S Hershey Medical Center
  - Lewisburg, Pennsylvania, Verenigde Staten, 17837
    - Geisinger Medical Oncology-Lewisburg
  - Lewistown, Pennsylvania, Verenigde Staten, 17044
    - Lewistown Hospital
  - Monroeville, Pennsylvania, Verenigde Staten, 15146
    - UPMC Hillman Cancer Center - Monroeville
  - Monroeville, Pennsylvania, Verenigde Staten, 15146
    - UPMC Cancer Center - Monroeville
  - Philadelphia, Pennsylvania, Verenigde Staten, 19107
    - Thomas Jefferson University Hospital
  - Philadelphia, Pennsylvania, Verenigde Staten, 19114
    - Jefferson Torresdale Hospital
  - Pittsburgh, Pennsylvania, Verenigde Staten, 15232
    - UPMC Hillman Cancer Center
  - Pittsburgh, Pennsylvania, Verenigde Staten, 15232
    - UPMC-Shadyside Hospital
  - Pittsburgh, Pennsylvania, Verenigde Staten, 15237
    - UPMC-Passavant Hospital
  - Pittsburgh, Pennsylvania, Verenigde Staten, 15243
    - UPMC-Saint Clair Hospital Cancer Center
  - Pottsville, Pennsylvania, Verenigde Staten, 17901
    - Geisinger Cancer Services-Pottsville
  - Scranton, Pennsylvania, Verenigde Staten, 18510
    - Community Medical Center
  - West Reading, Pennsylvania, Verenigde Staten, 19611
    - Reading Hospital
  - Wilkes-Barre, Pennsylvania, Verenigde Staten, 18711
    - Geisinger Wyoming Valley/Henry Cancer Center
  - Willow Grove, Pennsylvania, Verenigde Staten, 19090
    - Asplundh Cancer Pavilion
- South Carolina
  - Boiling Springs, South Carolina, Verenigde Staten, 29316
    - Prisma Health Cancer Institute - Spartanburg
  - Charleston, South Carolina, Verenigde Staten, 29425
    - Medical University of South Carolina
  - Easley, South Carolina, Verenigde Staten, 29640
    - Prisma Health Cancer Institute - Easley
  - Gaffney, South Carolina, Verenigde Staten, 29341
    - Gibbs Cancer Center-Gaffney
  - Greenville, South Carolina, Verenigde Staten, 29605
    - Prisma Health Cancer Institute - Faris
  - Greenville, South Carolina, Verenigde Staten, 29607
    - Saint Francis Cancer Center
  - Greenville, South Carolina, Verenigde Staten, 29615
    - Prisma Health Cancer Institute - Eastside
  - Greenville, South Carolina, Verenigde Staten, 29605
    - Prisma Health Cancer Institute - Butternut
  - Greenville, South Carolina, Verenigde Staten, 29601
    - Saint Francis Hospital
  - Greer, South Carolina, Verenigde Staten, 29650
    - Prisma Health Cancer Institute - Greer
  - Greer, South Carolina, Verenigde Staten, 29651
    - Gibbs Cancer Center-Pelham
  - Seneca, South Carolina, Verenigde Staten, 29672
    - Prisma Health Cancer Institute - Seneca
  - Spartanburg, South Carolina, Verenigde Staten, 29303
    - Spartanburg Medical Center
  - Union, South Carolina, Verenigde Staten, 29379
    - SMC Center for Hematology Oncology Union
- South Dakota
  - Aberdeen, South Dakota, Verenigde Staten, 57401
    - Avera Cancer Institute-Aberdeen
  - Sioux Falls, South Dakota, Verenigde Staten, 57105
    - Avera Cancer Institute
  - 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
- Tennessee
  - Nashville, Tennessee, Verenigde Staten, 37232
    - Vanderbilt University/Ingram Cancer Center
- Texas
  - Amarillo, Texas, Verenigde Staten, 79106
    - The Don and Sybil Harrington Cancer Center
  - Austin, Texas, Verenigde Staten, 78712
    - University of Texas at Austin
  - Austin, Texas, Verenigde Staten, 78701
    - Dell Seton Medical Center at The University of Texas
  - Bryan, Texas, Verenigde Staten, 77802
    - Saint Joseph Regional Cancer Center
  - Dallas, Texas, Verenigde Staten, 75235
    - Parkland Memorial Hospital
  - Dallas, Texas, Verenigde Staten, 75390
    - UT Southwestern/Simmons Cancer Center-Dallas
  - Houston, Texas, Verenigde Staten, 77030
    - Memorial Hermann Texas Medical Center
  - Humble, Texas, Verenigde Staten, 77338
    - Memorial Hermann Northeast Hospital
- Utah
  - American Fork, Utah, Verenigde Staten, 84003
    - American Fork Hospital / Huntsman Intermountain Cancer Center
  - Cedar City, Utah, Verenigde Staten, 84720
    - Sandra L Maxwell Cancer Center
  - Logan, Utah, Verenigde Staten, 84321
    - Logan Regional Hospital
  - Murray, Utah, Verenigde Staten, 84107
    - Intermountain Medical Center
  - Ogden, Utah, Verenigde Staten, 84403
    - McKay-Dee Hospital Center
  - Provo, Utah, Verenigde Staten, 84604
    - Utah Valley Regional Medical Center
  - Riverton, Utah, Verenigde Staten, 84065
    - Riverton Hospital
  - Salt Lake City, Utah, Verenigde Staten, 84106
    - Utah Cancer Specialists-Salt Lake City
  - Salt Lake City, Utah, Verenigde Staten, 84143
    - LDS Hospital
  - St. George, Utah, Verenigde Staten, 84770
    - Saint George Regional Medical Center
- Vermont
  - Saint Johnsbury, Vermont, Verenigde Staten, 05819
    - Dartmouth Cancer Center - North
- Virginia
  - Richmond, Virginia, Verenigde Staten, 23235
    - VCU Massey Cancer Center at Stony Point
  - Richmond, Virginia, Verenigde Staten, 23298
    - VCU Massey Comprehensive Cancer Center
- Washington
  - Aberdeen, Washington, Verenigde Staten, 98520
    - Providence Regional Cancer System-Aberdeen
  - Auburn, Washington, Verenigde Staten, 98001
    - MultiCare Auburn Medical Center
  - Bellevue, Washington, Verenigde Staten, 98004
    - Overlake Medical Center
  - Bellingham, Washington, Verenigde Staten, 98225
    - PeaceHealth Saint Joseph Medical Center
  - Burien, Washington, Verenigde Staten, 98166
    - Saint Anne Hospital
  - Centralia, Washington, Verenigde Staten, 98531
    - Providence Regional Cancer System-Centralia
  - Edmonds, Washington, Verenigde Staten, 98026
    - Swedish Cancer Institute-Edmonds
  - Enumclaw, Washington, Verenigde Staten, 98022
    - Saint Elizabeth Hospital
  - Everett, Washington, Verenigde Staten, 98201
    - Providence Regional Cancer Partnership
  - Federal Way, Washington, Verenigde Staten, 98003
    - Saint Francis Hospital
  - Gig Harbor, Washington, Verenigde Staten, 98335
    - MultiCare Gig Harbor Medical Park
  - Issaquah, Washington, Verenigde Staten, 98029
    - Swedish Cancer Institute-Issaquah
  - Kennewick, Washington, Verenigde Staten, 99336
    - Kadlec Clinic Hematology and Oncology
  - Lacey, Washington, Verenigde Staten, 98503
    - Providence Regional Cancer System-Lacey
  - Lakewood, Washington, Verenigde Staten, 98499
    - Saint Clare Hospital
  - Longview, Washington, Verenigde Staten, 98632
    - PeaceHealth Saint John Medical Center
  - Mount Vernon, Washington, Verenigde Staten, 98274
    - Skagit Regional Health Cancer Care Center
  - Port Townsend, Washington, Verenigde Staten, 98368
    - Jefferson Healthcare
  - Poulsbo, Washington, Verenigde Staten, 98370
    - Harrison HealthPartners Hematology and Oncology-Poulsbo
  - Puyallup, Washington, Verenigde Staten, 98372
    - MultiCare Good Samaritan Hospital
  - Renton, Washington, Verenigde Staten, 98055
    - Valley Medical Center
  - Seattle, Washington, Verenigde Staten, 98107
    - Swedish Medical Center-Ballard Campus
  - Seattle, Washington, Verenigde Staten, 98122
    - Swedish Medical Center-First Hill
  - Seattle, Washington, Verenigde Staten, 98104
    - Pacific Gynecology Specialists
  - Seattle, Washington, Verenigde Staten, 98122-5711
    - Swedish Medical Center-Cherry Hill
  - Sedro-Woolley, Washington, Verenigde Staten, 98284
    - PeaceHealth United General Medical Center
  - Shelton, Washington, Verenigde Staten, 98584
    - Providence Regional Cancer System-Shelton
  - Silverdale, Washington, Verenigde Staten, 98383
    - Saint Joseph Medical Center Hematology and Oncology - Silverdale
  - Spokane, Washington, Verenigde Staten, 99204
    - MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
  - Spokane, Washington, Verenigde Staten, 99218
    - MultiCare Deaconess Cancer and Blood Specialty Center - North
  - Spokane Valley, Washington, Verenigde Staten, 99216
    - MultiCare Deaconess Cancer and Blood Specialty Center - Valley
  - Tacoma, Washington, Verenigde Staten, 98405
    - Mary Bridge Children's Hospital and Health Center
  - Tacoma, Washington, Verenigde Staten, 98405
    - Northwest Medical Specialties PLLC
  - Tacoma, Washington, Verenigde Staten, 98405
    - MultiCare Tacoma General Hospital
  - Tacoma, Washington, Verenigde Staten, 98405
    - Franciscan Research Center-Northwest Medical Plaza
  - Vancouver, Washington, Verenigde Staten, 98664
    - PeaceHealth Southwest Medical Center
  - Walla Walla, Washington, Verenigde Staten, 99362
    - Providence Saint Mary Regional Cancer Center
  - Yakima, Washington, Verenigde Staten, 98902
    - North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
  - Yelm, Washington, Verenigde Staten, 98597
    - Providence Regional Cancer System-Yelm
- Wisconsin
  - Appleton, Wisconsin, Verenigde Staten, 54911
    - ThedaCare Regional Cancer Center
  - Burlington, Wisconsin, Verenigde Staten, 53105
    - Aurora Cancer Care-Southern Lakes VLCC
  - Eau Claire, Wisconsin, Verenigde Staten, 54701
    - Marshfield Medical Center-EC Cancer Center
  - Eau Claire, Wisconsin, Verenigde Staten, 54701
    - HSHS Sacred Heart Hospital
  - 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
  - Kenosha, Wisconsin, Verenigde Staten, 53142
    - Aurora Cancer Care-Kenosha South
  - La Crosse, Wisconsin, Verenigde Staten, 54601
    - Gundersen Lutheran Medical Center
  - Manitowoc, Wisconsin, Verenigde Staten, 54221
    - Holy Family Memorial Hospital
  - Marinette, Wisconsin, Verenigde Staten, 54143
    - Aurora Bay Area Medical Group-Marinette
  - Marshfield, Wisconsin, Verenigde Staten, 54449
    - Marshfield Medical Center-Marshfield
  - Menomonee Falls, Wisconsin, Verenigde Staten, 53051
    - Froedtert Menomonee Falls Hospital
  - Milwaukee, Wisconsin, Verenigde Staten, 53226
    - Medical College of Wisconsin
  - 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 Medical Center - Minocqua
  - Mukwonago, Wisconsin, Verenigde Staten, 53149
    - ProHealth D N Greenwald Center
  - New Richmond, Wisconsin, Verenigde Staten, 54017
    - Cancer Center of Western Wisconsin
  - Oak Creek, Wisconsin, Verenigde Staten, 53154
    - Drexel Town Square Health Center
  - Oconomowoc, Wisconsin, Verenigde Staten, 53066
    - ProHealth Oconomowoc Memorial Hospital
  - Oconto Falls, Wisconsin, Verenigde Staten, 54154
    - Saint Vincent Hospital Cancer Center at Oconto Falls
  - Oshkosh, Wisconsin, Verenigde Staten, 54904
    - Vince Lombardi Cancer Clinic - Oshkosh
  - Racine, Wisconsin, Verenigde Staten, 53406
    - Aurora Cancer Care-Racine
  - Rice Lake, Wisconsin, Verenigde Staten, 54868
    - Marshfield Medical Center-Rice Lake
  - Sheboygan, Wisconsin, Verenigde Staten, 53081
    - Vince Lombardi Cancer Clinic-Sheboygan
  - Sheboygan, Wisconsin, Verenigde Staten, 53081
    - HSHS Saint Nicholas Hospital
  - Stevens Point, Wisconsin, Verenigde Staten, 54482
    - Marshfield Medical Center-River Region at Stevens Point
  - Sturgeon Bay, Wisconsin, Verenigde Staten, 54235-1495
    - Saint Vincent Hospital Cancer Center at 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
  - Wauwatosa, Wisconsin, Verenigde Staten, 53226
    - Aurora Cancer Care-Milwaukee West
  - West Allis, Wisconsin, Verenigde Staten, 53227
    - Aurora West Allis Medical Center
  - West Bend, Wisconsin, Verenigde Staten, 53095
    - Froedtert West Bend Hospital/Kraemer Cancer Center
  - Weston, Wisconsin, Verenigde Staten, 54476
    - Marshfield Medical Center - Weston
- Wyoming
  - Cheyenne, Wyoming, Verenigde Staten, 82001
    - Cheyenne Regional Medical Center-West
  - 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:

STEP 1: Age >= 18 years
STEP 1: Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
STEP 1: Patients must have oropharynx cancer (American Joint Committee on Cancer [AJCC] 8) that is p16-positive by immunohistochemistry OR p16 equivocal by IHC and HPV positive by in situ hybridization with the following criteria: >= 10 pack-years, stage T1-2N2-N3 or T3-4N0-3 (less than 10 pack-years is considered a non-smoker) OR < 10 pack-years, stage T4N0-N3 or T1-3N2-3
STEP 1: Patients must not have known hypersensitivity to nivolumab or compounds of similar chemical or biologic composition.
STEP 1: Patients with a history of allergic reactions attributed to platinum-based chemotherapy agents are excluded.
STEP 1: Patients must not have had prior systemic therapy, radiation treatment or surgery for p16 positive oropharyngeal squamous cell carcinoma (OPSCC).
- NOTE: Patients who had resection of T1 or T2 carcinoma with no radiation or chemotherapy are eligible if surgery was done 5 years prior to enrollment
STEP 1: Patients must not have received previous irradiation for head and neck tumor, skull base, or brain tumors.
STEP 1: Patients must not receive investigational agents within 4 weeks of enrollment or at any time while on study.
STEP 1: Patients with evidence of distant metastases or leptomeningeal disease (LMD) are excluded.
STEP 1: Patients with uncontrolled inter-current illnesses which in the opinion of the investigator will interfere with the ability to undergo therapy including chemotherapy are excluded.
STEP 1: Patients with a history of prior or second malignancy are excluded, with the exception of curatively treated non-melanoma skin cancer, or curatively treated cervical cancer; additionally, patients curatively treated for malignancy who remain disease-free at > 2 years of follow up, are not excluded.
STEP 1: Absolute neutrophil count (ANC) >= 1500/mm^3 (must be obtained =< 2 weeks prior to randomization).
STEP 1: Hemoglobin (Hgb) >= 8.0 g/dL (must be obtained =< 2 weeks prior to randomization).
STEP 1: Platelet count >= 100,000/mm^3 (must be obtained =< 2 weeks prior to randomization).
STEP 1: Creatinine clearance of >= 60 ml/min (must be obtained =< 2 weeks prior to randomization). Creatinine clearance may be measured or calculated. If calculating, creatinine clearance, use the Cockcroft-Gault formula.
STEP 1: Total bilirubin within 1.5 times the normal limits (must be obtained =< 2 weeks prior to randomization).
STEP 1: Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) within 2.0 times the normal limits (must be obtained =< 2 weeks prior to randomization).
STEP 1: Alkaline phosphatase within 2.0 times the normal limits (must be obtained =< 2 weeks prior to randomization).
STEP 1: Patients must not be pregnant or breast-feeding as chemotherapy, radiation, and immunotherapy may have possible teratogenicity effects; in addition, complications from pregnancy may interfere with the ability of patients to have an uninterrupted therapy. All patients of childbearing potential must have a blood test or urine study within 2 weeks prior to randomization to rule out pregnancy. A patient of childbearing potential is any patient, regardless of whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).
STEP 1: Patients of childbearing potential must use an accepted and effective method of contraception or abstain from sexual intercourse for at least one week prior to the start of treatment, and continue for 5 months after the last dose of protocol treatment. Patients must also not donate ova during this same time period.
STEP 1: Patients must have measurable disease
STEP 1: Patients must have tumor measurements with CT of neck and CT of chest (or CT of neck and FDG PET/CT if standard of care) within 4 weeks prior to Step 1 randomization.
STEP 1: Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids, should be excluded. These include but are not limited to patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue disease, scleroderma, inflammatory bowel disease (IBD), Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome should be excluded because of the risk of recurrence or exacerbation of disease. Patients with vitiligo, endocrine deficiencies including thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible. Patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome and psoriasis controlled with topical medication and patients with positive serology, such as antinuclear antibodies (ANA), anti-thyroid antibodies should be evaluated for the presence of target organ involvement and potential need for systemic treatment but should otherwise be eligible.
STEP 1: Patients are permitted to enroll if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger (precipitating event).
STEP 1: Patients must not have a condition requiring systemic treatment with either corticosteroids (> 10 mg/day prednisone equivalents) or other immunosuppressive medications which are expected to continue during nivolumab administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg/day prednisone equivalents are permitted in the absence of active autoimmune disease
STEP 1: Patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
STEP 1: Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
STEP 1: Patients with a known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) must have no detectable viral load on a stable antiviral regimen
STEP 1: Patients must not be receiving any other investigational agents.
STEP 1: Patient must not have a baseline clinically significant hearing loss, which in the opinion of the investigator would preclude the use of cisplatin
STEP 2: Patients must have progression per RECIST criteria AND tissue-proven progression on Arm B treatment within 12 months after completion of radiation therapy.
STEP 2: ECOG performance status of 0 or 1.
STEP 2: Patients must not have known hypersensitivity to nivolumab or compounds of similar chemical or biologic composition.
STEP 2: Patients must not have received non-protocol anti-cancer therapy after completion of radiation and chemotherapy.
STEP 2: ANC >= 1500/mm^3 (must be obtained =< 2 weeks prior to registration).
STEP 2: Hgb >= 8.0 g/dL (must be obtained =< 2 weeks prior to registration).
STEP 2: Platelet count >= 100,000/mm^3 (must be obtained =< 2 weeks prior to registration).
STEP 2: Creatinine within institutional limits of normal (must be obtained =< 2 weeks prior to registration)
STEP 2: Total bilirubin within 1.5 times the normal limits (must be obtained =< 2 weeks prior to registration).
STEP 2: SGOT (AST) or SGPT (ALT) within 2.0 times the normal limits (must be obtained =< 2 weeks prior to registration).
STEP 2: Alkaline phosphatase within 1.5 times the normal limits (must be obtained =< 2 weeks prior to registration).
STEP 2: Patients must not be pregnant or breast-feeding as chemotherapy, radiation, and immunotherapy may have possible teratogenicity effects; in addition, complications from pregnancy may interfere with the ability of patients to have an uninterrupted therapy. All patients of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy. A patient of childbearing potential is any patient, regardless of whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).
STEP 2: Patients of childbearing potential must use an accepted and effective method of contraception or abstain from sexual intercourse for at least one week prior to the start of treatment, and continue for 5 months after the last dose of protocol treatment. Patients must also not donate ova during this same time period.
STEP 2: Patients must have measurable disease at the time of documented progression
- NOTE: For patients that have undergone salvage surgery for disease recurrence, measurable disease is not required at the time of registration to Step 2
STEP 2: Patients must have tumor measurements with CT of neck and CT of chest (or CT of neck and FDG PET/CT if standard of care) within 4 weeks prior to Step 2 registration
- NOTE: Patients that have undergone salvage surgery for disease recurrence prior to Step 2 are not required to have measurable disease post-resection, but must have CT of neck and CT of chest (or CT of neck and FDG PET/CT if standard of care) after salvage surgery and within 4 weeks prior to step 2 registration to establish a baseline prior to nivolumab

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)

Aantal wapens

Wapens en interventies

Deelnemersgroep / Arm	Interventie / Behandeling
Experimenteel: Arm A (cisplatin, IMRT, nivolumab) Patients receive cisplatin IV over 60 minutes weekly and IMRT 5 days a week for 7 weeks for a total of 35 fractions. Within 4 weeks after completion of concurrent therapy, patients receive nivolumab IV once weekly over 30 minutes every 4 weeks for 12 months in the absence of disease progression or unacceptable toxicity. Patients undergo CT or FDG PET/CT scans throughout the trial. Patients may undergo ECHO as clinically indicated. Additionally, patients undergo blood sample collection during screening.	Geneesmiddel: Cisplatin Given IV Andere namen: CDDP Cis-diamminedichloridoplatina Cismaplat Cisplatina Neoplatine Platina Abiplatine Blastolem Briplatine Cis-diammine-dichloorplatina Cis-diamminedichloor Platina (II) Cis-diamminedichloorplatina Cis-dichlooramine platina (II) Cis-platina Diamine Dichloride Cis-platina Cis-platina II Cis-platina II diaminedichloride Cisplatine Cisplatyl Citoplatina Citosine Cysplatina DDP Lederplatina Metaplatine Chloride van Peyrone Zout van Peyrone Plaats Kunststof Platamine Platiblastine Platiblastine-S Platinex Platinol-AQ Platinol-AQ VHA Plus Platinoxaan Platina diamminodichloride Platiraans Platistine Platosine Procedure: Biospecimen Collection Undergo blood sample collection Andere namen: Biologische monsterverzameling Biospecimen verzameld Specimenverzameling Monsterverzameling Procedure: Echocardiography Test Undergo ECHO Andere namen: Echocardiografie EG Biologisch: Nivolumab Given IV Andere namen: BMS-936558 MDX-1106 NIVO ONO-4538 Optie CMAB819 Nivolumab Biosimilar CMAB819 MDX 1106 MDX1106 GBS 936558 ABP 206 Nivolumab Biosimilar ABP 206 BCD-263 Nivolumab Biosimilar BCD-263 BMS936558 ONO 4538 ONO4538 Procedure: Computed Tomography Undergo CT or PET/CT Andere namen: CT KAT CT-scan Axiale computertomografie Computergestuurde axiale tomografie Computergestuurde tomografie tomografie Geautomatiseerde axiale tomografie (procedure) Computertomografie (CT)-scan Diagnostische kattencan Diagnostisch CAT -scanservice type Procedure: Positron Emission Tomography Undergo PET/CT Andere namen: Medische beeldvorming, positronemissietomografie HUISDIER PET-scan Positron Emissie Tomografie Scan Positron-emissietomografie PT Positronemissietomografie (procedure) Straling: Intensity-Modulated Radiation Therapy Undergo IMRT Andere namen: IMRT Intensiteit gemoduleerde RT Intensiteitsgemoduleerde radiotherapie Straling, intensiteitsgemoduleerde radiotherapie Intensiteit gemoduleerde radiotherapie (procedure) Ander: Fludeoxyglucose F-18 Receive FDG Andere namen: 18FDG FDG fludeoxyglucose F 18 Fludeoxyglucose (18F) Fludeoxyglucose F18 Fluor-18 2-fluor-2-deoxy-D-glucose Fluorodeoxyglucose F18
Actieve vergelijker: Arm B (cisplatin, IMRT, observation) Patients receive cisplatin IV over 60 minutes weekly and IMRT 5 days a week for 7 weeks for a total of 35 fractions, and then go on observation. Patients will be offered the option to cross-over to Arm C if they have clearly documented progression within 12 months from the end of cisplatin/radiation therapy. Patients undergo CT or FDG PET/CT scans throughout the trial. Patients may undergo ECHO as clinically indicated. Additionally, patients undergo blood sample collection during screening.	Geneesmiddel: Cisplatin Given IV Andere namen: CDDP Cis-diamminedichloridoplatina Cismaplat Cisplatina Neoplatine Platina Abiplatine Blastolem Briplatine Cis-diammine-dichloorplatina Cis-diamminedichloor Platina (II) Cis-diamminedichloorplatina Cis-dichlooramine platina (II) Cis-platina Diamine Dichloride Cis-platina Cis-platina II Cis-platina II diaminedichloride Cisplatine Cisplatyl Citoplatina Citosine Cysplatina DDP Lederplatina Metaplatine Chloride van Peyrone Zout van Peyrone Plaats Kunststof Platamine Platiblastine Platiblastine-S Platinex Platinol-AQ Platinol-AQ VHA Plus Platinoxaan Platina diamminodichloride Platiraans Platistine Platosine Procedure: Biospecimen Collection Undergo blood sample collection Andere namen: Biologische monsterverzameling Biospecimen verzameld Specimenverzameling Monsterverzameling Procedure: Echocardiography Test Undergo ECHO Andere namen: Echocardiografie EG Procedure: Computed Tomography Undergo CT or PET/CT Andere namen: CT KAT CT-scan Axiale computertomografie Computergestuurde axiale tomografie Computergestuurde tomografie tomografie Geautomatiseerde axiale tomografie (procedure) Computertomografie (CT)-scan Diagnostische kattencan Diagnostisch CAT -scanservice type Procedure: Positron Emission Tomography Undergo PET/CT Andere namen: Medische beeldvorming, positronemissietomografie HUISDIER PET-scan Positron Emissie Tomografie Scan Positron-emissietomografie PT Positronemissietomografie (procedure) Straling: Intensity-Modulated Radiation Therapy Undergo IMRT Andere namen: IMRT Intensiteit gemoduleerde RT Intensiteitsgemoduleerde radiotherapie Straling, intensiteitsgemoduleerde radiotherapie Intensiteit gemoduleerde radiotherapie (procedure) Ander: Patient Observation Undergo observation Andere namen: Observatie Actief toezicht uitgestelde therapie afwachtend beheer Waakzaam wachten Ander: Fludeoxyglucose F-18 Receive FDG Andere namen: 18FDG FDG fludeoxyglucose F 18 Fludeoxyglucose (18F) Fludeoxyglucose F18 Fluor-18 2-fluor-2-deoxy-D-glucose Fluorodeoxyglucose F18
Experimenteel: Arm C (nivolumab) Patients receive nivolumab IV over 30 minutes every 4 weeks for 12 months in the absence of disease progression or unacceptable toxicity. Patients undergo CT or FDG PET/CT scans throughout the trial. Patients may undergo ECHO as clinically indicated. Additionally, patients undergo blood sample collection during screening.	Procedure: Biospecimen Collection Undergo blood sample collection Andere namen: Biologische monsterverzameling Biospecimen verzameld Specimenverzameling Monsterverzameling Procedure: Echocardiography Test Undergo ECHO Andere namen: Echocardiografie EG Biologisch: Nivolumab Given IV Andere namen: BMS-936558 MDX-1106 NIVO ONO-4538 Optie CMAB819 Nivolumab Biosimilar CMAB819 MDX 1106 MDX1106 GBS 936558 ABP 206 Nivolumab Biosimilar ABP 206 BCD-263 Nivolumab Biosimilar BCD-263 BMS936558 ONO 4538 ONO4538 Procedure: Computed Tomography Undergo CT or PET/CT Andere namen: CT KAT CT-scan Axiale computertomografie Computergestuurde axiale tomografie Computergestuurde tomografie tomografie Geautomatiseerde axiale tomografie (procedure) Computertomografie (CT)-scan Diagnostische kattencan Diagnostisch CAT -scanservice type Procedure: Positron Emission Tomography Undergo PET/CT Andere namen: Medische beeldvorming, positronemissietomografie HUISDIER PET-scan Positron Emissie Tomografie Scan Positron-emissietomografie PT Positronemissietomografie (procedure) Ander: Fludeoxyglucose F-18 Receive FDG Andere namen: 18FDG FDG fludeoxyglucose F 18 Fludeoxyglucose (18F) Fludeoxyglucose F18 Fluor-18 2-fluor-2-deoxy-D-glucose Fluorodeoxyglucose F18

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat	Maatregel Beschrijving	Tijdsspanne
Overall survival (OS) Tijdsspanne: From randomization to death, assessed up to 10 years	Log rank test will be used to compare OS. As patients on the observation arm are allowed to cross-over to the nivolumab arm upon progression, an overall survival analysis using inverse probability censoring weights (IPCW, Robins et. al, 2000) will also be considered. Kaplan-Meier method and Cox regression will be used for the survival outcome analyses.	From randomization to death, assessed up to 10 years
Negative (standardized qualitative) 12 week post therapy (cisplatin + radiation therapy [RT]) FDG positron emission tomography/computed tomography (PET/CT) associated with OS for patients who have a PET/CT Tijdsspanne: At 12 weeks post therapy	Logrank tests and input hazard rates will be used.	At 12 weeks post therapy
Negative (standardized qualitative) 12 week post therapy (cisplatin + RT) FDG PET/CT associated with PFS for patients who have a PET/CT Tijdsspanne: At 12 weeks post therapy	Logrank tests and input hazard rates will be used.	At 12 weeks post therapy

Secundaire uitkomstmaten

Uitkomstmaat	Maatregel Beschrijving	Tijdsspanne
Progression-free survival (PFS) Tijdsspanne: From randomization to date of progression, second primary tumor from the head and neck region, or death, assessed up to 10 years	Progression will be defined using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. The comparison of PFS will use stratified log rank test and will be intent-to-treat analyses.	From randomization to date of progression, second primary tumor from the head and neck region, or death, assessed up to 10 years
Prognostic effect of baseline PD-L1 expression (positive versus [vs.] negative) on OS and PFS Tijdsspanne: Baseline up to 10 years	Chi-square testing or Pearson correlation testing will be used for the secondary correlation analyses.	Baseline up to 10 years
Prognostic effect of baseline saliva and/or plasma human papillomavirus (HPV) status (positive vs. negative) on OS and PFS Tijdsspanne: Baseline up to 10 years	Saliva and plasma HPV status at 12 weeks and 9 months following completion of concurrent therapy will also be analyzed regarding effect on outcome. Chi-square testing or Pearson correlation testing will be used for the secondary correlation analyses.	Baseline up to 10 years
Prognostic value of maximum standardized uptake value (SUVmax) of primary tumor or neck nodal metastasis of baseline FDG PET/CT for OS Tijdsspanne: Baseline up to 10 years	Chi-square testing or Pearson correlation testing will be used for the secondary correlation analyses.	Baseline up to 10 years
Prognostic value of SUVmax of primary tumor or neck nodal metastasis of baseline FDG PET/CT for PFS Tijdsspanne: Baseline up to 10 years	Chi-square testing or Pearson correlation testing will be used for the secondary correlation analyses.	Baseline up to 10 years
SUVmax of primary tumor or nodal metastasis of baseline FDG PET/CT with PD-L1 expression (positive vs. negative) Tijdsspanne: Baseline up to 10 years	Chi-square testing or Pearson correlation testing will be used for the secondary correlation analyses.	Baseline up to 10 years
Post therapy (cisplatin + RT) FDG PET/CT with saliva or plasma levels of HPV deoxyribonucleic acid (DNA) Tijdsspanne: Up to 9 months post-therapy	Chi-square testing or Pearson correlation testing will be used for the secondary correlation analyses.	Up to 9 months post-therapy
PET based therapy response assessment compared to RECIST 1.1 assessment for patients who have a PET/CT scan at 12 weeks Tijdsspanne: At 12 weeks post chemoradiation therapy	Kappa statistics will be applied to evaluate the agreement between PET based therapy response assessment (Hopkins criteria) and RECIST 1.1 assessment at 12 weeks post chemoradiation therapy.	At 12 weeks post chemoradiation therapy

Medewerkers en onderzoekers

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

Sponsor

National Cancer Institute (NCI)

Onderzoekers

Hoofdonderzoeker: Nabil F Saba, ECOG-ACRIN Cancer Research Group

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 (Werkelijk)

16 augustus 2019

Primaire voltooiing (Geschat)

31 januari 2030

Studie voltooiing (Geschat)

31 januari 2030

Studieregistratiedata

Eerst ingediend

18 januari 2019

Eerst ingediend dat voldeed aan de QC-criteria

18 januari 2019

Eerst geplaatst (Werkelijk)

22 januari 2019

Updates van studierecords

Laatste update geplaatst (Werkelijk)

26 oktober 2026

Laatste update ingediend die voldeed aan QC-criteria

23 oktober 2026

Laatst geverifieerd

1 september 2026

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

NCI-2019-00179
U10CA180820 (Subsidie/contract van de Amerikaanse NIH)
NCI-2019-00179 (Register-ID: CTRP (Clinical Trial Reporting Program))
EA3161 (Andere identificatie: CTEP)
EA3161 (Andere identificatie: ECOG-ACRIN Cancer Research Group)

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

Beschrijving IPD-plan

NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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 .

Testen van immunotherapie versus observatie bij patiënten met HPV-keelkanker

Een gerandomiseerde fase III-studie van onderhoudsbehandeling met nivolumab versus observatie bij patiënten met HPV-positieve OPSCC met lokaal gevorderd, gemiddeld risico

Studie Overzicht

Toestand

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Studietype

Inschrijving (Geschat)

Fase

Contacten en locaties

Studie Locaties

Deelname Criteria

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

Accepteert gezonde vrijwilligers

Geslachten die in aanmerking komen voor studie

Beschrijving

Studie plan

Hoe is de studie opgezet?

Ontwerpdetails

Aantal wapens

Wapens en interventies

Deelnemersgroep / Arm

Interventie / Behandeling

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat

Maatregel Beschrijving

Tijdsspanne

Secundaire uitkomstmaten

Uitkomstmaat

Maatregel Beschrijving

Tijdsspanne

Medewerkers en onderzoekers

Sponsor

Onderzoekers

Studie record data

Bestudeer belangrijke data

Studie start (Werkelijk)

Primaire voltooiing (Geschat)

Studie voltooiing (Geschat)

Studieregistratiedata

Eerst ingediend

Eerst ingediend dat voldeed aan de QC-criteria

Eerst geplaatst (Werkelijk)

Updates van studierecords

Laatste update geplaatst (Werkelijk)

Laatste update ingediend die voldeed aan QC-criteria

Laatst geverifieerd

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

Beschrijving IPD-plan

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct