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Testowanie immunoterapii a obserwacja u pacjentów z rakiem gardła HPV

23 października 2026 zaktualizowane przez: National Cancer Institute (NCI)

Randomizowane badanie fazy III dotyczące leczenia podtrzymującego niwolumabu w porównaniu z obserwacją u pacjentów z miejscowo zaawansowanym, pośrednim ryzykiem HPV dodatnim OPSCC

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.

Przegląd badań

Status

Aktywny, nie rekrutujący

Warunki

Interwencja / Leczenie

Szczegółowy opis

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.

Typ studiów

Interwencyjne

Zapisy (Szacowany)

636

Faza

Faza 3

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Lokalizacje studiów

Stany Zjednoczone
- Alabama
  - Fairhope, Alabama, Stany Zjednoczone, 36532
    - Thomas Hospital
  - Mobile, Alabama, Stany Zjednoczone, 36607
    - Mobile Infirmary Medical Center
- Alaska
  - Anchorage, Alaska, Stany Zjednoczone, 98508
    - Anchorage Associates in Radiation Medicine
  - Anchorage, Alaska, Stany Zjednoczone, 99508
    - Alaska Breast Care and Surgery LLC
  - Anchorage, Alaska, Stany Zjednoczone, 99508
    - Alaska Oncology and Hematology LLC
  - Anchorage, Alaska, Stany Zjednoczone, 99508
    - Alaska Women's Cancer Care
  - Anchorage, Alaska, Stany Zjednoczone, 99508
    - Anchorage Oncology Centre
  - Anchorage, Alaska, Stany Zjednoczone, 99508
    - Katmai Oncology Group
  - Anchorage, Alaska, Stany Zjednoczone, 99508
    - Providence Alaska Medical Center
  - Anchorage, Alaska, Stany Zjednoczone, 99504
    - Anchorage Radiation Therapy Center
  - Fairbanks, Alaska, Stany Zjednoczone, 99701
    - Fairbanks Memorial Hospital
- Arizona
  - Goodyear, Arizona, Stany Zjednoczone, 85338
    - CTCA at Western Regional Medical Center
  - Kingman, Arizona, Stany Zjednoczone, 86401
    - Kingman Regional Medical Center
  - Phoenix, Arizona, Stany Zjednoczone, 85004
    - Cancer Center at Saint Joseph's
- Arkansas
  - Fort Smith, Arkansas, Stany Zjednoczone, 72903
    - Mercy Hospital Fort Smith
  - Hot Springs, Arkansas, Stany Zjednoczone, 71913
    - CHI Saint Vincent Cancer Center Hot Springs
- California
  - Antioch, California, Stany Zjednoczone, 94531
    - Kaiser Permanente-Deer Valley Medical Center
  - Arroyo Grande, California, Stany Zjednoczone, 93420
    - PCR Oncology
  - Arroyo Grande, California, Stany Zjednoczone, 93420
    - Mission Hope Medical Oncology - Arroyo Grande
  - Burbank, California, Stany Zjednoczone, 91505
    - Providence Saint Joseph Medical Center/Disney Family Cancer Center
  - Carmichael, California, Stany Zjednoczone, 95608
    - Mercy San Juan Medical Center
  - Carmichael, California, Stany Zjednoczone, 95608
    - Mercy Cancer Center - Carmichael
  - Dublin, California, Stany Zjednoczone, 94568
    - Kaiser Permanente Dublin
  - Dublin, California, Stany Zjednoczone, 94568
    - Epic Care-Dublin
  - Elk Grove, California, Stany Zjednoczone, 95758
    - Mercy Cancer Center - Elk Grove
  - Emeryville, California, Stany Zjednoczone, 94608
    - Bay Area Breast Surgeons Inc
  - Emeryville, California, Stany Zjednoczone, 94608
    - Epic Care Partners in Cancer Care
  - Fremont, California, Stany Zjednoczone, 94538
    - Kaiser Permanente-Fremont
  - Fresno, California, Stany Zjednoczone, 93720
    - Kaiser Permanente-Fresno
  - Fresno, California, Stany Zjednoczone, 93720
    - Fresno Cancer Center
  - Long Beach, California, Stany Zjednoczone, 90822
    - Tibor Rubin VA Medical Center
  - Martinez, California, Stany Zjednoczone, 94553-3156
    - Contra Costa Regional Medical Center
  - Merced, California, Stany Zjednoczone, 95340
    - Mercy Cancer Center
  - Modesto, California, Stany Zjednoczone, 95356
    - Kaiser Permanente-Modesto
  - Napa, California, Stany Zjednoczone, 94558
    - Providence Queen of The Valley
  - Oakland, California, Stany Zjednoczone, 94611
    - Kaiser Permanente-Oakland
  - Oakland, California, Stany Zjednoczone, 94611
    - Kaiser Permanente Oakland-Broadway
  - Oakland, California, Stany Zjednoczone, 94609
    - Alta Bates Summit Medical Center - Summit Campus
  - Oakland, California, Stany Zjednoczone, 94609
    - Bay Area Tumor Institute
  - Palo Alto, California, Stany Zjednoczone, 94304
    - VA Palo Alto Health Care System
  - Rancho Cordova, California, Stany Zjednoczone, 95670
    - Kaiser Permanente-Rancho Cordova Cancer Center
  - Redwood City, California, Stany Zjednoczone, 94063
    - Kaiser Permanente-Redwood City
  - Richmond, California, Stany Zjednoczone, 94801
    - Kaiser Permanente-Richmond
  - Rocklin, California, Stany Zjednoczone, 95765
    - Mercy Cancer Center - Rocklin
  - Rohnert Park, California, Stany Zjednoczone, 94928
    - Rohnert Park Cancer Center
  - Roseville, California, Stany Zjednoczone, 95678
    - The Permanente Medical Group-Roseville Radiation Oncology
  - Roseville, California, Stany Zjednoczone, 95661
    - Kaiser Permanente-Roseville
  - Sacramento, California, Stany Zjednoczone, 95814
    - Kaiser Permanente Downtown Commons
  - Sacramento, California, Stany Zjednoczone, 95823
    - South Sacramento Cancer Center
  - Sacramento, California, Stany Zjednoczone, 95816
    - Mercy Cancer Center - Sacramento
  - Salinas, California, Stany Zjednoczone, 93901
    - Salinas Valley Memorial
  - San Diego, California, Stany Zjednoczone, 92134
    - Naval Medical Center -San Diego
  - San Diego, California, Stany Zjednoczone, 92103
    - UC San Diego Medical Center - Hillcrest
  - San Francisco, California, Stany Zjednoczone, 94115
    - Kaiser Permanente-San Francisco
  - San Jose, California, Stany Zjednoczone, 95119
    - Kaiser Permanente-Santa Teresa-San Jose
  - San Leandro, California, Stany Zjednoczone, 94577
    - Kaiser Permanente San Leandro
  - San Luis Obispo, California, Stany Zjednoczone, 93401
    - Pacific Central Coast Health Center-San Luis Obispo
  - San Rafael, California, Stany Zjednoczone, 94903
    - Kaiser San Rafael-Gallinas
  - Santa Clara, California, Stany Zjednoczone, 95051
    - Kaiser Permanente Medical Center - Santa Clara
  - Santa Maria, California, Stany Zjednoczone, 93444
    - Mission Hope Medical Oncology - Santa Maria
  - Santa Rosa, California, Stany Zjednoczone, 95403
    - Kaiser Permanente-Santa Rosa
  - Santa Rosa, California, Stany Zjednoczone, 95403
    - Providence Medical Foundation - Santa Rosa
  - South San Francisco, California, Stany Zjednoczone, 94080
    - Kaiser Permanente Cancer Treatment Center
  - South San Francisco, California, Stany Zjednoczone, 94080
    - Kaiser Permanente-South San Francisco
  - Stockton, California, Stany Zjednoczone, 95210
    - Kaiser Permanente-Stockton
  - Vacaville, California, Stany Zjednoczone, 95688
    - Kaiser Permanente Medical Center-Vacaville
  - Vallejo, California, Stany Zjednoczone, 94589
    - Kaiser Permanente-Vallejo
  - Walnut Creek, California, Stany Zjednoczone, 94596
    - Kaiser Permanente-Walnut Creek
  - Walnut Creek, California, Stany Zjednoczone, 94597
    - Epic Care Cyberknife Center
  - Woodland, California, Stany Zjednoczone, 95695
    - Woodland Memorial Hospital
- Colorado
  - Aurora, Colorado, Stany Zjednoczone, 80012
    - Rocky Mountain Cancer Centers-Aurora
  - Aurora, Colorado, Stany Zjednoczone, 80012
    - The Medical Center of Aurora
  - Aurora, Colorado, Stany Zjednoczone, 80045
    - UCHealth University of Colorado Hospital
  - Boulder, Colorado, Stany Zjednoczone, 80303
    - Boulder Community Foothills Hospital
  - Boulder, Colorado, Stany Zjednoczone, 80304
    - Rocky Mountain Cancer Centers-Boulder
  - Centennial, Colorado, Stany Zjednoczone, 80112
    - Rocky Mountain Cancer Centers - Centennial
  - Colorado Springs, Colorado, Stany Zjednoczone, 80907
    - Penrose-Saint Francis Healthcare
  - Colorado Springs, Colorado, Stany Zjednoczone, 80909
    - UCHealth Memorial Hospital Central
  - Colorado Springs, Colorado, Stany Zjednoczone, 80907
    - Rocky Mountain Cancer Centers-Penrose
  - Colorado Springs, Colorado, Stany Zjednoczone, 80920
    - Memorial Hospital North
  - Colorado Springs, Colorado, Stany Zjednoczone, 80923
    - Saint Francis Cancer Center
  - Denver, Colorado, Stany Zjednoczone, 80218
    - Presbyterian - Saint Lukes Medical Center - Health One
  - Denver, Colorado, Stany Zjednoczone, 80220
    - Rose Medical Center
  - Denver, Colorado, Stany Zjednoczone, 80218
    - Rocky Mountain Cancer Centers-Midtown
  - Denver, Colorado, Stany Zjednoczone, 80220
    - Rocky Mountain Cancer Centers-Rose
  - Denver, Colorado, Stany Zjednoczone, 80218
    - Colorado Blood Cancer Institute
  - Denver, Colorado, Stany Zjednoczone, 80204
    - Cancer Center of Colorado at Sloan's Lake
  - Denver, Colorado, Stany Zjednoczone, 80209
    - The Women's Imaging Center
  - Denver, Colorado, Stany Zjednoczone, 80206
    - National Jewish Health-Main Campus
  - Denver, Colorado, Stany Zjednoczone, 80220
    - Western Surgical Care
  - Denver, Colorado, Stany Zjednoczone, 80218
    - Saint Joseph Hospital - Cancer Centers of Colorado
  - Denver, Colorado, Stany Zjednoczone, 80210
    - AdventHealth Porter
  - Durango, Colorado, Stany Zjednoczone, 81301
    - Mercy Medical Center
  - Durango, Colorado, Stany Zjednoczone, 81301
    - CommonSpirit Cancer Center Mercy
  - Englewood, Colorado, Stany Zjednoczone, 80113
    - Mountain Blue Cancer Care Center - Swedish
  - Englewood, Colorado, Stany Zjednoczone, 80113
    - Swedish Medical Center
  - Englewood, Colorado, Stany Zjednoczone, 80113
    - Rocky Mountain Cancer Centers - Swedish
  - Englewood, Colorado, Stany Zjednoczone, 80113
    - The Melanoma and Skin Cancer Institute
  - Fort Collins, Colorado, Stany Zjednoczone, 80524
    - Poudre Valley Hospital
  - Fort Collins, Colorado, Stany Zjednoczone, 80528
    - Cancer Care and Hematology-Fort Collins
  - Golden, Colorado, Stany Zjednoczone, 80401
    - National Jewish Health-Western Hematology Oncology
  - Grand Junction, Colorado, Stany Zjednoczone, 81501
    - Saint Mary's Hospital and Regional Medical Center
  - Greeley, Colorado, Stany Zjednoczone, 80631
    - UCHealth Greeley Hospital
  - Greeley, Colorado, Stany Zjednoczone, 80631
    - Banner North Colorado Medical Center
  - Lafayette, Colorado, Stany Zjednoczone, 80026
    - Good Samaritan Hospital - Cancer Centers of Colorado
  - Lakewood, Colorado, Stany Zjednoczone, 80228
    - Rocky Mountain Cancer Centers-Lakewood
  - Lakewood, Colorado, Stany Zjednoczone, 80228
    - CommonSpirit Saint Anthony Hospital Cancer Center
  - Littleton, Colorado, Stany Zjednoczone, 80120
    - Rocky Mountain Cancer Centers-Littleton
  - Littleton, Colorado, Stany Zjednoczone, 80122
    - AdventHealth Littleton
  - Lone Tree, Colorado, Stany Zjednoczone, 80124
    - Sky Ridge Medical Center
  - Lone Tree, Colorado, Stany Zjednoczone, 80124
    - Rocky Mountain Cancer Centers-Sky Ridge
  - Longmont, Colorado, Stany Zjednoczone, 80501
    - Longmont United Hospital
  - Longmont, Colorado, Stany Zjednoczone, 80501
    - Rocky Mountain Cancer Centers-Longmont
  - Loveland, Colorado, Stany Zjednoczone, 80538
    - Medical Center of the Rockies
  - Loveland, Colorado, Stany Zjednoczone, 80539
    - Banner North Colorado Medical Center - Loveland Campus
  - Parker, Colorado, Stany Zjednoczone, 80138
    - AdventHealth Parker
  - Pueblo, Colorado, Stany Zjednoczone, 81004
    - Saint Mary Corwin Medical Center
  - Thornton, Colorado, Stany Zjednoczone, 80260
    - Rocky Mountain Cancer Centers-Thornton
  - Thornton, Colorado, Stany Zjednoczone, 80260
    - National Jewish Health-Northern Hematology Oncology
  - Wheat Ridge, Colorado, Stany Zjednoczone, 80401
    - Intermountain Health Lutheran Hospital
- Connecticut
  - Greenwich, Connecticut, Stany Zjednoczone, 06830
    - Smilow Cancer Hospital Care Center at Greenwich
  - Guilford, Connecticut, Stany Zjednoczone, 06437
    - Smilow Cancer Hospital Care Center - Guilford
  - New Haven, Connecticut, Stany Zjednoczone, 06520
    - Yale University
  - New Haven, Connecticut, Stany Zjednoczone, 06510
    - Smilow Cancer Center/Yale-New Haven Hospital
  - North Haven, Connecticut, Stany Zjednoczone, 06473
    - Yale-New Haven Hospital North Haven Medical Center
  - Orange, Connecticut, Stany Zjednoczone, 06477
    - Smilow Cancer Hospital-Orange Care Center
  - Trumbull, Connecticut, Stany Zjednoczone, 06611
    - Smilow Cancer Hospital Care Center-Trumbull
  - Waterford, Connecticut, Stany Zjednoczone, 06385
    - Smilow Cancer Hospital Care Center - Waterford
- Delaware
  - Lewes, Delaware, Stany Zjednoczone, 19958
    - Beebe Medical Center
  - Millville, Delaware, Stany Zjednoczone, 19967
    - Beebe South Coastal Health Campus
  - Newark, Delaware, Stany Zjednoczone, 19713
    - Helen F Graham Cancer Center
  - Newark, Delaware, Stany Zjednoczone, 19713
    - Delaware Clinical and Laboratory Physicians PA
  - Newark, Delaware, Stany Zjednoczone, 19713
    - Medical Oncology Hematology Consultants PA
  - Newark, Delaware, Stany Zjednoczone, 19718
    - Christiana Care Health System-Christiana Hospital
  - Rehoboth Beach, Delaware, Stany Zjednoczone, 19971
    - Beebe Health Campus
- District of Columbia
  - Washington D.C., District of Columbia, Stany Zjednoczone, 20037
    - George Washington University Medical Center
- Florida
  - Deerfield Beach, Florida, Stany Zjednoczone, 33064
    - Broward Health North
  - Fort Lauderdale, Florida, Stany Zjednoczone, 33316
    - Broward Health Medical Center
  - Fort Lauderdale, Florida, Stany Zjednoczone, 33308
    - Holy Cross Hospital
  - Lakeland, Florida, Stany Zjednoczone, 33805
    - The Watson Clinic
  - Tampa, Florida, Stany Zjednoczone, 33612
    - Moffitt Cancer Center
  - Tampa, Florida, Stany Zjednoczone, 33607
    - Moffitt Cancer Center-International Plaza
  - Tampa, Florida, Stany Zjednoczone, 33612
    - Moffitt Cancer Center - McKinley Campus
  - Wesley Chapel, Florida, Stany Zjednoczone, 33544
    - Moffitt Cancer Center at Wesley Chapel
- Georgia
  - Atlanta, Georgia, Stany Zjednoczone, 30308
    - Emory University Hospital Midtown
  - Atlanta, Georgia, Stany Zjednoczone, 30322
    - Emory University Hospital/Winship Cancer Institute
  - Decatur, Georgia, Stany Zjednoczone, 30033
    - Atlanta VA Medical Center
  - Savannah, Georgia, Stany Zjednoczone, 31405
    - Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
  - Valdosta, Georgia, Stany Zjednoczone, 31602
    - South Georgia Medical Center/Pearlman Cancer Center
- Hawaii
  - Honolulu, Hawaii, Stany Zjednoczone, 96813
    - Queen's Medical Center
  - Honolulu, Hawaii, Stany Zjednoczone, 96817
    - The Cancer Center of Hawaii-Liliha
  - Honolulu, Hawaii, Stany Zjednoczone, 96813
    - Hawaii Cancer Care Inc - Waterfront Plaza
  - Honolulu, Hawaii, Stany Zjednoczone, 96813
    - Queen's Cancer Cenrer - POB I
  - Honolulu, Hawaii, Stany Zjednoczone, 96813
    - Straub Clinic and Hospital
  - Honolulu, Hawaii, Stany Zjednoczone, 96813
    - University of Hawaii Cancer Center
  - Honolulu, Hawaii, Stany Zjednoczone, 96817
    - Kuakini Medical Center
  - Honolulu, Hawaii, Stany Zjednoczone, 96817
    - Queen's Cancer Center - Kuakini
  - Honolulu, Hawaii, Stany Zjednoczone, 96826
    - Kapiolani Medical Center for Women and Children
  - Honolulu, Hawaii, Stany Zjednoczone, 96819
    - Kaiser Permanente Moanalua Medical Center
  - Lihue, Hawaii, Stany Zjednoczone, 96766
    - Wilcox Memorial Hospital and Kauai Medical Clinic
  - ‘Aiea, Hawaii, Stany Zjednoczone, 96701
    - Hawaii Cancer Care - Westridge
  - ‘Aiea, Hawaii, Stany Zjednoczone, 96701
    - Pali Momi Medical Center
  - ‘Aiea, Hawaii, Stany Zjednoczone, 96701
    - Queen's Cancer Center - Pearlridge
  - ‘Aiea, Hawaii, Stany Zjednoczone, 96701
    - The Cancer Center of Hawaii-Pali Momi
- Idaho
  - Boise, Idaho, Stany Zjednoczone, 83706
    - Saint Alphonsus Cancer Care Center-Boise
  - Boise, Idaho, Stany Zjednoczone, 83712
    - Saint Luke's Cancer Institute - Boise
  - Caldwell, Idaho, Stany Zjednoczone, 83605
    - Saint Alphonsus Cancer Care Center-Caldwell
  - Coeur d'Alene, Idaho, Stany Zjednoczone, 83814
    - Kootenai Health - Coeur d'Alene
  - Emmett, Idaho, Stany Zjednoczone, 83617
    - Walter Knox Memorial Hospital
  - Fruitland, Idaho, Stany Zjednoczone, 83619
    - Saint Luke's Cancer Institute - Fruitland
  - Meridian, Idaho, Stany Zjednoczone, 83642
    - Idaho Urologic Institute-Meridian
  - Meridian, Idaho, Stany Zjednoczone, 83642
    - Saint Luke's Cancer Institute - Meridian
  - Nampa, Idaho, Stany Zjednoczone, 83687
    - Saint Alphonsus Cancer Care Center-Nampa
  - Nampa, Idaho, Stany Zjednoczone, 83687
    - Saint Luke's Cancer Institute - Nampa
  - Post Falls, Idaho, Stany Zjednoczone, 83854
    - Kootenai Clinic Cancer Services - Post Falls
  - Sandpoint, Idaho, Stany Zjednoczone, 83864
    - Kootenai Clinic Cancer Services - Sandpoint
  - Twin Falls, Idaho, Stany Zjednoczone, 83301
    - Saint Luke's Cancer Institute - Twin Falls
- Illinois
  - Alton, Illinois, Stany Zjednoczone, 62002
    - OSF Saint Anthony's Health Center
  - Aurora, Illinois, Stany Zjednoczone, 60504
    - Rush-Copley Medical Center
  - Barrington, Illinois, Stany Zjednoczone, 60010
    - Advocate Good Shepherd Hospital
  - Bloomington, Illinois, Stany Zjednoczone, 61704
    - Illinois CancerCare-Bloomington
  - Canton, Illinois, Stany Zjednoczone, 61520
    - Illinois CancerCare-Canton
  - Carbondale, Illinois, Stany Zjednoczone, 62902
    - Memorial Hospital of Carbondale
  - Carterville, Illinois, Stany Zjednoczone, 62918
    - SIH Cancer Institute
  - Carthage, Illinois, Stany Zjednoczone, 62321
    - Illinois CancerCare-Carthage
  - Centralia, Illinois, Stany Zjednoczone, 62801
    - Centralia Oncology Clinic
  - Centralia, Illinois, Stany Zjednoczone, 62801
    - Saint Mary's Hospital
  - Chicago, Illinois, Stany Zjednoczone, 60611
    - Northwestern University
  - Chicago, Illinois, Stany Zjednoczone, 60612
    - University of Illinois
  - Chicago, Illinois, Stany Zjednoczone, 60612
    - John H Stroger Jr Hospital of Cook County
  - Chicago, Illinois, Stany Zjednoczone, 60657
    - Advocate Illinois Masonic Medical Center
  - Crystal Lake, Illinois, Stany Zjednoczone, 60014
    - AMG Crystal Lake - Oncology
  - Danville, Illinois, Stany Zjednoczone, 61832
    - Carle at The Riverfront
  - Decatur, Illinois, Stany Zjednoczone, 62526
    - Decatur Memorial Hospital
  - Decatur, Illinois, Stany Zjednoczone, 62526
    - Cancer Care Specialists of Illinois - Decatur
  - Dixon, Illinois, Stany Zjednoczone, 61021
    - Illinois CancerCare-Dixon
  - Downers Grove, Illinois, Stany Zjednoczone, 60515
    - Advocate Good Samaritan Hospital
  - Effingham, Illinois, Stany Zjednoczone, 62401
    - Crossroads Cancer Center
  - Effingham, Illinois, Stany Zjednoczone, 62401
    - Carle Physician Group-Effingham
  - Elgin, Illinois, Stany Zjednoczone, 60123
    - Advocate Sherman Hospital
  - Eureka, Illinois, Stany Zjednoczone, 61530
    - Illinois CancerCare-Eureka
  - Galesburg, Illinois, Stany Zjednoczone, 61401
    - Western Illinois Cancer Treatment Center
  - Galesburg, Illinois, Stany Zjednoczone, 61401
    - Illinois CancerCare-Galesburg
  - Hazel Crest, Illinois, Stany Zjednoczone, 60429
    - Advocate South Suburban Hospital
  - Hinsdale, Illinois, Stany Zjednoczone, 60521
    - UChicago Medicine AdventHealth Cancer Institute Hinsdale
  - Kewanee, Illinois, Stany Zjednoczone, 61443
    - Illinois CancerCare-Kewanee Clinic
  - Lake Forest, Illinois, Stany Zjednoczone, 60045
    - Northwestern Medicine Lake Forest Hospital
  - Libertyville, Illinois, Stany Zjednoczone, 60048
    - Condell Memorial Hospital
  - Libertyville, Illinois, Stany Zjednoczone, 60048
    - AMG Libertyville - Oncology
  - Macomb, Illinois, Stany Zjednoczone, 61455
    - Illinois CancerCare-Macomb
  - Mattoon, Illinois, Stany Zjednoczone, 61938
    - Carle Physician Group-Mattoon/Charleston
  - Mount Vernon, Illinois, Stany Zjednoczone, 62864
    - SSM Health Good Samaritan
  - O'Fallon, Illinois, Stany Zjednoczone, 62269
    - Cancer Care Center of O'Fallon
  - O'Fallon, Illinois, Stany Zjednoczone, 62269
    - HSHS Saint Elizabeth's Hospital
  - Oak Lawn, Illinois, Stany Zjednoczone, 60453-2699
    - Advocate Christ Medical Center
  - Ottawa, Illinois, Stany Zjednoczone, 61350
    - Illinois CancerCare-Ottawa Clinic
  - Palos Heights, Illinois, Stany Zjednoczone, 60463
    - Advocate High Tech Medical Park
  - Park Ridge, Illinois, Stany Zjednoczone, 60068
    - Advocate Lutheran General Hospital
  - Pekin, Illinois, Stany Zjednoczone, 61554
    - Illinois CancerCare-Pekin
  - Pekin, Illinois, Stany Zjednoczone, 61554
    - OSF Saint Francis Radiation Oncology at Pekin
  - Peoria, Illinois, Stany Zjednoczone, 61636
    - Methodist Medical Center of Illinois
  - Peoria, Illinois, Stany Zjednoczone, 61637
    - OSF Saint Francis Medical Center
  - Peoria, Illinois, Stany Zjednoczone, 61615
    - Illinois CancerCare-Peoria
  - Peoria, Illinois, Stany Zjednoczone, 61615
    - OSF Saint Francis Radiation Oncology at Peoria Cancer Center
  - Peru, Illinois, Stany Zjednoczone, 61354
    - Illinois CancerCare-Peru
  - Peru, Illinois, Stany Zjednoczone, 61354
    - Valley Radiation Oncology
  - Princeton, Illinois, Stany Zjednoczone, 61356
    - Illinois CancerCare-Princeton
  - Springfield, Illinois, Stany Zjednoczone, 62702
    - Southern Illinois University School of Medicine
  - Springfield, Illinois, Stany Zjednoczone, 62702
    - Springfield Clinic
  - Springfield, Illinois, Stany Zjednoczone, 62781
    - Springfield Memorial Hospital
  - Swansea, Illinois, Stany Zjednoczone, 62226
    - Southwest Illinois Health Services LLP
  - Urbana, Illinois, Stany Zjednoczone, 61801
    - Carle Cancer Center
  - Urbana, Illinois, Stany Zjednoczone, 61801
    - The Carle Foundation Hospital
  - Washington, Illinois, Stany Zjednoczone, 61571
    - Illinois CancerCare - Washington
  - Yorkville, Illinois, Stany Zjednoczone, 60560
    - Rush-Copley Healthcare Center
- Indiana
  - Fort Wayne, Indiana, Stany Zjednoczone, 46845
    - Parkview Regional Medical Center
  - Indianapolis, Indiana, Stany Zjednoczone, 46237
    - Franciscan Health Indianapolis
  - Indianapolis, Indiana, Stany Zjednoczone, 46219
    - Community Cancer Center East
  - Indianapolis, Indiana, Stany Zjednoczone, 46227
    - Community Cancer Center South
  - Indianapolis, Indiana, Stany Zjednoczone, 46256
    - Community Cancer Center North
  - Kokomo, Indiana, Stany Zjednoczone, 46904
    - Community Howard Regional Health
  - Michigan City, Indiana, Stany Zjednoczone, 46360
    - Woodland Cancer Care Center
  - Mooresville, Indiana, Stany Zjednoczone, 46158
    - Franciscan Health Mooresville
  - Terre Haute, Indiana, Stany Zjednoczone, 47804
    - Union Hospital
- Iowa
  - Ames, Iowa, Stany Zjednoczone, 50010
    - Mary Greeley Medical Center
  - Ames, Iowa, Stany Zjednoczone, 50010
    - McFarland Clinic - Ames
  - Ankeny, Iowa, Stany Zjednoczone, 50023
    - UI Health Care Mission Cancer and Blood - Ankeny Clinic
  - Boone, Iowa, Stany Zjednoczone, 50036
    - McFarland Clinic - Boone
  - Carroll, Iowa, Stany Zjednoczone, 51401
    - Saint Anthony Regional Hospital
  - Clive, Iowa, Stany Zjednoczone, 50325
    - Mercy Cancer Center-West Lakes
  - Clive, Iowa, Stany Zjednoczone, 50325
    - UI Health Care Mission Cancer and Blood - West Des Moines Clinic
  - Council Bluffs, Iowa, Stany Zjednoczone, 51503
    - Alegent Health Mercy Hospital
  - Creston, Iowa, Stany Zjednoczone, 50801
    - Greater Regional Medical Center
  - Des Moines, Iowa, Stany Zjednoczone, 50309
    - Iowa Methodist Medical Center
  - Des Moines, Iowa, Stany Zjednoczone, 50314
    - Mercy Medical Center - Des Moines
  - Des Moines, Iowa, Stany Zjednoczone, 50314
    - Broadlawns Medical Center
  - Des Moines, Iowa, Stany Zjednoczone, 50316
    - Iowa Lutheran Hospital
  - Des Moines, Iowa, Stany Zjednoczone, 50309
    - UI Health Care Mission Cancer and Blood - Des Moines Clinic
  - Des Moines, Iowa, Stany Zjednoczone, 50314
    - UI Health Care Mission Cancer and Blood - Laurel Clinic
  - Fort Dodge, Iowa, Stany Zjednoczone, 50501
    - McFarland Clinic - Trinity Cancer Center
  - Fort Dodge, Iowa, Stany Zjednoczone, 50501
    - UI Healthcare Mission Cancer and Blood - Fort Dodge
  - Jefferson, Iowa, Stany Zjednoczone, 50129
    - McFarland Clinic - Jefferson
  - Marshalltown, Iowa, Stany Zjednoczone, 50158
    - McFarland Clinic - Marshalltown
  - West Des Moines, Iowa, Stany Zjednoczone, 50266-7700
    - Methodist West Hospital
  - West Des Moines, Iowa, Stany Zjednoczone, 50266
    - Mercy Medical Center-West Lakes
- Kansas
  - Garden City, Kansas, Stany Zjednoczone, 67846
    - Central Care Cancer Center - Garden City
  - Great Bend, Kansas, Stany Zjednoczone, 67530
    - Central Care Cancer Center - Great Bend
- Kentucky
  - Bardstown, Kentucky, Stany Zjednoczone, 40004
    - CommonSpirit Saint Joseph Hospital - Bardstown
  - Corbin, Kentucky, Stany Zjednoczone, 40701
    - Commonwealth Cancer Center-Corbin
  - Lexington, Kentucky, Stany Zjednoczone, 40504
    - Saint Joseph Radiation Oncology Resource Center
  - Lexington, Kentucky, Stany Zjednoczone, 40509
    - CommonSpirit Saint Joseph Medical Center - East Lexington
  - Lexington, Kentucky, Stany Zjednoczone, 40504
    - CommonSpirit Saint Joseph Hospital - Lexington
  - London, Kentucky, Stany Zjednoczone, 40741
    - CommonSpirit Saint Joseph Hospital London
  - Louisville, Kentucky, Stany Zjednoczone, 40202
    - The James Graham Brown Cancer Center at University of Louisville
  - Louisville, Kentucky, Stany Zjednoczone, 40202
    - Jewish Hospital
  - Louisville, Kentucky, Stany Zjednoczone, 40245
    - UofL Health Medical Center Northeast
  - Louisville, Kentucky, Stany Zjednoczone, 40215
    - Saints Mary and Elizabeth Hospital
  - Shepherdsville, Kentucky, Stany Zjednoczone, 40165
    - Jewish Hospital Medical Center South
- Louisiana
  - Baton Rouge, Louisiana, Stany Zjednoczone, 70805
    - LSU Health Baton Rouge-North Clinic
  - Baton Rouge, Louisiana, Stany Zjednoczone, 70809
    - Louisiana Hematology Oncology Associates LLC
  - Baton Rouge, Louisiana, Stany Zjednoczone, 70809
    - Mary Bird Perkins Cancer Center
  - Baton Rouge, Louisiana, Stany Zjednoczone, 70808
    - Our Lady of The Lake
  - Baton Rouge, Louisiana, Stany Zjednoczone, 70808
    - Our Lady of the Lake Physician Group
  - New Orleans, Louisiana, Stany Zjednoczone, 70112
    - University Medical Center New Orleans
  - New Orleans, Louisiana, Stany Zjednoczone, 70112
    - Louisiana State University Health Science Center
- Maryland
  - Baltimore, Maryland, Stany Zjednoczone, 21204
    - Greater Baltimore Medical Center
  - Baltimore, Maryland, Stany Zjednoczone, 21201
    - University of Maryland/Greenebaum Cancer Center
  - Bel Air, Maryland, Stany Zjednoczone, 21014
    - UM Upper Chesapeake Medical Center
- Massachusetts
  - Boston, Massachusetts, Stany Zjednoczone, 02111
    - Tufts Medical Center
  - Lowell, Massachusetts, Stany Zjednoczone, 01854
    - Lowell General Hospital
  - Springfield, Massachusetts, Stany Zjednoczone, 01104
    - Mercy Medical Center
  - Worcester, Massachusetts, Stany Zjednoczone, 01655
    - UMass Memorial Medical Center - University Campus
- Michigan
  - Ann Arbor, Michigan, Stany Zjednoczone, 48106
    - Trinity Health Saint Joseph Mercy Hospital Ann Arbor
  - Battle Creek, Michigan, Stany Zjednoczone, 49017
    - Bronson Battle Creek
  - Bay City, Michigan, Stany Zjednoczone, 48706
    - McLaren Cancer Institute-Bay City
  - Brighton, Michigan, Stany Zjednoczone, 48114
    - Trinity Health IHA Medical Group Hematology Oncology - Brighton
  - Brighton, Michigan, Stany Zjednoczone, 48114
    - Trinity Health Medical Center - Brighton
  - Canton, Michigan, Stany Zjednoczone, 48188
    - Trinity Health IHA Medical Group Hematology Oncology - Canton
  - Canton, Michigan, Stany Zjednoczone, 48188
    - Trinity Health Medical Center - Canton
  - Caro, Michigan, Stany Zjednoczone, 48723
    - Caro Cancer Center
  - Chelsea, Michigan, Stany Zjednoczone, 48118
    - Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
  - Chelsea, Michigan, Stany Zjednoczone, 48118
    - Chelsea Hospital
  - Clarkston, Michigan, Stany Zjednoczone, 48346
    - McLaren Cancer Institute-Clarkston
  - Clarkston, Michigan, Stany Zjednoczone, 48346
    - Hematology Oncology Consultants-Clarkston
  - Clarkston, Michigan, Stany Zjednoczone, 48346
    - Newland Medical Associates-Clarkston
  - Detroit, Michigan, Stany Zjednoczone, 48201
    - Wayne State University/Karmanos Cancer Institute
  - Detroit, Michigan, Stany Zjednoczone, 48236
    - Henry Ford Health Saint John Hospital
  - East China Township, Michigan, Stany Zjednoczone, 48054
    - Henry Ford River District Hospital
  - Farmington Hills, Michigan, Stany Zjednoczone, 48334
    - Weisberg Cancer Treatment Center
  - Flint, Michigan, Stany Zjednoczone, 48532
    - McLaren Cancer Institute-Flint
  - Flint, Michigan, Stany Zjednoczone, 48532
    - Singh and Arora Hematology Oncology PC
  - Flint, Michigan, Stany Zjednoczone, 48503
    - Hurley Medical Center
  - Flint, Michigan, Stany Zjednoczone, 48503
    - Genesee Hematology Oncology PC
  - Flint, Michigan, Stany Zjednoczone, 48503
    - Genesys Hurley Cancer Institute
  - Flint, Michigan, Stany Zjednoczone, 48503
    - Cancer Hematology Centers - Flint
  - Grand Rapids, Michigan, Stany Zjednoczone, 49503
    - Trinity Health Grand Rapids Hospital
  - Grand Rapids, Michigan, Stany Zjednoczone, 49503
    - Corewell Health Grand Rapids Hospitals - Butterworth Hospital
  - Grand Rapids, Michigan, Stany Zjednoczone, 49503
    - Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
  - Grosse Pointe Woods, Michigan, Stany Zjednoczone, 48236
    - Henry Ford Saint John Hospital - Academic
  - Grosse Pointe Woods, Michigan, Stany Zjednoczone, 48236
    - Henry Ford Saint John Hospital - Breast
  - Grosse Pointe Woods, Michigan, Stany Zjednoczone, 48236
    - Henry Ford Saint John Hospital - Van Elslander
  - Kalamazoo, Michigan, Stany Zjednoczone, 49007
    - West Michigan Cancer Center
  - Kalamazoo, Michigan, Stany Zjednoczone, 49007
    - Bronson Methodist Hospital
  - Kalamazoo, Michigan, Stany Zjednoczone, 49009
    - Beacon Kalamazoo Cancer Center
  - Kalamazoo, Michigan, Stany Zjednoczone, 49048
    - Beacon Kalamazoo
  - Lansing, Michigan, Stany Zjednoczone, 48912
    - Mid-Michigan Physicians-Lansing
  - Lansing, Michigan, Stany Zjednoczone, 48910
    - Karmanos Cancer Institute at McLaren Greater Lansing
  - Lansing, Michigan, Stany Zjednoczone, 48912
    - University of Michigan Health - Sparrow Lansing
  - Lapeer, Michigan, Stany Zjednoczone, 48446
    - McLaren Cancer Institute-Lapeer Region
  - Livonia, Michigan, Stany Zjednoczone, 48154
    - Trinity Health Saint Mary Mercy Livonia Hospital
  - Livonia, Michigan, Stany Zjednoczone, 48154
    - Hope Cancer Clinic
  - Macomb, Michigan, Stany Zjednoczone, 48044
    - Henry Ford Warren Hospital - Breast Macomb
  - Macomb, Michigan, Stany Zjednoczone, 48044
    - Henry Ford Saint John Hospital - Macomb Medical
  - Marlette, Michigan, Stany Zjednoczone, 48453
    - Saint Mary's Oncology/Hematology Associates of Marlette
  - Mount Clemens, Michigan, Stany Zjednoczone, 48043
    - McLaren Cancer Institute-Macomb
  - Mount Pleasant, Michigan, Stany Zjednoczone, 48858
    - McLaren Cancer Institute-Central Michigan
  - Muskegon, Michigan, Stany Zjednoczone, 49444
    - Trinity Health Muskegon Hospital
  - Niles, Michigan, Stany Zjednoczone, 49120
    - Corewell Health Lakeland Hospitals - Niles Hospital
  - Norton Shores, Michigan, Stany Zjednoczone, 49444
    - Cancer and Hematology Centers of Western Michigan - Norton Shores
  - Petoskey, Michigan, Stany Zjednoczone, 49770
    - McLaren Cancer Institute-Northern Michigan
  - Pontiac, Michigan, Stany Zjednoczone, 48341
    - Hope Cancer Center
  - Pontiac, Michigan, Stany Zjednoczone, 48341
    - Trinity Health Saint Joseph Mercy Oakland Hospital
  - Pontiac, Michigan, Stany Zjednoczone, 48341
    - Michigan Healthcare Professionals Pontiac
  - Pontiac, Michigan, Stany Zjednoczone, 48341
    - Trinity Health IHA Medical Group-Alice Gustafson Center
  - Port Huron, Michigan, Stany Zjednoczone, 48060
    - McLaren-Port Huron
  - Reed City, Michigan, Stany Zjednoczone, 49677
    - Corewell Health Reed City Hospital
  - Rochester Hills, Michigan, Stany Zjednoczone, 48309
    - Henry Ford Rochester Hospital
  - Saginaw, Michigan, Stany Zjednoczone, 48604
    - Oncology Hematology Associates of Saginaw Valley PC
  - Saginaw, Michigan, Stany Zjednoczone, 48601
    - MyMichigan Medical Center Saginaw
  - Saint Joseph, Michigan, Stany Zjednoczone, 49085
    - Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
  - Saint Joseph, Michigan, Stany Zjednoczone, 49085
    - Corewell Health Lakeland Hospitals - Saint Joseph Hospital
  - Sterling Heights, Michigan, Stany Zjednoczone, 48312
    - Bhadresh Nayak MD PC-Sterling Heights
  - Tawas City, Michigan, Stany Zjednoczone, 48764
    - MyMichigan Medical Center Tawas
  - Traverse City, Michigan, Stany Zjednoczone, 49684
    - Munson Medical Center
  - Warren, Michigan, Stany Zjednoczone, 48088
    - Advanced Breast Care Center PLLC
  - Warren, Michigan, Stany Zjednoczone, 48093
    - Macomb Hematology Oncology PC
  - Warren, Michigan, Stany Zjednoczone, 48093
    - Henry Ford Madison Heights Hospital - Breast
  - Warren, Michigan, Stany Zjednoczone, 48093
    - Henry Ford Health Warren Hospital
  - Warren, Michigan, Stany Zjednoczone, 48093
    - Henry Ford Warren Hospital - GLCMS
  - West Branch, Michigan, Stany Zjednoczone, 48661
    - Saint Mary's Oncology/Hematology Associates of West Branch
  - Wyoming, Michigan, Stany Zjednoczone, 49519
    - University of Michigan Health - West
  - Ypsilanti, Michigan, Stany Zjednoczone, 48197
    - Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
  - Ypsilanti, Michigan, Stany Zjednoczone, 48106
    - Huron Gastroenterology PC
- Minnesota
  - Bemidji, Minnesota, Stany Zjednoczone, 56601
    - Sanford Joe Lueken Cancer Center
  - Burnsville, Minnesota, Stany Zjednoczone, 55337
    - Fairview Ridges Hospital
  - Burnsville, Minnesota, Stany Zjednoczone, 55337
    - Minnesota Oncology - Burnsville
  - Cambridge, Minnesota, Stany Zjednoczone, 55008
    - Cambridge Medical Center
  - Coon Rapids, Minnesota, Stany Zjednoczone, 55433
    - Mercy Hospital
  - Edina, Minnesota, Stany Zjednoczone, 55435
    - Fairview Southdale Hospital
  - Fridley, Minnesota, Stany Zjednoczone, 55432
    - Unity Hospital
  - Maple Grove, Minnesota, Stany Zjednoczone, 55369
    - Fairview Clinics and Surgery Center Maple Grove
  - Maplewood, Minnesota, Stany Zjednoczone, 55109
    - Saint John's Hospital - Healtheast
  - Maplewood, Minnesota, Stany Zjednoczone, 55109
    - Minnesota Oncology Hematology PA-Maplewood
  - Minneapolis, Minnesota, Stany Zjednoczone, 55415
    - Hennepin County Medical Center
  - Minneapolis, Minnesota, Stany Zjednoczone, 55407
    - Abbott-Northwestern Hospital
  - Minneapolis, Minnesota, Stany Zjednoczone, 55454
    - Health Partners Inc
  - Minneapolis, Minnesota, Stany Zjednoczone, 55417
    - Minneapolis VA Medical Center
  - Monticello, Minnesota, Stany Zjednoczone, 55362
    - Monticello Cancer Center
  - New Ulm, Minnesota, Stany Zjednoczone, 56073
    - New Ulm Medical Center
  - Princeton, Minnesota, Stany Zjednoczone, 55371
    - Fairview Northland Medical Center
  - Robbinsdale, Minnesota, Stany Zjednoczone, 55422
    - North Memorial Medical Health Center
  - Saint Louis Park, Minnesota, Stany Zjednoczone, 55416
    - Park Nicollet Clinic - Saint Louis Park
  - Saint Paul, Minnesota, Stany Zjednoczone, 55101
    - Regions Hospital
  - Saint Paul, Minnesota, Stany Zjednoczone, 55102
    - United Hospital
  - Shakopee, Minnesota, Stany Zjednoczone, 55379
    - Saint Francis Regional Medical Center
  - Stillwater, Minnesota, Stany Zjednoczone, 55082
    - Lakeview Hospital
  - Thief River Falls, Minnesota, Stany Zjednoczone, 56701
    - Sanford Thief River Falls Medical Center
  - Waconia, Minnesota, Stany Zjednoczone, 55387
    - Ridgeview Medical Center
  - Willmar, Minnesota, Stany Zjednoczone, 56201
    - Rice Memorial Hospital
  - Woodbury, Minnesota, Stany Zjednoczone, 55125
    - Minnesota Oncology Hematology PA-Woodbury
  - Worthington, Minnesota, Stany Zjednoczone, 56187
    - Sanford Cancer Center Worthington
  - Wyoming, Minnesota, Stany Zjednoczone, 55092
    - Fairview Lakes Medical Center
- Missouri
  - Ballwin, Missouri, Stany Zjednoczone, 63011
    - Mercy Oncology and Hematology - Clayton-Clarkson
  - Bolivar, Missouri, Stany Zjednoczone, 65613
    - Central Care Cancer Center - Bolivar
  - Bonne Terre, Missouri, Stany Zjednoczone, 63628
    - Parkland Health Center-Bonne Terre
  - Branson, Missouri, Stany Zjednoczone, 65616
    - Cox Cancer Center Branson
  - Cape Girardeau, Missouri, Stany Zjednoczone, 63703
    - Saint Francis Medical Center
  - Cape Girardeau, Missouri, Stany Zjednoczone, 63703
    - Mercy Cancer Center - Cape Girardeau
  - Jefferson City, Missouri, Stany Zjednoczone, 65109
    - MU Health Care Goldschmidt Cancer Center
  - Joplin, Missouri, Stany Zjednoczone, 64804
    - Freeman Health System
  - Joplin, Missouri, Stany Zjednoczone, 64804
    - Mercy Hospital Joplin
  - Rolla, Missouri, Stany Zjednoczone, 65401
    - Mercy Clinic-Rolla-Cancer and Hematology
  - Rolla, Missouri, Stany Zjednoczone, 65401
    - Phelps Health Delbert Day Cancer Institute
  - Saint Joseph, Missouri, Stany Zjednoczone, 64506
    - Heartland Regional Medical Center
  - Sainte Genevieve, Missouri, Stany Zjednoczone, 63670
    - Sainte Genevieve County Memorial Hospital
  - Springfield, Missouri, Stany Zjednoczone, 65807
    - CoxHealth South Hospital
  - Springfield, Missouri, Stany Zjednoczone, 65804
    - Mercy Hospital Springfield
  - St Louis, Missouri, Stany Zjednoczone, 63131
    - Missouri Baptist Medical Center
  - St Louis, Missouri, Stany Zjednoczone, 63109
    - Mercy Infusion Center - Chippewa
  - St Louis, Missouri, Stany Zjednoczone, 63141
    - Mercy Hospital Saint Louis
  - St Louis, Missouri, Stany Zjednoczone, 63128
    - Mercy Hospital South
  - Sullivan, Missouri, Stany Zjednoczone, 63080
    - Missouri Baptist Sullivan Hospital
  - Washington, Missouri, Stany Zjednoczone, 63090
    - Mercy Hospital Washington
- Montana
  - Anaconda, Montana, Stany Zjednoczone, 59711
    - Community Hospital of Anaconda
  - Billings, Montana, Stany Zjednoczone, 59101
    - Billings Clinic Cancer Center
  - Billings, Montana, Stany Zjednoczone, 59101
    - Saint Vincent Healthcare
  - Billings, Montana, Stany Zjednoczone, 59102
    - Saint Vincent Frontier Cancer Center
  - Bozeman, Montana, Stany Zjednoczone, 59715
    - Bozeman Health Deaconess Hospital
  - Butte, Montana, Stany Zjednoczone, 59701
    - Saint James Community Hospital and Cancer Treatment Center
  - Great Falls, Montana, Stany Zjednoczone, 59405
    - Great Falls Clinic
  - Great Falls, Montana, Stany Zjednoczone, 59405
    - Benefis Sletten Cancer Institute
  - Helena, Montana, Stany Zjednoczone, 59601
    - Saint Peter's Community Hospital
  - Kalispell, Montana, Stany Zjednoczone, 59901
    - Logan Health Medical Center
  - Missoula, Montana, Stany Zjednoczone, 59802
    - Saint Patrick Hospital - Community Hospital
  - Missoula, Montana, Stany Zjednoczone, 59804
    - Community Medical Center
- Nebraska
  - Bellevue, Nebraska, Stany Zjednoczone, 68123
    - Nebraska Medicine-Bellevue
  - Grand Island, Nebraska, Stany Zjednoczone, 68803
    - Nebraska Cancer Specialists/Oncology Hematology West PC
  - Kearney, Nebraska, Stany Zjednoczone, 68847
    - CHI Health Good Samaritan
  - Lincoln, Nebraska, Stany Zjednoczone, 68510
    - Saint Elizabeth Regional Medical Center
  - Omaha, Nebraska, Stany Zjednoczone, 68198
    - University of Nebraska Medical Center
  - Omaha, Nebraska, Stany Zjednoczone, 68124
    - Alegent Health Bergan Mercy Medical Center
  - Omaha, Nebraska, Stany Zjednoczone, 68118
    - Nebraska Medicine-Village Pointe
  - Omaha, Nebraska, Stany Zjednoczone, 68122
    - Alegent Health Immanuel Medical Center
  - Omaha, Nebraska, Stany Zjednoczone, 68130
    - Alegent Health Lakeside Hospital
  - Papillion, Nebraska, Stany Zjednoczone, 68046
    - Midlands Community Hospital
- Nevada
  - Carson City, Nevada, Stany Zjednoczone, 89703
    - Carson Tahoe Regional Medical Center
  - Henderson, Nevada, Stany Zjednoczone, 89052
    - Comprehensive Cancer Centers of Nevada - Henderson
  - Henderson, Nevada, Stany Zjednoczone, 89052
    - Cancer and Blood Specialists-Henderson
  - Henderson, Nevada, Stany Zjednoczone, 89052
    - Las Vegas Cancer Center-Henderson
  - Henderson, Nevada, Stany Zjednoczone, 89074
    - Comprehensive Cancer Centers of Nevada-Southeast Henderson
  - Henderson, Nevada, Stany Zjednoczone, 89052
    - Comprehensive Cancer Centers of Nevada-Horizon Ridge
  - Henderson, Nevada, Stany Zjednoczone, 89074
    - Las Vegas Urology - Green Valley
  - Henderson, Nevada, Stany Zjednoczone, 89074
    - Las Vegas Urology - Pebble
  - Henderson, Nevada, Stany Zjednoczone, 89074
    - Urology Specialists of Nevada - Green Valley
  - Henderson, Nevada, Stany Zjednoczone, 89074
    - Oncology Las Vegas - Henderson
  - Las Vegas, Nevada, Stany Zjednoczone, 89144
    - Summerlin Hospital Medical Center
  - Las Vegas, Nevada, Stany Zjednoczone, 89109
    - Sunrise Hospital and Medical Center
  - Las Vegas, Nevada, Stany Zjednoczone, 89102
    - OptumCare Cancer Care at Charleston
  - Las Vegas, Nevada, Stany Zjednoczone, 89106
    - Radiation Oncology Centers of Nevada Central
  - Las Vegas, Nevada, Stany Zjednoczone, 89119
    - Radiation Oncology Centers of Nevada Southeast
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - Comprehensive Cancer Centers of Nevada - Northwest
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - OptumCare Cancer Care at MountainView
  - Las Vegas, Nevada, Stany Zjednoczone, 89135
    - Alliance for Childhood Diseases/Cure 4 the Kids Foundation
  - Las Vegas, Nevada, Stany Zjednoczone, 89144
    - Comprehensive Cancer Centers of Nevada - Town Center
  - Las Vegas, Nevada, Stany Zjednoczone, 89144
    - Comprehensive Cancer Centers of Nevada-Summerlin
  - Las Vegas, Nevada, Stany Zjednoczone, 89148
    - Comprehensive Cancer Centers of Nevada
  - Las Vegas, Nevada, Stany Zjednoczone, 89169
    - Comprehensive Cancer Centers of Nevada - Central Valley
  - Las Vegas, Nevada, Stany Zjednoczone, 89102
    - University Medical Center of Southern Nevada
  - Las Vegas, Nevada, Stany Zjednoczone, 89106
    - Cancer and Blood Specialists-Shadow
  - Las Vegas, Nevada, Stany Zjednoczone, 89109
    - HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
  - Las Vegas, Nevada, Stany Zjednoczone, 89113
    - HealthCare Partners Medical Group Oncology/Hematology-San Martin
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - Cancer and Blood Specialists-Tenaya
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - HealthCare Partners Medical Group Oncology/Hematology-Tenaya
  - Las Vegas, Nevada, Stany Zjednoczone, 89148-2405
    - Las Vegas Cancer Center-Medical Center
  - Las Vegas, Nevada, Stany Zjednoczone, 89149
    - HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - Ann M Wierman MD LTD
  - Las Vegas, Nevada, Stany Zjednoczone, 89074
    - Las Vegas Urology - Pecos
  - Las Vegas, Nevada, Stany Zjednoczone, 89102
    - Desert West Surgery
  - Las Vegas, Nevada, Stany Zjednoczone, 89103
    - Hope Cancer Care of Nevada
  - Las Vegas, Nevada, Stany Zjednoczone, 89106
    - Urology Specialists of Nevada - Central
  - Las Vegas, Nevada, Stany Zjednoczone, 89113
    - Las Vegas Prostate Cancer Center
  - Las Vegas, Nevada, Stany Zjednoczone, 89113
    - Las Vegas Urology - Sunset
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - Las Vegas Urology - Cathedral Rock
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - Las Vegas Urology - Smoke Ranch
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - Urology Specialists of Nevada - Northwest
  - Las Vegas, Nevada, Stany Zjednoczone, 89169
    - University Cancer Center
  - Las Vegas, Nevada, Stany Zjednoczone, 89113
    - Urology Specialists of Nevada - Southwest
  - Las Vegas, Nevada, Stany Zjednoczone, 89128
    - Oncology Las Vegas - Tenaya
  - Las Vegas, Nevada, Stany Zjednoczone, 89183
    - OptumCare Cancer Care at Fort Apache
  - Pahrump, Nevada, Stany Zjednoczone, 89048
    - Hope Cancer Care of Nevada-Pahrump
  - Reno, Nevada, Stany Zjednoczone, 89502
    - Renown Regional Medical Center
  - Reno, Nevada, Stany Zjednoczone, 89503
    - Saint Mary's Regional Medical Center
  - Reno, Nevada, Stany Zjednoczone, 89509
    - Radiation Oncology Associates
- New Hampshire
  - Lebanon, New Hampshire, Stany Zjednoczone, 03756
    - Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
- New Jersey
  - Cape May Court House, New Jersey, Stany Zjednoczone, 08210
    - AtlantiCare Health Park-Cape May Court House
  - Egg Harbor, New Jersey, Stany Zjednoczone, 08234
    - AtlantiCare Surgery Center
  - Hamilton, New Jersey, Stany Zjednoczone, 08690
    - The Cancer Institute of New Jersey Hamilton
  - Jersey City, New Jersey, Stany Zjednoczone, 07302
    - Jersey City Medical Center
  - Livingston, New Jersey, Stany Zjednoczone, 07039
    - Cooperman Barnabas Medical Center
  - Moorestown, New Jersey, Stany Zjednoczone, 08057
    - Virtua Samson Cancer Center
  - Morristown, New Jersey, Stany Zjednoczone, 07960
    - Morristown Medical Center
  - Mount Holly, New Jersey, Stany Zjednoczone, 08060
    - Virtua Memorial
  - New Brunswick, New Jersey, Stany Zjednoczone, 08903
    - Rutgers Cancer Institute of New Jersey
  - Newark, New Jersey, Stany Zjednoczone, 07101
    - Rutgers New Jersey Medical School
  - Summit, New Jersey, Stany Zjednoczone, 07902
    - Overlook Hospital
  - Voorhees Township, New Jersey, Stany Zjednoczone, 08043
    - Virtua Voorhees
- New Mexico
  - Albuquerque, New Mexico, Stany Zjednoczone, 87106
    - University of New Mexico Cancer Center
- New York
  - Brooklyn, New York, Stany Zjednoczone, 11215
    - New York-Presbyterian/Brooklyn Methodist Hospital
  - Buffalo, New York, Stany Zjednoczone, 14263
    - Roswell Park Cancer Institute
  - New York, New York, Stany Zjednoczone, 10065
    - NYP/Weill Cornell Medical Center
  - Rochester, New York, Stany Zjednoczone, 14642
    - University of Rochester
  - Stony Brook, New York, Stany Zjednoczone, 11794
    - Stony Brook University Medical Center
  - Syracuse, New York, Stany Zjednoczone, 13210
    - State University of New York Upstate Medical University
  - Syracuse, New York, Stany Zjednoczone, 13215
    - SUNY Upstate Medical Center-Community Campus
  - The Bronx, New York, Stany Zjednoczone, 10461
    - Montefiore Medical Center-Einstein Campus
  - The Bronx, New York, Stany Zjednoczone, 10467
    - Montefiore Medical Center - Moses Campus
  - The Bronx, New York, Stany Zjednoczone, 10461
    - Montefiore Medical Center-Weiler Hospital
- North Carolina
  - Asheville, North Carolina, Stany Zjednoczone, 28803
    - AdventHealth Infusion Center Asheville
  - Charlotte, North Carolina, Stany Zjednoczone, 28204
    - Novant Health Presbyterian Medical Center
  - Clyde, North Carolina, Stany Zjednoczone, 28721
    - AdventHealth Infusion Center Haywood
  - Gastonia, North Carolina, Stany Zjednoczone, 28054
    - CaroMont Regional Medical Center
  - Greenville, North Carolina, Stany Zjednoczone, 27834
    - East Carolina University
  - Hendersonville, North Carolina, Stany Zjednoczone, 28792
    - AdventHealth Hendersonville
  - Huntersville, North Carolina, Stany Zjednoczone, 28078
    - Novant Health Cancer Institute - Huntersville
  - Huntersville, North Carolina, Stany Zjednoczone, 28078
    - Novant Health Presbyterian Medical Center Huntersville
  - Kernersville, North Carolina, Stany Zjednoczone, 27284
    - Novant Health Cancer Institute - Kernersville
  - Matthews, North Carolina, Stany Zjednoczone, 28105
    - Novant Health Cancer Institute - Matthews
  - Mooresville, North Carolina, Stany Zjednoczone, 28117
    - Novant Health Cancer Institute - Mooresville
  - Mount Airy, North Carolina, Stany Zjednoczone, 27030
    - Novant Health Cancer Institute - Mount Airy
  - New Bern, North Carolina, Stany Zjednoczone, 28561
    - CarolinaEast Medical Center
  - North Wilkesboro, North Carolina, Stany Zjednoczone, 28659
    - Novant Health Cancer Institute - Wilkesboro
  - Statesville, North Carolina, Stany Zjednoczone, 28625
    - Novant Health Cancer Institute - Statesville
  - Thomasville, North Carolina, Stany Zjednoczone, 27360
    - Novant Health Cancer Institute - Thomasville
  - Weaverville, North Carolina, Stany Zjednoczone, 28787
    - AdventHealth Infusion Center Weaverville
  - Winston-Salem, North Carolina, Stany Zjednoczone, 27103
    - Novant Health Forsyth Medical Center
- North Dakota
  - Bismarck, North Dakota, Stany Zjednoczone, 58501
    - Sanford Bismarck Medical Center
  - Fargo, North Dakota, Stany Zjednoczone, 58122
    - Sanford Roger Maris Cancer Center
  - Fargo, North Dakota, Stany Zjednoczone, 58122
    - Sanford Broadway Medical Center
  - Fargo, North Dakota, Stany Zjednoczone, 58103
    - Sanford South University Medical Center
  - Fargo, North Dakota, Stany Zjednoczone, 58103
    - Southpointe-Sanford Medical Center Fargo
  - Fargo, North Dakota, Stany Zjednoczone, 58104
    - Sanford Medical Center Fargo
- Ohio
  - Akron, Ohio, Stany Zjednoczone, 44304
    - Summa Health System - Akron Campus
  - Avon, Ohio, Stany Zjednoczone, 44011
    - UH Seidman Cancer Center at UH Avon Health Center
  - Barberton, Ohio, Stany Zjednoczone, 44203
    - Summa Health System - Barberton Campus
  - Beachwood, Ohio, Stany Zjednoczone, 44122
    - UHHS-Chagrin Highlands Medical Center
  - Canton, Ohio, Stany Zjednoczone, 44708
    - Cleveland Clinic Mercy Hospital
  - Centerville, Ohio, Stany Zjednoczone, 45459
    - Miami Valley Hospital South
  - Chardon, Ohio, Stany Zjednoczone, 44024
    - Geauga Hospital
  - Cincinnati, Ohio, Stany Zjednoczone, 45220
    - Good Samaritan Hospital - Cincinnati
  - Cincinnati, Ohio, Stany Zjednoczone, 45242
    - Bethesda North Hospital
  - Cincinnati, Ohio, Stany Zjednoczone, 45247
    - TriHealth Cancer Institute-Westside
  - Cincinnati, Ohio, Stany Zjednoczone, 45255
    - TriHealth Cancer Institute-Anderson
  - Cleveland, Ohio, Stany Zjednoczone, 44106
    - Case Western Reserve University
  - Cleveland, Ohio, Stany Zjednoczone, 44109
    - MetroHealth Medical Center
  - Cleveland, Ohio, Stany Zjednoczone, 44195
    - Cleveland Clinic Foundation
  - Cleveland, Ohio, Stany Zjednoczone, 44111
    - Cleveland Clinic Cancer Center/Fairview Hospital
  - Columbus, Ohio, Stany Zjednoczone, 43210
    - Ohio State University Comprehensive Cancer Center
  - Dayton, Ohio, Stany Zjednoczone, 45409
    - Miami Valley Hospital
  - Dayton, Ohio, Stany Zjednoczone, 45415
    - Miami Valley Hospital North
  - Dayton, Ohio, Stany Zjednoczone, 45409
    - Premier Blood and Cancer Center
  - Elyria, Ohio, Stany Zjednoczone, 44035
    - Mercy Cancer Center-Elyria
  - Franklin, Ohio, Stany Zjednoczone, 45005-1066
    - Atrium Medical Center-Middletown Regional Hospital
  - Greenville, Ohio, Stany Zjednoczone, 45331
    - Miami Valley Cancer Care and Infusion
  - Mansfield, Ohio, Stany Zjednoczone, 44906
    - Cleveland Clinic Cancer Center Mansfield
  - Mayfield Heights, Ohio, Stany Zjednoczone, 44124
    - Hillcrest Hospital Cancer Center
  - Medina, Ohio, Stany Zjednoczone, 44256
    - Summa Health Medina Medical Center
  - Mentor, Ohio, Stany Zjednoczone, 44060
    - UH Seidman Cancer Center at Lake Health Mentor Campus
  - Middleburg Heights, Ohio, Stany Zjednoczone, 44130
    - UH Seidman Cancer Center at Southwest General Hospital
  - Parma, Ohio, Stany Zjednoczone, 44129
    - University Hospitals Parma Medical Center
  - Ravenna, Ohio, Stany Zjednoczone, 44266
    - University Hospitals Portage Medical Center
  - Sandusky, Ohio, Stany Zjednoczone, 44870
    - North Coast Cancer Care
  - Strongsville, Ohio, Stany Zjednoczone, 44136
    - Cleveland Clinic Cancer Center Strongsville
  - Troy, Ohio, Stany Zjednoczone, 45373
    - Upper Valley Medical Center
  - Westlake, Ohio, Stany Zjednoczone, 44145
    - UH Seidman Cancer Center at Saint John Medical Center
  - Westlake, Ohio, Stany Zjednoczone, 44145
    - UHHS-Westlake Medical Center
- Oklahoma
  - Lawton, Oklahoma, Stany Zjednoczone, 73505
    - Cancer Centers of Southwest Oklahoma Research
  - Oklahoma City, Oklahoma, Stany Zjednoczone, 73104
    - University of Oklahoma Health Sciences Center
  - Oklahoma City, Oklahoma, Stany Zjednoczone, 73120
    - Mercy Hospital Oklahoma City
  - Tulsa, Oklahoma, Stany Zjednoczone, 74146
    - Oklahoma Cancer Specialists and Research Institute-Tulsa
- Oregon
  - Baker City, Oregon, Stany Zjednoczone, 97814
    - Saint Alphonsus Cancer Care Center-Baker City
  - Bend, Oregon, Stany Zjednoczone, 97701
    - Saint Charles Health System
  - Clackamas, Oregon, Stany Zjednoczone, 97015
    - Clackamas Radiation Oncology Center
  - Clackamas, Oregon, Stany Zjednoczone, 97015
    - Providence Cancer Institute Clackamas Clinic
  - Coos Bay, Oregon, Stany Zjednoczone, 97420
    - Bay Area Hospital
  - Newberg, Oregon, Stany Zjednoczone, 97132
    - Providence Newberg Medical Center
  - Ontario, Oregon, Stany Zjednoczone, 97914
    - Saint Alphonsus Cancer Care Center-Ontario
  - Oregon City, Oregon, Stany Zjednoczone, 97045
    - Providence Willamette Falls Medical Center
  - Portland, Oregon, Stany Zjednoczone, 97213
    - Providence Portland Medical Center
  - Portland, Oregon, Stany Zjednoczone, 97225
    - Providence Saint Vincent Medical Center
  - Redmond, Oregon, Stany Zjednoczone, 97756
    - Saint Charles Health System-Redmond
- Pennsylvania
  - Allentown, Pennsylvania, Stany Zjednoczone, 18103
    - Lehigh Valley Hospital-Cedar Crest
  - Bethlehem, Pennsylvania, Stany Zjednoczone, 18017
    - Lehigh Valley Hospital - Muhlenberg
  - Chadds Ford, Pennsylvania, Stany Zjednoczone, 19317
    - Christiana Care Health System-Concord Health Center
  - Danville, Pennsylvania, Stany Zjednoczone, 17822
    - Geisinger Medical Center
  - East Stroudsburg, Pennsylvania, Stany Zjednoczone, 18301
    - Pocono Medical Center
  - Erie, Pennsylvania, Stany Zjednoczone, 16505
    - UPMC Hillman Cancer Center Erie
  - Farrell, Pennsylvania, Stany Zjednoczone, 16121
    - UPMC Cancer Center at UPMC Horizon
  - Hazleton, Pennsylvania, Stany Zjednoczone, 18201
    - Geisinger Medical Center-Cancer Center Hazleton
  - Hazleton, Pennsylvania, Stany Zjednoczone, 18201
    - Lehigh Valley Hospital-Hazleton
  - Hershey, Pennsylvania, Stany Zjednoczone, 17033-0850
    - Penn State Milton S Hershey Medical Center
  - Lewisburg, Pennsylvania, Stany Zjednoczone, 17837
    - Geisinger Medical Oncology-Lewisburg
  - Lewistown, Pennsylvania, Stany Zjednoczone, 17044
    - Lewistown Hospital
  - Monroeville, Pennsylvania, Stany Zjednoczone, 15146
    - UPMC Hillman Cancer Center - Monroeville
  - Monroeville, Pennsylvania, Stany Zjednoczone, 15146
    - UPMC Cancer Center - Monroeville
  - Philadelphia, Pennsylvania, Stany Zjednoczone, 19107
    - Thomas Jefferson University Hospital
  - Philadelphia, Pennsylvania, Stany Zjednoczone, 19114
    - Jefferson Torresdale Hospital
  - Pittsburgh, Pennsylvania, Stany Zjednoczone, 15232
    - UPMC Hillman Cancer Center
  - Pittsburgh, Pennsylvania, Stany Zjednoczone, 15232
    - UPMC-Shadyside Hospital
  - Pittsburgh, Pennsylvania, Stany Zjednoczone, 15237
    - UPMC-Passavant Hospital
  - Pittsburgh, Pennsylvania, Stany Zjednoczone, 15243
    - UPMC-Saint Clair Hospital Cancer Center
  - Pottsville, Pennsylvania, Stany Zjednoczone, 17901
    - Geisinger Cancer Services-Pottsville
  - Scranton, Pennsylvania, Stany Zjednoczone, 18510
    - Community Medical Center
  - West Reading, Pennsylvania, Stany Zjednoczone, 19611
    - Reading Hospital
  - Wilkes-Barre, Pennsylvania, Stany Zjednoczone, 18711
    - Geisinger Wyoming Valley/Henry Cancer Center
  - Willow Grove, Pennsylvania, Stany Zjednoczone, 19090
    - Asplundh Cancer Pavilion
- South Carolina
  - Boiling Springs, South Carolina, Stany Zjednoczone, 29316
    - Prisma Health Cancer Institute - Spartanburg
  - Charleston, South Carolina, Stany Zjednoczone, 29425
    - Medical University of South Carolina
  - Easley, South Carolina, Stany Zjednoczone, 29640
    - Prisma Health Cancer Institute - Easley
  - Gaffney, South Carolina, Stany Zjednoczone, 29341
    - Gibbs Cancer Center-Gaffney
  - Greenville, South Carolina, Stany Zjednoczone, 29605
    - Prisma Health Cancer Institute - Faris
  - Greenville, South Carolina, Stany Zjednoczone, 29607
    - Saint Francis Cancer Center
  - Greenville, South Carolina, Stany Zjednoczone, 29615
    - Prisma Health Cancer Institute - Eastside
  - Greenville, South Carolina, Stany Zjednoczone, 29605
    - Prisma Health Cancer Institute - Butternut
  - Greenville, South Carolina, Stany Zjednoczone, 29601
    - Saint Francis Hospital
  - Greer, South Carolina, Stany Zjednoczone, 29650
    - Prisma Health Cancer Institute - Greer
  - Greer, South Carolina, Stany Zjednoczone, 29651
    - Gibbs Cancer Center-Pelham
  - Seneca, South Carolina, Stany Zjednoczone, 29672
    - Prisma Health Cancer Institute - Seneca
  - Spartanburg, South Carolina, Stany Zjednoczone, 29303
    - Spartanburg Medical Center
  - Union, South Carolina, Stany Zjednoczone, 29379
    - SMC Center for Hematology Oncology Union
- South Dakota
  - Aberdeen, South Dakota, Stany Zjednoczone, 57401
    - Avera Cancer Institute-Aberdeen
  - Sioux Falls, South Dakota, Stany Zjednoczone, 57105
    - Avera Cancer Institute
  - Sioux Falls, South Dakota, Stany Zjednoczone, 57117-5134
    - Sanford USD Medical Center - Sioux Falls
  - Sioux Falls, South Dakota, Stany Zjednoczone, 57104
    - Sanford Cancer Center Oncology Clinic
- Tennessee
  - Nashville, Tennessee, Stany Zjednoczone, 37232
    - Vanderbilt University/Ingram Cancer Center
- Texas
  - Amarillo, Texas, Stany Zjednoczone, 79106
    - The Don and Sybil Harrington Cancer Center
  - Austin, Texas, Stany Zjednoczone, 78712
    - University of Texas at Austin
  - Austin, Texas, Stany Zjednoczone, 78701
    - Dell Seton Medical Center at The University of Texas
  - Bryan, Texas, Stany Zjednoczone, 77802
    - Saint Joseph Regional Cancer Center
  - Dallas, Texas, Stany Zjednoczone, 75235
    - Parkland Memorial Hospital
  - Dallas, Texas, Stany Zjednoczone, 75390
    - UT Southwestern/Simmons Cancer Center-Dallas
  - Houston, Texas, Stany Zjednoczone, 77030
    - Memorial Hermann Texas Medical Center
  - Humble, Texas, Stany Zjednoczone, 77338
    - Memorial Hermann Northeast Hospital
- Utah
  - American Fork, Utah, Stany Zjednoczone, 84003
    - American Fork Hospital / Huntsman Intermountain Cancer Center
  - Cedar City, Utah, Stany Zjednoczone, 84720
    - Sandra L Maxwell Cancer Center
  - Logan, Utah, Stany Zjednoczone, 84321
    - Logan Regional Hospital
  - Murray, Utah, Stany Zjednoczone, 84107
    - Intermountain Medical Center
  - Ogden, Utah, Stany Zjednoczone, 84403
    - McKay-Dee Hospital Center
  - Provo, Utah, Stany Zjednoczone, 84604
    - Utah Valley Regional Medical Center
  - Riverton, Utah, Stany Zjednoczone, 84065
    - Riverton Hospital
  - Salt Lake City, Utah, Stany Zjednoczone, 84106
    - Utah Cancer Specialists-Salt Lake City
  - Salt Lake City, Utah, Stany Zjednoczone, 84143
    - LDS Hospital
  - St. George, Utah, Stany Zjednoczone, 84770
    - Saint George Regional Medical Center
- Vermont
  - Saint Johnsbury, Vermont, Stany Zjednoczone, 05819
    - Dartmouth Cancer Center - North
- Virginia
  - Richmond, Virginia, Stany Zjednoczone, 23235
    - VCU Massey Cancer Center at Stony Point
  - Richmond, Virginia, Stany Zjednoczone, 23298
    - VCU Massey Comprehensive Cancer Center
- Washington
  - Aberdeen, Washington, Stany Zjednoczone, 98520
    - Providence Regional Cancer System-Aberdeen
  - Auburn, Washington, Stany Zjednoczone, 98001
    - MultiCare Auburn Medical Center
  - Bellevue, Washington, Stany Zjednoczone, 98004
    - Overlake Medical Center
  - Bellingham, Washington, Stany Zjednoczone, 98225
    - PeaceHealth Saint Joseph Medical Center
  - Burien, Washington, Stany Zjednoczone, 98166
    - Saint Anne Hospital
  - Centralia, Washington, Stany Zjednoczone, 98531
    - Providence Regional Cancer System-Centralia
  - Edmonds, Washington, Stany Zjednoczone, 98026
    - Swedish Cancer Institute-Edmonds
  - Enumclaw, Washington, Stany Zjednoczone, 98022
    - Saint Elizabeth Hospital
  - Everett, Washington, Stany Zjednoczone, 98201
    - Providence Regional Cancer Partnership
  - Federal Way, Washington, Stany Zjednoczone, 98003
    - Saint Francis Hospital
  - Gig Harbor, Washington, Stany Zjednoczone, 98335
    - MultiCare Gig Harbor Medical Park
  - Issaquah, Washington, Stany Zjednoczone, 98029
    - Swedish Cancer Institute-Issaquah
  - Kennewick, Washington, Stany Zjednoczone, 99336
    - Kadlec Clinic Hematology and Oncology
  - Lacey, Washington, Stany Zjednoczone, 98503
    - Providence Regional Cancer System-Lacey
  - Lakewood, Washington, Stany Zjednoczone, 98499
    - Saint Clare Hospital
  - Longview, Washington, Stany Zjednoczone, 98632
    - PeaceHealth Saint John Medical Center
  - Mount Vernon, Washington, Stany Zjednoczone, 98274
    - Skagit Regional Health Cancer Care Center
  - Port Townsend, Washington, Stany Zjednoczone, 98368
    - Jefferson Healthcare
  - Poulsbo, Washington, Stany Zjednoczone, 98370
    - Harrison HealthPartners Hematology and Oncology-Poulsbo
  - Puyallup, Washington, Stany Zjednoczone, 98372
    - MultiCare Good Samaritan Hospital
  - Renton, Washington, Stany Zjednoczone, 98055
    - Valley Medical Center
  - Seattle, Washington, Stany Zjednoczone, 98107
    - Swedish Medical Center-Ballard Campus
  - Seattle, Washington, Stany Zjednoczone, 98122
    - Swedish Medical Center-First Hill
  - Seattle, Washington, Stany Zjednoczone, 98104
    - Pacific Gynecology Specialists
  - Seattle, Washington, Stany Zjednoczone, 98122-5711
    - Swedish Medical Center-Cherry Hill
  - Sedro-Woolley, Washington, Stany Zjednoczone, 98284
    - PeaceHealth United General Medical Center
  - Shelton, Washington, Stany Zjednoczone, 98584
    - Providence Regional Cancer System-Shelton
  - Silverdale, Washington, Stany Zjednoczone, 98383
    - Saint Joseph Medical Center Hematology and Oncology - Silverdale
  - Spokane, Washington, Stany Zjednoczone, 99204
    - MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
  - Spokane, Washington, Stany Zjednoczone, 99218
    - MultiCare Deaconess Cancer and Blood Specialty Center - North
  - Spokane Valley, Washington, Stany Zjednoczone, 99216
    - MultiCare Deaconess Cancer and Blood Specialty Center - Valley
  - Tacoma, Washington, Stany Zjednoczone, 98405
    - Mary Bridge Children's Hospital and Health Center
  - Tacoma, Washington, Stany Zjednoczone, 98405
    - Northwest Medical Specialties PLLC
  - Tacoma, Washington, Stany Zjednoczone, 98405
    - MultiCare Tacoma General Hospital
  - Tacoma, Washington, Stany Zjednoczone, 98405
    - Franciscan Research Center-Northwest Medical Plaza
  - Vancouver, Washington, Stany Zjednoczone, 98664
    - PeaceHealth Southwest Medical Center
  - Walla Walla, Washington, Stany Zjednoczone, 99362
    - Providence Saint Mary Regional Cancer Center
  - Yakima, Washington, Stany Zjednoczone, 98902
    - North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
  - Yelm, Washington, Stany Zjednoczone, 98597
    - Providence Regional Cancer System-Yelm
- Wisconsin
  - Appleton, Wisconsin, Stany Zjednoczone, 54911
    - ThedaCare Regional Cancer Center
  - Burlington, Wisconsin, Stany Zjednoczone, 53105
    - Aurora Cancer Care-Southern Lakes VLCC
  - Eau Claire, Wisconsin, Stany Zjednoczone, 54701
    - Marshfield Medical Center-EC Cancer Center
  - Eau Claire, Wisconsin, Stany Zjednoczone, 54701
    - HSHS Sacred Heart Hospital
  - Germantown, Wisconsin, Stany Zjednoczone, 53022
    - Aurora Health Care Germantown Health Center
  - Grafton, Wisconsin, Stany Zjednoczone, 53024
    - Aurora Cancer Care-Grafton
  - Green Bay, Wisconsin, Stany Zjednoczone, 54311
    - Aurora BayCare Medical Center
  - Green Bay, Wisconsin, Stany Zjednoczone, 54301
    - Saint Vincent Hospital Cancer Center Green Bay
  - Green Bay, Wisconsin, Stany Zjednoczone, 54303
    - Saint Vincent Hospital Cancer Center at Saint Mary's
  - Kenosha, Wisconsin, Stany Zjednoczone, 53142
    - Aurora Cancer Care-Kenosha South
  - La Crosse, Wisconsin, Stany Zjednoczone, 54601
    - Gundersen Lutheran Medical Center
  - Manitowoc, Wisconsin, Stany Zjednoczone, 54221
    - Holy Family Memorial Hospital
  - Marinette, Wisconsin, Stany Zjednoczone, 54143
    - Aurora Bay Area Medical Group-Marinette
  - Marshfield, Wisconsin, Stany Zjednoczone, 54449
    - Marshfield Medical Center-Marshfield
  - Menomonee Falls, Wisconsin, Stany Zjednoczone, 53051
    - Froedtert Menomonee Falls Hospital
  - Milwaukee, Wisconsin, Stany Zjednoczone, 53226
    - Medical College of Wisconsin
  - Milwaukee, Wisconsin, Stany Zjednoczone, 53209
    - Aurora Cancer Care-Milwaukee
  - Milwaukee, Wisconsin, Stany Zjednoczone, 53215
    - Aurora Saint Luke's Medical Center
  - Milwaukee, Wisconsin, Stany Zjednoczone, 53233
    - Aurora Sinai Medical Center
  - Minocqua, Wisconsin, Stany Zjednoczone, 54548
    - Marshfield Medical Center - Minocqua
  - Mukwonago, Wisconsin, Stany Zjednoczone, 53149
    - ProHealth D N Greenwald Center
  - New Richmond, Wisconsin, Stany Zjednoczone, 54017
    - Cancer Center of Western Wisconsin
  - Oak Creek, Wisconsin, Stany Zjednoczone, 53154
    - Drexel Town Square Health Center
  - Oconomowoc, Wisconsin, Stany Zjednoczone, 53066
    - ProHealth Oconomowoc Memorial Hospital
  - Oconto Falls, Wisconsin, Stany Zjednoczone, 54154
    - Saint Vincent Hospital Cancer Center at Oconto Falls
  - Oshkosh, Wisconsin, Stany Zjednoczone, 54904
    - Vince Lombardi Cancer Clinic - Oshkosh
  - Racine, Wisconsin, Stany Zjednoczone, 53406
    - Aurora Cancer Care-Racine
  - Rice Lake, Wisconsin, Stany Zjednoczone, 54868
    - Marshfield Medical Center-Rice Lake
  - Sheboygan, Wisconsin, Stany Zjednoczone, 53081
    - Vince Lombardi Cancer Clinic-Sheboygan
  - Sheboygan, Wisconsin, Stany Zjednoczone, 53081
    - HSHS Saint Nicholas Hospital
  - Stevens Point, Wisconsin, Stany Zjednoczone, 54482
    - Marshfield Medical Center-River Region at Stevens Point
  - Sturgeon Bay, Wisconsin, Stany Zjednoczone, 54235-1495
    - Saint Vincent Hospital Cancer Center at Sturgeon Bay
  - Summit, Wisconsin, Stany Zjednoczone, 53066
    - Aurora Medical Center in Summit
  - Two Rivers, Wisconsin, Stany Zjednoczone, 54241
    - Vince Lombardi Cancer Clinic-Two Rivers
  - Waukesha, Wisconsin, Stany Zjednoczone, 53188
    - UW Cancer Center at ProHealth Care
  - Waukesha, Wisconsin, Stany Zjednoczone, 53188
    - ProHealth Waukesha Memorial Hospital
  - Wauwatosa, Wisconsin, Stany Zjednoczone, 53226
    - Aurora Cancer Care-Milwaukee West
  - West Allis, Wisconsin, Stany Zjednoczone, 53227
    - Aurora West Allis Medical Center
  - West Bend, Wisconsin, Stany Zjednoczone, 53095
    - Froedtert West Bend Hospital/Kraemer Cancer Center
  - Weston, Wisconsin, Stany Zjednoczone, 54476
    - Marshfield Medical Center - Weston
- Wyoming
  - Cheyenne, Wyoming, Stany Zjednoczone, 82001
    - Cheyenne Regional Medical Center-West
  - Cody, Wyoming, Stany Zjednoczone, 82414
    - Billings Clinic-Cody
  - Sheridan, Wyoming, Stany Zjednoczone, 82801
    - Welch Cancer Center

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Wszystko

Opis

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

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

Główny cel: Leczenie
Przydział: Randomizowane
Model interwencyjny: Zadanie krzyżowe
Maskowanie: Brak (otwarta etykieta)

Liczba ramion

Broń i interwencje

Grupa uczestników / Arm	Interwencja / Leczenie
Eksperymentalny: 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.	Lek: Cisplatin Given IV Inne nazwy: CDDP Cis-diaminodichloridoplatyna Cismaplat Cisplatyna Neoplatyna Platynol Abiplatyna Blastolem Bryplatyna Cis-diamino-dichloroplatyna Cis-diaminodichloro Platyna (II) Cis-diaminodichloroplatyna Cis-dichloroamina Platyna (II) Cis-platynowy dichlorek diaminy Cis-platyna Cis-platyna II Dichlorek diaminy cis-platyny II Cisplatyl Citoplatyno Cytozyna Cysplatyna DDP Lederplatyna Metaplatyna Chlorek Peyrone'a Sól Peyrone'a Placis Plastistil Platamina Platyblastyna Platiblastyna-S Platinex Platinol- AQ Platinol-AQ Platinol-AQ VHA Plus Platynoksan Platyna Diaminochlorek platyny Platiran Platistyna Platosin Procedura: Biospecimen Collection Undergo blood sample collection Inne nazwy: Pobieranie próbek biologicznych Zebrano próbki biologiczne Kolekcja próbek Procedura: Echocardiography Test Undergo ECHO Inne nazwy: Echokardiografia WE Biologiczny: Nivolumab Given IV Inne nazwy: BMS-936558 MDX-1106 NIWO ONO-4538 Opdivo CMAB819 Niwolumab biopodobny CMAB819 MDX 1106 MDX1106 BMS 936558 ABP 206 Niwolumab Biopodobny ABP 206 BCD-263 Niwolumab Biopodobny BCD-263 BMS936558 ONO 4538 ONO4538 Procedura: Computed Tomography Undergo CT or PET/CT Inne nazwy: Tomografia komputerowa KOT Skanowanie CAT Tomografia komputerowa osiowa Komputerowa tomografia osiowa tomografia Komputerowa tomografia osiowa (zabieg) Tomografia komputerowa (CT). Diagnostyczny skan CAT Diagnostyczny typ usługi skanowania CAT Procedura: Positron Emission Tomography Undergo PET/CT Inne nazwy: Obrazowanie medyczne, pozytonowa tomografia emisyjna ZWIERZAK DOMOWY Skanowanie zwierzęcia Skan pozytonowej tomografii emisyjnej Pozytonowa emisyjna tomografia komputerowa PT Pozytronowa tomografia emisyjna (zabieg) Promieniowanie: Intensity-Modulated Radiation Therapy Undergo IMRT Inne nazwy: IMRT RT z modulacją intensywności Radioterapia z modulacją intensywności Promieniowanie, radioterapia z modulacją intensywności Radioterapia modulowana intensywnością (zabieg) Inny: Fludeoxyglucose F-18 Receive FDG Inne nazwy: 18FDG FDG fludeoksyglukoza F 18 Fludeoksyglukoza (18F) Fludeoksyglukoza F18 Fluor-18 2-Fluoro-2-deoksy-D-glukoza Fluorodeoksyglukoza F18
Aktywny komparator: 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.	Lek: Cisplatin Given IV Inne nazwy: CDDP Cis-diaminodichloridoplatyna Cismaplat Cisplatyna Neoplatyna Platynol Abiplatyna Blastolem Bryplatyna Cis-diamino-dichloroplatyna Cis-diaminodichloro Platyna (II) Cis-diaminodichloroplatyna Cis-dichloroamina Platyna (II) Cis-platynowy dichlorek diaminy Cis-platyna Cis-platyna II Dichlorek diaminy cis-platyny II Cisplatyl Citoplatyno Cytozyna Cysplatyna DDP Lederplatyna Metaplatyna Chlorek Peyrone'a Sól Peyrone'a Placis Plastistil Platamina Platyblastyna Platiblastyna-S Platinex Platinol- AQ Platinol-AQ Platinol-AQ VHA Plus Platynoksan Platyna Diaminochlorek platyny Platiran Platistyna Platosin Procedura: Biospecimen Collection Undergo blood sample collection Inne nazwy: Pobieranie próbek biologicznych Zebrano próbki biologiczne Kolekcja próbek Procedura: Echocardiography Test Undergo ECHO Inne nazwy: Echokardiografia WE Procedura: Computed Tomography Undergo CT or PET/CT Inne nazwy: Tomografia komputerowa KOT Skanowanie CAT Tomografia komputerowa osiowa Komputerowa tomografia osiowa tomografia Komputerowa tomografia osiowa (zabieg) Tomografia komputerowa (CT). Diagnostyczny skan CAT Diagnostyczny typ usługi skanowania CAT Procedura: Positron Emission Tomography Undergo PET/CT Inne nazwy: Obrazowanie medyczne, pozytonowa tomografia emisyjna ZWIERZAK DOMOWY Skanowanie zwierzęcia Skan pozytonowej tomografii emisyjnej Pozytonowa emisyjna tomografia komputerowa PT Pozytronowa tomografia emisyjna (zabieg) Promieniowanie: Intensity-Modulated Radiation Therapy Undergo IMRT Inne nazwy: IMRT RT z modulacją intensywności Radioterapia z modulacją intensywności Promieniowanie, radioterapia z modulacją intensywności Radioterapia modulowana intensywnością (zabieg) Inny: Patient Observation Undergo observation Inne nazwy: Obserwacja Aktywny nadzór odroczona terapia oczekujące zarządzanie Czujne czekanie Inny: Fludeoxyglucose F-18 Receive FDG Inne nazwy: 18FDG FDG fludeoksyglukoza F 18 Fludeoksyglukoza (18F) Fludeoksyglukoza F18 Fluor-18 2-Fluoro-2-deoksy-D-glukoza Fluorodeoksyglukoza F18
Eksperymentalny: 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.	Procedura: Biospecimen Collection Undergo blood sample collection Inne nazwy: Pobieranie próbek biologicznych Zebrano próbki biologiczne Kolekcja próbek Procedura: Echocardiography Test Undergo ECHO Inne nazwy: Echokardiografia WE Biologiczny: Nivolumab Given IV Inne nazwy: BMS-936558 MDX-1106 NIWO ONO-4538 Opdivo CMAB819 Niwolumab biopodobny CMAB819 MDX 1106 MDX1106 BMS 936558 ABP 206 Niwolumab Biopodobny ABP 206 BCD-263 Niwolumab Biopodobny BCD-263 BMS936558 ONO 4538 ONO4538 Procedura: Computed Tomography Undergo CT or PET/CT Inne nazwy: Tomografia komputerowa KOT Skanowanie CAT Tomografia komputerowa osiowa Komputerowa tomografia osiowa tomografia Komputerowa tomografia osiowa (zabieg) Tomografia komputerowa (CT). Diagnostyczny skan CAT Diagnostyczny typ usługi skanowania CAT Procedura: Positron Emission Tomography Undergo PET/CT Inne nazwy: Obrazowanie medyczne, pozytonowa tomografia emisyjna ZWIERZAK DOMOWY Skanowanie zwierzęcia Skan pozytonowej tomografii emisyjnej Pozytonowa emisyjna tomografia komputerowa PT Pozytronowa tomografia emisyjna (zabieg) Inny: Fludeoxyglucose F-18 Receive FDG Inne nazwy: 18FDG FDG fludeoksyglukoza F 18 Fludeoksyglukoza (18F) Fludeoksyglukoza F18 Fluor-18 2-Fluoro-2-deoksy-D-glukoza Fluorodeoksyglukoza F18

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku	Opis środka	Ramy czasowe
Overall survival (OS) Ramy czasowe: 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 Ramy czasowe: 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 Ramy czasowe: At 12 weeks post therapy	Logrank tests and input hazard rates will be used.	At 12 weeks post therapy

Miary wyników drugorzędnych

Miara wyniku	Opis środka	Ramy czasowe
Progression-free survival (PFS) Ramy czasowe: 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 Ramy czasowe: 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 Ramy czasowe: 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 Ramy czasowe: 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 Ramy czasowe: 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) Ramy czasowe: 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) Ramy czasowe: 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 Ramy czasowe: 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

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Sponsor

National Cancer Institute (NCI)

Śledczy

Główny śledczy: Nabil F Saba, ECOG-ACRIN Cancer Research Group

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów (Rzeczywisty)

16 sierpnia 2019

Zakończenie podstawowe (Szacowany)

31 stycznia 2030

Ukończenie studiów (Szacowany)

31 stycznia 2030

Daty rejestracji na studia

Pierwszy przesłany

18 stycznia 2019

Pierwszy przesłany, który spełnia kryteria kontroli jakości

18 stycznia 2019

Pierwszy wysłany (Rzeczywisty)

22 stycznia 2019

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

26 października 2026

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

23 października 2026

Ostatnia weryfikacja

1 września 2026

Więcej informacji

Terminy związane z tym badaniem

Dodatkowe istotne warunki MeSH

Inne numery identyfikacyjne badania

NCI-2019-00179
U10CA180820 (Grant/umowa NIH USA)
NCI-2019-00179 (Identyfikator rejestru: CTRP (Clinical Trial Reporting Program))
EA3161 (Inny identyfikator: CTEP)
EA3161 (Inny identyfikator: ECOG-ACRIN Cancer Research Group)

Plan dla danych uczestnika indywidualnego (IPD)

Planujesz udostępniać dane poszczególnych uczestników (IPD)?

TAK

Opis planu IPD

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

Informacje o lekach i urządzeniach, dokumenty badawcze

Bada produkt leczniczy regulowany przez amerykańską FDA

Tak

Bada produkt urządzenia regulowany przez amerykańską FDA

Nie

Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .

Testowanie immunoterapii a obserwacja u pacjentów z rakiem gardła HPV

Randomizowane badanie fazy III dotyczące leczenia podtrzymującego niwolumabu w porównaniu z obserwacją u pacjentów z miejscowo zaawansowanym, pośrednim ryzykiem HPV dodatnim OPSCC

Przegląd badań

Status

Warunki

Interwencja / Leczenie

Szczegółowy opis

Typ studiów

Zapisy (Szacowany)

Faza

Kontakty i lokalizacje

Lokalizacje studiów

Kryteria uczestnictwa

Kryteria kwalifikacji

Wiek uprawniający do nauki

Akceptuje zdrowych ochotników

Płeć kwalifikująca się do nauki

Opis

Plan studiów

Jak projektuje się badanie?

Szczegóły projektu

Liczba ramion

Broń i interwencje

Grupa uczestników / Arm

Interwencja / Leczenie

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku

Opis środka

Ramy czasowe

Miary wyników drugorzędnych

Miara wyniku

Opis środka

Ramy czasowe

Współpracownicy i badacze

Sponsor

Śledczy

Daty zapisu na studia

Główne daty studiów

Rozpoczęcie studiów (Rzeczywisty)

Zakończenie podstawowe (Szacowany)

Ukończenie studiów (Szacowany)

Daty rejestracji na studia

Pierwszy przesłany

Pierwszy przesłany, który spełnia kryteria kontroli jakości

Pierwszy wysłany (Rzeczywisty)

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

Ostatnia weryfikacja

Więcej informacji

Terminy związane z tym badaniem

Dodatkowe istotne warunki MeSH

Inne numery identyfikacyjne badania

Plan dla danych uczestnika indywidualnego (IPD)

Planujesz udostępniać dane poszczególnych uczestników (IPD)?

Opis planu IPD

Informacje o lekach i urządzeniach, dokumenty badawcze

Bada produkt leczniczy regulowany przez amerykańską FDA

Bada produkt urządzenia regulowany przez amerykańską FDA