Testing Higher Dose Radiation Therapy for Locally Advanced Pancreatic Cancer

Summary

This phase III trial compares the effect of dose-escalated radiation therapy to usual care in patients with locally advanced unresectable pancreatic ductal adenocarcinoma who have received an initial 4-8 months of chemotherapy. Usual care options include additional chemotherapy, observation, or standard lower-dose radiation therapy. These treatments may delay tumor growth but have not been shown to improve survival. Radiation therapy uses high energy X-rays to kill cancer cells and shrink tumors. Dose-escalated radiation therapy involves the precise delivery of higher doses to the tumor, often over a shorter period of time. This trial assesses whether using dose-escalated radiation therapy can prolong survival.

Interventions

• Biopsy Procedure · PROCEDURE

  Undergo tumor tissue biopsy

• Biospecimen Collection · PROCEDURE

  Undergo blood sample collection

• Capecitabine · DRUG

  Given capecitabine

• Computed Tomography · PROCEDURE

  Undergo CT or PET/CT

• Dose-escalated Radiation Therapy · RADIATION

  Undergo dose-escalated radiation using intensity-modulated radiation therapy treatment planning

• Fluorouracil · DRUG

  Given fluorouracil

• Gemcitabine · DRUG

  Given gemcitabine

• Irinotecan Hydrochloride · DRUG

  Given irinotecan hydrochloride

• Irinotecan Sucrosofate · DRUG

  Given liposomal irinotecan

• Leucovorin Calcium · DRUG

  Given leucovorin calcium

• Magnetic Resonance Imaging · PROCEDURE

  Undergo MRI

• Nab-paclitaxel · DRUG

  Given nab-paclitaxel

• Observation Activity · OTHER

  Undergo observation

• Oxaliplatin · DRUG

  Given oxaliplatin

• Positron Emission Tomography · PROCEDURE

  Undergo PET/CT

• Questionnaire Administration · OTHER

  Ancillary studies

• Radiation Therapy · RADIATION

  Undergo standard radiation therapy

• Tumor Treating Fields Therapy · PROCEDURE

  Undergo TTF

Published eligibility criteria

Verbatim from the registry. Only the site can decide how these apply to a specific patient.

Inclusion Criteria:

* At time of enrollment, the patient must have received 4-8 months of active chemotherapy with FOLFIRINOX or NALIRIFOX or gemcitabine/nab-paclitaxel. Patients are permitted to receive more than 1 type of chemotherapy for reasons other than radiographic progression by Response Evaluation Criteria in Solid Tumors (RECIST) (i.e. chemotherapy regimen switch is allowed for toxicity, and/or switch is allowed for toxicity and/or CA19-9 level not declining). Patients are allowed to receive chemotherapy after restaging scans, as long as 1) restaging scans are performed after at least 4 months of chemotherapy and 2) the total chemotherapy duration does not exceed 8 months

  * "Active chemotherapy" refers to time on chemotherapy not counting treatment breaks (i.e. if a patient had 1 month of chemotherapy followed by 1 month break, this would count as 1 month chemotherapy). Study registration must occur within 45 days of last day of pre-study entry chemotherapy
* BASELINE PRE-ENTRY CHEMOTHERAPY REQUIREMENTS:
* Pathologically (histologically or cytologically) proven diagnosis of pancreatic ductal adenocarcinoma
* Locally advanced unresectable disease (as defined per the National Comprehensive Cancer Network \[NCCN\] guidelines and institutional tumor board review)
* Patients must have baseline pre-chemotherapy scans for staging. Options include: CT chest/abdomen/pelvis, CT chest/MRI abdomen/pelvis, CT chest/CT pelvis/MRI abdomen, or PET/CT performed prior to enrollment
* Age ≥ 18 years
* Performance status Eastern Cooperative Oncology Group (ECOG) 0-2
* Required initial laboratory values:

All laboratory values must be obtained any time prior to initiation of chemotherapy up to 30 days post initiation of chemotherapy

* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 x upper limit of normal (ULN)
* BASELINE CA19-9 AND BILIRUBIN REQUIREMENTS: The purpose is to obtain a baseline CA19-9 in the setting of a normal (or close to normal) bilirubin, since serologic response by serial CA19-9 measurements is part of post-chemotherapy eligibility criteria

  * If baseline CA19-9 \> 37 U/mL the concurrent bilirubin must be ≤ 1.5 x ULN. (Note: if the bilirubin is not ≤ 1.5 x ULN both the CA19-9 and concurrent bilirubin can be repeated until bilirubin is ≤ 1.5 x ULN, as long as done within specified timeframe \[up to 30 days post chemotherapy initiation\])
  * If baseline CA19-9 U/mL ≤ 37, there are no restrictions on the required concurrent bilirubin level, and this can be the accepted baseline value

    * Prior radiation treatment
* Has the patient had prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
* Prior non-overlapping radiation (e.g., breast, head and neck, extremity) is permitted
* If uncertain about prior overlap, please contact the study principal investigator, Dr. Nina Sanford

  * POST PRE-ENTRY CHEMOTHERAPY REQUIREMENTS:
  * If baseline CA19-9 is elevated (defined as \> 37 u/mL) the post-pre-entry chemotherapy CA19-9 must be less than 200 u/mL OR a 70% decline from pre-chemotherapy level (i.e. a patient with post induction chemotherapy CA199 value ≥ 200 u/mL would qualify, as long as they had at least 70% drop from baseline CA199 value; similarly, a patient with less than a 70% decline would qualify as long as absolute value post induction chemotherapy is under 200 u/mL) (must be completed any time post month 4 of chemotherapy and prior to study entry)
  * If baseline CA19-9 is not elevated (defined as ≤ 37 u/mL) the post-pre-entry chemotherapy CA19-9 must remain ≤ 37 u/mL (must be completed any time post month 4 of chemotherapy and prior to study entry)
  * No active duodenal or gastric ulcers
  * No direct tumor invasion of the bowel or stomach
  * Restaging scans showing at least stable disease (no progression). Options for scans include: CT chest/abdomen/pelvis, CT chest/MRI abdomen/pelvis, or CT chest/CT pelvis/MRI abdomen, or PET/CT performed prior to enrollment, with restaging CT showing at least stable disease
  * Not pregnant and not nursing
  * No cardiac condition that was the primary reason for hospitalization in the last 6 months
  * New York Heart Association Functional Classification II or better (NYHA Functional Classification III/IV are not eligible) (Note: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification.)
  * HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial

Sites (333)

• Banner MD Anderson Cancer Center, Gilbert, Arizona · RECRUITING
• Arizona Center for Cancer Care - Gilbert, Gilbert, Arizona · RECRUITING
• Arizona Center for Cancer Care-Peoria, Peoria, Arizona · RECRUITING
• Banner-University Medical Center Phoenix, Phoenix, Arizona · RECRUITING
• Arizona Center for Cancer Care - Phoenix, Phoenix, Arizona · RECRUITING
• Arizona Center for Cancer Care - Scottsdale, Scottsdale, Arizona · RECRUITING
• Arizona Center for Cancer Care-Surprise, Surprise, Arizona · RECRUITING
• Arizona Center for Cancer Care, Tempe, Arizona · RECRUITING
• NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro, Jonesboro, Arkansas · RECRUITING
• Mission Hope Medical Oncology - Arroyo Grande, Arroyo Grande, California · RECRUITING
• AIS Cancer Center at San Joaquin Community Hospital, Bakersfield, California · RECRUITING
• Alta Bates Summit Medical Center-Herrick Campus, Berkeley, California · RECRUITING
• Mills-Peninsula Medical Center, Burlingame, California · RECRUITING
• Sutter Cancer Centers Radiation Oncology Services-Cameron Park, Cameron Park, California · RECRUITING
• Palo Alto Medical Foundation-Fremont, Fremont, California · RECRUITING
• UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care, Irvine, California · RECRUITING
• UC San Diego Moores Cancer Center, La Jolla, California · RECRUITING
• Memorial Medical Center, Modesto, California · RECRUITING
• Palo Alto Medical Foundation-Camino Division, Mountain View, California · RECRUITING
• UC Irvine Health/Chao Family Comprehensive Cancer Center, Orange, California · RECRUITING
• Palo Alto Medical Foundation Health Care, Palo Alto, California · RECRUITING
• Stanford Cancer Institute Palo Alto, Palo Alto, California · RECRUITING
• Sutter Cancer Centers Radiation Oncology Services-Roseville, Roseville, California · RECRUITING
• Sutter Roseville Medical Center, Roseville, California · RECRUITING
• Sutter Medical Center Sacramento, Sacramento, California · RECRUITING
• California Pacific Medical Center-Pacific Campus, San Francisco, California · RECRUITING
• Mills Health Center, San Mateo, California · RECRUITING
• Ridley-Tree Cancer Center, Santa Barbara, California · RECRUITING
• Mission Hope Medical Oncology - Santa Maria, Santa Maria, California · RECRUITING
• Sutter Pacific Medical Foundation, Santa Rosa, California · RECRUITING
• Palo Alto Medical Foundation-Sunnyvale, Sunnyvale, California · RECRUITING
• Sutter Solano Medical Center/Cancer Center, Vallejo, California · RECRUITING
• BASS Medical Group - Lennon, Walnut Creek, California · ACTIVE_NOT_RECRUITING
• Rocky Mountain Cancer Centers-Boulder, Boulder, Colorado · ACTIVE_NOT_RECRUITING
• Rocky Mountain Cancer Centers-Penrose, Colorado Springs, Colorado · RECRUITING
• UCHealth Memorial Hospital Central, Colorado Springs, Colorado · RECRUITING
• Memorial Hospital North, Colorado Springs, Colorado · RECRUITING
• AdventHealth Porter, Denver, Colorado · RECRUITING
• AdventHealth Littleton, Littleton, Colorado · RECRUITING
• AdventHealth Parker, Parker, Colorado · RECRUITING
• Danbury Hospital, Danbury, Connecticut · RECRUITING
• Smilow Cancer Hospital-Derby Care Center, Derby, Connecticut · RECRUITING
• Smilow Cancer Hospital Care Center-Fairfield, Fairfield, Connecticut · RECRUITING
• Smilow Cancer Hospital Care Center at Glastonbury, Glastonbury, Connecticut · RECRUITING
• Smilow Cancer Hospital Care Center at Greenwich, Greenwich, Connecticut · RECRUITING
• Smilow Cancer Hospital Care Center - Guilford, Guilford, Connecticut · RECRUITING
• Smilow Cancer Hospital-Hamden Care Center, Hamden, Connecticut · RECRUITING
• Smilow Cancer Hospital Care Center at Saint Francis, Hartford, Connecticut · RECRUITING
• Smilow Cancer Center/Yale-New Haven Hospital, New Haven, Connecticut · RECRUITING
• Yale University, New Haven, Connecticut · RECRUITING
• Yale-New Haven Hospital North Haven Medical Center, North Haven, Connecticut · RECRUITING
• Norwalk Hospital, Norwalk, Connecticut · RECRUITING
• Smilow Cancer Hospital-Torrington Care Center, Torrington, Connecticut · RECRUITING
• Smilow Cancer Hospital Care Center-Trumbull, Trumbull, Connecticut · RECRUITING
• Smilow Cancer Hospital-Waterbury Care Center, Waterbury, Connecticut · RECRUITING
• Smilow Cancer Hospital Care Center - Waterford, Waterford, Connecticut · RECRUITING
• Helen F Graham Cancer Center, Newark, Delaware · RECRUITING
• Medical Oncology Hematology Consultants PA, Newark, Delaware · RECRUITING
• Christiana Care Health System-Christiana Hospital, Newark, Delaware · RECRUITING
• Christiana Care Health System-Wilmington Hospital, Wilmington, Delaware · RECRUITING
• MedStar Washington Hospital Center, Washington D.C., District of Columbia · RECRUITING
• Morton Plant Hospital, Clearwater, Florida · RECRUITING
• UF Health Cancer Institute - Gainesville, Gainesville, Florida · RECRUITING
• Miami Cancer Institute, Miami, Florida · RECRUITING
• AdventHealth Orlando, Orlando, Florida · RECRUITING
• Saint Joseph's Hospital/Children's Hospital-Tampa, Tampa, Florida · RECRUITING
• Grady Health System, Atlanta, Georgia · RECRUITING
• Emory University Hospital Midtown, Atlanta, Georgia · RECRUITING
• Piedmont Hospital, Atlanta, Georgia · RECRUITING
• Emory University Hospital/Winship Cancer Institute, Atlanta, Georgia · RECRUITING
• Emory Saint Joseph's Hospital, Atlanta, Georgia · RECRUITING
• Memorial Health University Medical Center, Savannah, Georgia · RECRUITING
• Hawaii Cancer Care Inc - Waterfront Plaza, Honolulu, Hawaii · RECRUITING
• Queen's Cancer Cenrer - POB I, Honolulu, Hawaii · RECRUITING
• Queen's Medical Center, Honolulu, Hawaii · RECRUITING
• Straub Clinic and Hospital, Honolulu, Hawaii · RECRUITING
• University of Hawaii Cancer Center, Honolulu, Hawaii · RECRUITING
• Kuakini Medical Center, Honolulu, Hawaii · RECRUITING
• Queen's Cancer Center - Kuakini, Honolulu, Hawaii · RECRUITING
• The Cancer Center of Hawaii-Liliha, Honolulu, Hawaii · SUSPENDED
• Kapiolani Medical Center for Women and Children, Honolulu, Hawaii · RECRUITING
• Wilcox Memorial Hospital and Kauai Medical Clinic, Lihue, Hawaii · RECRUITING
• Hawaii Cancer Care - Westridge, ‘Aiea, Hawaii · RECRUITING
• Pali Momi Medical Center, ‘Aiea, Hawaii · RECRUITING
• Queen's Cancer Center - Pearlridge, ‘Aiea, Hawaii · RECRUITING
• The Cancer Center of Hawaii-Pali Momi, ‘Aiea, Hawaii · SUSPENDED
• The Queen's Medical Center - West Oahu, ‘Ewa Beach, Hawaii · RECRUITING
• Rush-Copley Medical Center, Aurora, Illinois · RECRUITING
• Advocate Outpatient Center - Aurora, Aurora, Illinois · RECRUITING
• Illinois CancerCare-Bloomington, Bloomington, Illinois · RECRUITING
• Illinois CancerCare-Canton, Canton, Illinois · RECRUITING
• Illinois CancerCare-Carthage, Carthage, Illinois · RECRUITING
• Centralia Oncology Clinic, Centralia, Illinois · RECRUITING
• Northwestern University, Chicago, Illinois · RECRUITING
• University of Illinois, Chicago, Illinois · RECRUITING
• Advocate Illinois Masonic Medical Center, Chicago, Illinois · RECRUITING
• AMG Crystal Lake - Oncology, Crystal Lake, Illinois · RECRUITING
• Carle at The Riverfront, Danville, Illinois · RECRUITING
• Cancer Care Specialists of Illinois - Decatur, Decatur, Illinois · RECRUITING
• Decatur Memorial Hospital, Decatur, Illinois · RECRUITING
• Northwestern Medicine Cancer Center Kishwaukee, DeKalb, Illinois · RECRUITING
• Advocate Good Samaritan Hospital, Downers Grove, Illinois · RECRUITING
• Carle Physician Group-Effingham, Effingham, Illinois · RECRUITING
• Crossroads Cancer Center, Effingham, Illinois · RECRUITING
• Advocate Sherman Hospital, Elgin, Illinois · RECRUITING
• Illinois CancerCare-Eureka, Eureka, Illinois · RECRUITING
• Illinois CancerCare-Galesburg, Galesburg, Illinois · RECRUITING
• Northwestern Medicine Cancer Center Delnor, Geneva, Illinois · RECRUITING
• Northwestern Medicine Glenview Outpatient Center, Glenview, Illinois · RECRUITING
• Northwestern Medicine Grayslake Outpatient Center, Grayslake, Illinois · RECRUITING
• Advocate South Suburban Hospital, Hazel Crest, Illinois · RECRUITING
• Illinois CancerCare-Kewanee Clinic, Kewanee, Illinois · RECRUITING
• Northwestern Medicine Lake Forest Hospital, Lake Forest, Illinois · RECRUITING
• AMG Libertyville - Oncology, Libertyville, Illinois · RECRUITING
• Condell Memorial Hospital, Libertyville, Illinois · RECRUITING
• Illinois CancerCare-Macomb, Macomb, Illinois · RECRUITING
• Carle Physician Group-Mattoon/Charleston, Mattoon, Illinois · RECRUITING
• Cancer Care Center of O'Fallon, O'Fallon, Illinois · RECRUITING
• HSHS Saint Elizabeth's Hospital, O'Fallon, Illinois · RECRUITING
• Northwestern Medicine Oak Brook, Oak Brook, Illinois · RECRUITING
• Advocate Christ Medical Center, Oak Lawn, Illinois · RECRUITING
• Illinois CancerCare-Ottawa Clinic, Ottawa, Illinois · RECRUITING
• Advocate High Tech Medical Park, Palos Heights, Illinois · RECRUITING
• Advocate Lutheran General Hospital, Park Ridge, Illinois · RECRUITING
• Illinois CancerCare-Pekin, Pekin, Illinois · RECRUITING
• Illinois CancerCare-Peoria, Peoria, Illinois · RECRUITING
• OSF Saint Francis Medical Center, Peoria, Illinois · RECRUITING
• Illinois CancerCare-Peru, Peru, Illinois · RECRUITING
• Illinois CancerCare-Princeton, Princeton, Illinois · RECRUITING
• Southern Illinois University School of Medicine, Springfield, Illinois · RECRUITING
• Springfield Clinic, Springfield, Illinois · RECRUITING
• Springfield Memorial Hospital, Springfield, Illinois · RECRUITING
• Carle Cancer Center, Urbana, Illinois · RECRUITING
• Northwestern Medicine Cancer Center Warrenville, Warrenville, Illinois · RECRUITING
• Illinois CancerCare - Washington, Washington, Illinois · RECRUITING
• Northwest Cancer Center - Crown Point, Crown Point, Indiana · RECRUITING
• Northwest Oncology LLC, Dyer, Indiana · RECRUITING
• Goshen Center for Cancer Care, Goshen, Indiana · RECRUITING
• Northwest Cancer Center - Hobart, Hobart, Indiana · RECRUITING
• Saint Mary Medical Center, Hobart, Indiana · RECRUITING
• The Community Hospital, Munster, Indiana · RECRUITING
• Women's Diagnostic Center - Munster, Munster, Indiana · RECRUITING
• Northwest Cancer Center - Valparaiso, Valparaiso, Indiana · RECRUITING
• UI Health Care Mission Cancer and Blood - Ankeny Clinic, Ankeny, Iowa · RECRUITING
• UI Health Care Mission Cancer and Blood - West Des Moines Clinic, Clive, Iowa · RECRUITING
• Iowa Methodist Medical Center, Des Moines, Iowa · RECRUITING
• UI Health Care Mission Cancer and Blood - Des Moines Clinic, Des Moines, Iowa · RECRUITING
• UI Health Care Mission Cancer and Blood - Laurel Clinic, Des Moines, Iowa · RECRUITING
• UI Health Care Mission Cancer and Blood - Waukee Clinic, Waukee, Iowa · RECRUITING
• University of Kansas Cancer Center, Kansas City, Kansas · RECRUITING
• Lawrence Memorial Hospital, Lawrence, Kansas · RECRUITING
• The University of Kansas Cancer Center - Olathe, Olathe, Kansas · RECRUITING
• University of Kansas Cancer Center-Overland Park, Overland Park, Kansas · RECRUITING
• Salina Regional Health Center, Salina, Kansas · RECRUITING
• University of Kansas Health System Saint Francis Campus, Topeka, Kansas · RECRUITING
• University of Kansas Hospital-Westwood Cancer Center, Westwood, Kansas · RECRUITING
• University of Kentucky/Markey Cancer Center, Lexington, Kentucky · RECRUITING
• West Jefferson Medical Center, Marrero, Louisiana · RECRUITING
• University Medical Center New Orleans, New Orleans, Louisiana · RECRUITING
• MaineHealth Coastal Cancer Treatment Center, Bath, Maine · RECRUITING
• MaineHealth Maine Medical Center - Portland, Portland, Maine · RECRUITING
• MaineHealth Cancer Care Center of York County, Sanford, Maine · RECRUITING
• MaineHealth Maine Medical Center- Scarborough, Scarborough, Maine · RECRUITING
• MaineHealth Cancer Care and IV Therapy - South Portland, South Portland, Maine · RECRUITING
• Sinai Hospital of Baltimore, Baltimore, Maryland · RECRUITING
• William E Kahlert Regional Cancer Center/Sinai Hospital, Westminster, Maryland · RECRUITING
• Trinity Health Saint Joseph Mercy Hospital Ann Arbor, Ann Arbor, Michigan · RECRUITING
• University of Michigan Rogel Cancer Center, Ann Arbor, Michigan · RECRUITING
• Trinity Health IHA Medical Group Hematology Oncology - Brighton, Brighton, Michigan · RECRUITING
• Trinity Health Medical Center - Brighton, Brighton, Michigan · RECRUITING
• University of Michigan - Brighton Center for Specialty Care, Brighton, Michigan · RECRUITING
• Henry Ford Cancer Institute-Downriver, Brownstown, Michigan · RECRUITING
• Trinity Health IHA Medical Group Hematology Oncology - Canton, Canton, Michigan · RECRUITING
• Trinity Health Medical Center - Canton, Canton, Michigan · RECRUITING
• Chelsea Hospital, Chelsea, Michigan · RECRUITING
• Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital, Chelsea, Michigan · RECRUITING
• Henry Ford Macomb Hospital-Clinton Township, Clinton Township, Michigan · RECRUITING
• Henry Ford Medical Center-Fairlane, Dearborn, Michigan · RECRUITING
• Henry Ford Hospital, Detroit, Michigan · RECRUITING
• Corewell Health Grand Rapids Hospitals - Butterworth Hospital, Grand Rapids, Michigan · RECRUITING
• Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital, Grand Rapids, Michigan · RECRUITING
• Trinity Health Grand Rapids Hospital, Grand Rapids, Michigan · SUSPENDED
• Allegiance Health, Jackson, Michigan · RECRUITING
• Bronson Methodist Hospital, Kalamazoo, Michigan · RECRUITING
• West Michigan Cancer Center, Kalamazoo, Michigan · RECRUITING
• Beacon Kalamazoo, Kalamazoo, Michigan · RECRUITING
• University of Michigan Health - Sparrow Lansing, Lansing, Michigan · RECRUITING
• Trinity Health Saint Mary Mercy Livonia Hospital, Livonia, Michigan · RECRUITING
• Henry Ford Medical Center-Columbus, Novi, Michigan · RECRUITING
• Michigan Healthcare Professionals Pontiac, Pontiac, Michigan · RECRUITING
• Trinity Health Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan · RECRUITING
• MyMichigan Medical Center Saginaw, Saginaw, Michigan · RECRUITING
• MyMichigan Medical Center Tawas, Tawas City, Michigan · RECRUITING
• Henry Ford West Bloomfield Hospital, West Bloomfield, Michigan · RECRUITING
• Henry Ford Wyandotte Hospital, Wyandotte, Michigan · RECRUITING
• University of Michigan Health - West, Wyoming, Michigan · RECRUITING
• Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus, Ypsilanti, Michigan · RECRUITING
• Sanford Joe Lueken Cancer Center, Bemidji, Minnesota · RECRUITING
• Baptist Memorial Hospital and Cancer Center-Golden Triangle, Columbus, Mississippi · RECRUITING
• Baptist Cancer Center-Grenada, Grenada, Mississippi · RECRUITING
• Baptist Memorial Hospital and Cancer Center-Union County, New Albany, Mississippi · RECRUITING
• Baptist Memorial Hospital and Cancer Center-Oxford, Oxford, Mississippi · RECRUITING
• Baptist Memorial Hospital and Cancer Center-Desoto, Southhaven, Mississippi · RECRUITING
• University of Kansas Cancer Center - North, Kansas City, Missouri · RECRUITING
• University of Kansas Cancer Center - Lee's Summit, Lee's Summit, Missouri · RECRUITING
• Nebraska Medicine-Village Pointe, Omaha, Nebraska · RECRUITING
• University of Nebraska Medical Center, Omaha, Nebraska · RECRUITING
• Renown Regional Medical Center, Reno, Nevada · RECRUITING
• Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center, Lebanon, New Hampshire · RECRUITING
• Memorial Sloan Kettering Basking Ridge, Basking Ridge, New Jersey · RECRUITING
• Cooper Hospital University Medical Center, Camden, New Jersey · RECRUITING
• Jefferson Cherry Hill Hospital, Cherry Hill, New Jersey · RECRUITING
• Memorial Sloan Kettering Monmouth, Middletown, New Jersey · RECRUITING
• Memorial Sloan Kettering Bergen, Montvale, New Jersey · RECRUITING
• New York-Presbyterian/Brooklyn Methodist Hospital, Brooklyn, New York · RECRUITING
• Roswell Park Cancer Institute, Buffalo, New York · RECRUITING
• Memorial Sloan Kettering Commack, Commack, New York · RECRUITING
• Memorial Sloan Kettering Westchester, Harrison, New York · RECRUITING
• NYU Langone Hospital - Long Island, Mineola, New York · RECRUITING
• Laura and Isaac Perlmutter Cancer Center at NYU Langone, New York, New York · RECRUITING
• Mount Sinai West, New York, New York · RECRUITING
• Mount Sinai Hospital, New York, New York · RECRUITING
• NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center, New York, New York · RECRUITING
• Memorial Sloan Kettering Cancer Center, New York, New York · RECRUITING
• Vassar Brothers Medical Center, Poughkeepsie, New York · RECRUITING
• Montefiore Medical Center-Einstein Campus, The Bronx, New York · RECRUITING
• Montefiore Medical Center - Moses Campus, The Bronx, New York · RECRUITING
• Memorial Sloan Kettering Nassau, Uniondale, New York · RECRUITING
• UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina · RECRUITING
• Sanford Bismarck Medical Center, Bismarck, North Dakota · RECRUITING
• Sanford Broadway Medical Center, Fargo, North Dakota · RECRUITING
• Sanford Roger Maris Cancer Center, Fargo, North Dakota · RECRUITING
• Aultman Health Foundation, Canton, Ohio · RECRUITING
• Miami Valley Hospital South, Centerville, Ohio · RECRUITING
• University of Cincinnati Cancer Center-UC Medical Center, Cincinnati, Ohio · RECRUITING
• Ohio State University Comprehensive Cancer Center, Columbus, Ohio · RECRUITING
• Miami Valley Hospital, Dayton, Ohio · RECRUITING
• Premier Blood and Cancer Center, Dayton, Ohio · RECRUITING
• Miami Valley Hospital North, Dayton, Ohio · RECRUITING
• Dublin Methodist Hospital, Dublin, Ohio · RECRUITING
• Atrium Medical Center-Middletown Regional Hospital, Franklin, Ohio · RECRUITING
• Miami Valley Cancer Care and Infusion, Greenville, Ohio · RECRUITING
• ProMedica Flower Hospital, Sylvania, Ohio · RECRUITING
• ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital, Toledo, Ohio · RECRUITING
• Upper Valley Medical Center, Troy, Ohio · RECRUITING
• University of Cincinnati Cancer Center-West Chester, West Chester, Ohio · RECRUITING
• Oregon Health and Science University, Portland, Oregon · RECRUITING
• Christiana Care Health System-Concord Health Center, Chadds Ford, Pennsylvania · RECRUITING
• Geisinger Medical Center, Danville, Pennsylvania · RECRUITING
• Geisinger Cancer Center Dickson City, Dickson City, Pennsylvania · RECRUITING
• Jefferson Hospital, Jefferson Hills, Pennsylvania · RECRUITING
• Geisinger Medical Oncology-Lewisburg, Lewisburg, Pennsylvania · RECRUITING
• Forbes Hospital, Monroeville, Pennsylvania · RECRUITING
• Paoli Memorial Hospital, Paoli, Pennsylvania · SUSPENDED
• Thomas Jefferson University Hospital, Philadelphia, Pennsylvania · RECRUITING
• Jefferson Torresdale Hospital, Philadelphia, Pennsylvania · RECRUITING
• Allegheny General Hospital, Pittsburgh, Pennsylvania · RECRUITING
• West Penn Hospital, Pittsburgh, Pennsylvania · RECRUITING
• Reading Hospital, West Reading, Pennsylvania · RECRUITING
• Geisinger Wyoming Valley/Henry Cancer Center, Wilkes-Barre, Pennsylvania · RECRUITING
• Rhode Island Hospital, Providence, Rhode Island · RECRUITING
• Medical University of South Carolina, Charleston, South Carolina · RECRUITING
• Saint Francis Hospital, Greenville, South Carolina · RECRUITING
• Saint Francis Cancer Center, Greenville, South Carolina · RECRUITING
• Sanford Cancer Center Oncology Clinic, Sioux Falls, South Dakota · RECRUITING
• Sanford USD Medical Center - Sioux Falls, Sioux Falls, South Dakota · RECRUITING
• Baptist Memorial Hospital and Cancer Center-Collierville, Collierville, Tennessee · RECRUITING
• Regional Cancer Center at Johnson City Medical Center, Johnson City, Tennessee · RECRUITING
• Baptist Memorial Hospital and Cancer Center-Memphis, Memphis, Tennessee · RECRUITING
• Houston Methodist San Jacinto Hospital, Baytown, Texas · RECRUITING
• UT MD Anderson - The Woodlands, Conroe, Texas · RECRUITING
• Houston Methodist Cypress Hospital, Cypress, Texas · RECRUITING
• Parkland Memorial Hospital, Dallas, Texas · RECRUITING
• UT Southwestern Simmons Cancer Center - RedBird, Dallas, Texas · RECRUITING
• UT Southwestern/Simmons Cancer Center-Dallas, Dallas, Texas · RECRUITING
• Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center, Houston, Texas · RECRUITING
• Ben Taub General Hospital, Houston, Texas · RECRUITING
• Houston Methodist Hospital, Houston, Texas · RECRUITING
• UT MD Anderson Cancer Center, Houston, Texas · RECRUITING
• Methodist Willowbrook Hospital, Houston, Texas · RECRUITING
• UT MD Anderson - West Houston, Houston, Texas · RECRUITING
• Houston Methodist West Hospital, Houston, Texas · RECRUITING
• UT MD Anderson - League City, League City, Texas · RECRUITING
• Houston Methodist Saint John Hospital, Nassau Bay, Texas · RECRUITING
• University of Texas Health Science Center at San Antonio, San Antonio, Texas · RECRUITING
• UT MD Anderson - Sugar Land, Sugar Land, Texas · RECRUITING
• Houston Methodist Sugar Land Hospital, Sugar Land, Texas · RECRUITING
• Houston Methodist The Woodlands Hospital, The Woodlands, Texas · RECRUITING
• Dartmouth Cancer Center - North, Saint Johnsbury, Vermont · RECRUITING
• Inova Alexandria Hospital, Alexandria, Virginia · RECRUITING
• Inova Schar Cancer Institute, Fairfax, Virginia · RECRUITING
• Inova Fair Oaks Hospital, Fairfax, Virginia · RECRUITING
• Inova Fairfax Hospital, Falls Church, Virginia · RECRUITING
• Inova Loudoun Hospital, Leesburg, Virginia · RECRUITING
• Bon Secours Memorial Regional Medical Center, Mechanicsville, Virginia · RECRUITING
• Bon Secours Saint Francis Medical Center, Midlothian, Virginia · RECRUITING
• Bon Secours Saint Mary's Hospital, Richmond, Virginia · RECRUITING
• Bon Secours Cancer Institute at Reynolds Crossing, Richmond, Virginia · RECRUITING
• Fred Hutchinson Cancer Center, Seattle, Washington · RECRUITING
• University of Washington Medical Center - Montlake, Seattle, Washington · RECRUITING
• Edwards Comprehensive Cancer Center, Huntington, West Virginia · RECRUITING
• Aspirus Cancer Care-Antigo-Volm Cancer Center, Antigo, Wisconsin · RECRUITING
• Aurora Cancer Care-Southern Lakes VLCC, Burlington, Wisconsin · RECRUITING
• Aurora Saint Luke's South Shore, Cudahy, Wisconsin · RECRUITING
• Marshfield Medical Center-EC Cancer Center, Eau Claire, Wisconsin · RECRUITING
• Aurora Health Care Germantown Health Center, Germantown, Wisconsin · RECRUITING
• Aurora Cancer Care-Grafton, Grafton, Wisconsin · RECRUITING
• Aurora BayCare Medical Center, Green Bay, Wisconsin · RECRUITING
• Aurora Cancer Care-Kenosha South, Kenosha, Wisconsin · RECRUITING
• Aurora Bay Area Medical Group-Marinette, Marinette, Wisconsin · RECRUITING
• Marshfield Medical Center-Marshfield, Marshfield, Wisconsin · RECRUITING
• Froedtert Menomonee Falls Hospital, Menomonee Falls, Wisconsin · RECRUITING
• Aurora Cancer Care-Milwaukee, Milwaukee, Wisconsin · RECRUITING
• Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin · RECRUITING
• Medical College of Wisconsin, Milwaukee, Wisconsin · RECRUITING
• Aurora Sinai Medical Center, Milwaukee, Wisconsin · RECRUITING
• Drexel Town Square Health Center, Oak Creek, Wisconsin · RECRUITING
• Vince Lombardi Cancer Clinic - Oshkosh, Oshkosh, Wisconsin · RECRUITING
• Aurora Cancer Care-Racine, Racine, Wisconsin · RECRUITING
• Aspirus Cancer Care-Rhinelander-James Beck Cancer Center, Rhinelander, Wisconsin · RECRUITING
• Marshfield Medical Center-Rice Lake, Rice Lake, Wisconsin · RECRUITING
• Vince Lombardi Cancer Clinic-Sheboygan, Sheboygan, Wisconsin · RECRUITING
• Aspirus Cancer Care - Stevens Point, Stevens Point, Wisconsin · RECRUITING
• Marshfield Medical Center-River Region at Stevens Point, Stevens Point, Wisconsin · RECRUITING
• Aurora Medical Center in Summit, Summit, Wisconsin · RECRUITING
• Vince Lombardi Cancer Clinic-Two Rivers, Two Rivers, Wisconsin · RECRUITING
• Aspirus Cancer Care-Wausau, Wausau, Wisconsin · RECRUITING
• Aurora Cancer Care-Milwaukee West, Wauwatosa, Wisconsin · RECRUITING
• Aurora West Allis Medical Center, West Allis, Wisconsin · RECRUITING
• Froedtert West Bend Hospital/Kraemer Cancer Center, West Bend, Wisconsin · RECRUITING
• Marshfield Medical Center - Weston, Weston, Wisconsin · RECRUITING
• Aspirus Cancer Care - Wisconsin Rapids, Wisconsin Rapids, Wisconsin · RECRUITING
• Cross Cancer Institute, Edmonton, Alberta, Canada · RECRUITING