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Tester tillegget av et kreftmedisin, irinotecan, til standard kjemoterapibehandling (FOLFOX) etter langvarig strålebehandling for avansert stadium av rektalkreft for å forbedre graden av fullstendig respons og langsiktig organkonservering (JANUS)

31. august 2026 oppdatert av: Alliance for Clinical Trials in Oncology

Janus Rectal Cancer Trial: En randomisert fase II studie som tester effekten av triplett versus doublet kjemoterapi for å oppnå klinisk fullstendig respons hos pasienter med lokalt avansert rektal kreft

Denne fase II-studien sammenligner effekten av irinotekan versus oksaliplatin etter langtidsbehandling med kjemoradiasjon hos pasienter med stadium II-III rektalkreft. Kombinasjonskjemoterapimedisiner, som FOLFIRINOX (fluorouracil, irinotecan, leukovorin og oxaliplatin), FOLFOX (leucovorin, fluorouracil, oxaliplatin og irinotecan) og CAPOX (capecitabin og oxaliplatin) virker på forskjellige måter for å stoppe veksten av svulster. ved å drepe cellene, ved å hindre dem i å dele seg, eller ved å hindre dem i å spre seg. FOLFOX eller CAPOX brukes etter kjemoradiasjon som vanlig behandling for endetarmskreft. Å gi FOLFIRINOX etter kjemoradiasjon kan øke responsraten og føre til høyere grad av klinisk fullstendig respons (med en sjanse for å unngå kirurgi) sammenlignet med FOLFOX eller CAPOX etter kjemoradiasjon hos pasienter med lokalt avansert rektalkreft.

Studieoversikt

Status

Aktiv, ikke rekrutterende

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

HOVEDMÅL:

I. For å evaluere og sammenligne de kliniske fullstendige responsratene (cCR) hos pasienter med lokalt avansert endetarmskreft behandlet med neoadjuvant langtids neoadjuvant strålebehandling (LCRT) etterfulgt av neoadjuvant modifisert fluorouracil, irinotekan, leukovorin og oksaliplatin (mFOLFIRINOX) versus neoadjuvant. etterfulgt av neoadjuvant modifisert leucovorin, fluorouracil og oxaliplatin (mFOLFOX6).

SEKUNDÆRE MÅL:

I. Å evaluere og sammenligne organkonserveringstid (OPT) mellom to behandlingsarmer.

II. For å evaluere og sammenligne den sykdomsfrie overlevelsestiden (DFS) mellom de to behandlingsarmene.

III. For å evaluere og sammenligne tid til fjernmetastaser mellom to behandlingsarmer.

IV. For å evaluere og sammenligne total overlevelse (OS) mellom to behandlingsarmer. V. Å evaluere og sammenligne toksisitetsprofiler for total neoadjuvant terapi (TNT) mellom to behandlingsarmer.

UNDERSØKENDE MÅL:

I. Evaluering av sirkulerende tumor deoksyribonukleinsyre (ctDNA) kinetikk under neoadjuvant terapi og overvåking og for å korrelere med radiografiske, patologiske og kliniske utfall.

OVERSIGT: Pasienter randomiseres til 1 av 2 armer.

GRUPPE I: Pasienter mottar langtids kjemoradiasjonsbehandling på studien og får deretter enten: FOLFOX-regime bestående av leukovorin intravenøst (IV), fluorouracil IV og oxaliplatin IV eller CAPOX bestående av capecitabin oralt (PO), og oxaliplatin IV på studien. Pasienter gjennomgår computertomografi (CT), magnetisk resonansavbildning (MRI) og innsamling av bioprøver gjennom hele forsøket. Pasienter gjennomgår også sigmoidoskopi gjennom hele forsøket og biopsi under screening.

GRUPPE II: Pasienter får langtids kjemoradiasjonsbehandling på studien og får deretter FOLFIRINOX-regime bestående av leucovorin IV, fluorouracil IV, irinotecan IV og oxaliplatin IV på studien. Pasienter gjennomgår CT-skanning, MR-skanning og blodprøvetaking gjennom hele forsøket. Pasienter gjennomgår sigmoidoskopi gjennom hele forsøket og biopsi under screening.

Studietype

Intervensjonell

Registrering (Faktiske)

760

Fase

Fase 2
Fase 3

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

Forente stater
- Alabama
  - Birmingham, Alabama, Forente stater, 35233
    - University of Alabama at Birmingham Cancer Center
  - Mobile, Alabama, Forente stater, 36688
    - University of South Alabama Mitchell Cancer Institute
- Alaska
  - Anchorage, Alaska, Forente stater, 98508
    - Anchorage Associates in Radiation Medicine
  - Anchorage, Alaska, Forente stater, 99508
    - Alaska Breast Care and Surgery LLC
  - Anchorage, Alaska, Forente stater, 99508
    - Alaska Oncology and Hematology LLC
  - Anchorage, Alaska, Forente stater, 99508
    - Alaska Women's Cancer Care
  - Anchorage, Alaska, Forente stater, 99508
    - Anchorage Oncology Centre
  - Anchorage, Alaska, Forente stater, 99508
    - Katmai Oncology Group
  - Anchorage, Alaska, Forente stater, 99508
    - Providence Alaska Medical Center
- Arizona
  - Kingman, Arizona, Forente stater, 86401
    - Kingman Regional Medical Center
  - Phoenix, Arizona, Forente stater, 85054
    - Mayo Clinic Hospital in Arizona
  - Phoenix, Arizona, Forente stater, 85004
    - Cancer Center at Saint Joseph's
- Arkansas
  - Fort Smith, Arkansas, Forente stater, 72903
    - Mercy Hospital Fort Smith
  - Jonesboro, Arkansas, Forente stater, 72401
    - NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
  - Little Rock, Arkansas, Forente stater, 72205
    - University of Arkansas for Medical Sciences
- California
  - Arroyo Grande, California, Forente stater, 93420
    - PCR Oncology
  - Arroyo Grande, California, Forente stater, 93420
    - Mission Hope Medical Oncology - Arroyo Grande
  - Buena Park, California, Forente stater, 90621
    - Keck Medicine of USC Buena Park
  - Burbank, California, Forente stater, 91505
    - Providence Saint Joseph Medical Center/Disney Family Cancer Center
  - Carmichael, California, Forente stater, 95608
    - Mercy San Juan Medical Center
  - Carmichael, California, Forente stater, 95608
    - Mercy Cancer Center - Carmichael
  - Duarte, California, Forente stater, 91010
    - City of Hope Comprehensive Cancer Center
  - Elk Grove, California, Forente stater, 95758
    - Mercy Cancer Center - Elk Grove
  - Fremont, California, Forente stater, 94538
    - Washington Hospital
  - Irvine, California, Forente stater, 92618
    - City of Hope at Irvine Lennar
  - Irvine, California, Forente stater, 92612
    - UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
  - Los Angeles, California, Forente stater, 90033
    - USC / Norris Comprehensive Cancer Center
  - Los Angeles, California, Forente stater, 90033
    - Los Angeles General Medical Center
  - Merced, California, Forente stater, 95340
    - Mercy Cancer Center
  - Napa, California, Forente stater, 94558
    - Providence Queen of The Valley
  - Newport Beach, California, Forente stater, 92663
    - USC Norris Oncology/Hematology-Newport Beach
  - Orange, California, Forente stater, 92868
    - UC Irvine Health/Chao Family Comprehensive Cancer Center
  - Orange, California, Forente stater, 92868
    - Saint Joseph Hospital - Orange
  - Rocklin, California, Forente stater, 95765
    - Mercy Cancer Center - Rocklin
  - Sacramento, California, Forente stater, 95817
    - University of California Davis Comprehensive Cancer Center
  - Sacramento, California, Forente stater, 95816
    - Mercy Cancer Center - Sacramento
  - Salinas, California, Forente stater, 93901
    - Salinas Valley Memorial
  - San Luis Obispo, California, Forente stater, 93401
    - Pacific Central Coast Health Center-San Luis Obispo
  - Santa Maria, California, Forente stater, 93444
    - Mission Hope Medical Oncology - Santa Maria
  - Santa Rosa, California, Forente stater, 95403
    - Providence Medical Foundation - Santa Rosa
  - South Pasadena, California, Forente stater, 91030
    - City of Hope South Pasadena
  - St. Helena, California, Forente stater, 94574
    - Saint Helena Hospital
  - Stockton, California, Forente stater, 95204
    - Saint Joseph's Medical Center
  - Torrance, California, Forente stater, 90503
    - City of Hope South Bay
  - Truckee, California, Forente stater, 96161
    - Gene Upshaw Memorial Tahoe Forest Cancer Center
  - Upland, California, Forente stater, 91786
    - City of Hope Upland
  - Walnut Creek, California, Forente stater, 94598
    - John Muir Medical Center-Walnut Creek
  - Woodland, California, Forente stater, 95695
    - Woodland Memorial Hospital
- Colorado
  - Aurora, Colorado, Forente stater, 80045
    - UCHealth University of Colorado Hospital
  - Colorado Springs, Colorado, Forente stater, 80907
    - Penrose-Saint Francis Healthcare
  - Colorado Springs, Colorado, Forente stater, 80909
    - UCHealth Memorial Hospital Central
  - Colorado Springs, Colorado, Forente stater, 80907
    - Rocky Mountain Cancer Centers-Penrose
  - Colorado Springs, Colorado, Forente stater, 80920
    - Memorial Hospital North
  - Colorado Springs, Colorado, Forente stater, 80923
    - Saint Francis Cancer Center
  - Denver, Colorado, Forente stater, 80206
    - UCHealth - Cherry Creek
  - Denver, Colorado, Forente stater, 80218
    - Saint Joseph Hospital - Cancer Centers of Colorado
  - Denver, Colorado, Forente stater, 80210
    - AdventHealth Porter
  - Golden, Colorado, Forente stater, 80401
    - Lutheran Hospital - Cancer Centers of Colorado
  - Grand Junction, Colorado, Forente stater, 81501
    - Saint Mary's Hospital and Regional Medical Center
  - Highlands Ranch, Colorado, Forente stater, 80129
    - UCHealth Highlands Ranch Hospital
  - Lakewood, Colorado, Forente stater, 80228
    - Saint Anthony Hospital
  - Littleton, Colorado, Forente stater, 80122
    - AdventHealth Littleton
  - Longmont, Colorado, Forente stater, 80501
    - Longmont United Hospital
  - Parker, Colorado, Forente stater, 80138
    - AdventHealth Parker
  - Pueblo, Colorado, Forente stater, 81004
    - Saint Mary Corwin Medical Center
  - Westminster, Colorado, Forente stater, 80023
    - Saint Anthony North Hospital
  - Wheat Ridge, Colorado, Forente stater, 80401
    - Intermountain Health Lutheran Hospital
- Connecticut
  - Hartford, Connecticut, Forente stater, 06102
    - Hartford Hospital
  - Meriden, Connecticut, Forente stater, 06451
    - Midstate Medical Center
  - New Britain, Connecticut, Forente stater, 06050
    - The Hospital of Central Connecticut
- Delaware
  - Lewes, Delaware, Forente stater, 19958
    - Beebe Medical Center
  - Millville, Delaware, Forente stater, 19967
    - Beebe South Coastal Health Campus
  - Newark, Delaware, Forente stater, 19713
    - Helen F Graham Cancer Center
  - Newark, Delaware, Forente stater, 19713
    - Delaware Clinical and Laboratory Physicians PA
  - Newark, Delaware, Forente stater, 19713
    - Medical Oncology Hematology Consultants PA
  - Newark, Delaware, Forente stater, 19718
    - Christiana Care Health System-Christiana Hospital
  - Rehoboth Beach, Delaware, Forente stater, 19971
    - Beebe Health Campus
  - Wilmington, Delaware, Forente stater, 19801
    - Christiana Care Health System-Wilmington Hospital
- District of Columbia
  - Washington D.C., District of Columbia, Forente stater, 20037
    - George Washington University Medical Center
  - Washington D.C., District of Columbia, Forente stater, 20010
    - MedStar Washington Hospital Center
  - Washington D.C., District of Columbia, Forente stater, 20007
    - MedStar Georgetown University Hospital
- Florida
  - Altamonte Springs, Florida, Forente stater, 32701
    - AdventHealth Altamonte
  - Aventura, Florida, Forente stater, 33180
    - Mount Sinai Comprehensive Cancer Center at Aventura
  - Celebration, Florida, Forente stater, 34747
    - AdventHealth Celebration
  - Clearwater, Florida, Forente stater, 33756
    - Morton Plant Hospital
  - Fort Lauderdale, Florida, Forente stater, 33308
    - Holy Cross Hospital
  - Gainesville, Florida, Forente stater, 32610
    - University of Florida Health Science Center - Gainesville
  - Hollywood, Florida, Forente stater, 33021
    - Memorial Regional Hospital/Joe DiMaggio Children's Hospital
  - Jacksonville, Florida, Forente stater, 32224-9980
    - Mayo Clinic in Florida
  - Kissimmee, Florida, Forente stater, 34744
    - AdventHealth Kissimmee
  - Lutz, Florida, Forente stater, 33558
    - Saint Joseph's Hospital-North
  - Miami Beach, Florida, Forente stater, 33140
    - Mount Sinai Medical Center
  - Orlando, Florida, Forente stater, 32803
    - AdventHealth Orlando
  - Orlando, Florida, Forente stater, 32822
    - AdventHealth East Orlando
  - Pembroke Pines, Florida, Forente stater, 33028
    - Memorial Hospital West
  - St. Petersburg, Florida, Forente stater, 33705
    - Saint Anthony's Hospital Cancer Care Center
  - Tampa, Florida, Forente stater, 33606
    - Tampa General Hospital
  - Tampa, Florida, Forente stater, 33607
    - Saint Joseph's Hospital/Children's Hospital-Tampa
- Georgia
  - Atlanta, Georgia, Forente stater, 30308
    - Emory University Hospital Midtown
  - Atlanta, Georgia, Forente stater, 30322
    - Emory University Hospital/Winship Cancer Institute
  - Atlanta, Georgia, Forente stater, 30342
    - Emory Saint Joseph's Hospital
  - Decatur, Georgia, Forente stater, 30033
    - Emory Decatur Hospital
  - Johns Creek, Georgia, Forente stater, 30097
    - Emory Johns Creek Hospital
  - Savannah, Georgia, Forente stater, 31404
    - Memorial Health University Medical Center
- Hawaii
  - Honolulu, Hawaii, Forente stater, 96813
    - Queen's Medical Center
  - Honolulu, Hawaii, Forente stater, 96817
    - The Cancer Center of Hawaii-Liliha
  - Honolulu, Hawaii, Forente stater, 96813
    - Hawaii Cancer Care Inc - Waterfront Plaza
  - Honolulu, Hawaii, Forente stater, 96813
    - Queen's Cancer Cenrer - POB I
  - Honolulu, Hawaii, Forente stater, 96813
    - Straub Clinic and Hospital
  - Honolulu, Hawaii, Forente stater, 96813
    - University of Hawaii Cancer Center
  - Honolulu, Hawaii, Forente stater, 96817
    - Kuakini Medical Center
  - Honolulu, Hawaii, Forente stater, 96817
    - Queen's Cancer Center - Kuakini
  - Honolulu, Hawaii, Forente stater, 96826
    - Kapiolani Medical Center for Women and Children
  - Kailua, Hawaii, Forente stater, 96734
    - Castle Medical Center
  - Lihue, Hawaii, Forente stater, 96766
    - Wilcox Memorial Hospital and Kauai Medical Clinic
  - ‘Aiea, Hawaii, Forente stater, 96701
    - Hawaii Cancer Care - Westridge
  - ‘Aiea, Hawaii, Forente stater, 96701
    - Pali Momi Medical Center
  - ‘Aiea, Hawaii, Forente stater, 96701
    - Queen's Cancer Center - Pearlridge
  - ‘Aiea, Hawaii, Forente stater, 96701
    - The Cancer Center of Hawaii-Pali Momi
  - ‘Ewa Beach, Hawaii, Forente stater, 96706
    - The Queen's Medical Center - West Oahu
- Idaho
  - Boise, Idaho, Forente stater, 83706
    - Saint Alphonsus Cancer Care Center-Boise
  - Boise, Idaho, Forente stater, 83712
    - Saint Luke's Cancer Institute - Boise
  - Caldwell, Idaho, Forente stater, 83605
    - Saint Alphonsus Cancer Care Center-Caldwell
  - Coeur d'Alene, Idaho, Forente stater, 83814
    - Kootenai Health - Coeur d'Alene
  - Fruitland, Idaho, Forente stater, 83619
    - Saint Luke's Cancer Institute - Fruitland
  - Meridian, Idaho, Forente stater, 83642
    - Idaho Urologic Institute-Meridian
  - Meridian, Idaho, Forente stater, 83642
    - Saint Luke's Cancer Institute - Meridian
  - Nampa, Idaho, Forente stater, 83687
    - Saint Alphonsus Cancer Care Center-Nampa
  - Nampa, Idaho, Forente stater, 83687
    - Saint Luke's Cancer Institute - Nampa
  - Post Falls, Idaho, Forente stater, 83854
    - Kootenai Clinic Cancer Services - Post Falls
  - Twin Falls, Idaho, Forente stater, 83301
    - Saint Luke's Cancer Institute - Twin Falls
- Illinois
  - Alton, Illinois, Forente stater, 62002
    - OSF Saint Anthony's Health Center
  - Aurora, Illinois, Forente stater, 60504
    - Rush-Copley Medical Center
  - Aurora, Illinois, Forente stater, 60506
    - Advocate Outpatient Center - Aurora
  - Barrington, Illinois, Forente stater, 60010
    - Advocate Good Shepherd Hospital
  - Bloomington, Illinois, Forente stater, 61704
    - Illinois CancerCare-Bloomington
  - Bloomington, Illinois, Forente stater, 61701
    - OSF Saint Joseph Medical Center
  - Canton, Illinois, Forente stater, 61520
    - Illinois CancerCare-Canton
  - Carbondale, Illinois, Forente stater, 62902
    - Memorial Hospital of Carbondale
  - Carterville, Illinois, Forente stater, 62918
    - SIH Cancer Institute
  - Carthage, Illinois, Forente stater, 62321
    - Illinois CancerCare-Carthage
  - Centralia, Illinois, Forente stater, 62801
    - Centralia Oncology Clinic
  - Centralia, Illinois, Forente stater, 62801
    - Saint Mary's Hospital
  - Chicago, Illinois, Forente stater, 60611
    - Northwestern University
  - Chicago, Illinois, Forente stater, 60637
    - University of Chicago Comprehensive Cancer Center
  - Chicago, Illinois, Forente stater, 60612
    - John H Stroger Jr Hospital of Cook County
  - Chicago, Illinois, Forente stater, 60657
    - Advocate Illinois Masonic Medical Center
  - Crystal Lake, Illinois, Forente stater, 60014
    - AMG Crystal Lake - Oncology
  - Danville, Illinois, Forente stater, 61832
    - Carle at The Riverfront
  - DeKalb, Illinois, Forente stater, 60115
    - Northwestern Medicine Cancer Center Kishwaukee
  - Decatur, Illinois, Forente stater, 62526
    - Decatur Memorial Hospital
  - Decatur, Illinois, Forente stater, 62526
    - Cancer Care Specialists of Illinois - Decatur
  - Dixon, Illinois, Forente stater, 61021
    - Illinois CancerCare-Dixon
  - Downers Grove, Illinois, Forente stater, 60515
    - Advocate Good Samaritan Hospital
  - Effingham, Illinois, Forente stater, 62401
    - Crossroads Cancer Center
  - Effingham, Illinois, Forente stater, 62401
    - Carle Physician Group-Effingham
  - Elgin, Illinois, Forente stater, 60123
    - Advocate Sherman Hospital
  - Elmhurst, Illinois, Forente stater, 60126
    - Elmhurst Memorial Hospital
  - Eureka, Illinois, Forente stater, 61530
    - Illinois CancerCare-Eureka
  - Galesburg, Illinois, Forente stater, 61401
    - Western Illinois Cancer Treatment Center
  - Galesburg, Illinois, Forente stater, 61401
    - Illinois CancerCare-Galesburg
  - Geneva, Illinois, Forente stater, 60134
    - Northwestern Medicine Cancer Center Delnor
  - Glenview, Illinois, Forente stater, 60026
    - Northwestern Medicine Glenview Outpatient Center
  - Grayslake, Illinois, Forente stater, 60030
    - Northwestern Medicine Grayslake Outpatient Center
  - Harvey, Illinois, Forente stater, 60426
    - Ingalls Memorial Hospital
  - Hazel Crest, Illinois, Forente stater, 60429
    - Advocate South Suburban Hospital
  - Kewanee, Illinois, Forente stater, 61443
    - Illinois CancerCare-Kewanee Clinic
  - Lake Forest, Illinois, Forente stater, 60045
    - Northwestern Medicine Lake Forest Hospital
  - Libertyville, Illinois, Forente stater, 60048
    - Condell Memorial Hospital
  - Libertyville, Illinois, Forente stater, 60048
    - AMG Libertyville - Oncology
  - Macomb, Illinois, Forente stater, 61455
    - Illinois CancerCare-Macomb
  - Mattoon, Illinois, Forente stater, 61938
    - Carle Physician Group-Mattoon/Charleston
  - Mount Vernon, Illinois, Forente stater, 62864
    - SSM Health Good Samaritan
  - Naperville, Illinois, Forente stater, 60540
    - Edward Hospital/Cancer Center
  - New Lenox, Illinois, Forente stater, 60451
    - UC Comprehensive Cancer Center at Silver Cross
  - Normal, Illinois, Forente stater, 61761
    - Carle Cancer Institute Normal
  - Normal, Illinois, Forente stater, 61761
    - Carle BroMenn Medical Center
  - O'Fallon, Illinois, Forente stater, 62269
    - Cancer Care Center of O'Fallon
  - O'Fallon, Illinois, Forente stater, 62269
    - HSHS Saint Elizabeth's Hospital
  - Oak Lawn, Illinois, Forente stater, 60453-2699
    - Advocate Christ Medical Center
  - Orland Park, Illinois, Forente stater, 60462
    - University of Chicago Medicine-Orland Park
  - Ottawa, Illinois, Forente stater, 61350
    - Illinois CancerCare-Ottawa Clinic
  - Palos Heights, Illinois, Forente stater, 60463
    - Advocate High Tech Medical Park
  - Park Ridge, Illinois, Forente stater, 60068
    - Advocate Lutheran General Hospital
  - Pekin, Illinois, Forente stater, 61554
    - Illinois CancerCare-Pekin
  - Peoria, Illinois, Forente stater, 61636
    - Methodist Medical Center of Illinois
  - Peoria, Illinois, Forente stater, 61615
    - Illinois CancerCare-Peoria
  - Peru, Illinois, Forente stater, 61354
    - Illinois CancerCare-Peru
  - Peru, Illinois, Forente stater, 61354
    - Valley Radiation Oncology
  - Plainfield, Illinois, Forente stater, 60585
    - Edward Hospital/Cancer Center?Plainfield
  - Princeton, Illinois, Forente stater, 61356
    - Illinois CancerCare-Princeton
  - Springfield, Illinois, Forente stater, 62702
    - Southern Illinois University School of Medicine
  - Springfield, Illinois, Forente stater, 62702
    - Springfield Clinic
  - Springfield, Illinois, Forente stater, 62781
    - Springfield Memorial Hospital
  - Urbana, Illinois, Forente stater, 61801
    - Carle Cancer Center
  - Warrenville, Illinois, Forente stater, 60555
    - Northwestern Medicine Cancer Center Warrenville
  - Washington, Illinois, Forente stater, 61571
    - Illinois CancerCare - Washington
- Indiana
  - Crown Point, Indiana, Forente stater, 46307
    - Northwest Cancer Center - Main Campus
  - Dyer, Indiana, Forente stater, 46311
    - Northwest Oncology LLC
  - Fort Wayne, Indiana, Forente stater, 46845
    - Parkview Regional Medical Center
  - Hobart, Indiana, Forente stater, 46342
    - Northwest Cancer Center - Hobart
  - Hobart, Indiana, Forente stater, 46342
    - Saint Mary Medical Center
  - Munster, Indiana, Forente stater, 46321
    - The Community Hospital
  - Munster, Indiana, Forente stater, 46321
    - Women's Diagnostic Center - Munster
  - New Albany, Indiana, Forente stater, 47150
    - Baptist Health Floyd
  - Richmond, Indiana, Forente stater, 47374
    - Reid Health
  - Valparaiso, Indiana, Forente stater, 46383
    - Northwest Cancer Center - Valparaiso
- Iowa
  - Ankeny, Iowa, Forente stater, 50023
    - UI Health Care Mission Cancer and Blood - Ankeny Clinic
  - Cedar Rapids, Iowa, Forente stater, 52403
    - Mercy Hospital
  - Cedar Rapids, Iowa, Forente stater, 52403
    - Oncology Associates at Mercy Medical Center
  - Clive, Iowa, Forente stater, 50325
    - Mercy Cancer Center-West Lakes
  - Clive, Iowa, Forente stater, 50325
    - UI Health Care Mission Cancer and Blood - West Des Moines Clinic
  - Creston, Iowa, Forente stater, 50801
    - Greater Regional Medical Center
  - Des Moines, Iowa, Forente stater, 50309
    - Iowa Methodist Medical Center
  - Des Moines, Iowa, Forente stater, 50314
    - Mercy Medical Center - Des Moines
  - Des Moines, Iowa, Forente stater, 50309
    - UI Health Care Mission Cancer and Blood - Des Moines Clinic
  - Des Moines, Iowa, Forente stater, 50314
    - UI Health Care Mission Cancer and Blood - Laurel Clinic
  - Waukee, Iowa, Forente stater, 50263
    - UI Health Care Mission Cancer and Blood - Waukee Clinic
  - West Des Moines, Iowa, Forente stater, 50266
    - Mercy Medical Center-West Lakes
- Kansas
  - Garden City, Kansas, Forente stater, 67846
    - Central Care Cancer Center - Garden City
  - Great Bend, Kansas, Forente stater, 67530
    - Central Care Cancer Center - Great Bend
- Kentucky
  - Corbin, Kentucky, Forente stater, 40701
    - Baptist Health Corbin
  - Edgewood, Kentucky, Forente stater, 41017
    - Saint Elizabeth Healthcare Edgewood
  - Fort Thomas, Kentucky, Forente stater, 41075
    - Saint Elizabeth Healthcare Fort Thomas
  - Lexington, Kentucky, Forente stater, 40536
    - University of Kentucky/Markey Cancer Center
  - Lexington, Kentucky, Forente stater, 40504
    - Saint Joseph Radiation Oncology Resource Center
  - Lexington, Kentucky, Forente stater, 40509
    - Saint Joseph Hospital East
  - Lexington, Kentucky, Forente stater, 40503
    - Baptist Health Lexington
  - Lexington, Kentucky, Forente stater, 40504
    - Saint Joseph Hospital
  - Lexington, Kentucky, Forente stater, 40509
    - Baptist Health Hamburg
  - Louisville, Kentucky, Forente stater, 40202
    - The James Graham Brown Cancer Center at University of Louisville
  - Louisville, Kentucky, Forente stater, 40245
    - UofL Health Medical Center Northeast
  - Louisville, Kentucky, Forente stater, 40207
    - Baptist Health Louisville
  - Paducah, Kentucky, Forente stater, 42003
    - Baptist Health Paducah
- Louisiana
  - Covington, Louisiana, Forente stater, 70433
    - Ochsner Hematology Oncology North Shore - Covington (West Region)
  - New Orleans, Louisiana, Forente stater, 70121
    - Ochsner Medical Center Jefferson
  - New Orleans, Louisiana, Forente stater, 70112
    - University Medical Center New Orleans
- Maine
  - Brewer, Maine, Forente stater, 04412
    - Lafayette Family Cancer Center-EMMC
- Maryland
  - Baltimore, Maryland, Forente stater, 21237
    - MedStar Franklin Square Medical Center/Weinberg Cancer Institute
  - Baltimore, Maryland, Forente stater, 21215
    - Sinai Hospital of Baltimore
  - Baltimore, Maryland, Forente stater, 21239
    - MedStar Good Samaritan Hospital
  - Cumberland, Maryland, Forente stater, 21502
    - UPMC Western Maryland
  - Westminster, Maryland, Forente stater, 21157
    - William E Kahlert Regional Cancer Center/Sinai Hospital
- Massachusetts
  - Boston, Massachusetts, Forente stater, 02215
    - Beth Israel Deaconess Medical Center
  - Boston, Massachusetts, Forente stater, 02215
    - Dana-Farber Cancer Institute
  - Boston, Massachusetts, Forente stater, 02118
    - Boston Medical Center
  - Burlington, Massachusetts, Forente stater, 01805
    - Lahey Hospital and Medical Center
  - Foxborough, Massachusetts, Forente stater, 02035
    - Dana-Farber Cancer Institute at Foxborough
  - Methuen, Massachusetts, Forente stater, 01844
    - Dana Farber-Merrimack Valley
  - Milford, Massachusetts, Forente stater, 01757
    - Dana-Farber/Brigham and Women's Cancer Center at Milford Regional
  - Peabody, Massachusetts, Forente stater, 01960
    - Lahey Medical Center-Peabody
  - South Weymouth, Massachusetts, Forente stater, 02190
    - Dana-Farber/Brigham and Women's Cancer Center at South Shore
- Michigan
  - Ann Arbor, Michigan, Forente stater, 48109
    - University Of Michigan Comprehensive Cancer Center
  - Ann Arbor, Michigan, Forente stater, 48106
    - Trinity Health Saint Joseph Mercy Hospital Ann Arbor
  - Brighton, Michigan, Forente stater, 48114
    - Trinity Health IHA Medical Group Hematology Oncology - Brighton
  - Brighton, Michigan, Forente stater, 48116
    - University of Michigan - Brighton Center for Specialty Care
  - Brighton, Michigan, Forente stater, 48114
    - Trinity Health Medical Center - Brighton
  - Brownstown, Michigan, Forente stater, 48183
    - Henry Ford Cancer Institute-Downriver
  - Canton, Michigan, Forente stater, 48188
    - Trinity Health IHA Medical Group Hematology Oncology - Canton
  - Canton, Michigan, Forente stater, 48188
    - Trinity Health Medical Center - Canton
  - Caro, Michigan, Forente stater, 48723
    - Caro Cancer Center
  - Chelsea, Michigan, Forente stater, 48118
    - Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
  - Chelsea, Michigan, Forente stater, 48118
    - Chelsea Hospital
  - Clinton Township, Michigan, Forente stater, 48038
    - Henry Ford Macomb Hospital-Clinton Township
  - Dearborn, Michigan, Forente stater, 48124
    - Corewell Health Dearborn Hospital
  - Detroit, Michigan, Forente stater, 48202
    - Henry Ford Hospital
  - Detroit, Michigan, Forente stater, 48236
    - Henry Ford Health Saint John Hospital
  - Farmington Hills, Michigan, Forente stater, 48336
    - Corewell Health Farmington Hills Hospital
  - Flint, Michigan, Forente stater, 48503
    - Hurley Medical Center
  - Flint, Michigan, Forente stater, 48503
    - Genesys Hurley Cancer Institute
  - Grosse Pointe Woods, Michigan, Forente stater, 48236
    - Henry Ford Saint John Hospital - Van Elslander
  - Jackson, Michigan, Forente stater, 49201
    - Allegiance Health
  - Lansing, Michigan, Forente stater, 48912
    - University of Michigan Health - Sparrow Lansing
  - Livonia, Michigan, Forente stater, 48154
    - Trinity Health Saint Mary Mercy Livonia Hospital
  - Macomb, Michigan, Forente stater, 48044
    - Henry Ford Saint John Hospital - Macomb Medical
  - Marlette, Michigan, Forente stater, 48453
    - Saint Mary's Oncology/Hematology Associates of Marlette
  - Midland, Michigan, Forente stater, 48670
    - MyMichigan Medical Center Midland
  - Novi, Michigan, Forente stater, 48377
    - Henry Ford Medical Center-Columbus
  - Novi, Michigan, Forente stater, 48374
    - Henry Ford Health Providence Novi Hospital
  - Pontiac, Michigan, Forente stater, 48341
    - Trinity Health Saint Joseph Mercy Oakland Hospital
  - Pontiac, Michigan, Forente stater, 48341
    - Michigan Healthcare Professionals Pontiac
  - Royal Oak, Michigan, Forente stater, 48073
    - Corewell Health William Beaumont University Hospital
  - Saginaw, Michigan, Forente stater, 48604
    - Oncology Hematology Associates of Saginaw Valley PC
  - Saginaw, Michigan, Forente stater, 48601
    - MyMichigan Medical Center Saginaw
  - Southfield, Michigan, Forente stater, 48075
    - Henry Ford Health Providence Southfield Hospital
  - Tawas City, Michigan, Forente stater, 48764
    - MyMichigan Medical Center Tawas
  - Troy, Michigan, Forente stater, 48085
    - Corewell Health Beaumont Troy Hospital
  - Warren, Michigan, Forente stater, 48093
    - Henry Ford Health Warren Hospital
  - West Bloomfield, Michigan, Forente stater, 48322
    - Henry Ford West Bloomfield Hospital
  - West Branch, Michigan, Forente stater, 48661
    - Saint Mary's Oncology/Hematology Associates of West Branch
  - Ypsilanti, Michigan, Forente stater, 48197
    - Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
- Minnesota
  - Bemidji, Minnesota, Forente stater, 56601
    - Sanford Joe Lueken Cancer Center
  - Brainerd, Minnesota, Forente stater, 56401
    - Essentia Health Saint Joseph's Medical Center
  - Burnsville, Minnesota, Forente stater, 55337
    - Minnesota Oncology - Burnsville
  - Coon Rapids, Minnesota, Forente stater, 55433
    - Mercy Hospital
  - Deer River, Minnesota, Forente stater, 56636
    - Essentia Health - Deer River Clinic
  - Detroit Lakes, Minnesota, Forente stater, 56501
    - Essentia Health Saint Mary's - Detroit Lakes Clinic
  - Duluth, Minnesota, Forente stater, 55805
    - Essentia Health Cancer Center
  - Duluth, Minnesota, Forente stater, 55805
    - Essentia Health Saint Mary's Medical Center
  - Duluth, Minnesota, Forente stater, 55805
    - Miller-Dwan Hospital
  - Edina, Minnesota, Forente stater, 55435
    - Fairview Southdale Hospital
  - Fosston, Minnesota, Forente stater, 56542
    - Essentia Health - Fosston
  - Hibbing, Minnesota, Forente stater, 55746
    - Essentia Health Hibbing Clinic
  - Maple Grove, Minnesota, Forente stater, 55369
    - Fairview Clinics and Surgery Center Maple Grove
  - Maplewood, Minnesota, Forente stater, 55109
    - Saint John's Hospital - Healtheast
  - Maplewood, Minnesota, Forente stater, 55109
    - Minnesota Oncology Hematology PA-Maplewood
  - Minneapolis, Minnesota, Forente stater, 55415
    - Hennepin County Medical Center
  - Minneapolis, Minnesota, Forente stater, 55407
    - Abbott-Northwestern Hospital
  - Minneapolis, Minnesota, Forente stater, 55454
    - Health Partners Inc
  - Monticello, Minnesota, Forente stater, 55362
    - Monticello Cancer Center
  - Park Rapids, Minnesota, Forente stater, 56470
    - Essentia Health - Park Rapids
  - Robbinsdale, Minnesota, Forente stater, 55422
    - North Memorial Medical Health Center
  - Rochester, Minnesota, Forente stater, 55905
    - Mayo Clinic in Rochester
  - Saint Cloud, Minnesota, Forente stater, 56303
    - Coborn Cancer Center at Saint Cloud Hospital
  - Saint Louis Park, Minnesota, Forente stater, 55416
    - Park Nicollet Clinic - Saint Louis Park
  - Saint Paul, Minnesota, Forente stater, 55101
    - Regions Hospital
  - Saint Paul, Minnesota, Forente stater, 55102
    - United Hospital
  - Sandstone, Minnesota, Forente stater, 55072
    - Essentia Health Sandstone
  - Shakopee, Minnesota, Forente stater, 55379
    - Saint Francis Regional Medical Center
  - Stillwater, Minnesota, Forente stater, 55082
    - Lakeview Hospital
  - Virginia, Minnesota, Forente stater, 55792
    - Essentia Health Virginia Clinic
  - Waconia, Minnesota, Forente stater, 55387
    - Ridgeview Medical Center
  - Willmar, Minnesota, Forente stater, 56201
    - Rice Memorial Hospital
  - Woodbury, Minnesota, Forente stater, 55125
    - Minnesota Oncology Hematology PA-Woodbury
- Mississippi
  - Columbus, Mississippi, Forente stater, 39705
    - Baptist Memorial Hospital and Cancer Center-Golden Triangle
  - Grenada, Mississippi, Forente stater, 38901
    - Baptist Cancer Center-Grenada
  - New Albany, Mississippi, Forente stater, 38652
    - Baptist Memorial Hospital and Cancer Center-Union County
  - Oxford, Mississippi, Forente stater, 38655
    - Baptist Memorial Hospital and Cancer Center-Oxford
  - Southhaven, Mississippi, Forente stater, 38671
    - Baptist Memorial Hospital and Cancer Center-Desoto
- Missouri
  - Bolivar, Missouri, Forente stater, 65613
    - Central Care Cancer Center - Bolivar
  - Cape Girardeau, Missouri, Forente stater, 63703
    - Saint Francis Medical Center
  - Cape Girardeau, Missouri, Forente stater, 63703
    - Mercy Cancer Center - Cape Girardeau
  - Farmington, Missouri, Forente stater, 63640
    - Parkland Health Center - Farmington
  - Jefferson City, Missouri, Forente stater, 65109
    - MU Health Care Goldschmidt Cancer Center
  - Joplin, Missouri, Forente stater, 64804
    - Freeman Health System
  - Joplin, Missouri, Forente stater, 64804
    - Mercy Hospital Joplin
  - Osage Beach, Missouri, Forente stater, 65065
    - Lake Regional Hospital
  - Rolla, Missouri, Forente stater, 65401
    - Mercy Clinic-Rolla-Cancer and Hematology
  - Rolla, Missouri, Forente stater, 65401
    - Phelps Health Delbert Day Cancer Institute
  - Saint Joseph, Missouri, Forente stater, 64506
    - Heartland Regional Medical Center
  - Sainte Genevieve, Missouri, Forente stater, 63670
    - Sainte Genevieve County Memorial Hospital
  - Springfield, Missouri, Forente stater, 65807
    - CoxHealth South Hospital
  - Springfield, Missouri, Forente stater, 65804
    - Mercy Hospital Springfield
  - St Louis, Missouri, Forente stater, 63131
    - Missouri Baptist Medical Center
  - St Louis, Missouri, Forente stater, 63141
    - Mercy Hospital Saint Louis
  - St Louis, Missouri, Forente stater, 63128
    - Mercy Hospital South
  - Sullivan, Missouri, Forente stater, 63080
    - Missouri Baptist Sullivan Hospital
  - Sunset Hills, Missouri, Forente stater, 63127
    - BJC Outpatient Center at Sunset Hills
- Montana
  - Billings, Montana, Forente stater, 59101
    - Billings Clinic Cancer Center
  - Bozeman, Montana, Forente stater, 59715
    - Bozeman Health Deaconess Hospital
  - Butte, Montana, Forente stater, 59701
    - Saint James Community Hospital and Cancer Treatment Center
  - Great Falls, Montana, Forente stater, 59405
    - Great Falls Clinic
  - Great Falls, Montana, Forente stater, 59405
    - Benefis Sletten Cancer Institute
  - Havre, Montana, Forente stater, 59501
    - Hi-Line Sletten Cancer Center
  - Kalispell, Montana, Forente stater, 59901
    - Logan Health Medical Center
  - Missoula, Montana, Forente stater, 59802
    - Saint Patrick Hospital - Community Hospital
  - Missoula, Montana, Forente stater, 59804
    - Community Medical Center
- Nebraska
  - Kearney, Nebraska, Forente stater, 68847
    - CHI Health Good Samaritan
  - Omaha, Nebraska, Forente stater, 68124
    - Alegent Health Bergan Mercy Medical Center
  - Omaha, Nebraska, Forente stater, 68122
    - Alegent Health Immanuel Medical Center
  - Omaha, Nebraska, Forente stater, 68130
    - Alegent Health Lakeside Hospital
  - Omaha, Nebraska, Forente stater, 68131
    - Creighton University Medical Center
- Nevada
  - Henderson, Nevada, Forente stater, 89052
    - Comprehensive Cancer Centers of Nevada - Henderson
  - Henderson, Nevada, Forente stater, 89052
    - OptumCare Cancer Care at Seven Hills
  - Las Vegas, Nevada, Forente stater, 89144
    - Summerlin Hospital Medical Center
  - Las Vegas, Nevada, Forente stater, 89102
    - OptumCare Cancer Care at Charleston
  - Las Vegas, Nevada, Forente stater, 89106
    - Radiation Oncology Centers of Nevada Central
  - Las Vegas, Nevada, Forente stater, 89109
    - GenesisCare USA - Las Vegas
  - Las Vegas, Nevada, Forente stater, 89119
    - Radiation Oncology Centers of Nevada Southeast
  - Las Vegas, Nevada, Forente stater, 89128
    - Comprehensive Cancer Centers of Nevada - Northwest
  - Las Vegas, Nevada, Forente stater, 89128
    - OptumCare Cancer Care at MountainView
  - Las Vegas, Nevada, Forente stater, 89135
    - Alliance for Childhood Diseases/Cure 4 the Kids Foundation
  - Las Vegas, Nevada, Forente stater, 89144
    - Comprehensive Cancer Centers of Nevada - Town Center
  - Las Vegas, Nevada, Forente stater, 89144
    - Comprehensive Cancer Centers of Nevada-Summerlin
  - Las Vegas, Nevada, Forente stater, 89148
    - Comprehensive Cancer Centers of Nevada
  - Las Vegas, Nevada, Forente stater, 89148
    - OptumCare Cancer Care at Fort Apache
  - Las Vegas, Nevada, Forente stater, 89169
    - Comprehensive Cancer Centers of Nevada - Central Valley
  - Las Vegas, Nevada, Forente stater, 89148
    - GenesisCare USA - Fort Apache
  - Reno, Nevada, Forente stater, 89502
    - Renown Regional Medical Center
  - Reno, Nevada, Forente stater, 89503
    - Saint Mary's Regional Medical Center
  - Reno, Nevada, Forente stater, 89509
    - Radiation Oncology Associates
- New Hampshire
  - Concord, New Hampshire, Forente stater, 03301
    - New Hampshire Oncology Hematology PA-Concord
  - Lebanon, New Hampshire, Forente stater, 03756
    - Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
  - Londonderry, New Hampshire, Forente stater, 03053
    - The Dana-Farber Cancer Institute at Londonderry
  - Manchester, New Hampshire, Forente stater, 03103
    - Solinsky Center for Cancer Care
- New Jersey
  - Basking Ridge, New Jersey, Forente stater, 07920
    - Memorial Sloan Kettering Basking Ridge
  - Camden, New Jersey, Forente stater, 08103
    - Cooper Hospital University Medical Center
  - Cherry Hill, New Jersey, Forente stater, 08002
    - Jefferson Cherry Hill Hospital
  - Middletown, New Jersey, Forente stater, 07748
    - Memorial Sloan Kettering Monmouth
  - Montvale, New Jersey, Forente stater, 07645
    - Memorial Sloan Kettering Bergen
  - Morristown, New Jersey, Forente stater, 07960
    - Morristown Medical Center
  - Paramus, New Jersey, Forente stater, 07652
    - The Valley Hospital - Luckow Pavilion
  - Pompton, New Jersey, Forente stater, 07444
    - Chilton Medical Center
  - Ridgewood, New Jersey, Forente stater, 07450
    - Valley Health System Ridgewood Campus
  - Sewell, New Jersey, Forente stater, 08080
    - Sidney Kimmel Cancer Center Washington Township
  - Summit, New Jersey, Forente stater, 07902
    - Overlook Hospital
  - Teaneck, New Jersey, Forente stater, 07666
    - Holy Name Hospital
  - Westwood, New Jersey, Forente stater, 07675
    - Valley Health System-Hematology/Oncology
- New Mexico
  - Albuquerque, New Mexico, Forente stater, 87106
    - University of New Mexico Cancer Center
- New York
  - Brooklyn, New York, Forente stater, 11215
    - New York-Presbyterian/Brooklyn Methodist Hospital
  - Brooklyn, New York, Forente stater, 11220
    - NYU Langone Hospital - Brooklyn
  - Buffalo, New York, Forente stater, 14263
    - Roswell Park Cancer Institute
  - Commack, New York, Forente stater, 11725
    - Memorial Sloan Kettering Commack
  - East White Plains, New York, Forente stater, 10604
    - Memorial Sloan Kettering Westchester
  - Flushing, New York, Forente stater, 11355
    - The New York Hospital Medical Center of Queens
  - Forest Hills, New York, Forente stater, 11375
    - Northwell Health Physicians Partners Radiation Medicine at Queens
  - Glens Falls, New York, Forente stater, 12801
    - Glens Falls Hospital
  - Greenlawn, New York, Forente stater, 11740
    - Northwell Health Cancer Institute at Huntington
  - Lake Success, New York, Forente stater, 11042
    - Northwell Health/Center for Advanced Medicine
  - Manhasset, New York, Forente stater, 11030
    - North Shore University Hospital
  - Middletown, New York, Forente stater, 10940
    - Garnet Health Medical Center
  - Mineola, New York, Forente stater, 11501
    - NYU Langone Hospital - Long Island
  - Mount Kisco, New York, Forente stater, 10549
    - Northern Westchester Hospital
  - New Hyde Park, New York, Forente stater, 11040
    - Long Island Jewish Medical Center
  - New York, New York, Forente stater, 10065
    - Memorial Sloan Kettering Cancer Center
  - New York, New York, Forente stater, 10019
    - Mount Sinai West
  - New York, New York, Forente stater, 10029
    - Mount Sinai Hospital
  - New York, New York, Forente stater, 10032
    - NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
  - New York, New York, Forente stater, 10065
    - NYP/Weill Cornell Medical Center
  - New York, New York, Forente stater, 10016
    - Laura and Isaac Perlmutter Cancer Center at NYU Langone
  - New York, New York, Forente stater, 10075
    - Lenox Hill Hospital
  - New York, New York, Forente stater, 10065
    - Manhattan Eye Ear and Throat Hospital
  - Oswego, New York, Forente stater, 13126
    - Upstate Cancer Center at Oswego
  - Rego Park, New York, Forente stater, 11374
    - Queens Cancer Center
  - Rochester, New York, Forente stater, 14642
    - University of Rochester
  - Sleepy Hollow, New York, Forente stater, 10591
    - Phelps Memorial Hospital Center
  - Syracuse, New York, Forente stater, 13210
    - State University of New York Upstate Medical University
  - Syracuse, New York, Forente stater, 13215
    - SUNY Upstate Medical Center-Community Campus
  - The Bronx, New York, Forente stater, 10461
    - Montefiore Medical Center-Einstein Campus
  - The Bronx, New York, Forente stater, 10467
    - Montefiore Medical Center - Moses Campus
  - The Bronx, New York, Forente stater, 10461
    - Montefiore Medical Center-Weiler Hospital
  - Uniondale, New York, Forente stater, 11553
    - Memorial Sloan Kettering Nassau
  - Verona, New York, Forente stater, 13478
    - Upstate Cancer Center at Verona
  - Webster, New York, Forente stater, 14580
    - Wilmot Cancer Institute at Webster
- North Carolina
  - Albemarle, North Carolina, Forente stater, 28002
    - Atrium Health Stanly/LCI-Albemarle
  - Cary, North Carolina, Forente stater, 27518
    - Duke Cancer Center Cary
  - Chapel Hill, North Carolina, Forente stater, 27599
    - UNC Lineberger Comprehensive Cancer Center
  - Charlotte, North Carolina, Forente stater, 28203
    - Carolinas Medical Center/Levine Cancer Institute
  - Charlotte, North Carolina, Forente stater, 28210
    - Atrium Health Pineville/LCI-Pineville
  - Charlotte, North Carolina, Forente stater, 28262
    - Atrium Health University City/LCI-University
  - Charlotte, North Carolina, Forente stater, 28211
    - Levine Cancer Institute-SouthPark
  - Charlotte, North Carolina, Forente stater, 28277
    - Levine Cancer Institute-Ballantyne
  - Clemmons, North Carolina, Forente stater, 27012
    - Wake Forest University at Clemmons
  - Concord, North Carolina, Forente stater, 28025
    - Atrium Health Cabarrus/LCI-Concord
  - Durham, North Carolina, Forente stater, 27710
    - Duke University Medical Center
  - Forest City, North Carolina, Forente stater, 28043
    - Levine Cancer Institute - Rutherford
  - Gastonia, North Carolina, Forente stater, 28054
    - Levine Cancer Institute-Gaston
  - Greenville, North Carolina, Forente stater, 27834
    - East Carolina University
  - High Point, North Carolina, Forente stater, 27262
    - Hayworth Cancer Center
  - Hillsborough, North Carolina, Forente stater, 27278
    - University of North Carolina-Hillsborough Campus
  - Lincolnton, North Carolina, Forente stater, 28092
    - Atrium Health Lincoln/LCI-Lincolnton
  - Matthews, North Carolina, Forente stater, 28104
    - Levine Cancer Institute - Union West
  - Monroe, North Carolina, Forente stater, 28112
    - Atrium Health Union/LCI-Union
  - Raleigh, North Carolina, Forente stater, 27609
    - Duke Cancer Center Raleigh
  - Shelby, North Carolina, Forente stater, 28150
    - Atrium Health Cleveland/LCI-Cleveland
  - Wilkesboro, North Carolina, Forente stater, 28659
    - Wake Forest Baptist Health - Wilkes Medical Center
  - Winston-Salem, North Carolina, Forente stater, 27157
    - Wake Forest University Health Sciences
- North Dakota
  - Bismarck, North Dakota, Forente stater, 58501
    - Sanford Bismarck Medical Center
  - Fargo, North Dakota, Forente stater, 58122
    - Sanford Roger Maris Cancer Center
  - Fargo, North Dakota, Forente stater, 58103
    - Essentia Health Cancer Center-South University Clinic
  - Fargo, North Dakota, Forente stater, 58122
    - Sanford Broadway Medical Center
  - Jamestown, North Dakota, Forente stater, 58401
    - Essentia Health - Jamestown Clinic
- Ohio
  - Beavercreek, Ohio, Forente stater, 45431
    - Indu and Raj Soin Medical Center
  - Boardman, Ohio, Forente stater, 44512
    - Saint Elizabeth Boardman Hospital
  - Canton, Ohio, Forente stater, 44710
    - Aultman Health Foundation
  - Centerville, Ohio, Forente stater, 45459
    - Dayton Physicians LLC-Miami Valley South
  - Cincinnati, Ohio, Forente stater, 45220
    - Good Samaritan Hospital - Cincinnati
  - Cincinnati, Ohio, Forente stater, 45242
    - Bethesda North Hospital
  - Cincinnati, Ohio, Forente stater, 45236
    - Oncology Hematology Care Inc-Kenwood
  - Cleveland, Ohio, Forente stater, 44109
    - MetroHealth Medical Center
  - Columbus, Ohio, Forente stater, 43210
    - Ohio State University Comprehensive Cancer Center
  - Dayton, Ohio, Forente stater, 45415
    - Dayton Physician LLC - Englewood
  - Findlay, Ohio, Forente stater, 45840
    - Blanchard Valley Hospital
  - Findlay, Ohio, Forente stater, 45840
    - Armes Family Cancer Center
  - Findlay, Ohio, Forente stater, 45840
    - Orion Cancer Care
  - Franklin, Ohio, Forente stater, 45005
    - Dayton Physicians LLC-Atrium
  - Greenville, Ohio, Forente stater, 45331
    - Wayne Hospital
  - Greenville, Ohio, Forente stater, 45331
    - Dayton Physicians LLC-Wayne
  - Kettering, Ohio, Forente stater, 45429
    - Kettering Medical Center
  - Kettering, Ohio, Forente stater, 45409
    - Greater Dayton Cancer Center
  - Troy, Ohio, Forente stater, 45373
    - Dayton Physicians LLC - Troy
  - Warren, Ohio, Forente stater, 44484
    - Saint Joseph Warren Hospital
  - Youngstown, Ohio, Forente stater, 44501
    - Saint Elizabeth Youngstown Hospital
- Oklahoma
  - Oklahoma City, Oklahoma, Forente stater, 73104
    - University of Oklahoma Health Sciences Center
  - Oklahoma City, Oklahoma, Forente stater, 73120
    - Mercy Hospital Oklahoma City
- Oregon
  - Bend, Oregon, Forente stater, 97701
    - Saint Charles Health System
  - Clackamas, Oregon, Forente stater, 97015
    - Clackamas Radiation Oncology Center
  - Clackamas, Oregon, Forente stater, 97015
    - Providence Cancer Institute Clackamas Clinic
  - Coos Bay, Oregon, Forente stater, 97420
    - Bay Area Hospital
  - Gresham, Oregon, Forente stater, 97030
    - Legacy Mount Hood Medical Center
  - Newberg, Oregon, Forente stater, 97132
    - Providence Newberg Medical Center
  - Oregon City, Oregon, Forente stater, 97045
    - Providence Willamette Falls Medical Center
  - Portland, Oregon, Forente stater, 97210
    - Legacy Good Samaritan Hospital and Medical Center
  - Portland, Oregon, Forente stater, 97213
    - Providence Portland Medical Center
  - Portland, Oregon, Forente stater, 97225
    - Providence Saint Vincent Medical Center
  - Tualatin, Oregon, Forente stater, 97062
    - Legacy Meridian Park Hospital
- Pennsylvania
  - Allentown, Pennsylvania, Forente stater, 18103
    - Lehigh Valley Hospital-Cedar Crest
  - Altoona, Pennsylvania, Forente stater, 16601
    - UPMC Altoona
  - Beaver, Pennsylvania, Forente stater, 15009
    - UPMC-Heritage Valley Health System Beaver
  - Bethlehem, Pennsylvania, Forente stater, 18017
    - Lehigh Valley Hospital - Muhlenberg
  - Camp Hill, Pennsylvania, Forente stater, 17011
    - UPMC Camp Hill
  - Carlisle, Pennsylvania, Forente stater, 17015
    - Carlisle Regional Cancer Center
  - Chadds Ford, Pennsylvania, Forente stater, 19317
    - Christiana Care Health System-Concord Health Center
  - East Stroudsburg, Pennsylvania, Forente stater, 18301
    - Pocono Medical Center
  - Erie, Pennsylvania, Forente stater, 16505
    - UPMC Hillman Cancer Center Erie
  - Erie, Pennsylvania, Forente stater, 16544
    - Saint Vincent Hospital
  - Farrell, Pennsylvania, Forente stater, 16121
    - UPMC Cancer Center at UPMC Horizon
  - Greensburg, Pennsylvania, Forente stater, 15601
    - UPMC Cancer Centers - Arnold Palmer Pavilion
  - Greenville, Pennsylvania, Forente stater, 16125
    - UPMC Hillman Cancer Center in Greenville/UPMC Horizon
  - Harrisburg, Pennsylvania, Forente stater, 17109
    - UPMC Pinnacle Cancer Center/Community Osteopathic Campus
  - Hershey, Pennsylvania, Forente stater, 17033-0850
    - Penn State Milton S Hershey Medical Center
  - Indiana, Pennsylvania, Forente stater, 15701
    - IRMC Cancer Center
  - Jefferson Hills, Pennsylvania, Forente stater, 15025
    - Jefferson Hospital
  - Johnstown, Pennsylvania, Forente stater, 15901
    - UPMC-Johnstown/John P. Murtha Regional Cancer Center
  - McKeesport, Pennsylvania, Forente stater, 15132
    - UPMC Cancer Center at UPMC McKeesport
  - Mechanicsburg, Pennsylvania, Forente stater, 17050
    - UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
  - Monroeville, Pennsylvania, Forente stater, 15146
    - Forbes Hospital
  - Monroeville, Pennsylvania, Forente stater, 15146
    - UPMC Hillman Cancer Center - Monroeville
  - Monroeville, Pennsylvania, Forente stater, 15146
    - UPMC Cancer Center - Monroeville
  - Moon Township, Pennsylvania, Forente stater, 15108
    - UPMC Hillman Cancer Center in Coraopolis
  - Mount Pleasant, Pennsylvania, Forente stater, 15666
    - UPMC Hillman Cancer Center - Part of Frick Hospital
  - Natrona Heights, Pennsylvania, Forente stater, 15065
    - UPMC Cancer Center-Natrona Heights
  - New Castle, Pennsylvania, Forente stater, 16105
    - UPMC Hillman Cancer Center - New Castle
  - North Huntingdon, Pennsylvania, Forente stater, 15642
    - Arnold Palmer Cancer Center Medical Oncology Norwin
  - Philadelphia, Pennsylvania, Forente stater, 19107
    - Thomas Jefferson University Hospital
  - Philadelphia, Pennsylvania, Forente stater, 19114
    - Jefferson Torresdale Hospital
  - Pittsburgh, Pennsylvania, Forente stater, 15212
    - Allegheny General Hospital
  - Pittsburgh, Pennsylvania, Forente stater, 15224
    - West Penn Hospital
  - Pittsburgh, Pennsylvania, Forente stater, 15213
    - UPMC-Magee Womens Hospital
  - Pittsburgh, Pennsylvania, Forente stater, 15232
    - University of Pittsburgh Cancer Institute (UPCI)
  - Pittsburgh, Pennsylvania, Forente stater, 15232
    - UPMC-Shadyside Hospital
  - Pittsburgh, Pennsylvania, Forente stater, 15215
    - UPMC-Saint Margaret
  - Pittsburgh, Pennsylvania, Forente stater, 15237
    - UPMC-Passavant Hospital
  - Pittsburgh, Pennsylvania, Forente stater, 15243
    - UPMC-Saint Clair Hospital Cancer Center
  - Pittsburgh, Pennsylvania, Forente stater, 15219
    - UPMC-Mercy Hospital
  - Seneca, Pennsylvania, Forente stater, 16346
    - UPMC Cancer Center at UPMC Northwest
  - Uniontown, Pennsylvania, Forente stater, 15401
    - UPMC Uniontown Hospital Radiation Oncology
  - Uniontown, Pennsylvania, Forente stater, 15401
    - UPMC Cancer Center-Uniontown
  - Washington, Pennsylvania, Forente stater, 15301
    - UPMC Washington Hospital Radiation Oncology
  - Washington, Pennsylvania, Forente stater, 15301
    - UPMC Cancer Center-Washington
  - West Chester, Pennsylvania, Forente stater, 19380
    - Chester County Hospital
  - West Reading, Pennsylvania, Forente stater, 19611
    - Reading Hospital
  - Wexford, Pennsylvania, Forente stater, 15090
    - Wexford Health and Wellness Pavilion
  - Williamsport, Pennsylvania, Forente stater, 17754
    - Divine Providence Hospital
  - Willow Grove, Pennsylvania, Forente stater, 19090
    - Asplundh Cancer Pavilion
  - York, Pennsylvania, Forente stater, 17408
    - UPMC Memorial
- South Carolina
  - Anderson, South Carolina, Forente stater, 29621
    - AnMed Health Cancer Center
  - Charleston, South Carolina, Forente stater, 29425
    - Medical University of South Carolina
  - Gaffney, South Carolina, Forente stater, 29341
    - Gibbs Cancer Center-Gaffney
  - Georgetown, South Carolina, Forente stater, 29440
    - Tidelands Georgetown Memorial Hospital
  - Greenville, South Carolina, Forente stater, 29605
    - Prisma Health Cancer Institute - Faris
  - Greenville, South Carolina, Forente stater, 29615
    - Prisma Health Cancer Institute - Eastside
  - Greer, South Carolina, Forente stater, 29650
    - Prisma Health Cancer Institute - Greer
  - Greer, South Carolina, Forente stater, 29651
    - Gibbs Cancer Center-Pelham
  - Murrells Inlet, South Carolina, Forente stater, 29576
    - MUSC Health Tidelands Health Radiation Therapy Center
  - Rock Hill, South Carolina, Forente stater, 29732
    - Levine Cancer Institute-Rock Hill
  - Rock Hill, South Carolina, Forente stater, 29730
    - Rock Hill Radiation Therapy Center
  - Seneca, South Carolina, Forente stater, 29672
    - Prisma Health Cancer Institute - Seneca
  - Spartanburg, South Carolina, Forente stater, 29303
    - Spartanburg Medical Center
  - Union, South Carolina, Forente stater, 29379
    - SMC Center for Hematology Oncology Union
  - West Columbia, South Carolina, Forente stater, 29169
    - Lexington Medical Center
- South Dakota
  - Aberdeen, South Dakota, Forente stater, 57401
    - Avera Cancer Institute-Aberdeen
  - Mitchell, South Dakota, Forente stater, 57301
    - Avera Cancer Institute - Mitchell
  - Pierre, South Dakota, Forente stater, 57501
    - Avera Cancer Institute at Pierre
  - Sioux Falls, South Dakota, Forente stater, 57105
    - Avera Cancer Institute
  - Sioux Falls, South Dakota, Forente stater, 57117-5134
    - Sanford USD Medical Center - Sioux Falls
  - Sioux Falls, South Dakota, Forente stater, 57104
    - Sanford Cancer Center Oncology Clinic
  - Yankton, South Dakota, Forente stater, 57078
    - Avera Cancer Institute at Yankton
- Tennessee
  - Collierville, Tennessee, Forente stater, 38017
    - Baptist Memorial Hospital and Cancer Center-Collierville
  - Germantown, Tennessee, Forente stater, 38138
    - The West Clinic - Wolf River
  - Memphis, Tennessee, Forente stater, 38120
    - Baptist Memorial Hospital and Cancer Center-Memphis
  - Nashville, Tennessee, Forente stater, 37232
    - Vanderbilt University/Ingram Cancer Center
  - Nashville, Tennessee, Forente stater, 37204
    - Vanderbilt Breast Center at One Hundred Oaks
- Texas
  - Amarillo, Texas, Forente stater, 79106
    - The Don and Sybil Harrington Cancer Center
  - Conroe, Texas, Forente stater, 77384
    - MD Anderson in The Woodlands
  - Dallas, Texas, Forente stater, 75235
    - Parkland Memorial Hospital
  - Dallas, Texas, Forente stater, 75390
    - UT Southwestern/Simmons Cancer Center-Dallas
  - Dallas, Texas, Forente stater, 75237
    - UT Southwestern Simmons Cancer Center - RedBird
  - Fort Worth, Texas, Forente stater, 76104
    - UT Southwestern/Simmons Cancer Center-Fort Worth
  - Fort Worth, Texas, Forente stater, 76104
    - Tarrant County Hospital District/JPS Health Network
  - Houston, Texas, Forente stater, 77030
    - M D Anderson Cancer Center
  - Houston, Texas, Forente stater, 77026-1967
    - Lyndon Baines Johnson General Hospital
  - Houston, Texas, Forente stater, 77030
    - Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
  - Houston, Texas, Forente stater, 77030
    - Ben Taub General Hospital
  - Houston, Texas, Forente stater, 77079
    - MD Anderson West Houston
  - League City, Texas, Forente stater, 77573
    - MD Anderson League City
  - Richardson, Texas, Forente stater, 75080
    - UT Southwestern Clinical Center at Richardson/Plano
  - Round Rock, Texas, Forente stater, 78665
    - Scott and White Healthcare Round Rock
  - San Antonio, Texas, Forente stater, 78229
    - University of Texas Health Science Center at San Antonio
  - Sugar Land, Texas, Forente stater, 77478
    - MD Anderson in Sugar Land
  - Temple, Texas, Forente stater, 76508
    - Scott and White Memorial Hospital
- Utah
  - Farmington, Utah, Forente stater, 84025
    - Farmington Health Center
  - Salt Lake City, Utah, Forente stater, 84112
    - Huntsman Cancer Institute/University of Utah
  - Salt Lake City, Utah, Forente stater, 84106
    - University of Utah Sugarhouse Health Center
- Vermont
  - Berlin Corners, Vermont, Forente stater, 05602
    - Central Vermont Medical Center/National Life Cancer Treatment
  - Burlington, Vermont, Forente stater, 05401
    - University of Vermont Medical Center
  - Burlington, Vermont, Forente stater, 05405
    - University of Vermont and State Agricultural College
- Virginia
  - Charlottesville, Virginia, Forente stater, 22908
    - University of Virginia Cancer Center
  - Fairfax, Virginia, Forente stater, 22031
    - Inova Schar Cancer Institute
  - Fairfax, Virginia, Forente stater, 22033
    - Inova Fair Oaks Hospital
  - Falls Church, Virginia, Forente stater, 22042
    - INOVA Fairfax Hospital
  - Leesburg, Virginia, Forente stater, 20176
    - Inova Loudoun Hospital
  - Martinsville, Virginia, Forente stater, 24112
    - Sovah Health Martinsville
  - Richmond, Virginia, Forente stater, 23235
    - VCU Massey Cancer Center at Stony Point
  - Richmond, Virginia, Forente stater, 23229
    - Virginia Cancer Institute
  - Richmond, Virginia, Forente stater, 23298
    - VCU Massey Comprehensive Cancer Center
- Washington
  - Aberdeen, Washington, Forente stater, 98520
    - Providence Regional Cancer System-Aberdeen
  - Bellingham, Washington, Forente stater, 98225
    - PeaceHealth Saint Joseph Medical Center
  - Centralia, Washington, Forente stater, 98531
    - Providence Regional Cancer System-Centralia
  - Edmonds, Washington, Forente stater, 98026
    - Swedish Cancer Institute-Edmonds
  - Everett, Washington, Forente stater, 98201
    - Providence Regional Cancer Partnership
  - Issaquah, Washington, Forente stater, 98029
    - Swedish Cancer Institute-Issaquah
  - Kennewick, Washington, Forente stater, 99336
    - Kadlec Clinic Hematology and Oncology
  - Kirkland, Washington, Forente stater, 98034
    - FHCC at EvergreenHealth
  - Lacey, Washington, Forente stater, 98503
    - Providence Regional Cancer System-Lacey
  - Longview, Washington, Forente stater, 98632
    - PeaceHealth Saint John Medical Center
  - Mount Vernon, Washington, Forente stater, 98274
    - Skagit Regional Health Cancer Care Center
  - Renton, Washington, Forente stater, 98055
    - Valley Medical Center
  - Seattle, Washington, Forente stater, 98101
    - Virginia Mason Medical Center
  - Seattle, Washington, Forente stater, 98107
    - Swedish Medical Center-Ballard Campus
  - Seattle, Washington, Forente stater, 98122
    - Swedish Medical Center-First Hill
  - Seattle, Washington, Forente stater, 98195
    - University of Washington Medical Center - Montlake
  - Seattle, Washington, Forente stater, 98109
    - Fred Hutchinson Cancer Center
  - Sedro-Woolley, Washington, Forente stater, 98284
    - PeaceHealth United General Medical Center
  - Silverdale, Washington, Forente stater, 98383
    - Saint Michael Cancer Center
  - Vancouver, Washington, Forente stater, 98686
    - Legacy Salmon Creek Hospital
  - Vancouver, Washington, Forente stater, 98664
    - PeaceHealth Southwest Medical Center
  - Vancouver, Washington, Forente stater, 98684
    - Legacy Cancer Institute Medical Oncology and Day Treatment
  - Walla Walla, Washington, Forente stater, 99362
    - Providence Saint Mary Regional Cancer Center
  - Yakima, Washington, Forente stater, 98902
    - North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
- West Virginia
  - Bridgeport, West Virginia, Forente stater, 26330
    - United Hospital Center
  - Morgantown, West Virginia, Forente stater, 26506
    - West Virginia University Healthcare
  - Parkersburg, West Virginia, Forente stater, 26101
    - Camden Clark Medical Center
- Wisconsin
  - Antigo, Wisconsin, Forente stater, 54409
    - Langlade Hospital and Cancer Center
  - Ashland, Wisconsin, Forente stater, 54806
    - Duluth Clinic Ashland
  - Ashland, Wisconsin, Forente stater, 54806
    - Northwest Wisconsin Cancer Center
  - Burlington, Wisconsin, Forente stater, 53105
    - Aurora Cancer Care-Southern Lakes VLCC
  - Eau Claire, Wisconsin, Forente stater, 54701
    - Marshfield Medical Center-EC Cancer Center
  - Germantown, Wisconsin, Forente stater, 53022
    - Aurora Health Care Germantown Health Center
  - Grafton, Wisconsin, Forente stater, 53024
    - Aurora Cancer Care-Grafton
  - Green Bay, Wisconsin, Forente stater, 54311
    - Aurora BayCare Medical Center
  - Green Bay, Wisconsin, Forente stater, 54301
    - Saint Vincent Hospital Cancer Center Green Bay
  - Green Bay, Wisconsin, Forente stater, 54303
    - Saint Vincent Hospital Cancer Center at Saint Mary's
  - Hayward, Wisconsin, Forente stater, 54843
    - Essentia Health-Hayward Clinic
  - Kenosha, Wisconsin, Forente stater, 53142
    - Aurora Cancer Care-Kenosha South
  - Marinette, Wisconsin, Forente stater, 54143
    - Aurora Bay Area Medical Group-Marinette
  - Marshfield, Wisconsin, Forente stater, 54449
    - Marshfield Medical Center-Marshfield
  - Medford, Wisconsin, Forente stater, 54451
    - Aspirus Medford Hospital
  - Menomonee Falls, Wisconsin, Forente stater, 53051
    - Froedtert Menomonee Falls Hospital
  - Milwaukee, Wisconsin, Forente stater, 53226
    - Medical College of Wisconsin
  - Milwaukee, Wisconsin, Forente stater, 53209
    - Aurora Cancer Care-Milwaukee
  - Milwaukee, Wisconsin, Forente stater, 53215
    - Aurora Saint Luke's Medical Center
  - Milwaukee, Wisconsin, Forente stater, 53233
    - Aurora Sinai Medical Center
  - Minocqua, Wisconsin, Forente stater, 54548
    - Marshfield Medical Center - Minocqua
  - Mukwonago, Wisconsin, Forente stater, 53149
    - ProHealth D N Greenwald Center
  - New Richmond, Wisconsin, Forente stater, 54017
    - Cancer Center of Western Wisconsin
  - Oak Creek, Wisconsin, Forente stater, 53154
    - Drexel Town Square Health Center
  - Oconomowoc, Wisconsin, Forente stater, 53066
    - ProHealth Oconomowoc Memorial Hospital
  - Oshkosh, Wisconsin, Forente stater, 54904
    - Vince Lombardi Cancer Clinic - Oshkosh
  - Racine, Wisconsin, Forente stater, 53406
    - Aurora Cancer Care-Racine
  - Rhinelander, Wisconsin, Forente stater, 54501
    - Aspirus Cancer Care - James Beck Cancer Center
  - Rice Lake, Wisconsin, Forente stater, 54868
    - Marshfield Medical Center-Rice Lake
  - Sheboygan, Wisconsin, Forente stater, 53081
    - Vince Lombardi Cancer Clinic-Sheboygan
  - Sheboygan, Wisconsin, Forente stater, 53081
    - Saint Vincent Hospital Cancer Center at Sheboygan
  - Spooner, Wisconsin, Forente stater, 54801
    - Essentia Health-Spooner Clinic
  - Stevens Point, Wisconsin, Forente stater, 54482
    - Marshfield Medical Center-River Region at Stevens Point
  - Stevens Point, Wisconsin, Forente stater, 54481
    - Aspirus Cancer Care - Stevens Point
  - Sturgeon Bay, Wisconsin, Forente stater, 54235-1495
    - Saint Vincent Hospital Cancer Center at Sturgeon Bay
  - Summit, Wisconsin, Forente stater, 53066
    - Aurora Medical Center in Summit
  - Superior, Wisconsin, Forente stater, 54880
    - Essentia Health Saint Mary's Hospital - Superior
  - Two Rivers, Wisconsin, Forente stater, 54241
    - Vince Lombardi Cancer Clinic-Two Rivers
  - Waukesha, Wisconsin, Forente stater, 53188
    - UW Cancer Center at ProHealth Care
  - Wausau, Wisconsin, Forente stater, 54401
    - Aspirus Regional Cancer Center
  - Wauwatosa, Wisconsin, Forente stater, 53226
    - Aurora Cancer Care-Milwaukee West
  - West Allis, Wisconsin, Forente stater, 53227
    - Aurora West Allis Medical Center
  - West Bend, Wisconsin, Forente stater, 53095
    - Froedtert West Bend Hospital/Kraemer Cancer Center
  - Weston, Wisconsin, Forente stater, 54476
    - Marshfield Medical Center - Weston
  - Wisconsin Rapids, Wisconsin, Forente stater, 54494
    - Aspirus Cancer Care - Wisconsin Rapids
- Wyoming
  - Sheridan, Wyoming, Forente stater, 82801
    - Welch Cancer Center
Puerto Rico
- - Bayamón, Puerto Rico, 00959-5060
    - Cancer Center-Metro Medical Center Bayamon
  - Manati, Puerto Rico, 00674
    - Doctors Cancer Center
  - San Juan, Puerto Rico, 00917
    - San Juan Community Oncology Group
  - San Juan, Puerto Rico, 00927
    - Centro Comprensivo de Cancer de UPR
  - San Juan, Puerto Rico, 00936
    - San Juan City Hospital
  - San Juan, Puerto Rico, 00902
    - Pan American Center for Oncology Trials LLC

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Beskrivelse

Inklusjonskriterier:

Stadium: Klinisk stadium II eller III rektalt adenokarsinom definert som T4N0 eller en hvilken som helst T med nodepositiv sykdom (enhver T, N+); også T3N0 som krever abdominal perineal reseksjon (APR) eller coloanal anastomose
Tumorsted: rektum; =< 12 cm fra analkanten
Ingen tidligere systemisk kjemoterapi, målrettet terapi eller immunterapi; eller strålebehandling gitt som behandling for tykktarmskreft i løpet av de siste 5 årene er tillatt
Ikke gravid og ikke ammende, fordi denne studien involverer et middel som har kjente genotoksiske, mutagene og teratogene effekter
* Derfor, kun for kvinner i fertil alder, kreves en negativ graviditetstest (urin eller serum i henhold til institusjonelle retningslinjer) utført =< 14 dager før registrering. Kvinnelige forsøkspersoner samtykker i å bruke svært effektiv prevensjon kombinert med en ekstra barrieremetode (f.eks. diafragma, med et sæddrepende middel) under studien og i >= 9 måneder etter siste dose av studiemedikamentet, og de samme kriteriene gjelder for mannlige forsøkspersoner hvis de har en partner med fødselspotensial. Mannlig forsøksperson samtykker i å bruke kondom og ikke donere sæd mens i denne studien og i >= 6 måneder etter siste behandling
Alder >= 18 år
Eastern Cooperative Oncology Group (ECOG) ytelsesstatus =< 2 (eller Karnofsky >= 60 %)
Absolutt nøytrofiltall (ANC) >= 1500/mm^3
Blodplateantall >= 100 000/mm
Kreatinin =< 1,5 x øvre normalgrense (ULN) ELLER beregnet (kalk.) kreatininclearance >= 50 ml/min
^3
Total bilirubin =< 1,5 x øvre normalgrense (ULN)
Aspartataminotransferase (AST)/alaninaminotransferase (ALT) =< 3 x øvre normalgrense (ULN)
Ingen øvre rektale svulster (distal margin av svulst > 12 cm fra analkanten)
Ingen tilbakevendende endetarmskreft; tidligere transanal eksisjon, tidligere distal sigmoidkreft med lav anastomose
Ingen kjent mismatch reparasjon mangelfull rektal adenokarsinom
Humant immunsviktvirus HIV-infiserte pasienter på effektiv antiretroviral terapi med uoppdagbar virusmengde innen 6 måneder er kvalifisert for denne studien
Pasienter med kjent historie eller nåværende symptomer på hjertesykdom, eller historie med behandling med kardiotoksiske midler, bør ha en klinisk risikovurdering av hjertefunksjonen ved bruk av New York Heart Association Functional Classification1. For å være kvalifisert for denne studien, bør pasienter være klasse 2B eller bedre
Kronisk samtidig behandling med sterke hemmere av CYP3A4 er ikke tillatt i denne studien. Pasienter på sterke CYP3A4-hemmere må seponere legemidlet i 14 dager før registrering på studien * Kronisk samtidig behandling med sterke CYP3A4-induktorer er ikke tillatt. Pasienter må seponere medikamentet 14 dager før start av studiebehandling

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Primært formål: Behandling
Tildeling: Randomisert
Intervensjonsmodell: Sekvensiell tildeling
Masking: Ingen (Open Label)

Antall våpen

Våpen og intervensjoner

Deltakergruppe / Arm	Intervensjon / Behandling
Aktiv komparator: Arm I (LCRT, FOLFOX or CAPOX) LCRT: Patients undergo long-course chemoradiation therapy for up to 5 weeks. Consolidation: Patients receive either: FOLFOX (consisting of leucovorin IV over 2 hours on day 1 of each cycle, fluorouracil IV bolus over 2-4 minutes and IV continuous infusion over 46-48 hours on day 1 of each cycle, and oxaliplatin IV over 2 hours on day 1 of each cycle) or CAPOX (consisting of capecitabine PO on days 1-14 of each cycle, and oxaliplatin IV over 2 hours on day 1 of each cycle). Treatment with FOLFOX repeats every 2 weeks for up to 8 cycles (16 weeks) in the absence of disease progression or unacceptable toxicity. Treatment with CAPOX repeats every 3 weeks for up to 5 cycles (15 weeks) in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan, MRI, collection of blood samples and sigmoidoscopy throughout the trial and undergo biopsy during screening.	Legemiddel: Oksaliplatin Gitt IV Legemiddel: Capecitabin Gitt PO Legemiddel: 5-fluoruracil Gitt IV Legemiddel: Leucovorin kalsium Gitt IV Stråling: Langkurs kjemoradioterapi Motta LCRT Fremgangsmåte: Computertomografi gjennomgå CT Fremgangsmåte: Magnetisk resonansavbildning gjennomgå MR Fremgangsmåte: Sigmoidoskopi gjennomgå sigmoidoskopi Fremgangsmåte: biopsi gjennomgå biopsi
Eksperimentell: Arm II (LCRT, FOLFIRINOX) LCRT: Patients undergo long-course chemoradiation therapy for up to 5 weeks. CONSOLIDATION: Patients receive FOLFIRINOX (consisting of leucovorin over 2 hours on day 1 of each cycle, fluorouracil IV continuous infusion over 46-48 hours on day 1 of each cycle, oxaliplatin IV over 2 hours on day 1 of each cycle, and irinotecan IV over 30-90 minutes on day 1 of each cycle). Treatment with FOLFIRINOX repeats every 2 weeks for up to 8 cycles (16 weeks) in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan, MRI and collection of blood samples and sigmoidoscopy throughout the trial and undergo biopsy during screening.	Legemiddel: Oksaliplatin Gitt IV Legemiddel: Irinotekan Gitt IV Legemiddel: Capecitabin Gitt PO Legemiddel: 5-fluoruracil Gitt IV Legemiddel: Leucovorin kalsium Gitt IV Stråling: Langkurs kjemoradioterapi Motta LCRT Fremgangsmåte: Computertomografi gjennomgå CT Fremgangsmåte: Magnetisk resonansavbildning gjennomgå MR Fremgangsmåte: Sigmoidoskopi gjennomgå sigmoidoskopi Fremgangsmåte: biopsi gjennomgå biopsi

Deltakergruppe / Arm

Intervensjon / Behandling

Aktiv komparator: Arm I (LCRT, FOLFOX or CAPOX)

LCRT: Patients undergo long-course chemoradiation therapy for up to 5 weeks. Consolidation: Patients receive either: FOLFOX (consisting of leucovorin IV over 2 hours on day 1 of each cycle, fluorouracil IV bolus over 2-4 minutes and IV continuous infusion over 46-48 hours on day 1 of each cycle, and oxaliplatin IV over 2 hours on day 1 of each cycle) or CAPOX (consisting of capecitabine PO on days 1-14 of each cycle, and oxaliplatin IV over 2 hours on day 1 of each cycle). Treatment with FOLFOX repeats every 2 weeks for up to 8 cycles (16 weeks) in the absence of disease progression or unacceptable toxicity. Treatment with CAPOX repeats every 3 weeks for up to 5 cycles (15 weeks) in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan, MRI, collection of blood samples and sigmoidoscopy throughout the trial and undergo biopsy during screening.

Legemiddel: Oksaliplatin

Gitt IV

Legemiddel: Capecitabin

Gitt PO

Legemiddel: 5-fluoruracil

Gitt IV

Legemiddel: Leucovorin kalsium

Gitt IV

Stråling: Langkurs kjemoradioterapi

Motta LCRT

Fremgangsmåte: Computertomografi

gjennomgå CT

Fremgangsmåte: Magnetisk resonansavbildning

gjennomgå MR

Fremgangsmåte: Sigmoidoskopi

gjennomgå sigmoidoskopi

Fremgangsmåte: biopsi

gjennomgå biopsi

Eksperimentell: Arm II (LCRT, FOLFIRINOX)

LCRT: Patients undergo long-course chemoradiation therapy for up to 5 weeks. CONSOLIDATION: Patients receive FOLFIRINOX (consisting of leucovorin over 2 hours on day 1 of each cycle, fluorouracil IV continuous infusion over 46-48 hours on day 1 of each cycle, oxaliplatin IV over 2 hours on day 1 of each cycle, and irinotecan IV over 30-90 minutes on day 1 of each cycle). Treatment with FOLFIRINOX repeats every 2 weeks for up to 8 cycles (16 weeks) in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan, MRI and collection of blood samples and sigmoidoscopy throughout the trial and undergo biopsy during screening.

Legemiddel: Oksaliplatin

Gitt IV

Legemiddel: Irinotekan

Gitt IV

Legemiddel: Capecitabin

Gitt PO

Legemiddel: 5-fluoruracil

Gitt IV

Legemiddel: Leucovorin kalsium

Gitt IV

Stråling: Langkurs kjemoradioterapi

Motta LCRT

Fremgangsmåte: Computertomografi

gjennomgå CT

Fremgangsmåte: Magnetisk resonansavbildning

gjennomgå MR

Fremgangsmåte: Sigmoidoskopi

gjennomgå sigmoidoskopi

Fremgangsmåte: biopsi

gjennomgå biopsi

Hva måler studien?

Primære resultatmål

Resultatmål	Tiltaksbeskrivelse	Tidsramme
Clincal Complete Response (cCR) Rates (Phase II) Tidsramme: Up to 5 years	Defined as the number of patients who achieved cCR at the end of total neoadjuvant therapy (TNT) divided by number of patients included in the analysis population. This endpoint will be assessed within 8-12 weeks after completion of TNT. If there is a cCR, then the patient will be counted in the numerator. If there is a near-complete response (nCR) then a re-evaluation within 4-8 weeks will be performed. If an nCR evolved to a cCR, then the patient will be counted in the numerator. Otherwise, the patient will be deemed as NOT achieving cCR status. Difference of proportions test will be conducted to compare cCR rate in the experimental arm to cCR rate in the control arm. If the one-sided p-value of the comparison is < 0.05 (difference in proportion > 9.3%), then we will conclude the cCR rate in the experimental arm is superior to the control arm.	Up to 5 years
Disease-free survival (DFS) rate (Phase III) Tidsramme: From date of randomization, assessed up to 5 years	Defined as the time from date of randomization to the date of first occurrence of the following events: death due to all causes, tumor that recurs locally after an R0 total mesorectal excision (TME), tumor that regrows after an initial apparent clinical and radiological CR and cannot be surgically removed with an R0 TME, and M1 disease diagnosed at any point after the initiation of treatment. Will be estimated, in each arm, using the method of Kaplan-Meier and compared by a stratified Cox regression model.	From date of randomization, assessed up to 5 years

Sekundære resultatmål

Resultatmål	Tiltaksbeskrivelse	Tidsramme
Tid til fjernmetastase (TDM) Tidsramme: Fra datoen for randomisering til datoen for første dokumenterte fjernmetastase, vurdert opp til 5 år	Vil bli estimert, i hver arm, ved hjelp av metoden til Kaplan-Meier og sammenlignet med en stratifisert Cox-regresjonsmodell.	Fra datoen for randomisering til datoen for første dokumenterte fjernmetastase, vurdert opp til 5 år
Total overlevelse (OS) Tidsramme: Fra dato for randomisering til dato for død på grunn av alle årsaker, vurdert opp til 5 år	Vil bli estimert, i hver arm, ved hjelp av metoden til Kaplan-Meier og sammenlignet med en stratifisert Cox-regresjonsmodell.	Fra dato for randomisering til dato for død på grunn av alle årsaker, vurdert opp til 5 år
Forekomst av uønskede hendelser (AE) Tidsramme: Inntil 5 år	Definert som andelen pasienter som opplevde minst én grad 3, grad 4 eller grad 5 av hver type AE. De samlede bivirkningsratene for uønskede hendelser av grad 3 eller høyere vil bli sammenlignet mellom to behandlingsgrupper ved bruk av Chi-square test (eller Fishers eksakte test hvis dataene i beredskapstabellen er sparsomme).	Inntil 5 år
Organ-preservation time (OPT) Tidsramme: From date of randomization, assessed up to 5 years	Defined as time from the date of randomization to the date of the first occurrence of the following events: TME performed or attempted, tumor that regrows after an initial apparent clinical and radiological complete response (CR) and death due to all causes. Will be estimated, in each arm, using the method of Kaplan-Meier and treatment compared by a stratified Cox regression model.	From date of randomization, assessed up to 5 years
Sustained cCR Tidsramme: Up to 5 years	Defined as a binary endpoint with two statuses: responder and non-responder. Responders are defined as those evaluable patients who achieved at least one of the following within 3 years after randomization: Had TME and the pathologic outcome is pathologic complete response Had a cCR, were on watch and wait (WW) with no regrowth and no distant metastases Had nCR, were on WW with no regrowth and no distant metastases Non-responders are defined as all patients who did not meet the criteria as noted above for the responders.	Up to 5 years

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Alliance for Clinical Trials in Oncology

Samarbeidspartnere

National Cancer Institute (NCI)

Etterforskere

Studiestol: J. Joshua Smith, MD, Memorial Sloan Kettering Cancer Center

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

8. desember 2022

Primær fullføring (Antatt)

30. september 2026

Studiet fullført (Antatt)

30. september 2033

Datoer for studieregistrering

Først innsendt

1. november 2022

Først innsendt som oppfylte QC-kriteriene

2. november 2022

Først lagt ut (Faktiske)

9. november 2022

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

2. september 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

31. august 2026

Sist bekreftet

1. august 2026

Mer informasjon

Begreper knyttet til denne studien

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

A022104
U10CA180821 (U.S. NIH-stipend/kontrakt)
NCI-2022-07800 (Annen identifikator: NCI)
NRG-GI010 (Annen identifikator: NRG Oncology)

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

produkt produsert i og eksportert fra USA

Nei

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

Tester tillegget av et kreftmedisin, irinotecan, til standard kjemoterapibehandling (FOLFOX) etter langvarig strålebehandling for avansert stadium av rektalkreft for å forbedre graden av fullstendig respons og langsiktig organkonservering (JANUS)

Janus Rectal Cancer Trial: En randomisert fase II studie som tester effekten av triplett versus doublet kjemoterapi for å oppnå klinisk fullstendig respons hos pasienter med lokalt avansert rektal kreft

Studieoversikt

Status

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

Studietype

Registrering (Faktiske)

Fase

Kontakter og plasseringer

Studiesteder

Deltakelseskriterier

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

Tar imot friske frivillige

Beskrivelse

Studieplan

Hvordan er studiet utformet?

Designdetaljer

Antall våpen

Våpen og intervensjoner

Deltakergruppe / Arm

Intervensjon / Behandling

Hva måler studien?

Primære resultatmål

Resultatmål

Tiltaksbeskrivelse

Tidsramme

Sekundære resultatmål

Resultatmål

Tiltaksbeskrivelse

Tidsramme

Samarbeidspartnere og etterforskere

Sponsor

Samarbeidspartnere

Etterforskere

Publikasjoner og nyttige lenker

Generelle publikasjoner

Studierekorddatoer

Studer hoveddatoer

Studiestart (Faktiske)

Primær fullføring (Antatt)

Studiet fullført (Antatt)

Datoer for studieregistrering

Først innsendt

Først innsendt som oppfylte QC-kriteriene

Først lagt ut (Faktiske)

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

Siste oppdatering sendt inn som oppfylte QC-kriteriene

Sist bekreftet

Mer informasjon

Begreper knyttet til denne studien

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Studerer et amerikansk FDA-regulert enhetsprodukt

produkt produsert i og eksportert fra USA