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 Genders
- 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, Arizona 85004
Phoenix, Arizona 85004
Banner University Medical Center - Tucson
Tucson, Arizona 85719
Tucson, Arizona 85719
University of Arizona Cancer Center-North Campus
Tucson, Arizona 85719
Tucson, Arizona 85719
Kaiser Permanente-Deer Valley Medical Center
Antioch, California 94531
Antioch, California 94531
Mission Hope Medical Oncology - Arroyo Grande
Arroyo Grande, California 93420
Arroyo Grande, California 93420
PCR Oncology
Arroyo Grande, California 93420
Arroyo Grande, California 93420
Sutter Auburn Faith Hospital
Auburn, California 95602
Auburn, California 95602
Sutter Cancer Centers Radiation Oncology Services-Auburn
Auburn, California 95603
Auburn, California 95603
Tower Cancer Research Foundation
Beverly Hills, California 90211
Beverly Hills, California 90211
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
Cameron Park, California 95682
Cameron Park, California 95682
City of Hope Comprehensive Cancer Center
Duarte, California 91010
Duarte, California 91010
Kaiser Permanente Dublin
Dublin, California 94568
Dublin, California 94568
Contact:
Site Public Contact
877-642-4691
Site Public Contact
877-642-4691
Kaiser Permanente-Fremont
Fremont, California 94538
Fremont, California 94538
Palo Alto Medical Foundation-Fremont
Fremont, California 94538
Fremont, California 94538
Fresno Cancer Center
Fresno, California 93720
Fresno, California 93720
Kaiser Permanente-Fresno
Fresno, California 93720
Fresno, California 93720
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
Irvine, California 92612
Irvine, California 92612
City of Hope at Irvine Lennar
Irvine, California 92618
Irvine, California 92618
Contact:
Site Public Contact
877-467-3411
Site Public Contact
877-467-3411
City of Hope Antelope Valley
Lancaster, California 93534
Lancaster, California 93534
Los Angeles General Medical Center
Los Angeles, California 90033
Los Angeles, California 90033
USC / Norris Comprehensive Cancer Center
Los Angeles, California 90033
Los Angeles, California 90033
Contact:
Site Public Contact
323-865-0451
Site Public Contact
323-865-0451
Cedars Sinai Medical Center
Los Angeles, California 90048
Los Angeles, California 90048
Contact:
Site Public Contact
310-423-8965
Site Public Contact
310-423-8965
Memorial Medical Center
Modesto, California 95355
Modesto, California 95355
Kaiser Permanente-Modesto
Modesto, California 95356
Modesto, California 95356
Palo Alto Medical Foundation-Camino Division
Mountain View, California 94040
Mountain View, California 94040
Kaiser Permanente Oakland-Broadway
Oakland, California 94611
Oakland, California 94611
Kaiser Permanente-Oakland
Oakland, California 94611
Oakland, California 94611
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange, California 92868
Orange, California 92868
Palo Alto Medical Foundation Health Care
Palo Alto, California 94301
Palo Alto, California 94301
Stanford Cancer Institute Palo Alto
Palo Alto, California 94304
Palo Alto, California 94304
Pomona Valley Hospital Medical Center
Pomona, California 91767
Pomona, California 91767
Contact:
Site Public Contact
909-865-9555
Site Public Contact
909-865-9555
Kaiser Permanente-Rancho Cordova Cancer Center
Rancho Cordova, California 95670
Rancho Cordova, California 95670
Kaiser Permanente- Marshall Medical Offices
Redwood City, California 94063
Redwood City, California 94063
Contact:
Site Public Contact
877-642-4691
Site Public Contact
877-642-4691
Kaiser Permanente-Richmond
Richmond, California 94801
Richmond, California 94801
Rohnert Park Cancer Center
Rohnert Park, California 94928
Rohnert Park, California 94928
Kaiser Permanente-Roseville
Roseville, California 95661
Roseville, California 95661
Sutter Cancer Centers Radiation Oncology Services-Roseville
Roseville, California 95661
Roseville, California 95661
Sutter Roseville Medical Center
Roseville, California 95661
Roseville, California 95661
The Permanente Medical Group-Roseville Radiation Oncology
Roseville, California 95678
Roseville, California 95678
Kaiser Permanente Downtown Commons
Sacramento, California 95814
Sacramento, California 95814
Sutter Medical Center Sacramento
Sacramento, California 95816
Sacramento, California 95816
University of California Davis Comprehensive Cancer Center
Sacramento, California 95817
Sacramento, California 95817
Contact:
Site Public Contact
916-734-3089
Site Public Contact
916-734-3089
Kaiser Permanente-South Sacramento
Sacramento, California 95823
Sacramento, California 95823
South Sacramento Cancer Center
Sacramento, California 95823
Sacramento, California 95823
California Pacific Medical Center-Pacific Campus
San Francisco, California 94115
San Francisco, California 94115
Kaiser Permanente-San Francisco
San Francisco, California 94115
San Francisco, California 94115
Kaiser Permanente-Santa Teresa-San Jose
San Jose, California 95119
San Jose, California 95119
Stanford Cancer Center South Bay
San Jose, California 95124
San Jose, California 95124
Kaiser Permanente San Leandro
San Leandro, California 94577
San Leandro, California 94577
Pacific Central Coast Health Center-San Luis Obispo
San Luis Obispo, California 93401
San Luis Obispo, California 93401
Kaiser San Rafael-Gallinas
San Rafael, California 94903
San Rafael, California 94903
Ridley-Tree Cancer Center
Santa Barbara, California 93105
Santa Barbara, California 93105
Kaiser Permanente Medical Center - Santa Clara
Santa Clara, California 95051
Santa Clara, California 95051
Mission Hope Medical Oncology - Santa Maria
Santa Maria, California 93444
Santa Maria, California 93444
Kaiser Permanente-Santa Rosa
Santa Rosa, California 95403
Santa Rosa, California 95403
Sutter Pacific Medical Foundation
Santa Rosa, California 95403
Santa Rosa, California 95403
City of Hope South Pasadena
South Pasadena, California 91030
South Pasadena, California 91030
Kaiser Permanente Cancer Treatment Center
South San Francisco, California 94080
South San Francisco, California 94080
Kaiser Permanente-South San Francisco
South San Francisco, California 94080
South San Francisco, California 94080
Kaiser Permanente-Stockton
Stockton, California 95210
Stockton, California 95210
Palo Alto Medical Foundation-Sunnyvale
Sunnyvale, California 94086
Sunnyvale, California 94086
Cedars-Sinai Cancer - Tarzana
Tarzana, California 91356
Tarzana, California 91356
Contact:
Site Public Contact
818-981-3818
Site Public Contact
818-981-3818
City of Hope South Bay
Torrance, California 90503
Torrance, California 90503
Contact:
Site Public Contact
877-467-3411
Site Public Contact
877-467-3411
Torrance Memorial Physician Network - Cancer Care
Torrance, California 90505
Torrance, California 90505
City of Hope Upland
Upland, California 91786
Upland, California 91786
Kaiser Permanente Medical Center-Vacaville
Vacaville, California 95688
Vacaville, California 95688
Kaiser Permanente-Vallejo
Vallejo, California 94589
Vallejo, California 94589
Kaiser Permanente-Walnut Creek
Walnut Creek, California 94596
Walnut Creek, California 94596
UCHealth University of Colorado Hospital
Aurora, Colorado 80045
Aurora, Colorado 80045
Contact:
Site Public Contact
720-848-0650
Site Public Contact
720-848-0650
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado 80907
Colorado Springs, Colorado 80907
Rocky Mountain Cancer Centers-Penrose
Colorado Springs, Colorado 80907
Colorado Springs, Colorado 80907
UCHealth Memorial Hospital Central
Colorado Springs, Colorado 80909
Colorado Springs, Colorado 80909
Contact:
Site Public Contact
719-365-2406
Site Public Contact
719-365-2406
Memorial Hospital North
Colorado Springs, Colorado 80920
Colorado Springs, Colorado 80920
Contact:
Site Public Contact
719-364-6700
Site Public Contact
719-364-6700
Saint Francis Cancer Center
Colorado Springs, Colorado 80923
Colorado Springs, Colorado 80923
Poudre Valley Hospital
Fort Collins, Colorado 80524
Fort Collins, Colorado 80524
Contact:
Site Public Contact
970-297-6150
Site Public Contact
970-297-6150
Cancer Care and Hematology-Fort Collins
Fort Collins, Colorado 80528
Fort Collins, Colorado 80528
UCHealth Greeley Hospital
Greeley, Colorado 80631
Greeley, Colorado 80631
UCHealth Highlands Ranch Hospital
Highlands Ranch, Colorado 80129
Highlands Ranch, Colorado 80129
Contact:
Site Public Contact
720-848-0650
Site Public Contact
720-848-0650
Medical Center of the Rockies
Loveland, Colorado 80538
Loveland, Colorado 80538
Contact:
Site Public Contact
970-203-7083
Site Public Contact
970-203-7083
John Fitzgerald Kennedy Medical Center
Atlantis, Florida 33462
Atlantis, Florida 33462
Contact:
Site Public Contact
561-964-2662
Site Public Contact
561-964-2662
Morton Plant Hospital
Clearwater, Florida 33756
Clearwater, Florida 33756
Contact:
Site Public Contact
855-314-8646
Site Public Contact
855-314-8646
Lee Memorial Health System
Fort Myers, Florida 33901
Fort Myers, Florida 33901
Contact:
Site Public Contact
877-680-0008
Site Public Contact
877-680-0008
Regional Cancer Center-Lee Memorial Health System
Fort Myers, Florida 33905
Fort Myers, Florida 33905
Sarasota Memorial Hospital-Venice
N. Venice, Florida 34275
N. Venice, Florida 34275
Contact:
Site Public Contact
941-261-9000
Site Public Contact
941-261-9000
GenesisCare USA - Plantation
Plantation, Florida 33324
Plantation, Florida 33324
Florida Cancer Specialists - Sarasota
Sarasota, Florida 34232
Sarasota, Florida 34232
Intercoastal Medical Group - Cattleridge II
Sarasota, Florida 34232
Sarasota, Florida 34232
Contact:
Site Public Contact
941-200-1125
Site Public Contact
941-200-1125
Florida Cancer Specialists - Sarasota Downtown
Sarasota, Florida 34236
Sarasota, Florida 34236
Contact:
Site Public Contact
941-957-1000
Site Public Contact
941-957-1000
First Physicians Group - Urology Robotic and Minimally Invasive Surgery
Sarasota, Florida 34239
Sarasota, Florida 34239
Contact:
Site Public Contact
941-917-5400
Site Public Contact
941-917-5400
First Physicians Group-Sarasota
Sarasota, Florida 34239
Sarasota, Florida 34239
Contact:
Site Public Contact
941-917-8383
Site Public Contact
941-917-8383
Sarasota Memorial Hospital
Sarasota, Florida 34239
Sarasota, Florida 34239
Contact:
Site Public Contact
941-917-2225
Site Public Contact
941-917-2225
Sarasota Memorial Health Care Center at University Parkway
Sarasota, Florida 34243
Sarasota, Florida 34243
Contact:
Site Public Contact
941-917-6519
Site Public Contact
941-917-6519
Moffitt Cancer Center-International Plaza
Tampa, Florida 33607
Tampa, Florida 33607
Moffitt Cancer Center - McKinley Campus
Tampa, Florida 33612
Tampa, Florida 33612
Moffitt Cancer Center
Tampa, Florida 33612
Tampa, Florida 33612
Florida Cancer Specialists - Venice Pinebrook
Venice, Florida 34275
Venice, Florida 34275
Moffitt Cancer Center at Wesley Chapel
Wesley Chapel, Florida 33544
Wesley Chapel, Florida 33544
Grady Health System
Atlanta, Georgia 30303
Atlanta, Georgia 30303
Contact:
Site Public Contact
404-778-1868
Site Public Contact
404-778-1868
Emory Proton Therapy Center
Atlanta, Georgia 30308
Atlanta, Georgia 30308
Emory University Hospital Midtown
Atlanta, Georgia 30308
Atlanta, Georgia 30308
Contact:
Site Public Contact
888-946-7447
Site Public Contact
888-946-7447
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia 30322
Atlanta, Georgia 30322
Contact:
Site Public Contact
404-778-1868
Site Public Contact
404-778-1868
Emory Saint Joseph's Hospital
Atlanta, Georgia 30342
Atlanta, Georgia 30342
Contact:
Site Public Contact
404-851-7115
Site Public Contact
404-851-7115
Emory Decatur Hospital
Decatur, Georgia 30033
Decatur, Georgia 30033
Emory Johns Creek Hospital
Johns Creek, Georgia 30097
Johns Creek, Georgia 30097
CTCA at Southeastern Regional Medical Center
Newnan, Georgia 30265
Newnan, Georgia 30265
Contact:
Site Public Contact
770-400-6629
Site Public Contact
770-400-6629
South Georgia Medical Center/Pearlman Cancer Center
Valdosta, Georgia 31602
Valdosta, Georgia 31602
Hawaii Cancer Care - Westridge
'Aiea, Hawaii 96701
'Aiea, Hawaii 96701
Pali Momi Medical Center
'Aiea, Hawaii 96701
'Aiea, Hawaii 96701
Contact:
Site Public Contact
808-486-6000
Site Public Contact
808-486-6000
Queen's Cancer Center - Pearlridge
'Aiea, Hawaii 96701
'Aiea, Hawaii 96701
Contact:
Site Public Contact
808-487-7447
Site Public Contact
808-487-7447
The Cancer Center of Hawaii-Pali Momi
'Aiea, Hawaii 96701
'Aiea, Hawaii 96701
Contact:
Site Public Contact
808-678-9000
Site Public Contact
808-678-9000
The Queen's Medical Center - West Oahu
'Ewa Beach, Hawaii 96706
'Ewa Beach, Hawaii 96706
Hawaii Cancer Care Inc - Waterfront Plaza
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Queen's Cancer Cenrer - POB I
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-532-0315
Site Public Contact
808-532-0315
Queen's Medical Center
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-545-8548
Site Public Contact
808-545-8548
Straub Clinic and Hospital
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-522-4333
Site Public Contact
808-522-4333
University of Hawaii Cancer Center
Honolulu, Hawaii 96813
Honolulu, Hawaii 96813
Contact:
Site Public Contact
808-586-2979
Site Public Contact
808-586-2979
Kuakini Medical Center
Honolulu, Hawaii 96817
Honolulu, Hawaii 96817
Contact:
Site Public Contact
808-547-9816
Site Public Contact
808-547-9816
Queen's Cancer Center - Kuakini
Honolulu, Hawaii 96817
Honolulu, Hawaii 96817
Contact:
Site Public Contact
808-531-8521
Site Public Contact
808-531-8521
Kapiolani Medical Center for Women and Children
Honolulu, Hawaii 96826
Honolulu, Hawaii 96826
Contact:
Site Public Contact
808-983-6090
Site Public Contact
808-983-6090
Castle Medical Center
Kailua, Hawaii 96734
Kailua, Hawaii 96734
Wilcox Memorial Hospital and Kauai Medical Clinic
Lihue, Hawaii 96766
Lihue, Hawaii 96766
Contact:
Site Public Contact
808-535-7960
Site Public Contact
808-535-7960
Saint Luke's Cancer Institute - Boise
Boise, Idaho 83712
Boise, Idaho 83712
Saint Luke's Cancer Institute - Fruitland
Fruitland, Idaho 83619
Fruitland, Idaho 83619
Saint Luke's Cancer Institute - Meridian
Meridian, Idaho 83642
Meridian, Idaho 83642
Saint Luke's Cancer Institute - Nampa
Nampa, Idaho 83687
Nampa, Idaho 83687
Saint Luke's Cancer Institute - Twin Falls
Twin Falls, Idaho 83301
Twin Falls, Idaho 83301
Centralia Oncology Clinic
Centralia, Illinois 62801
Centralia, Illinois 62801
Saint Mary's Hospital
Centralia, Illinois 62801
Centralia, Illinois 62801
Northwestern University
Chicago, Illinois 60611
Chicago, Illinois 60611
John H Stroger Jr Hospital of Cook County
Chicago, Illinois 60612
Chicago, Illinois 60612
Contact:
Site Public Contact
312-864-5204
Site Public Contact
312-864-5204
University of Chicago Comprehensive Cancer Center
Chicago, Illinois 60637
Chicago, Illinois 60637
Cancer Care Specialists of Illinois - Decatur
Decatur, Illinois 62526
Decatur, Illinois 62526
Decatur Memorial Hospital
Decatur, Illinois 62526
Decatur, Illinois 62526
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois 60115
DeKalb, Illinois 60115
Crossroads Cancer Center
Effingham, Illinois 62401
Effingham, Illinois 62401
Elmhurst Memorial Hospital
Elmhurst, Illinois 60126
Elmhurst, Illinois 60126
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois 60134
Geneva, Illinois 60134
Northwestern Medicine Glenview Outpatient Center
Glenview, Illinois 60026
Glenview, Illinois 60026
Contact:
Site Public Contact
312-695-1102
Site Public Contact
312-695-1102
Northwestern Medicine Grayslake Outpatient Center
Grayslake, Illinois 60030
Grayslake, Illinois 60030
Contact:
Site Public Contact
312-695-1102
Site Public Contact
312-695-1102
Ingalls Memorial Hospital
Harvey, Illinois 60426
Harvey, Illinois 60426
Northwestern Medicine Lake Forest Hospital
Lake Forest, Illinois 60045
Lake Forest, Illinois 60045
Loyola University Medical Center
Maywood, Illinois 60153
Maywood, Illinois 60153
Contact:
Site Public Contact
708-226-4357
Site Public Contact
708-226-4357
Edward Hospital/Cancer Center
Naperville, Illinois 60540
Naperville, Illinois 60540
Contact:
Site Public Contact
630-646-6075
Site Public Contact
630-646-6075
UC Comprehensive Cancer Center at Silver Cross
New Lenox, Illinois 60451
New Lenox, Illinois 60451
Cancer Care Center of O'Fallon
O'Fallon, Illinois 62269
O'Fallon, Illinois 62269
HSHS Saint Elizabeth's Hospital
O'Fallon, Illinois 62269
O'Fallon, Illinois 62269
Northwestern Medicine Orland Park
Orland Park, Illinois 60462
Orland Park, Illinois 60462
University of Chicago Medicine-Orland Park
Orland Park, Illinois 60462
Orland Park, Illinois 60462
Southern Illinois University School of Medicine
Springfield, Illinois 62702
Springfield, Illinois 62702
Contact:
Site Public Contact
217-545-7929
Site Public Contact
217-545-7929
Springfield Clinic
Springfield, Illinois 62702
Springfield, Illinois 62702
Contact:
Site Public Contact
800-444-7541
Site Public Contact
800-444-7541
Springfield Memorial Hospital
Springfield, Illinois 62781
Springfield, Illinois 62781
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois 60555
Warrenville, Illinois 60555
Midwestern Regional Medical Center
Zion, Illinois 60099
Zion, Illinois 60099
Contact:
Site Public Contact
844-793-0745
Site Public Contact
844-793-0745
UChicago Medicine Northwest Indiana
Crown Point, Indiana 46307
Crown Point, Indiana 46307
Goshen Center for Cancer Care
Goshen, Indiana 46526
Goshen, Indiana 46526
Reid Health
Richmond, Indiana 47374
Richmond, Indiana 47374
Mary Greeley Medical Center
Ames, Iowa 50010
Ames, Iowa 50010
Contact:
Site Public Contact
515-956-4132
Site Public Contact
515-956-4132
McFarland Clinic - Ames
Ames, Iowa 50010
Ames, Iowa 50010
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny, Iowa 50023
Ankeny, Iowa 50023
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
Physicians' Clinic of Iowa PC
Cedar Rapids, Iowa 52402
Cedar Rapids, Iowa 52402
Contact:
Site Public Contact
319-297-2900
Site Public Contact
319-297-2900
Mercy Cancer Center-West Lakes
Clive, Iowa 50325
Clive, Iowa 50325
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive, Iowa 50325
Clive, Iowa 50325
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
Greater Regional Medical Center
Creston, Iowa 50801
Creston, Iowa 50801
Iowa Methodist Medical Center
Des Moines, Iowa 50309
Des Moines, Iowa 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, Iowa 50309
Des Moines, Iowa 50309
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
Mercy Medical Center - Des Moines
Des Moines, Iowa 50314
Des Moines, Iowa 50314
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines, Iowa 50314
Des Moines, Iowa 50314
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
UI Health Care Mission Cancer and Blood - Waukee Clinic
Waukee, Iowa 50263
Waukee, Iowa 50263
Contact:
Site Public Contact
515-241-3305
Site Public Contact
515-241-3305
Mercy Medical Center-West Lakes
West Des Moines, Iowa 50266
West Des Moines, Iowa 50266
University of Kansas Cancer Center
Kansas City, Kansas 66160
Kansas City, Kansas 66160
The University of Kansas Cancer Center - Olathe
Olathe, Kansas 66061
Olathe, Kansas 66061
University of Kansas Cancer Center-Overland Park
Overland Park, Kansas 66210
Overland Park, Kansas 66210
University of Kansas Hospital-Indian Creek Campus
Overland Park, Kansas 66211
Overland Park, Kansas 66211
Salina Regional Health Center
Salina, Kansas 67401
Salina, Kansas 67401
University of Kansas Health System Saint Francis Campus
Topeka, Kansas 66606
Topeka, Kansas 66606
Contact:
Site Public Contact
785-295-8000
Site Public Contact
785-295-8000
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas 66205
Westwood, Kansas 66205
The James Graham Brown Cancer Center at University of Louisville
Louisville, Kentucky 40202
Louisville, Kentucky 40202
Contact:
Site Public Contact
502-562-3429
Site Public Contact
502-562-3429
UofL Health Medical Center Northeast
Louisville, Kentucky 40245
Louisville, Kentucky 40245
Greater Baltimore Medical Center
Baltimore, Maryland 21204
Baltimore, Maryland 21204
Contact:
Site Public Contact
443-849-3706
Site Public Contact
443-849-3706
UM Upper Chesapeake Medical Center
Bel Air, Maryland 21014
Bel Air, Maryland 21014
Contact:
Site Public Contact
443-643-3010
Site Public Contact
443-643-3010
University of Maryland Shore Medical Center at Easton
Easton, Maryland 21601
Easton, Maryland 21601
Bronson Battle Creek
Battle Creek, Michigan 49017
Battle Creek, Michigan 49017
Henry Ford Cancer Institute-Downriver
Brownstown, Michigan 48183
Brownstown, Michigan 48183
Michigan Healthcare Professionals Clarkston
Clarkston, Michigan 48346
Clarkston, Michigan 48346
Henry Ford Macomb Hospital-Clinton Township
Clinton Township, Michigan 48038
Clinton Township, Michigan 48038
Henry Ford Medical Center-Fairlane
Dearborn, Michigan 48126
Dearborn, Michigan 48126
Henry Ford Hospital
Detroit, Michigan 48202
Detroit, Michigan 48202
OSF Saint Francis Hospital and Medical Group
Escanaba, Michigan 49829
Escanaba, Michigan 49829
Michigan Healthcare Professionals Farmington
Farmington Hills, Michigan 48334
Farmington Hills, Michigan 48334
Genesys Hurley Cancer Institute
Flint, Michigan 48503
Flint, Michigan 48503
Hurley Medical Center
Flint, Michigan 48503
Flint, Michigan 48503
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids, Michigan 49503
Grand Rapids, Michigan 49503
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids, Michigan 49503
Grand Rapids, Michigan 49503
Trinity Health Grand Rapids Hospital
Grand Rapids, Michigan 49503
Grand Rapids, Michigan 49503
Allegiance Health
Jackson, Michigan 49201
Jackson, Michigan 49201
Michigan Healthcare Professionals Macomb
Macomb, Michigan 48044
Macomb, Michigan 48044
Michigan Healthcare Professionals Madison Heights
Madison Heights, Michigan 48071
Madison Heights, Michigan 48071
Henry Ford Medical Center-Columbus
Novi, Michigan 48377
Novi, Michigan 48377
Trinity Health Saint Joseph Mercy Oakland Hospital
Pontiac, Michigan 48341
Pontiac, Michigan 48341
Corewell Health William Beaumont University Hospital
Royal Oak, Michigan 48073
Royal Oak, Michigan 48073
Contact:
Site Public Contact
248-551-7695
Site Public Contact
248-551-7695
MyMichigan Medical Center Saginaw
Saginaw, Michigan 48601
Saginaw, Michigan 48601
MyMichigan Medical Center Tawas
Tawas City, Michigan 48764
Tawas City, Michigan 48764
Corewell Health Beaumont Troy Hospital
Troy, Michigan 48085
Troy, Michigan 48085
Contact:
Site Public Contact
248-551-7695
Site Public Contact
248-551-7695
Michigan Healthcare Professionals Troy
Troy, Michigan 48098
Troy, Michigan 48098
Henry Ford West Bloomfield Hospital
West Bloomfield, Michigan 48322
West Bloomfield, Michigan 48322
University of Michigan Health - West
Wyoming, Michigan 49519
Wyoming, Michigan 49519
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota 56601
Bemidji, Minnesota 56601
Essentia Health Saint Joseph's Medical Center
Brainerd, Minnesota 56401
Brainerd, Minnesota 56401
Mercy Hospital
Coon Rapids, Minnesota 55433
Coon Rapids, Minnesota 55433
Essentia Health - Deer River Clinic
Deer River, Minnesota 56636
Deer River, Minnesota 56636
Essentia Health Cancer Center
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Essentia Health Saint Mary's Medical Center
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Miller-Dwan Hospital
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Saint Luke's Hospital of Duluth
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Fairview Southdale Hospital
Edina, Minnesota 55435
Edina, Minnesota 55435
Essentia Health Hibbing Clinic
Hibbing, Minnesota 55746
Hibbing, Minnesota 55746
Contact:
Site Public Contact
218-786-3308
Site Public Contact
218-786-3308
Abbott-Northwestern Hospital
Minneapolis, Minnesota 55407
Minneapolis, Minnesota 55407
Monticello Cancer Center
Monticello, Minnesota 55362
Monticello, Minnesota 55362
Coborn Cancer Center at Saint Cloud Hospital
Saint Cloud, Minnesota 56303
Saint Cloud, Minnesota 56303
Regions Hospital
Saint Paul, Minnesota 55101
Saint Paul, Minnesota 55101
United Hospital
Saint Paul, Minnesota 55102
Saint Paul, Minnesota 55102
Essentia Health Sandstone
Sandstone, Minnesota 55072
Sandstone, Minnesota 55072
Saint Francis Regional Medical Center
Shakopee, Minnesota 55379
Shakopee, Minnesota 55379
Lakeview Hospital
Stillwater, Minnesota 55082
Stillwater, Minnesota 55082
Essentia Health Virginia Clinic
Virginia, Minnesota 55792
Virginia, Minnesota 55792
Ridgeview Medical Center
Waconia, Minnesota 55387
Waconia, Minnesota 55387
Baptist Memorial Hospital and Cancer Center-Golden Triangle
Columbus, Mississippi 39705
Columbus, Mississippi 39705
Baptist Cancer Center-Grenada
Grenada, Mississippi 38901
Grenada, Mississippi 38901
Baptist Memorial Hospital and Cancer Center-Union County
New Albany, Mississippi 38652
New Albany, Mississippi 38652
Baptist Memorial Hospital and Cancer Center-Oxford
Oxford, Mississippi 38655
Oxford, Mississippi 38655
Baptist Memorial Hospital and Cancer Center-Desoto
Southhaven, Mississippi 38671
Southhaven, Mississippi 38671
Saint Francis Medical Center
Cape Girardeau, Missouri 63703
Cape Girardeau, Missouri 63703
Parkland Health Center - Farmington
Farmington, Missouri 63640
Farmington, Missouri 63640
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
University of Kansas Cancer Center - North
Kansas City, Missouri 64154
Kansas City, Missouri 64154
University of Kansas Cancer Center - Lee's Summit
Lee's Summit, Missouri 64064
Lee's Summit, Missouri 64064
University of Kansas Cancer Center at North Kansas City Hospital
North Kansas City, Missouri 64116
North Kansas City, Missouri 64116
Mercy Hospital South
Saint Louis, Missouri 63128
Saint Louis, Missouri 63128
Missouri Baptist Medical Center
Saint Louis, Missouri 63131
Saint Louis, Missouri 63131
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Mercy Hospital Saint Louis
Saint Louis, Missouri 63141
Saint Louis, Missouri 63141
Contact:
Site Public Contact
314-251-7066
Site Public Contact
314-251-7066
Sainte Genevieve County Memorial Hospital
Sainte Genevieve, Missouri 63670
Sainte Genevieve, Missouri 63670
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Mercy Hospital Springfield
Springfield, Missouri 65804
Springfield, Missouri 65804
Contact:
Site Public Contact
417-269-4520
Site Public Contact
417-269-4520
Missouri Baptist Sullivan Hospital
Sullivan, Missouri 63080
Sullivan, Missouri 63080
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
BJC Outpatient Center at Sunset Hills
Sunset Hills, Missouri 63127
Sunset Hills, Missouri 63127
Contact:
Site Public Contact
314-996-5569
Site Public Contact
314-996-5569
Billings Clinic Cancer Center
Billings, Montana 59101
Billings, Montana 59101
Bozeman Health Deaconess Hospital
Bozeman, Montana 59715
Bozeman, Montana 59715
Nebraska Medicine-Bellevue
Bellevue, Nebraska 68123
Bellevue, Nebraska 68123
CHI Health Good Samaritan
Kearney, Nebraska 68847
Kearney, Nebraska 68847
Cancer Partners of Nebraska
Lincoln, Nebraska 68516
Lincoln, Nebraska 68516
Nebraska Medicine-Village Pointe
Omaha, Nebraska 68118
Omaha, Nebraska 68118
Contact:
Site Public Contact
402-559-5600
Site Public Contact
402-559-5600
University of Nebraska Medical Center
Omaha, Nebraska 68198
Omaha, Nebraska 68198
OptumCare Cancer Care at Seven Hills
Henderson, Nevada 89052
Henderson, Nevada 89052
OptumCare Cancer Care at Charleston
Las Vegas, Nevada 89102
Las Vegas, Nevada 89102
Radiation Oncology Centers of Nevada Central
Las Vegas, Nevada 89106
Las Vegas, Nevada 89106
Radiation Oncology Centers of Nevada Southeast
Las Vegas, Nevada 89119
Las Vegas, Nevada 89119
OptumCare Cancer Care at MountainView
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas, Nevada 89135
Las Vegas, Nevada 89135
Summerlin Hospital Medical Center
Las Vegas, Nevada 89144
Las Vegas, Nevada 89144
Comprehensive Cancer Centers of Nevada
Las Vegas, Nevada 89148
Las Vegas, Nevada 89148
OptumCare Cancer Care at Fort Apache
Las Vegas, Nevada 89148
Las Vegas, Nevada 89148
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire 03756
Lebanon, New Hampshire 03756
Memorial Sloan Kettering Basking Ridge
Basking Ridge, New Jersey 07920
Basking Ridge, New Jersey 07920
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Memorial Sloan Kettering Monmouth
Middletown, New Jersey 07748
Middletown, New Jersey 07748
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Memorial Sloan Kettering Bergen
Montvale, New Jersey 07645
Montvale, New Jersey 07645
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Northwell Health Imbert Cancer Center
Bay Shore, New York 11706
Bay Shore, New York 11706
Contact:
Site Public Contact
516-734-8896
Site Public Contact
516-734-8896
Montefiore Medical Center-Einstein Campus
Bronx, New York 10461
Bronx, New York 10461
Montefiore Medical Center-Weiler Hospital
Bronx, New York 10461
Bronx, New York 10461
Montefiore Medical Center - Moses Campus
Bronx, New York 10467
Bronx, New York 10467
Sands Cancer Center
Canandaigua, New York 14424
Canandaigua, New York 14424
Contact:
Site Public Contact
585-396-6161
Site Public Contact
585-396-6161
Memorial Sloan Kettering Commack
Commack, New York 11725
Commack, New York 11725
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Noyes Memorial Hospital/Myers Cancer Center
Dansville, New York 14437
Dansville, New York 14437
Northwell Health Cancer Institute at Huntington
Greenlawn, New York 11740
Greenlawn, New York 11740
Contact:
Site Public Contact
516-734-8896
Site Public Contact
516-734-8896
Memorial Sloan Kettering Westchester
Harrison, New York 10604
Harrison, New York 10604
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Northwell Health/Center for Advanced Medicine
Lake Success, New York 11042
Lake Success, New York 11042
Contact:
Site Public Contact
516-734-8896
Site Public Contact
516-734-8896
Northern Westchester Hospital
Mount Kisco, New York 10549
Mount Kisco, New York 10549
Memorial Sloan Kettering Cancer Center
New York, New York 10065
New York, New York 10065
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Upstate Cancer Center at Oswego
Oswego, New York 13126
Oswego, New York 13126
Wilmot Cancer Institute Radiation Oncology at Greece
Rochester, New York 14606
Rochester, New York 14606
Contact:
Site Public Contact
585-758-7877
Site Public Contact
585-758-7877
Highland Hospital
Rochester, New York 14620
Rochester, New York 14620
Contact:
Site Public Contact
585-341-8113
Site Public Contact
585-341-8113
Pluta Cancer Center
Rochester, New York 14623
Rochester, New York 14623
University of Rochester
Rochester, New York 14642
Rochester, New York 14642
Contact:
Site Public Contact
585-275-5830
Site Public Contact
585-275-5830
Phelps Memorial Hospital Center
Sleepy Hollow, New York 10591
Sleepy Hollow, New York 10591
Contact:
Site Public Contact
914-366-1600
Site Public Contact
914-366-1600
Staten Island University Hospital
Staten Island, New York 10305
Staten Island, New York 10305
Contact:
Site Public Contact
718-226-8888
Site Public Contact
718-226-8888
Stony Brook University Medical Center
Stony Brook, New York 11794
Stony Brook, New York 11794
Contact:
Site Public Contact
800-862-2215
Site Public Contact
800-862-2215
State University of New York Upstate Medical University
Syracuse, New York 13210
Syracuse, New York 13210
Contact:
Site Public Contact
315-464-5476
Site Public Contact
315-464-5476
SUNY Upstate Medical Center-Community Campus
Syracuse, New York 13215
Syracuse, New York 13215
Contact:
Site Public Contact
315-464-5476
Site Public Contact
315-464-5476
Memorial Sloan Kettering Nassau
Uniondale, New York 11553
Uniondale, New York 11553
Contact:
Site Public Contact
212-639-7592
Site Public Contact
212-639-7592
Upstate Cancer Center at Verona
Verona, New York 13478
Verona, New York 13478
Wilmot Cancer Institute at Webster
Webster, New York 14580
Webster, New York 14580
East Carolina University
Greenville, North Carolina 27834
Greenville, North Carolina 27834
Sanford Bismarck Medical Center
Bismarck, North Dakota 58501
Bismarck, North Dakota 58501
Sanford Broadway Medical Center
Fargo, North Dakota 58122
Fargo, North Dakota 58122
Sanford Roger Maris Cancer Center
Fargo, North Dakota 58122
Fargo, North Dakota 58122
Indu and Raj Soin Medical Center
Beavercreek, Ohio 45431
Beavercreek, Ohio 45431
Cleveland Clinic Mercy Hospital
Canton, Ohio 44708
Canton, Ohio 44708
Contact:
Site Public Contact
888-293-4673
Site Public Contact
888-293-4673
Dayton Physicians LLC-Miami Valley South
Centerville, Ohio 45459
Centerville, Ohio 45459
Miami Valley Hospital South
Centerville, Ohio 45459
Centerville, Ohio 45459
Ohio State University Comprehensive Cancer Center
Columbus, Ohio 43210
Columbus, Ohio 43210
Riverside Methodist Hospital
Columbus, Ohio 43214
Columbus, Ohio 43214
Grant Medical Center
Columbus, Ohio 43215
Columbus, Ohio 43215
Doctors Hospital
Columbus, Ohio 43228
Columbus, Ohio 43228
Miami Valley Hospital
Dayton, Ohio 45409
Dayton, Ohio 45409
Premier Blood and Cancer Center
Dayton, Ohio 45409
Dayton, Ohio 45409
Contact:
Site Public Contact
937-276-8320
Site Public Contact
937-276-8320
Dayton Physician LLC - Englewood
Dayton, Ohio 45415
Dayton, Ohio 45415
Miami Valley Hospital North
Dayton, Ohio 45415
Dayton, Ohio 45415
Delaware Health Center-Grady Cancer Center
Delaware, Ohio 43015
Delaware, Ohio 43015
Grady Memorial Hospital
Delaware, Ohio 43015
Delaware, Ohio 43015
Dublin Methodist Hospital
Dublin, Ohio 43016
Dublin, Ohio 43016
Atrium Medical Center-Middletown Regional Hospital
Franklin, Ohio 45005-1066
Franklin, Ohio 45005-1066
Dayton Physicians LLC-Atrium
Franklin, Ohio 45005
Franklin, Ohio 45005
Miami Valley Cancer Care and Infusion
Greenville, Ohio 45331
Greenville, Ohio 45331
Contact:
Site Public Contact
937-569-7515
Site Public Contact
937-569-7515
Kettering Medical Center
Kettering, Ohio 45429
Kettering, Ohio 45429
OhioHealth Mansfield Hospital
Mansfield, Ohio 44903
Mansfield, Ohio 44903
OhioHealth Marion General Hospital
Marion, Ohio 43302
Marion, Ohio 43302
Dayton Physicians LLC - Troy
Troy, Ohio 45373
Troy, Ohio 45373
Upper Valley Medical Center
Troy, Ohio 45373
Troy, Ohio 45373
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma 73104
Oklahoma City, Oklahoma 73104
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma 73120
Oklahoma City, Oklahoma 73120
Contact:
Site Public Contact
405-752-3402
Site Public Contact
405-752-3402
Saint Charles Health System
Bend, Oregon 97701
Bend, Oregon 97701
Clackamas Radiation Oncology Center
Clackamas, Oregon 97015
Clackamas, Oregon 97015
Legacy Mount Hood Medical Center
Gresham, Oregon 97030
Gresham, Oregon 97030
Contact:
Site Public Contact
503-413-2150
Site Public Contact
503-413-2150
Providence Newberg Medical Center
Newberg, Oregon 97132
Newberg, Oregon 97132
Providence Willamette Falls Medical Center
Oregon City, Oregon 97045
Oregon City, Oregon 97045
Legacy Good Samaritan Hospital and Medical Center
Portland, Oregon 97210
Portland, Oregon 97210
Providence Portland Medical Center
Portland, Oregon 97213
Portland, Oregon 97213
Providence Saint Vincent Medical Center
Portland, Oregon 97225
Portland, Oregon 97225
Legacy Meridian Park Hospital
Tualatin, Oregon 97062
Tualatin, Oregon 97062
Contact:
Site Public Contact
503-413-1742
Site Public Contact
503-413-1742
Penn State Milton S Hershey Medical Center
Hershey, Pennsylvania 17033-0850
Hershey, Pennsylvania 17033-0850
UPMC-Magee Womens Hospital
Pittsburgh, Pennsylvania 15213
Pittsburgh, Pennsylvania 15213
Contact:
Site Public Contact
412-647-2811
Site Public Contact
412-647-2811
Women and Infants Hospital
Providence, Rhode Island 02905
Providence, Rhode Island 02905
Contact:
Site Public Contact
401-274-1122
Site Public Contact
401-274-1122
Kent Hospital
Warwick, Rhode Island 02886
Warwick, Rhode Island 02886
Contact:
Site Public Contact
401-737-7010
Site Public Contact
401-737-7010
Medical University of South Carolina
Charleston, South Carolina 29425
Charleston, South Carolina 29425
Lexington Medical Center
West Columbia, South Carolina 29169
West Columbia, South Carolina 29169
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota 57104
Sioux Falls, South Dakota 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota 57117-5134
Sioux Falls, South Dakota 57117-5134
Baptist Memorial Hospital and Cancer Center-Collierville
Collierville, Tennessee 38017
Collierville, Tennessee 38017
Baptist Memorial Hospital and Cancer Center-Memphis
Memphis, Tennessee 38120
Memphis, Tennessee 38120
MD Anderson in The Woodlands
Conroe, Texas 77384
Conroe, Texas 77384
M D Anderson Cancer Center
Houston, Texas 77030
Houston, Texas 77030
MD Anderson West Houston
Houston, Texas 77079
Houston, Texas 77079
MD Anderson League City
League City, Texas 77573
League City, Texas 77573
MD Anderson in Sugar Land
Sugar Land, Texas 77478
Sugar Land, Texas 77478
Farmington Health Center
Farmington, Utah 84025
Farmington, Utah 84025
University of Utah Sugarhouse Health Center
Salt Lake City, Utah 84106
Salt Lake City, Utah 84106
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah 84112
Salt Lake City, Utah 84112
University of Vermont Medical Center
Burlington, Vermont 05401
Burlington, Vermont 05401
University of Vermont and State Agricultural College
Burlington, Vermont 05405
Burlington, Vermont 05405
Dartmouth Cancer Center - North
Saint Johnsbury, Vermont 05819
Saint Johnsbury, Vermont 05819
Bon Secours Memorial Regional Medical Center
Mechanicsville, Virginia 23116
Mechanicsville, Virginia 23116
Bon Secours Saint Francis Medical Center
Midlothian, Virginia 23114
Midlothian, Virginia 23114
Bon Secours Saint Mary's Hospital
Richmond, Virginia 23226
Richmond, Virginia 23226
Bon Secours Cancer Institute at Reynolds Crossing
Richmond, Virginia 23230
Richmond, Virginia 23230
Swedish Cancer Institute-Edmonds
Edmonds, Washington 98026
Edmonds, Washington 98026
Swedish Cancer Institute-Issaquah
Issaquah, Washington 98029
Issaquah, Washington 98029
Skagit Regional Health Cancer Care Center
Mount Vernon, Washington 98274
Mount Vernon, Washington 98274
Swedish Medical Center-Ballard Campus
Seattle, Washington 98107
Seattle, Washington 98107
Swedish Medical Center-First Hill
Seattle, Washington 98122
Seattle, Washington 98122
Legacy Cancer Institute Medical Oncology and Day Treatment
Vancouver, Washington 98684
Vancouver, Washington 98684
Legacy Salmon Creek Hospital
Vancouver, Washington 98686
Vancouver, Washington 98686
Contact:
Site Public Contact
503-413-2150
Site Public Contact
503-413-2150
Langlade Hospital and Cancer Center
Antigo, Wisconsin 54409
Antigo, Wisconsin 54409
Duluth Clinic Ashland
Ashland, Wisconsin 54806
Ashland, Wisconsin 54806
Northwest Wisconsin Cancer Center
Ashland, Wisconsin 54806
Ashland, Wisconsin 54806
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin 54301
Green Bay, Wisconsin 54301
Essentia Health-Hayward Clinic
Hayward, Wisconsin 54843
Hayward, Wisconsin 54843
Froedtert Menomonee Falls Hospital
Menomonee Falls, Wisconsin 53051
Menomonee Falls, Wisconsin 53051
Contact:
Site Public Contact
262-257-5100
Site Public Contact
262-257-5100
Medical College of Wisconsin
Milwaukee, Wisconsin 53226
Milwaukee, Wisconsin 53226
Contact:
Site Public Contact
414-805-3666
Site Public Contact
414-805-3666
ProHealth D N Greenwald Center
Mukwonago, Wisconsin 53149
Mukwonago, Wisconsin 53149
Cancer Center of Western Wisconsin
New Richmond, Wisconsin 54017
New Richmond, Wisconsin 54017
Drexel Town Square Health Center
Oak Creek, Wisconsin 53154
Oak Creek, Wisconsin 53154
Contact:
Site Public Contact
414-805-0505
Site Public Contact
414-805-0505
ProHealth Oconomowoc Memorial Hospital
Oconomowoc, Wisconsin 53066
Oconomowoc, Wisconsin 53066
Contact:
Site Public Contact
262-928-7878
Site Public Contact
262-928-7878
Aspirus Cancer Care - James Beck Cancer Center
Rhinelander, Wisconsin 54501
Rhinelander, Wisconsin 54501
Saint Vincent Hospital Cancer Center at Sheboygan
Sheboygan, Wisconsin 53081
Sheboygan, Wisconsin 53081
Sheboygan Physicians Group
Sheboygan, Wisconsin 53081
Sheboygan, Wisconsin 53081
Essentia Health-Spooner Clinic
Spooner, Wisconsin 54801
Spooner, Wisconsin 54801
Aspirus Cancer Care - Stevens Point
Stevens Point, Wisconsin 54481
Stevens Point, Wisconsin 54481
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Sturgeon Bay, Wisconsin 54235-1495
Sturgeon Bay, Wisconsin 54235-1495
Essentia Health Saint Mary's Hospital - Superior
Superior, Wisconsin 54880
Superior, Wisconsin 54880
Contact:
Site Public Contact
701-364-6272
Site Public Contact
701-364-6272
UW Cancer Center at ProHealth Care
Waukesha, Wisconsin 53188
Waukesha, Wisconsin 53188
Aspirus Regional Cancer Center
Wausau, Wisconsin 54401
Wausau, Wisconsin 54401
Contact:
Site Public Contact
877-405-6866
Site Public Contact
877-405-6866
Froedtert West Bend Hospital/Kraemer Cancer Center
West Bend, Wisconsin 53095
West Bend, Wisconsin 53095
Contact:
Site Public Contact
414-805-0505
Site Public Contact
414-805-0505
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin 54494
Wisconsin Rapids, Wisconsin 54494
Contact:
Site Public Contact
715-422-7718
Site Public Contact
715-422-7718
Cancer Center-Metro Medical Center Bayamon
Bayamon, Puerto Rico 00959-5060
Bayamon, Puerto Rico 00959-5060
Contact:
Site Public Contact
787-395-7085
Site Public Contact
787-395-7085
Doctors Cancer Center
Manati, Puerto Rico 00674
Manati, Puerto Rico 00674
Contact:
Site Public Contact
787-621-4397
Site Public Contact
787-621-4397
San Juan Community Oncology Group
San Juan, Puerto Rico 00917
San Juan, Puerto Rico 00917
Contact:
Site Public Contact
787-274-3387
Site Public Contact
787-274-3387
Centro Comprensivo de Cancer de UPR
San Juan, Puerto Rico 00927
San Juan, Puerto Rico 00927
San Juan City Hospital
San Juan, Puerto Rico 00936
San Juan, 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.