Testing Radiation and HER2-targeted Therapy Versus HER2-targeted Therapy Alone for Low-risk HER2-positive Breast Cancer
Purpose
This Phase III trial compares the recurrence-free interval (RFI) among patients with early-stage, low risk HER2+ breast cancer who undergo breast conserving surgery and receive HER2-directed therapy, and are randomized to not receive adjuvant breast radiotherapy versus those who are randomized to receive adjuvant radiotherapy per the standard of care.
Condition
- HER2-positive Breast Cancer
Eligibility
- Eligible Ages
- Over 40 Years
- Eligible Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and, for patients treated in the U.S., authorization permitting release of personal health information. - female and male patients who have undergone breast conserving surgery and completed a minimum of 4 cycles (12 weeks) of neoadjuvant or adjuvant chemotherapy in combination with HER2-targeted therapy. -≥ 40 years of age - ECOG performance status of 0 ,1, or 2/Karnofsky performance status above 60 - Histologically or cytologically confirmed invasive breast carcinoma. - tumor must have been determined to be HER2-positive by current ASCO/CAP guidelines based on local testing results. - Patient must have undergone axillary staging, either sentinel node biopsy (SNB) or axillary lymph nodal dissection (ALND). In neoadjuvant patients, SNB following neoadjuvant therapy is strongly recommended. SNB prior to neoadjuvant therapy is discouraged, but patients are permitted if node negative (pN0). - The following staging criteria must be met according to AJCC 8th edition criteria: Adjuvant cohort : By pathologic evaluation, the patient's primary tumor must be </= 2 cm and ipsilateral nodes must be pN0. Surgical lumpectomy margins must be negative for invasive cancer and ductal carcinoma in situ (no ink on tumor). Neoadjuvant cohort: Prior to neoadjuvant therapy, the patient's primary tumor must be < 3 cm by imaging studies, with negative axillary nodes (cN0) based on axillary U/S, CT, PET or MRI. Physical examination is not sufficient documentation of cN0 status; • Must be ypT0N0 at surgery (lumpectomy); patients with residual non-invasive disease (DCIS) in the surgical specimen (ypTis), are NOT eligible. - For the Adjuvant cohort, adjuvant therapy must have consisted of a minimum of 4 cycles (12 weeks) of chemotherapy in combination with HER2-targeted therapy. - For the Neoadjuvant cohort, neoadjuvant therapy must have consisted of a minimum of 4 cycles (12 weeks) of chemotherapy in combination with HER2-targeted therapy.- ; Patients who did not receive chemotherapy in the neoadjuvant setting are not eligible, even if they achieved pCR with their preoperative treatment; nor would these patients become eligible by receiving chemotherapy after surgery. - In patients assigned to radiation therapy, treatment should start ≤ 12 weeks from surgery on the Neoadjuvant cohort and ≤ 8 weeks from the completion of chemotherapy on the Adjuvant cohort. Patients should continue HER2-targeted therapy during assigned study treatment (radiation or observation). - Bilateral mammogram or MRI within 52 weeks prior to randomization. - HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of randomization are eligible for this trial.
Exclusion Criteria
- Definitive clinical or radiologic evidence of metastatic disease. - On the Adjuvant cohort, patients with a primary tumor >2 cm on pathologic examination of the surgical specimen. On the Neoadjuvant cohort, patients with a primary tumor > 3 cm or with abnormal or suspicious ipsilateral axillary nodes by pretreatment imaging, unless demonstrated to be negative by cytologic or histologic examination. - Pathologically positive axillary nodes at any time including of pN0(i+) or pN0(mol+) ypN0(i+) or ypN0(mol+) disease. - Patient planning for or status-post mastectomy. - Radiographically suspicious ipsilateral or contralateral axillary, supraclavicular, infraclavicular, or internal mammary lymph nodes, unless there is histological confirmation that these nodes are negative for metastatic disease. - Suspicious microcalcifications, densities, or palpable abnormalities (in the ipsilateral or contralateral breast), or mass or non-mass enhancement on MRI (if performed) aside from the known cancer, unless biopsied and found to be benign. - Non-epithelial breast malignancies such as sarcoma or lymphoma. - Multicentric carcinoma (invasive cancer or DCIS) in more than one quadrant or separated by > 4 centimeters. If multifocal, all foci should be confined to a maximum tumor bed of 3 cm determined by pathological assessment. - Paget's disease of the nipple. - Synchronous (unilateral or bilateral) invasive breast cancer or DCIS. (Patients with synchronous and/or previous contralateral LCIS are eligible.) - On the Adjuvant cohort, surgical margins that cannot be microscopically assessed or are positive at pathologic evaluation. (If surgical margins are rendered free of disease by re-excision, the patient is eligible). - Treatment plan that includes regional nodal irradiation. - Patients treated for a prior invasive breast malignancy are excluded. Contralateral DCIS ≥ 10 years prior to enrollment is permissible. - Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial. - Patients on oral, transdermal, or subdermal estrogen replacement (including all estrogen only and estrogen-progesterone formulas) are not eligible unless discontinued prior to randomization. - Prior ipsilateral breast or thoracic RT for any condition (contralateral RT for DCIS ≥ 10 years prior to randomization is permitted). - Active collagen vascular disease, specifically dermatomyositis with a CPK level above normal or with an active systemic lupus erythematosus, or scleroderma. - Clinicians should consider whether any conditions would make this protocol unreasonably hazardous for the patient. - Pregnancy or lactation at the time of randomization or intention to become pregnant during treatment. (Note: Pregnancy testing according to institutional standards for patients of childbearing potential must be performed within 14 days prior to randomization.) - Use of any investigational product within 30 days prior to randomization.
Study Design
- Phase
- Phase 3
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Intervention Model Description
- Subjects who are receiving standard of care systemic HER2-targeted therapies are randomized to standard of care adjuvant breast radiation or no breast radiation
- Primary Purpose
- Treatment
- Masking
- None (Open Label)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Active Comparator Standard of Care Adjuvant Breast Radiation |
Patients continue to receive their current planned adjuvant breast radiation and systemic HER2-targeted therapies |
|
|
Active Comparator Standard of Care HER2-targeted Therapy Without Adjuvant Breast Radiation |
Patients continue to receive their current systemic HER2-targeted therapy without breast adjuvant radiation |
|
Recruiting Locations
Cancer Center at Saint Joseph's
Phoenix 5308655, Arizona 5551752 85004
Phoenix 5308655, Arizona 5551752 85004
Banner University Medical Center - Tucson
Tucson 5318313, Arizona 5551752 85719
Tucson 5318313, Arizona 5551752 85719
University of Arizona Cancer Center-North Campus
Tucson 5318313, Arizona 5551752 85719
Tucson 5318313, Arizona 5551752 85719
NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
Jonesboro 4116834, Arkansas 4099753 72401
Jonesboro 4116834, Arkansas 4099753 72401
Kaiser Permanente-Deer Valley Medical Center
Antioch 5324200, California 5332921 94531
Antioch 5324200, California 5332921 94531
Mission Hope Medical Oncology - Arroyo Grande
Arroyo Grande 5324802, California 5332921 93420
Arroyo Grande 5324802, California 5332921 93420
PCR Oncology
Arroyo Grande 5324802, California 5332921 93420
Arroyo Grande 5324802, California 5332921 93420
Sutter Auburn Faith Hospital
Auburn 5325223, California 5332921 95602
Auburn 5325223, California 5332921 95602
Sutter Cancer Centers Radiation Oncology Services-Auburn
Auburn 5325223, California 5332921 95603
Auburn 5325223, California 5332921 95603
Tower Cancer Research Foundation
Beverly Hills 5328041, California 5332921 90211
Beverly Hills 5328041, California 5332921 90211
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
Cameron Park 5333282, California 5332921 95682
Cameron Park 5333282, California 5332921 95682
City of Hope Comprehensive Cancer Center
Duarte 5344147, California 5332921 91010
Duarte 5344147, California 5332921 91010
Kaiser Permanente Dublin
Dublin 5344157, California 5332921 94568
Dublin 5344157, California 5332921 94568
Contact:
Site Public Contact
877-642-4691
Site Public Contact
877-642-4691
Kaiser Permanente-Fremont
Fremont 5350734, California 5332921 94538
Fremont 5350734, California 5332921 94538
Palo Alto Medical Foundation-Fremont
Fremont 5350734, California 5332921 94538
Fremont 5350734, California 5332921 94538
Fresno Cancer Center
Fresno 5350937, California 5332921 93720
Fresno 5350937, California 5332921 93720
Kaiser Permanente-Fresno
Fresno 5350937, California 5332921 93720
Fresno 5350937, California 5332921 93720
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
Irvine 5359777, California 5332921 92612
Irvine 5359777, California 5332921 92612
City of Hope at Irvine Lennar
Irvine 5359777, California 5332921 92618
Irvine 5359777, California 5332921 92618
Contact:
Site Public Contact
877-467-3411
Site Public Contact
877-467-3411
City of Hope Antelope Valley
Lancaster 5364940, California 5332921 93534
Lancaster 5364940, California 5332921 93534
Los Angeles General Medical Center
Los Angeles 5368361, California 5332921 90033
Los Angeles 5368361, California 5332921 90033
USC / Norris Comprehensive Cancer Center
Los Angeles 5368361, California 5332921 90033
Los Angeles 5368361, California 5332921 90033
Contact:
Site Public Contact
323-865-0451
Site Public Contact
323-865-0451
Cedars Sinai Medical Center
Los Angeles 5368361, California 5332921 90048
Los Angeles 5368361, California 5332921 90048
Contact:
Site Public Contact
310-423-8965
Site Public Contact
310-423-8965
Memorial Medical Center
Modesto 5373900, California 5332921 95355
Modesto 5373900, California 5332921 95355
Kaiser Permanente-Modesto
Modesto 5373900, California 5332921 95356
Modesto 5373900, California 5332921 95356
Palo Alto Medical Foundation-Camino Division
Mountain View 5375480, California 5332921 94040
Mountain View 5375480, California 5332921 94040
Kaiser Permanente Oakland-Broadway
Oakland 5378538, California 5332921 94611
Oakland 5378538, California 5332921 94611
Kaiser Permanente-Oakland
Oakland 5378538, California 5332921 94611
Oakland 5378538, California 5332921 94611
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange 5379513, California 5332921 92868
Orange 5379513, California 5332921 92868
Palo Alto Medical Foundation Health Care
Palo Alto 5380748, California 5332921 94301
Palo Alto 5380748, California 5332921 94301
Stanford Cancer Institute Palo Alto
Palo Alto 5380748, California 5332921 94304
Palo Alto 5380748, California 5332921 94304
Pomona Valley Hospital Medical Center
Pomona 5384170, California 5332921 91767
Pomona 5384170, California 5332921 91767
Contact:
Site Public Contact
909-865-9555
Site Public Contact
909-865-9555
Kaiser Permanente-Rancho Cordova Cancer Center
Rancho Cordova 5385941, California 5332921 95670
Rancho Cordova 5385941, California 5332921 95670
Kaiser Permanente- Marshall Medical Offices
Redwood City 5386834, California 5332921 94063
Redwood City 5386834, California 5332921 94063
Contact:
Site Public Contact
877-642-4691
Site Public Contact
877-642-4691
Kaiser Permanente-Richmond
Richmond 5387428, California 5332921 94801
Richmond 5387428, California 5332921 94801
Rohnert Park Cancer Center
Rohnert Park 5388564, California 5332921 94928
Rohnert Park 5388564, California 5332921 94928
Kaiser Permanente-Roseville
Roseville 5388881, California 5332921 95661
Roseville 5388881, California 5332921 95661
Sutter Cancer Centers Radiation Oncology Services-Roseville
Roseville 5388881, California 5332921 95661
Roseville 5388881, California 5332921 95661
Sutter Roseville Medical Center
Roseville 5388881, California 5332921 95661
Roseville 5388881, California 5332921 95661
The Permanente Medical Group-Roseville Radiation Oncology
Roseville 5388881, California 5332921 95678
Roseville 5388881, California 5332921 95678
Kaiser Permanente Downtown Commons
Sacramento 5389489, California 5332921 95814
Sacramento 5389489, California 5332921 95814
Sutter Medical Center Sacramento
Sacramento 5389489, California 5332921 95816
Sacramento 5389489, California 5332921 95816
University of California Davis Comprehensive Cancer Center
Sacramento 5389489, California 5332921 95817
Sacramento 5389489, California 5332921 95817
Contact:
Site Public Contact
916-734-3089
Site Public Contact
916-734-3089
Kaiser Permanente-South Sacramento
Sacramento 5389489, California 5332921 95823
Sacramento 5389489, California 5332921 95823
South Sacramento Cancer Center
Sacramento 5389489, California 5332921 95823
Sacramento 5389489, California 5332921 95823
California Pacific Medical Center-Pacific Campus
San Francisco 5391959, California 5332921 94115
San Francisco 5391959, California 5332921 94115
Kaiser Permanente-San Francisco
San Francisco 5391959, California 5332921 94115
San Francisco 5391959, California 5332921 94115
Kaiser Permanente-Santa Teresa-San Jose
San Jose 5392171, California 5332921 95119
San Jose 5392171, California 5332921 95119
Stanford Cancer Center South Bay
San Jose 5392171, California 5332921 95124
San Jose 5392171, California 5332921 95124
Kaiser Permanente San Leandro
San Leandro 5392263, California 5332921 94577
San Leandro 5392263, California 5332921 94577
Pacific Central Coast Health Center-San Luis Obispo
San Luis Obispo 5392323, California 5332921 93401
San Luis Obispo 5392323, California 5332921 93401
Kaiser San Rafael-Gallinas
San Rafael 5392567, California 5332921 94903
San Rafael 5392567, California 5332921 94903
Ridley-Tree Cancer Center
Santa Barbara 5392952, California 5332921 93105
Santa Barbara 5392952, California 5332921 93105
Kaiser Permanente Medical Center - Santa Clara
Santa Clara 5393015, California 5332921 95051
Santa Clara 5393015, California 5332921 95051
Mission Hope Medical Oncology - Santa Maria
Santa Maria 5393180, California 5332921 93444
Santa Maria 5393180, California 5332921 93444
Kaiser Permanente-Santa Rosa
Santa Rosa 5393287, California 5332921 95403
Santa Rosa 5393287, California 5332921 95403
Sutter Pacific Medical Foundation
Santa Rosa 5393287, California 5332921 95403
Santa Rosa 5393287, California 5332921 95403
City of Hope South Pasadena
South Pasadena 5397717, California 5332921 91030
South Pasadena 5397717, California 5332921 91030
Kaiser Permanente Cancer Treatment Center
South San Francisco 5397765, California 5332921 94080
South San Francisco 5397765, California 5332921 94080
Kaiser Permanente-South San Francisco
South San Francisco 5397765, California 5332921 94080
South San Francisco 5397765, California 5332921 94080
Kaiser Permanente-Stockton
Stockton 5399020, California 5332921 95210
Stockton 5399020, California 5332921 95210
Palo Alto Medical Foundation-Sunnyvale
Sunnyvale 5400075, California 5332921 94086
Sunnyvale 5400075, California 5332921 94086
Cedars-Sinai Cancer - Tarzana
Tarzana 5401143, California 5332921 91356
Tarzana 5401143, California 5332921 91356
Contact:
Site Public Contact
818-981-3818
Site Public Contact
818-981-3818
City of Hope South Bay
Torrance 5403022, California 5332921 90503
Torrance 5403022, California 5332921 90503
Contact:
Site Public Contact
877-467-3411
Site Public Contact
877-467-3411
Torrance Memorial Physician Network - Cancer Care
Torrance 5403022, California 5332921 90505
Torrance 5403022, California 5332921 90505
City of Hope Upland
Upland 5404915, California 5332921 91786
Upland 5404915, California 5332921 91786
Kaiser Permanente Medical Center-Vacaville
Vacaville 5405228, California 5332921 95688
Vacaville 5405228, California 5332921 95688
Kaiser Permanente-Vallejo
Vallejo 5405380, California 5332921 94589
Vallejo 5405380, California 5332921 94589
Kaiser Permanente-Walnut Creek
Walnut Creek 5406990, California 5332921 94596
Walnut Creek 5406990, California 5332921 94596
UCHealth University of Colorado Hospital
Aurora 5412347, Colorado 5417618 80045
Aurora 5412347, Colorado 5417618 80045
Contact:
Site Public Contact
720-848-0650
Site Public Contact
720-848-0650
Penrose-Saint Francis Healthcare
Colorado Springs 5417598, Colorado 5417618 80907
Colorado Springs 5417598, Colorado 5417618 80907
Rocky Mountain Cancer Centers-Penrose
Colorado Springs 5417598, Colorado 5417618 80907
Colorado Springs 5417598, Colorado 5417618 80907
UCHealth Memorial Hospital Central
Colorado Springs 5417598, Colorado 5417618 80909
Colorado Springs 5417598, Colorado 5417618 80909
Contact:
Site Public Contact
719-365-2406
Site Public Contact
719-365-2406
Memorial Hospital North
Colorado Springs 5417598, Colorado 5417618 80920
Colorado Springs 5417598, Colorado 5417618 80920
Contact:
Site Public Contact
719-364-6700
Site Public Contact
719-364-6700
Saint Francis Cancer Center
Colorado Springs 5417598, Colorado 5417618 80923
Colorado Springs 5417598, Colorado 5417618 80923
Poudre Valley Hospital
Fort Collins 5577147, Colorado 5417618 80524
Fort Collins 5577147, Colorado 5417618 80524
Contact:
Site Public Contact
970-297-6150
Site Public Contact
970-297-6150
Cancer Care and Hematology-Fort Collins
Fort Collins 5577147, Colorado 5417618 80528
Fort Collins 5577147, Colorado 5417618 80528
UCHealth Greeley Hospital
Greeley 5577592, Colorado 5417618 80631
Greeley 5577592, Colorado 5417618 80631
UCHealth Highlands Ranch Hospital
Highlands Ranch 5425043, Colorado 5417618 80129
Highlands Ranch 5425043, Colorado 5417618 80129
Contact:
Site Public Contact
720-848-0650
Site Public Contact
720-848-0650
Medical Center of the Rockies
Loveland 5579368, Colorado 5417618 80538
Loveland 5579368, Colorado 5417618 80538
Contact:
Site Public Contact
970-203-7083
Site Public Contact
970-203-7083
John Fitzgerald Kennedy Medical Center
Atlantis 4146372, Florida 4155751 33462
Atlantis 4146372, Florida 4155751 33462
Contact:
Site Public Contact
561-964-2662
Site Public Contact
561-964-2662
Morton Plant Hospital
Clearwater 4151316, Florida 4155751 33756
Clearwater 4151316, Florida 4155751 33756
Contact:
Site Public Contact
855-314-8646
Site Public Contact
855-314-8646
Lee Memorial Health System
Fort Myers 4155995, Florida 4155751 33901
Fort Myers 4155995, Florida 4155751 33901
Contact:
Site Public Contact
877-680-0008
Site Public Contact
877-680-0008
Regional Cancer Center-Lee Memorial Health System
Fort Myers 4155995, Florida 4155751 33905
Fort Myers 4155995, Florida 4155751 33905
Sarasota Memorial Hospital-Venice
N. Venice, Florida 4155751 34275
N. Venice, Florida 4155751 34275
Contact:
Site Public Contact
941-261-9000
Site Public Contact
941-261-9000
GenesisCare USA - Plantation
Plantation 4168782, Florida 4155751 33324
Plantation 4168782, Florida 4155751 33324
Florida Cancer Specialists - Sarasota
Sarasota 4172131, Florida 4155751 34232
Sarasota 4172131, Florida 4155751 34232
Intercoastal Medical Group - Cattleridge II
Sarasota 4172131, Florida 4155751 34232
Sarasota 4172131, Florida 4155751 34232
Contact:
Site Public Contact
941-200-1125
Site Public Contact
941-200-1125
Florida Cancer Specialists - Sarasota Downtown
Sarasota 4172131, Florida 4155751 34236
Sarasota 4172131, Florida 4155751 34236
Contact:
Site Public Contact
941-957-1000
Site Public Contact
941-957-1000
First Physicians Group - Urology Robotic and Minimally Invasive Surgery
Sarasota 4172131, Florida 4155751 34239
Sarasota 4172131, Florida 4155751 34239
Contact:
Site Public Contact
941-917-5400
Site Public Contact
941-917-5400
First Physicians Group-Sarasota
Sarasota 4172131, Florida 4155751 34239
Sarasota 4172131, Florida 4155751 34239
Contact:
Site Public Contact
941-917-8383
Site Public Contact
941-917-8383
Sarasota Memorial Hospital
Sarasota 4172131, Florida 4155751 34239
Sarasota 4172131, Florida 4155751 34239
Contact:
Site Public Contact
941-917-2225
Site Public Contact
941-917-2225
Sarasota Memorial Health Care Center at University Parkway
Sarasota 4172131, Florida 4155751 34243
Sarasota 4172131, Florida 4155751 34243
Contact:
Site Public Contact
941-917-6519
Site Public Contact
941-917-6519
Moffitt Cancer Center-International Plaza
Tampa 4174757, Florida 4155751 33607
Tampa 4174757, Florida 4155751 33607
Moffitt Cancer Center - McKinley Campus
Tampa 4174757, Florida 4155751 33612
Tampa 4174757, Florida 4155751 33612
Moffitt Cancer Center
Tampa 4174757, Florida 4155751 33612
Tampa 4174757, Florida 4155751 33612
Florida Cancer Specialists - Venice Pinebrook
Venice 4176380, Florida 4155751 34275
Venice 4176380, Florida 4155751 34275
Florida Cancer Specialists - Venice Island
Venice 4176380, Florida 4155751 34285
Venice 4176380, Florida 4155751 34285
Moffitt Cancer Center at Wesley Chapel
Wesley Chapel 4177727, Florida 4155751 33544
Wesley Chapel 4177727, Florida 4155751 33544
Grady Health System
Atlanta 4180439, Georgia 4197000 30303
Atlanta 4180439, Georgia 4197000 30303
Contact:
Site Public Contact
404-778-1868
Site Public Contact
404-778-1868
Emory Proton Therapy Center
Atlanta 4180439, Georgia 4197000 30308
Atlanta 4180439, Georgia 4197000 30308
Emory University Hospital Midtown
Atlanta 4180439, Georgia 4197000 30308
Atlanta 4180439, Georgia 4197000 30308
Contact:
Site Public Contact
888-946-7447
Site Public Contact
888-946-7447
Emory University Hospital/Winship Cancer Institute
Atlanta 4180439, Georgia 4197000 30322
Atlanta 4180439, Georgia 4197000 30322
Contact:
Site Public Contact
404-778-1868
Site Public Contact
404-778-1868
Emory Saint Joseph's Hospital
Atlanta 4180439, Georgia 4197000 30342
Atlanta 4180439, Georgia 4197000 30342
Contact:
Site Public Contact
404-851-7115
Site Public Contact
404-851-7115
Emory Decatur Hospital
Decatur 4191124, Georgia 4197000 30033
Decatur 4191124, Georgia 4197000 30033
Emory Johns Creek Hospital
Johns Creek 6331909, Georgia 4197000 30097
Johns Creek 6331909, Georgia 4197000 30097
CTCA at Southeastern Regional Medical Center
Newnan 4212684, Georgia 4197000 30265
Newnan 4212684, Georgia 4197000 30265
Contact:
Site Public Contact
770-400-6629
Site Public Contact
770-400-6629
South Georgia Medical Center/Pearlman Cancer Center
Valdosta 4228147, Georgia 4197000 31602
Valdosta 4228147, Georgia 4197000 31602
Hawaii Cancer Care Inc - Waterfront Plaza
Honolulu 5856195, Hawaii 5855797 96813
Honolulu 5856195, Hawaii 5855797 96813
Queen's Cancer Cenrer - POB I
Honolulu 5856195, Hawaii 5855797 96813
Honolulu 5856195, Hawaii 5855797 96813
Contact:
Site Public Contact
808-532-0315
Site Public Contact
808-532-0315
Queen's Medical Center
Honolulu 5856195, Hawaii 5855797 96813
Honolulu 5856195, Hawaii 5855797 96813
Contact:
Site Public Contact
808-545-8548
Site Public Contact
808-545-8548
Straub Clinic and Hospital
Honolulu 5856195, Hawaii 5855797 96813
Honolulu 5856195, Hawaii 5855797 96813
Contact:
Site Public Contact
808-522-4333
Site Public Contact
808-522-4333
University of Hawaii Cancer Center
Honolulu 5856195, Hawaii 5855797 96813
Honolulu 5856195, Hawaii 5855797 96813
Contact:
Site Public Contact
808-586-2979
Site Public Contact
808-586-2979
Kuakini Medical Center
Honolulu 5856195, Hawaii 5855797 96817
Honolulu 5856195, Hawaii 5855797 96817
Contact:
Site Public Contact
808-547-9816
Site Public Contact
808-547-9816
Queen's Cancer Center - Kuakini
Honolulu 5856195, Hawaii 5855797 96817
Honolulu 5856195, Hawaii 5855797 96817
Contact:
Site Public Contact
808-531-8521
Site Public Contact
808-531-8521
Kapiolani Medical Center for Women and Children
Honolulu 5856195, Hawaii 5855797 96826
Honolulu 5856195, Hawaii 5855797 96826
Contact:
Site Public Contact
808-983-6090
Site Public Contact
808-983-6090
Castle Medical Center
Kailua 5847486, Hawaii 5855797 96734
Kailua 5847486, Hawaii 5855797 96734
Wilcox Memorial Hospital and Kauai Medical Clinic
Lihue 5850248, Hawaii 5855797 96766
Lihue 5850248, Hawaii 5855797 96766
Contact:
Site Public Contact
808-535-7960
Site Public Contact
808-535-7960
Hawaii Cancer Care - Westridge
‘Aiea 5856430, Hawaii 5855797 96701
‘Aiea 5856430, Hawaii 5855797 96701
Pali Momi Medical Center
‘Aiea 5856430, Hawaii 5855797 96701
‘Aiea 5856430, Hawaii 5855797 96701
Contact:
Site Public Contact
808-486-6000
Site Public Contact
808-486-6000
Queen's Cancer Center - Pearlridge
‘Aiea 5856430, Hawaii 5855797 96701
‘Aiea 5856430, Hawaii 5855797 96701
Contact:
Site Public Contact
808-487-7447
Site Public Contact
808-487-7447
The Cancer Center of Hawaii-Pali Momi
‘Aiea 5856430, Hawaii 5855797 96701
‘Aiea 5856430, Hawaii 5855797 96701
Contact:
Site Public Contact
808-678-9000
Site Public Contact
808-678-9000
The Queen's Medical Center - West Oahu
‘Ewa Beach 5855051, Hawaii 5855797 96706
‘Ewa Beach 5855051, Hawaii 5855797 96706
Saint Luke's Cancer Institute - Boise
Boise 5586437, Idaho 5596512 83712
Boise 5586437, Idaho 5596512 83712
Saint Luke's Cancer Institute - Fruitland
Fruitland 5593708, Idaho 5596512 83619
Fruitland 5593708, Idaho 5596512 83619
Saint Luke's Cancer Institute - Meridian
Meridian 5600685, Idaho 5596512 83642
Meridian 5600685, Idaho 5596512 83642
Saint Luke's Cancer Institute - Nampa
Nampa 5601933, Idaho 5596512 83687
Nampa 5601933, Idaho 5596512 83687
Saint Luke's Cancer Institute - Twin Falls
Twin Falls 5610810, Idaho 5596512 83301
Twin Falls 5610810, Idaho 5596512 83301
Rush-Copley Medical Center
Aurora 4883817, Illinois 4896861 60504
Aurora 4883817, Illinois 4896861 60504
Centralia Oncology Clinic
Centralia 4235587, Illinois 4896861 62801
Centralia 4235587, Illinois 4896861 62801
Northwestern University
Chicago 4887398, Illinois 4896861 60611
Chicago 4887398, Illinois 4896861 60611
John H Stroger Jr Hospital of Cook County
Chicago 4887398, Illinois 4896861 60612
Chicago 4887398, Illinois 4896861 60612
Contact:
Site Public Contact
312-864-5204
Site Public Contact
312-864-5204
University of Chicago Comprehensive Cancer Center
Chicago 4887398, Illinois 4896861 60637
Chicago 4887398, Illinois 4896861 60637
Carle at The Riverfront
Danville 4889426, Illinois 4896861 61832
Danville 4889426, Illinois 4896861 61832
Cancer Care Specialists of Illinois - Decatur
Decatur 4236895, Illinois 4896861 62526
Decatur 4236895, Illinois 4896861 62526
Decatur Memorial Hospital
Decatur 4236895, Illinois 4896861 62526
Decatur 4236895, Illinois 4896861 62526
Northwestern Medicine Cancer Center Kishwaukee
DeKalb 4889553, Illinois 4896861 60115
DeKalb 4889553, Illinois 4896861 60115
Carle Physician Group-Effingham
Effingham 4237727, Illinois 4896861 62401
Effingham 4237727, Illinois 4896861 62401
Crossroads Cancer Center
Effingham 4237727, Illinois 4896861 62401
Effingham 4237727, Illinois 4896861 62401
Elmhurst Memorial Hospital
Elmhurst 4891010, Illinois 4896861 60126
Elmhurst 4891010, Illinois 4896861 60126
Northwestern Medicine Cancer Center Delnor
Geneva 4893591, Illinois 4896861 60134
Geneva 4893591, Illinois 4896861 60134
Northwestern Medicine Glenview Outpatient Center
Glenview 4893886, Illinois 4896861 60026
Glenview 4893886, Illinois 4896861 60026
Contact:
Site Public Contact
312-695-1102
Site Public Contact
312-695-1102
Northwestern Medicine Grayslake Outpatient Center
Grayslake 4894465, Illinois 4896861 60030
Grayslake 4894465, Illinois 4896861 60030
Contact:
Site Public Contact
312-695-1102
Site Public Contact
312-695-1102
Ingalls Memorial Hospital
Harvey 4895298, Illinois 4896861 60426
Harvey 4895298, Illinois 4896861 60426
Northwestern Medicine Lake Forest Hospital
Lake Forest 4899012, Illinois 4896861 60045
Lake Forest 4899012, Illinois 4896861 60045
Carle Physician Group-Mattoon/Charleston
Mattoon 4244099, Illinois 4896861 61938
Mattoon 4244099, Illinois 4896861 61938
Loyola University Medical Center
Maywood 4901514, Illinois 4896861 60153
Maywood 4901514, Illinois 4896861 60153
Contact:
Site Public Contact
708-226-4357
Site Public Contact
708-226-4357
Edward Hospital/Cancer Center
Naperville 4903279, Illinois 4896861 60540
Naperville 4903279, Illinois 4896861 60540
Contact:
Site Public Contact
630-646-6075
Site Public Contact
630-646-6075
UC Comprehensive Cancer Center at Silver Cross
New Lenox 4903535, Illinois 4896861 60451
New Lenox 4903535, Illinois 4896861 60451
Carle Cancer Institute Normal
Normal 4903780, Illinois 4896861 61761
Normal 4903780, Illinois 4896861 61761
Cancer Care Center of O'Fallon
O'Fallon 4245926, Illinois 4896861 62269
O'Fallon 4245926, Illinois 4896861 62269
HSHS Saint Elizabeth's Hospital
O'Fallon 4245926, Illinois 4896861 62269
O'Fallon 4245926, Illinois 4896861 62269
Northwestern Medicine Orland Park
Orland Park 4904937, Illinois 4896861 60462
Orland Park 4904937, Illinois 4896861 60462
University of Chicago Medicine-Orland Park
Orland Park 4904937, Illinois 4896861 60462
Orland Park 4904937, Illinois 4896861 60462
Southern Illinois University School of Medicine
Springfield 4250542, Illinois 4896861 62702
Springfield 4250542, Illinois 4896861 62702
Contact:
Site Public Contact
217-545-7929
Site Public Contact
217-545-7929
Springfield Clinic
Springfield 4250542, Illinois 4896861 62702
Springfield 4250542, Illinois 4896861 62702
Contact:
Site Public Contact
800-444-7541
Site Public Contact
800-444-7541
Springfield Memorial Hospital
Springfield 4250542, Illinois 4896861 62781
Springfield 4250542, Illinois 4896861 62781
Carle Cancer Center
Urbana 4914570, Illinois 4896861 61801
Urbana 4914570, Illinois 4896861 61801
Northwestern Medicine Cancer Center Warrenville
Warrenville 4915525, Illinois 4896861 60555
Warrenville 4915525, Illinois 4896861 60555
Midwestern Regional Medical Center
Zion 4917358, Illinois 4896861 60099
Zion 4917358, Illinois 4896861 60099
Contact:
Site Public Contact
844-793-0745
Site Public Contact
844-793-0745
Northwest Cancer Center - Main Campus
Crown Point 4919451, Indiana 4921868 46307
Crown Point 4919451, Indiana 4921868 46307
Contact:
Site Public Contact
219-310-2550
Site Public Contact
219-310-2550
UChicago Medicine Northwest Indiana
Crown Point 4919451, Indiana 4921868 46307
Crown Point 4919451, Indiana 4921868 46307
Northwest Oncology LLC
Dyer 4919820, Indiana 4921868 46311
Dyer 4919820, Indiana 4921868 46311
Contact:
Site Public Contact
219-924-8178
Site Public Contact
219-924-8178
Goshen Center for Cancer Care
Goshen 4920808, Indiana 4921868 46526
Goshen 4920808, Indiana 4921868 46526
Northwest Cancer Center - Hobart
Hobart 4921476, Indiana 4921868 46342
Hobart 4921476, Indiana 4921868 46342
Contact:
Site Public Contact
219-947-1795
Site Public Contact
219-947-1795
Saint Mary Medical Center
Hobart 4921476, Indiana 4921868 46342
Hobart 4921476, Indiana 4921868 46342
The Community Hospital
Munster 4924014, Indiana 4921868 46321
Munster 4924014, Indiana 4921868 46321
Contact:
Site Public Contact
219-836-3349
Site Public Contact
219-836-3349
Women's Diagnostic Center - Munster
Munster 4924014, Indiana 4921868 46321
Munster 4924014, Indiana 4921868 46321
Reid Health
Richmond 4263681, Indiana 4921868 47374
Richmond 4263681, Indiana 4921868 47374
Northwest Cancer Center - Valparaiso
Valparaiso 4927537, Indiana 4921868 46383
Valparaiso 4927537, Indiana 4921868 46383
Mary Greeley Medical Center
Ames 4846834, Iowa 4862182 50010
Ames 4846834, Iowa 4862182 50010
Contact:
Site Public Contact
515-956-4132
Site Public Contact
515-956-4132
McFarland Clinic - Ames
Ames 4846834, Iowa 4862182 50010
Ames 4846834, Iowa 4862182 50010
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny 4846960, Iowa 4862182 50023
Ankeny 4846960, Iowa 4862182 50023
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
Physicians' Clinic of Iowa PC
Cedar Rapids 4850751, Iowa 4862182 52402
Cedar Rapids 4850751, Iowa 4862182 52402
Contact:
Site Public Contact
319-297-2900
Site Public Contact
319-297-2900
Mercy Cancer Center-West Lakes
Clive 4852065, Iowa 4862182 50325
Clive 4852065, Iowa 4862182 50325
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive 4852065, Iowa 4862182 50325
Clive 4852065, Iowa 4862182 50325
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
Greater Regional Medical Center
Creston 4853078, Iowa 4862182 50801
Creston 4853078, Iowa 4862182 50801
Iowa Methodist Medical Center
Des Moines 4853828, Iowa 4862182 50309
Des Moines 4853828, Iowa 4862182 50309
Contact:
Site Public Contact
515-241-6727
Site Public Contact
515-241-6727
UI Health Care Mission Cancer and Blood - Des Moines Clinic
Des Moines 4853828, Iowa 4862182 50309
Des Moines 4853828, Iowa 4862182 50309
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
Mercy Medical Center - Des Moines
Des Moines 4853828, Iowa 4862182 50314
Des Moines 4853828, Iowa 4862182 50314
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines 4853828, Iowa 4862182 50314
Des Moines 4853828, Iowa 4862182 50314
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
UI Health Care Mission Cancer and Blood - Waukee Clinic
Waukee 4880981, Iowa 4862182 50263
Waukee 4880981, Iowa 4862182 50263
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
Mercy Medical Center-West Lakes
West Des Moines 4881346, Iowa 4862182 50266
West Des Moines 4881346, Iowa 4862182 50266
University of Kansas Cancer Center
Kansas City 4273837, Kansas 4273857 66160
Kansas City 4273837, Kansas 4273857 66160
The University of Kansas Cancer Center - Olathe
Olathe 4276614, Kansas 4273857 66061
Olathe 4276614, Kansas 4273857 66061
University of Kansas Cancer Center-Overland Park
Overland Park 4276873, Kansas 4273857 66210
Overland Park 4276873, Kansas 4273857 66210
University of Kansas Hospital-Indian Creek Campus
Overland Park 4276873, Kansas 4273857 66211
Overland Park 4276873, Kansas 4273857 66211
Salina Regional Health Center
Salina 4278890, Kansas 4273857 67401
Salina 4278890, Kansas 4273857 67401
University of Kansas Health System Saint Francis Campus
Topeka 4280539, Kansas 4273857 66606
Topeka 4280539, Kansas 4273857 66606
Contact:
Site Public Contact
785-295-8000
Site Public Contact
785-295-8000
University of Kansas Hospital-Westwood Cancer Center
Westwood 4281639, Kansas 4273857 66205
Westwood 4281639, Kansas 4273857 66205
The James Graham Brown Cancer Center at University of Louisville
Louisville 4299276, Kentucky 6254925 40202
Louisville 4299276, Kentucky 6254925 40202
Contact:
Site Public Contact
502-562-3429
Site Public Contact
502-562-3429
UofL Health Medical Center Northeast
Louisville 4299276, Kentucky 6254925 40245
Louisville 4299276, Kentucky 6254925 40245
University of Maryland/Greenebaum Cancer Center
Baltimore 4347778, Maryland 4361885 21201
Baltimore 4347778, Maryland 4361885 21201
Contact:
Site Public Contact
800-888-8823
Site Public Contact
800-888-8823
UM Upper Chesapeake Medical Center
Bel Air 4348240, Maryland 4361885 21014
Bel Air 4348240, Maryland 4361885 21014
Contact:
Site Public Contact
443-643-3010
Site Public Contact
443-643-3010
Central Maryland Radiation Oncology in Howard County
Columbia 4352053, Maryland 4361885 21044
Columbia 4352053, Maryland 4361885 21044
Contact:
Site Public Contact
443-546-1300
Site Public Contact
443-546-1300
University of Maryland Shore Medical Center at Easton
Easton 4353962, Maryland 4361885 21601
Easton 4353962, Maryland 4361885 21601
UM Baltimore Washington Medical Center/Tate Cancer Center
Glen Burnie 4356188, Maryland 4361885 21061
Glen Burnie 4356188, Maryland 4361885 21061
Contact:
Site Public Contact
410-553-8100
Site Public Contact
410-553-8100
UM Capital Region Medical Center
Largo 4360345, Maryland 4361885 20774
Largo 4360345, Maryland 4361885 20774
Bronson Battle Creek
Battle Creek 4985153, Michigan 5001836 49017
Battle Creek 4985153, Michigan 5001836 49017
Henry Ford Cancer Institute-Downriver
Brownstown, Michigan 5001836 48183
Brownstown, Michigan 5001836 48183
Michigan Healthcare Professionals Clarkston
Clarkston 4988997, Michigan 5001836 48346
Clarkston 4988997, Michigan 5001836 48346
Henry Ford Macomb Hospital-Clinton Township
Clinton Township 4989133, Michigan 5001836 48038
Clinton Township 4989133, Michigan 5001836 48038
Henry Ford Medical Center-Fairlane
Dearborn 4990510, Michigan 5001836 48126
Dearborn 4990510, Michigan 5001836 48126
Henry Ford Hospital
Detroit 4990729, Michigan 5001836 48202
Detroit 4990729, Michigan 5001836 48202
OSF Saint Francis Hospital and Medical Group
Escanaba 4992232, Michigan 5001836 49829
Escanaba 4992232, Michigan 5001836 49829
Michigan Healthcare Professionals Farmington
Farmington Hills 4992523, Michigan 5001836 48334
Farmington Hills 4992523, Michigan 5001836 48334
Genesys Hurley Cancer Institute
Flint 4992982, Michigan 5001836 48503
Flint 4992982, Michigan 5001836 48503
Hurley Medical Center
Flint 4992982, Michigan 5001836 48503
Flint 4992982, Michigan 5001836 48503
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids 4994358, Michigan 5001836 49503
Grand Rapids 4994358, Michigan 5001836 49503
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids 4994358, Michigan 5001836 49503
Grand Rapids 4994358, Michigan 5001836 49503
Trinity Health Grand Rapids Hospital
Grand Rapids 4994358, Michigan 5001836 49503
Grand Rapids 4994358, Michigan 5001836 49503
Allegiance Health
Jackson 4997384, Michigan 5001836 49201
Jackson 4997384, Michigan 5001836 49201
Michigan Healthcare Professionals Macomb
Macomb 5000473, Michigan 5001836 48044
Macomb 5000473, Michigan 5001836 48044
Michigan Healthcare Professionals Madison Heights
Madison Heights 5000500, Michigan 5001836 48071
Madison Heights 5000500, Michigan 5001836 48071
Henry Ford Medical Center-Columbus
Novi 5004062, Michigan 5001836 48377
Novi 5004062, Michigan 5001836 48377
Trinity Health Saint Joseph Mercy Oakland Hospital
Pontiac 5006166, Michigan 5001836 48341
Pontiac 5006166, Michigan 5001836 48341
Corewell Health William Beaumont University Hospital
Royal Oak 5007804, Michigan 5001836 48073
Royal Oak 5007804, Michigan 5001836 48073
Contact:
Site Public Contact
248-551-7695
Site Public Contact
248-551-7695
MyMichigan Medical Center Saginaw
Saginaw 5007989, Michigan 5001836 48601
Saginaw 5007989, Michigan 5001836 48601
MyMichigan Medical Center Tawas
Tawas City 5011900, Michigan 5001836 48764
Tawas City 5011900, Michigan 5001836 48764
Corewell Health Beaumont Troy Hospital
Troy 5012639, Michigan 5001836 48085
Troy 5012639, Michigan 5001836 48085
Contact:
Site Public Contact
248-551-7695
Site Public Contact
248-551-7695
Michigan Healthcare Professionals Troy
Troy 5012639, Michigan 5001836 48098
Troy 5012639, Michigan 5001836 48098
Henry Ford West Bloomfield Hospital
West Bloomfield 7259621, Michigan 5001836 48322
West Bloomfield 7259621, Michigan 5001836 48322
University of Michigan Health - West
Wyoming 5015618, Michigan 5001836 49519
Wyoming 5015618, Michigan 5001836 49519
Sanford Joe Lueken Cancer Center
Bemidji 5017822, Minnesota 5037779 56601
Bemidji 5017822, Minnesota 5037779 56601
Essentia Health Saint Joseph's Medical Center
Brainerd 5019116, Minnesota 5037779 56401
Brainerd 5019116, Minnesota 5037779 56401
Mercy Hospital
Coon Rapids 5022025, Minnesota 5037779 55433
Coon Rapids 5022025, Minnesota 5037779 55433
Essentia Health - Deer River Clinic
Deer River 5024099, Minnesota 5037779 56636
Deer River 5024099, Minnesota 5037779 56636
Essentia Health Cancer Center
Duluth 5024719, Minnesota 5037779 55805
Duluth 5024719, Minnesota 5037779 55805
Essentia Health Saint Mary's Medical Center
Duluth 5024719, Minnesota 5037779 55805
Duluth 5024719, Minnesota 5037779 55805
Miller-Dwan Hospital
Duluth 5024719, Minnesota 5037779 55805
Duluth 5024719, Minnesota 5037779 55805
Saint Luke's Hospital of Duluth
Duluth 5024719, Minnesota 5037779 55805
Duluth 5024719, Minnesota 5037779 55805
Fairview Southdale Hospital
Edina 5025264, Minnesota 5037779 55435
Edina 5025264, Minnesota 5037779 55435
Essentia Health Hibbing Clinic
Hibbing 5030005, Minnesota 5037779 55746
Hibbing 5030005, Minnesota 5037779 55746
Contact:
Site Public Contact
218-786-3308
Site Public Contact
218-786-3308
Abbott-Northwestern Hospital
Minneapolis 5037649, Minnesota 5037779 55407
Minneapolis 5037649, Minnesota 5037779 55407
Monticello Cancer Center
Monticello 5038045, Minnesota 5037779 55362
Monticello 5038045, Minnesota 5037779 55362
Coborn Cancer Center at Saint Cloud Hospital
Saint Cloud 5044407, Minnesota 5037779 56303
Saint Cloud 5044407, Minnesota 5037779 56303
Regions Hospital
Saint Paul 5045360, Minnesota 5037779 55101
Saint Paul 5045360, Minnesota 5037779 55101
United Hospital
Saint Paul 5045360, Minnesota 5037779 55102
Saint Paul 5045360, Minnesota 5037779 55102
Essentia Health Sandstone
Sandstone 5045908, Minnesota 5037779 55072
Sandstone 5045908, Minnesota 5037779 55072
Saint Francis Regional Medical Center
Shakopee 5046997, Minnesota 5037779 55379
Shakopee 5046997, Minnesota 5037779 55379
Lakeview Hospital
Stillwater 5048814, Minnesota 5037779 55082
Stillwater 5048814, Minnesota 5037779 55082
Essentia Health Virginia Clinic
Virginia 5051468, Minnesota 5037779 55792
Virginia 5051468, Minnesota 5037779 55792
Ridgeview Medical Center
Waconia 5051640, Minnesota 5037779 55387
Waconia 5051640, Minnesota 5037779 55387
Baptist Memorial Hospital and Cancer Center-Golden Triangle
Columbus 4422442, Mississippi 4436296 39705
Columbus 4422442, Mississippi 4436296 39705
Baptist Cancer Center-Grenada
Grenada 4428539, Mississippi 4436296 38901
Grenada 4428539, Mississippi 4436296 38901
Baptist Memorial Hospital and Cancer Center-Union County
New Albany 4438121, Mississippi 4436296 38652
New Albany 4438121, Mississippi 4436296 38652
Baptist Memorial Hospital and Cancer Center-Oxford
Oxford 4440076, Mississippi 4436296 38655
Oxford 4440076, Mississippi 4436296 38655
Baptist Memorial Hospital and Cancer Center-Desoto
Southhaven 4446702, Mississippi 4436296 38671
Southhaven 4446702, Mississippi 4436296 38671
Saint Francis Medical Center
Cape Girardeau 4379966, Missouri 4398678 63703
Cape Girardeau 4379966, Missouri 4398678 63703
Parkland Health Center - Farmington
Farmington 4386289, Missouri 4398678 63640
Farmington 4386289, Missouri 4398678 63640
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
University of Kansas Cancer Center - North
Kansas City 4393217, Missouri 4398678 64154
Kansas City 4393217, Missouri 4398678 64154
University of Kansas Cancer Center - Lee's Summit
Lee's Summit 4394870, Missouri 4398678 64064
Lee's Summit 4394870, Missouri 4398678 64064
University of Kansas Cancer Center at North Kansas City Hospital
North Kansas City 4400860, Missouri 4398678 64116
North Kansas City 4400860, Missouri 4398678 64116
Sainte Genevieve County Memorial Hospital
Sainte Genevieve 4407294, Missouri 4398678 63670
Sainte Genevieve 4407294, Missouri 4398678 63670
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Mercy Hospital Springfield
Springfield 4409896, Missouri 4398678 65804
Springfield 4409896, Missouri 4398678 65804
Contact:
Site Public Contact
417-269-4520
Site Public Contact
417-269-4520
Mercy Hospital South
St Louis 4407066, Missouri 4398678 63128
St Louis 4407066, Missouri 4398678 63128
Missouri Baptist Medical Center
St Louis 4407066, Missouri 4398678 63131
St Louis 4407066, Missouri 4398678 63131
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Mercy Hospital Saint Louis
St Louis 4407066, Missouri 4398678 63141
St Louis 4407066, Missouri 4398678 63141
Contact:
Site Public Contact
314-251-7066
Site Public Contact
314-251-7066
Missouri Baptist Sullivan Hospital
Sullivan 4410669, Missouri 4398678 63080
Sullivan 4410669, Missouri 4398678 63080
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
BJC Outpatient Center at Sunset Hills
Sunset Hills 4410836, Missouri 4398678 63127
Sunset Hills 4410836, Missouri 4398678 63127
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Billings Clinic Cancer Center
Billings 5640350, Montana 5667009 59101
Billings 5640350, Montana 5667009 59101
Bozeman Health Deaconess Hospital
Bozeman 5641727, Montana 5667009 59715
Bozeman 5641727, Montana 5667009 59715
Nebraska Medicine-Bellevue
Bellevue 5063805, Nebraska 5073708 68123
Bellevue 5063805, Nebraska 5073708 68123
CHI Health Good Samaritan
Kearney 5071348, Nebraska 5073708 68847
Kearney 5071348, Nebraska 5073708 68847
Cancer Partners of Nebraska
Lincoln 5072006, Nebraska 5073708 68516
Lincoln 5072006, Nebraska 5073708 68516
Nebraska Medicine-Village Pointe
Omaha 5074472, Nebraska 5073708 68118
Omaha 5074472, Nebraska 5073708 68118
Contact:
Site Public Contact
402-559-5600
Site Public Contact
402-559-5600
University of Nebraska Medical Center
Omaha 5074472, Nebraska 5073708 68198
Omaha 5074472, Nebraska 5073708 68198
OptumCare Cancer Care at Seven Hills
Henderson 5505411, Nevada 5509151 89052
Henderson 5505411, Nevada 5509151 89052
OptumCare Cancer Care at Charleston
Las Vegas 5506956, Nevada 5509151 89102
Las Vegas 5506956, Nevada 5509151 89102
Radiation Oncology Centers of Nevada Central
Las Vegas 5506956, Nevada 5509151 89106
Las Vegas 5506956, Nevada 5509151 89106
Radiation Oncology Centers of Nevada Southeast
Las Vegas 5506956, Nevada 5509151 89119
Las Vegas 5506956, Nevada 5509151 89119
OptumCare Cancer Care at MountainView
Las Vegas 5506956, Nevada 5509151 89128
Las Vegas 5506956, Nevada 5509151 89128
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas 5506956, Nevada 5509151 89135
Las Vegas 5506956, Nevada 5509151 89135
Summerlin Hospital Medical Center
Las Vegas 5506956, Nevada 5509151 89144
Las Vegas 5506956, Nevada 5509151 89144
Comprehensive Cancer Centers of Nevada
Las Vegas 5506956, Nevada 5509151 89148
Las Vegas 5506956, Nevada 5509151 89148
OptumCare Cancer Care at Fort Apache
Las Vegas 5506956, Nevada 5509151 89148
Las Vegas 5506956, Nevada 5509151 89148
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon 5088597, New Hampshire 5090174 03756
Lebanon 5088597, New Hampshire 5090174 03756
Memorial Sloan Kettering Basking Ridge
Basking Ridge 5095409, New Jersey 5101760 07920
Basking Ridge 5095409, New Jersey 5101760 07920
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Memorial Sloan Kettering Monmouth
Middletown 5101170, New Jersey 5101760 07748
Middletown 5101170, New Jersey 5101760 07748
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Memorial Sloan Kettering Bergen
Montvale 5101361, New Jersey 5101760 07645
Montvale 5101361, New Jersey 5101760 07645
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Northwell Health Imbert Cancer Center
Bay Shore 5108169, New York 5128638 11706
Bay Shore 5108169, New York 5128638 11706
Contact:
Site Public Contact
516-734-8896
Site Public Contact
516-734-8896
Sands Cancer Center
Canandaigua 5111405, New York 5128638 14424
Canandaigua 5111405, New York 5128638 14424
Contact:
Site Public Contact
585-396-6161
Site Public Contact
585-396-6161
Memorial Sloan Kettering Commack
Commack 5113412, New York 5128638 11725
Commack 5113412, New York 5128638 11725
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Noyes Memorial Hospital/Myers Cancer Center
Dansville 5114492, New York 5128638 14437
Dansville 5114492, New York 5128638 14437
Northwell Health Cancer Institute at Huntington
Greenlawn 5119377, New York 5128638 11740
Greenlawn 5119377, New York 5128638 11740
Contact:
Site Public Contact
516-734-8896
Site Public Contact
516-734-8896
Memorial Sloan Kettering Westchester
Harrison 5120095, New York 5128638 10604
Harrison 5120095, New York 5128638 10604
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Northwell Health/Center for Advanced Medicine
Lake Success 5123853, New York 5128638 11042
Lake Success 5123853, New York 5128638 11042
Contact:
Site Public Contact
516-734-8896
Site Public Contact
516-734-8896
Northern Westchester Hospital
Mount Kisco 5127744, New York 5128638 10549
Mount Kisco 5127744, New York 5128638 10549
Memorial Sloan Kettering Cancer Center
New York 5128581, New York 5128638 10065
New York 5128581, New York 5128638 10065
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Upstate Cancer Center at Oswego
Oswego 5130081, New York 5128638 13126
Oswego 5130081, New York 5128638 13126
Wilmot Cancer Institute Radiation Oncology at Greece
Rochester 5134086, New York 5128638 14606
Rochester 5134086, New York 5128638 14606
Contact:
Site Public Contact
585-758-7877
Site Public Contact
585-758-7877
Highland Hospital
Rochester 5134086, New York 5128638 14620
Rochester 5134086, New York 5128638 14620
Contact:
Site Public Contact
585-341-8113
Site Public Contact
585-341-8113
Pluta Cancer Center
Rochester 5134086, New York 5128638 14623
Rochester 5134086, New York 5128638 14623
University of Rochester
Rochester 5134086, New York 5128638 14642
Rochester 5134086, New York 5128638 14642
Contact:
Site Public Contact
585-275-5830
Site Public Contact
585-275-5830
Phelps Memorial Hospital Center
Sleepy Hollow 5138371, New York 5128638 10591
Sleepy Hollow 5138371, New York 5128638 10591
Contact:
Site Public Contact
914-366-1600
Site Public Contact
914-366-1600
Staten Island University Hospital
Staten Island 5139568, New York 5128638 10305
Staten Island 5139568, New York 5128638 10305
Contact:
Site Public Contact
718-226-8888
Site Public Contact
718-226-8888
Stony Brook University Medical Center
Stony Brook 5139865, New York 5128638 11794
Stony Brook 5139865, New York 5128638 11794
Contact:
Site Public Contact
800-862-2215
Site Public Contact
800-862-2215
State University of New York Upstate Medical University
Syracuse 5140405, New York 5128638 13210
Syracuse 5140405, New York 5128638 13210
Contact:
Site Public Contact
315-464-5476
Site Public Contact
315-464-5476
SUNY Upstate Medical Center-Community Campus
Syracuse 5140405, New York 5128638 13215
Syracuse 5140405, New York 5128638 13215
Contact:
Site Public Contact
315-464-5476
Site Public Contact
315-464-5476
Montefiore Medical Center-Einstein Campus
The Bronx 5110266, New York 5128638 10461
The Bronx 5110266, New York 5128638 10461
Montefiore Medical Center-Weiler Hospital
The Bronx 5110266, New York 5128638 10461
The Bronx 5110266, New York 5128638 10461
Montefiore Medical Center - Moses Campus
The Bronx 5110266, New York 5128638 10467
The Bronx 5110266, New York 5128638 10467
Memorial Sloan Kettering Nassau
Uniondale 5141927, New York 5128638 11553
Uniondale 5141927, New York 5128638 11553
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Upstate Cancer Center at Verona
Verona 5142333, New York 5128638 13478
Verona 5142333, New York 5128638 13478
Wilmot Cancer Institute at Webster
Webster 5143495, New York 5128638 14580
Webster 5143495, New York 5128638 14580
East Carolina University
Greenville 4469160, North Carolina 4482348 27834
Greenville 4469160, North Carolina 4482348 27834
Sanford Bismarck Medical Center
Bismarck 5688025, North Dakota 5690763 58501
Bismarck 5688025, North Dakota 5690763 58501
Sanford Broadway Medical Center
Fargo 5059163, North Dakota 5690763 58122
Fargo 5059163, North Dakota 5690763 58122
Sanford Roger Maris Cancer Center
Fargo 5059163, North Dakota 5690763 58122
Fargo 5059163, North Dakota 5690763 58122
Indu and Raj Soin Medical Center
Beavercreek 4506008, Ohio 5165418 45431
Beavercreek 4506008, Ohio 5165418 45431
Cleveland Clinic Mercy Hospital
Canton 5149222, Ohio 5165418 44708
Canton 5149222, Ohio 5165418 44708
Contact:
Site Public Contact
888-293-4673
Site Public Contact
888-293-4673
Dayton Physicians LLC-Miami Valley South
Centerville 4508204, Ohio 5165418 45459
Centerville 4508204, Ohio 5165418 45459
Miami Valley Hospital South
Centerville 4508204, Ohio 5165418 45459
Centerville 4508204, Ohio 5165418 45459
Ohio State University Comprehensive Cancer Center
Columbus 4509177, Ohio 5165418 43210
Columbus 4509177, Ohio 5165418 43210
Riverside Methodist Hospital
Columbus 4509177, Ohio 5165418 43214
Columbus 4509177, Ohio 5165418 43214
Grant Medical Center
Columbus 4509177, Ohio 5165418 43215
Columbus 4509177, Ohio 5165418 43215
Doctors Hospital
Columbus 4509177, Ohio 5165418 43228
Columbus 4509177, Ohio 5165418 43228
Miami Valley Hospital
Dayton 4509884, Ohio 5165418 45409
Dayton 4509884, Ohio 5165418 45409
Premier Blood and Cancer Center
Dayton 4509884, Ohio 5165418 45409
Dayton 4509884, Ohio 5165418 45409
Contact:
Site Public Contact
937-276-8320
Site Public Contact
937-276-8320
Dayton Physician LLC - Englewood
Dayton 4509884, Ohio 5165418 45415
Dayton 4509884, Ohio 5165418 45415
Miami Valley Hospital North
Dayton 4509884, Ohio 5165418 45415
Dayton 4509884, Ohio 5165418 45415
Delaware Health Center-Grady Cancer Center
Delaware 5151891, Ohio 5165418 43015
Delaware 5151891, Ohio 5165418 43015
Grady Memorial Hospital
Delaware 5151891, Ohio 5165418 43015
Delaware 5151891, Ohio 5165418 43015
Dublin Methodist Hospital
Dublin 5152333, Ohio 5165418 43016
Dublin 5152333, Ohio 5165418 43016
Atrium Medical Center-Middletown Regional Hospital
Franklin 4512203, Ohio 5165418 45005-1066
Franklin 4512203, Ohio 5165418 45005-1066
Dayton Physicians LLC-Atrium
Franklin 4512203, Ohio 5165418 45005
Franklin 4512203, Ohio 5165418 45005
Miami Valley Cancer Care and Infusion
Greenville 5156493, Ohio 5165418 45331
Greenville 5156493, Ohio 5165418 45331
Contact:
Site Public Contact
937-569-7515
Site Public Contact
937-569-7515
Kettering Medical Center
Kettering 4515843, Ohio 5165418 45429
Kettering 4515843, Ohio 5165418 45429
OhioHealth Mansfield Hospital
Mansfield 5161723, Ohio 5165418 44903
Mansfield 5161723, Ohio 5165418 44903
OhioHealth Marion General Hospital
Marion 5161902, Ohio 5165418 43302
Marion 5161902, Ohio 5165418 43302
Dayton Physicians LLC - Troy
Troy 5174358, Ohio 5165418 45373
Troy 5174358, Ohio 5165418 45373
Upper Valley Medical Center
Troy 5174358, Ohio 5165418 45373
Troy 5174358, Ohio 5165418 45373
University of Oklahoma Health Sciences Center
Oklahoma City 4544349, Oklahoma 4544379 73104
Oklahoma City 4544349, Oklahoma 4544379 73104
Mercy Hospital Oklahoma City
Oklahoma City 4544349, Oklahoma 4544379 73120
Oklahoma City 4544349, Oklahoma 4544379 73120
Contact:
Site Public Contact
405-752-3402
Site Public Contact
405-752-3402
Saint Charles Health System
Bend 5713587, Oregon 5744337 97701
Bend 5713587, Oregon 5744337 97701
Clackamas Radiation Oncology Center
Clackamas 5719308, Oregon 5744337 97015
Clackamas 5719308, Oregon 5744337 97015
Legacy Mount Hood Medical Center
Gresham 5729485, Oregon 5744337 97030
Gresham 5729485, Oregon 5744337 97030
Contact:
Site Public Contact
503-413-2150
Site Public Contact
503-413-2150
Providence Newberg Medical Center
Newberg 5742726, Oregon 5744337 97132
Newberg 5742726, Oregon 5744337 97132
Providence Willamette Falls Medical Center
Oregon City 5744253, Oregon 5744337 97045
Oregon City 5744253, Oregon 5744337 97045
Legacy Good Samaritan Hospital and Medical Center
Portland 5746545, Oregon 5744337 97210
Portland 5746545, Oregon 5744337 97210
Providence Portland Medical Center
Portland 5746545, Oregon 5744337 97213
Portland 5746545, Oregon 5744337 97213
Providence Saint Vincent Medical Center
Portland 5746545, Oregon 5744337 97225
Portland 5746545, Oregon 5744337 97225
Legacy Meridian Park Hospital
Tualatin 5757506, Oregon 5744337 97062
Tualatin 5757506, Oregon 5744337 97062
Contact:
Site Public Contact
503-413-1742
Site Public Contact
503-413-1742
Penn State Milton S Hershey Medical Center
Hershey 5193342, Pennsylvania 6254927 17033-0850
Hershey 5193342, Pennsylvania 6254927 17033-0850
UPMC-Magee Womens Hospital
Pittsburgh 5206379, Pennsylvania 6254927 15213
Pittsburgh 5206379, Pennsylvania 6254927 15213
Contact:
Site Public Contact
412-647-2811
Site Public Contact
412-647-2811
Women and Infants Hospital
Providence 5224151, Rhode Island 5224323 02905
Providence 5224151, Rhode Island 5224323 02905
Contact:
Site Public Contact
401-274-1122
Site Public Contact
401-274-1122
Kent Hospital
Warwick 5225507, Rhode Island 5224323 02886
Warwick 5225507, Rhode Island 5224323 02886
Contact:
Site Public Contact
401-737-7010
Site Public Contact
401-737-7010
Medical University of South Carolina
Charleston 4574324, South Carolina 4597040 29425
Charleston 4574324, South Carolina 4597040 29425
Lexington Medical Center
West Columbia 4600541, South Carolina 4597040 29169
West Columbia 4600541, South Carolina 4597040 29169
Sanford Cancer Center Oncology Clinic
Sioux Falls 5231851, South Dakota 5769223 57104
Sioux Falls 5231851, South Dakota 5769223 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls 5231851, South Dakota 5769223 57117-5134
Sioux Falls 5231851, South Dakota 5769223 57117-5134
Baptist Memorial Hospital and Cancer Center-Collierville
Collierville 4614748, Tennessee 4662168 38017
Collierville 4614748, Tennessee 4662168 38017
Baptist Memorial Hospital and Cancer Center-Memphis
Memphis 4641239, Tennessee 4662168 38120
Memphis 4641239, Tennessee 4662168 38120
MD Anderson in The Woodlands
Conroe 4682991, Texas 4736286 77384
Conroe 4682991, Texas 4736286 77384
M D Anderson Cancer Center
Houston 4699066, Texas 4736286 77030
Houston 4699066, Texas 4736286 77030
MD Anderson West Houston
Houston 4699066, Texas 4736286 77079
Houston 4699066, Texas 4736286 77079
MD Anderson League City
League City 4705692, Texas 4736286 77573
League City 4705692, Texas 4736286 77573
MD Anderson in Sugar Land
Sugar Land 4734825, Texas 4736286 77478
Sugar Land 4734825, Texas 4736286 77478
Farmington Health Center
Farmington 5774662, Utah 5549030 84025
Farmington 5774662, Utah 5549030 84025
University of Utah Sugarhouse Health Center
Salt Lake City 5780993, Utah 5549030 84106
Salt Lake City 5780993, Utah 5549030 84106
Huntsman Cancer Institute/University of Utah
Salt Lake City 5780993, Utah 5549030 84112
Salt Lake City 5780993, Utah 5549030 84112
University of Vermont Medical Center
Burlington 5234372, Vermont 5242283 05401
Burlington 5234372, Vermont 5242283 05401
University of Vermont and State Agricultural College
Burlington 5234372, Vermont 5242283 05405
Burlington 5234372, Vermont 5242283 05405
Dartmouth Cancer Center - North
Saint Johnsbury 5240656, Vermont 5242283 05819
Saint Johnsbury 5240656, Vermont 5242283 05819
Bon Secours Memorial Regional Medical Center
Mechanicsville 4772566, Virginia 6254928 23116
Mechanicsville 4772566, Virginia 6254928 23116
Bon Secours Saint Francis Medical Center
Midlothian 4772943, Virginia 6254928 23114
Midlothian 4772943, Virginia 6254928 23114
Bon Secours Saint Mary's Hospital
Richmond 4781708, Virginia 6254928 23226
Richmond 4781708, Virginia 6254928 23226
Bon Secours Cancer Institute at Reynolds Crossing
Richmond 4781708, Virginia 6254928 23230
Richmond 4781708, Virginia 6254928 23230
Swedish Cancer Institute-Edmonds
Edmonds 5793427, Washington 5815135 98026
Edmonds 5793427, Washington 5815135 98026
Swedish Cancer Institute-Issaquah
Issaquah 5798487, Washington 5815135 98029
Issaquah 5798487, Washington 5815135 98029
Kadlec Clinic Hematology and Oncology
Kennewick 5799610, Washington 5815135 99336
Kennewick 5799610, Washington 5815135 99336
Skagit Regional Health Cancer Care Center
Mount Vernon 5804127, Washington 5815135 98274
Mount Vernon 5804127, Washington 5815135 98274
Swedish Medical Center-Ballard Campus
Seattle 5809844, Washington 5815135 98107
Seattle 5809844, Washington 5815135 98107
Swedish Medical Center-First Hill
Seattle 5809844, Washington 5815135 98122
Seattle 5809844, Washington 5815135 98122
Legacy Cancer Institute Medical Oncology and Day Treatment
Vancouver 5814616, Washington 5815135 98684
Vancouver 5814616, Washington 5815135 98684
Legacy Salmon Creek Hospital
Vancouver 5814616, Washington 5815135 98686
Vancouver 5814616, Washington 5815135 98686
Contact:
Site Public Contact
503-413-2150
Site Public Contact
503-413-2150
Langlade Hospital and Cancer Center
Antigo 5244010, Wisconsin 5279468 54409
Antigo 5244010, Wisconsin 5279468 54409
Duluth Clinic Ashland
Ashland 5244247, Wisconsin 5279468 54806
Ashland 5244247, Wisconsin 5279468 54806
Northwest Wisconsin Cancer Center
Ashland 5244247, Wisconsin 5279468 54806
Ashland 5244247, Wisconsin 5279468 54806
Saint Vincent Hospital Cancer Center Green Bay
Green Bay 5254962, Wisconsin 5279468 54301
Green Bay 5254962, Wisconsin 5279468 54301
Essentia Health-Hayward Clinic
Hayward 5255882, Wisconsin 5279468 54843
Hayward 5255882, Wisconsin 5279468 54843
Froedtert Menomonee Falls Hospital
Menomonee Falls 5262630, Wisconsin 5279468 53051
Menomonee Falls 5262630, Wisconsin 5279468 53051
Contact:
Site Public Contact
262-257-5100
Site Public Contact
262-257-5100
Medical College of Wisconsin
Milwaukee 5263045, Wisconsin 5279468 53226
Milwaukee 5263045, Wisconsin 5279468 53226
Contact:
Site Public Contact
414-805-3666
Site Public Contact
414-805-3666
ProHealth D N Greenwald Center
Mukwonago 5263965, Wisconsin 5279468 53149
Mukwonago 5263965, Wisconsin 5279468 53149
Cancer Center of Western Wisconsin
New Richmond 5264475, Wisconsin 5279468 54017
New Richmond 5264475, Wisconsin 5279468 54017
Drexel Town Square Health Center
Oak Creek 5265228, Wisconsin 5279468 53154
Oak Creek 5265228, Wisconsin 5279468 53154
Contact:
Site Public Contact
414-805-0505
Site Public Contact
414-805-0505
ProHealth Oconomowoc Memorial Hospital
Oconomowoc 5265499, Wisconsin 5279468 53066
Oconomowoc 5265499, Wisconsin 5279468 53066
Contact:
Site Public Contact
262-928-7878
Site Public Contact
262-928-7878
Aspirus Cancer Care - James Beck Cancer Center
Rhinelander 5268720, Wisconsin 5279468 54501
Rhinelander 5268720, Wisconsin 5279468 54501
Saint Vincent Hospital Cancer Center at Sheboygan
Sheboygan 5272893, Wisconsin 5279468 53081
Sheboygan 5272893, Wisconsin 5279468 53081
Sheboygan Physicians Group
Sheboygan 5272893, Wisconsin 5279468 53081
Sheboygan 5272893, Wisconsin 5279468 53081
Essentia Health-Spooner Clinic
Spooner 5274034, Wisconsin 5279468 54801
Spooner 5274034, Wisconsin 5279468 54801
Aspirus Cancer Care - Stevens Point
Stevens Point 5274644, Wisconsin 5279468 54481
Stevens Point 5274644, Wisconsin 5279468 54481
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Sturgeon Bay 5274867, Wisconsin 5279468 54235-1495
Sturgeon Bay 5274867, Wisconsin 5279468 54235-1495
Essentia Health Saint Mary's Hospital - Superior
Superior 5275191, Wisconsin 5279468 54880
Superior 5275191, Wisconsin 5279468 54880
Contact:
Site Public Contact
701-364-6272
Site Public Contact
701-364-6272
UW Cancer Center at ProHealth Care
Waukesha 5278052, Wisconsin 5279468 53188
Waukesha 5278052, Wisconsin 5279468 53188
Aspirus Regional Cancer Center
Wausau 5278120, Wisconsin 5279468 54401
Wausau 5278120, Wisconsin 5279468 54401
Contact:
Site Public Contact
877-405-6866
Site Public Contact
877-405-6866
Froedtert West Bend Hospital/Kraemer Cancer Center
West Bend 5278422, Wisconsin 5279468 53095
West Bend 5278422, Wisconsin 5279468 53095
Contact:
Site Public Contact
414-805-0505
Site Public Contact
414-805-0505
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids 5279436, Wisconsin 5279468 54494
Wisconsin Rapids 5279436, Wisconsin 5279468 54494
Contact:
Site Public Contact
715-422-7718
Site Public Contact
715-422-7718
Cancer Center-Metro Medical Center Bayamon
Bayamón 4562831, Puerto Rico 00959-5060
Bayamón 4562831, Puerto Rico 00959-5060
Contact:
Site Public Contact
787-395-7085
Site Public Contact
787-395-7085
Doctors Cancer Center
Manatí 4566137, Puerto Rico 00674
Manatí 4566137, Puerto Rico 00674
Contact:
Site Public Contact
787-621-4397
Site Public Contact
787-621-4397
San Juan Community Oncology Group
San Juan 4568127, Puerto Rico 00917
San Juan 4568127, Puerto Rico 00917
Contact:
Site Public Contact
787-274-3387
Site Public Contact
787-274-3387
Centro Comprensivo de Cancer de UPR
San Juan 4568127, Puerto Rico 00927
San Juan 4568127, Puerto Rico 00927
San Juan City Hospital
San Juan 4568127, Puerto Rico 00936
San Juan 4568127, Puerto Rico 00936
Contact:
Site Public Contact
787-763-1296
Site Public Contact
787-763-1296
More Details
- NCT ID
- NCT05705401
- Status
- Recruiting
- Sponsor
- NRG Oncology
Detailed Description
The landmark trials that established breast conservation therapy (BCT) (breast-conserving surgery followed by adjuvant breast irradiation) as a suitable alternative to mastectomy were conducted in an era that predated biological subtyping of breast cancer and the use of HER2-directed therapies in patients with HER2+ cancers. These trials established adjuvant radiotherapy following breast-conserving surgery as necessary to maximize local control, yet, in the intervening years, overall outcomes have improved significantly owing to widespread adoption of screening mammography, resulting in a substantial reduction in average tumor size at diagnosis, as well as improvements in surgical techniques and, crucial for this proposal, the development of highly active systemic therapies. Before the development of HER2-targeted therapies, patients with HER2-driven localized breast cancer had among the highest rates of local recurrence. However, with improved identification of these patients and the advent of HER2-directed therapies, outcomes have improved significantly, and trials have sought to optimize treatment to reduce the morbidity of both local and systemic treatment. Among the most salient of these examples is the APT trial, a single-arm adjuvant study that enrolled 410 breast cancer patients with HER2+ tumors ≤ 3cm in size and negative axillary nodes, who received adjuvant systemic therapy with weekly paclitaxel and trastuzumab for 12 weeks (TH) followed by 9 months of trastuzumab monotherapy. In addition to demonstrating a very low incidence of distant recurrence, among those on the trial who underwent BCT (lumpectomy and radiation, n = 244), only 2 local recurrence (LR) events have been reported after 7 years of follow-up (7-year LR = 1.2%), representing among the most favorable local outcomes of any breast cancer cohort studied to date. Confirmatory results are forthcoming from the ATEMPT trial, which evaluated the antibody-drug conjugate T-DM1 (ado-trastuzumab emtansine) (n=383) vs the TH regimen from the APT trial (n = 114), thus far showing only 3 LRs in each arm with a median 3-years of follow-up. Importantly, per the current standard of care for HER2+ patients undergoing BCT, all patients presumably received adjuvant breast radiotherapy. The balance of the BCT literature, including a landmark meta-analysis by the Early Breast Cancer Trialists' Collaborative Group, suggests that adjuvant radiotherapy approximately halves the risk of local recurrence following lumpectomy across all analyzable subgroups. While the relative benefit appears constant across subgroups, the absolute benefit of adjuvant radiotherapy varies with the underlying risk. Taking the favorable results of the APT trial (1.2% 7-year LR), if one presumes that omission of radiotherapy yields a doubling or tripling of local recurrence (based on the observed RR of 0.5 - 0.66 for those receiving radiotherapy across the preponderance of historical trials), this population might have manifested a LR rate of 2.4 - 3.6% with the omission of radiotherapy. That is to say, the hypothesis is that administration of RT to APT patients undergoing BCT may have reduced the 7-year absolute risk of LR by only 1.2-2.4%. Through the identification of patients who are at low risk of LR, it may be acceptable for such patients to forego radiation. This hypothesis will be studied by evaluating omission of radiotherapy among patients with pT1N0 disease at breast-conserving surgery who receive adjuvant HER2-directed therapy (trastuzumab/paclitaxel preferred, other options per protocol), or with clinical tumors ≤ 3 cm and clinically negative axillary nodes (cN0) who achieve a pathologic complete response (pCR; ypT0N0) following preoperative (neoadjuvant) administration of HER2-directed therapy (trastuzumab/paclitaxel preferred, other options per protocol). It is expcted that the 5-year LR rate for this population omitting radiotherapy will be 2% or less, and that omission of radiation will not have a measurable impact on regional and distant recurrences or overall survival. The practice of breast radiation oncology has benefited immensely from practice-changing trials that have refined the application of adjuvant radiotherapy since the early surgical studies determined whole breast radiotherapy to be necessary following lumpectomy. There are now several favorable breast cancer subtypes in which patients routinely forego radiotherapy after trials demonstrating modest benefits in terms of local recurrence and no impact on distant recurrence or survival, such as among small, low grade luminal cancers in older women and "good-risk" DCIS. Therefore, this will study the omission of radiotherapy among a population of HER2+ breast cancer patients who are now appreciated to also have favorable risk, so as to similarly weigh the attendant inconveniences, cost and morbidity of radiotherapy in light of an established absolute benefit, which may prove to be modest.