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Combination Chemotherapy With or Without Ganitumab in Treating Patients With Newly Diagnosed Metastatic Ewing Sarcoma
Study Purpose
This randomized phase III trial studies how well combination chemotherapy with or without ganitumab works in treating patients with newly diagnosed Ewing sarcoma that has spread to other parts of the body. Treatment with drugs that block the IGF-1R pathway, such as ganitumab, may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether adding ganitumab to combination chemotherapy is more effective in treating patients with newly diagnosed metastatic Ewing sarcoma.
Recruitment Criteria
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Accepts Healthy Volunteers
Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms |
No |
|
Study Type
An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes. An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes. Searching Both is inclusive of interventional and observational studies. |
Interventional |
| Eligible Ages | N/A - 50 Years |
| Gender | All |
Inclusion Criteria:
- - Patients with histologic diagnosis (by institutional pathologist) of newly diagnosed Ewing sarcoma or peripheral primitive neuroectodermal tumor (PNET) arising from bone or soft tissue and with metastatic disease involving lung, bone, bone marrow, or other metastatic site.
- - For the purpose of this study metastatic disease is defined as one or more of the following: - Lesions which are discontinuous from the primary tumor, are not regional lymph nodes, and do not share a bone or body cavity with the primary tumor; skip lesions in the same bone as the primary tumor do not constitute metastatic disease; skip lesions in an adjacent bone are considered bone metastases; if there is any doubt whether lesions are metastatic, a biopsy of those lesions should be performed.
- - Contralateral pleural effusion and/or contralateral pleural nodules.
- - Distant lymph node involvement.
- - Patients with pulmonary nodules are considered to have metastatic disease if the patient has: - Solitary nodule >= 0.5 cm or multiple nodules of >= 0.3 cm unless lesion is biopsied and negative for tumor.
- - Patients with solitary nodule < 0.5 cm or multiple nodules < 0.3 cm are not considered to have lung metastasis unless biopsy documents tumor.
- - Bone marrow metastatic disease is based on morphologic evidence of Ewing sarcoma based on hematoxylin and eosin (H&E) stains; in the absence of morphologic evidence of marrow involvement on H&E, patients with bone marrow involvement detected ONLY by flow cytometry, reverse-transcriptase (RT)-polymerase chain reaction (PCR), fluorescence in situ hybridization (FISH), or immunohistochemistry will NOT be considered to have clinical bone marrow involvement for the purposes of this study.
- - This study requires bilateral bone marrow biopsies at study entry; the suggested approach for patients with large pelvic tumors in which a posterior iliac crest bone marrow biopsy would track through the tumor is to instead undergo 2 marrow biopsies on the contralateral side (either 2 posterior biopsies or one posterior and one anterior biopsy) - Bone metastasis: This study utilizes whole body FDG-PET scans to screen patients for bone metastases; areas suspicious for bone metastasis based on FDG-PET scans require confirmatory anatomic imaging with either MRI or computed tomography (CT) (whole body FDG-PET/CT or FDG-PET/magnetic resonance [MR] scan acceptable); whole body technetium bone scans may be performed at the discretion of the investigator and are not required; for patients without other sites of metastatic disease whose sole metastatic site to qualify for study entry is a single area suspicious for bone metastasis identified by FDG-PET, confirmatory biopsy or anatomic imaging evidence of an associated soft tissue mass at that site is required for study entry.
- - Patients must have adequate tumor tissue to meet the minimum requirement for submission.
- - Enrolling institutions are reminded that submission of pre-treatment serum, tumor tissue and whole blood is required.
- - Patients should only have had a biopsy of the primary tumor without an attempt at complete or partial resection; patients will still be eligible if excision was attempted or accomplished as long as adequate anatomic imaging (MRI for most primary tumor sites) was obtained prior to surgery.
- - Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows (performed within 7 days prior to enrollment): - Age < 6 months: Maximum serum creatinine (mg/dL): 0.4 for males and females.
- - Age 6 months to < 1 year: Maximum serum creatinine (mg/dL): 0.5 for males and females.
- - Age 1 to < 2 years: Maximum serum creatinine (mg/dL): 0.6 for males and females.
- - Age 2 to < 6 years: Maximum serum creatinine (mg/dL): 0.8 for males and females.
- - Age 6 to < 10 years: Maximum serum creatinine (mg/dL): 1 for males and females.
- - Age 10 to < 13 years: Maximum serum creatinine (mg/dL): 1.2 for males and females.
- - Age 13 to < 16 years: Maximum serum creatinine (mg/dL): 1.5 for males and 1.4 for females.
- - Age >= 16 years: Maximum serum creatinine (mg/dL): 1.7 for males and 1.4 for females.
- - Total bilirubin =< 1.5 x upper limit of normal (ULN) for age (performed within 7 days prior to enrollment), and.
- - Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 3 x upper limit of normal (ULN) for age (performed within 7 days prior to enrollment) (except for patients with liver metastasis who may enroll if ALT < 5 times ULN for age) - Shortening fraction of >= 27% or.
- - Ejection fraction of >= 50% - Patients must have a normal blood sugar level for age to participate; if an initial random draw (ie. non-fasting) blood glucose value is out of range, it is acceptable to repeat this test as a fasting draw.
- - All patients and/or their parents or legal guardians must sign a written informed consent.
- - All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met.
Exclusion Criteria:
- - Patients with regional node involvement as their only site of disease beyond the primary tumor will not be eligible.
- - Patients whose primary tumors arise in the intra-dural soft tissue (e.g. brain and spinal cord) are not eligible.
- - Patients who have received prior chemotherapy or radiation therapy are not eligible.
- - Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained; lactating females are not eligible unless they have agreed not to breastfeed their infants for the duration of protocol therapy; sexually active patients of reproductive potential are not eligible unless they have agreed to use an effective contraceptive method for the duration of protocol therapy.
- - Patients with known pre-existing diabetes mellitus will be excluded from study.
Trial Details
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Trial ID:
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries. |
NCT02306161 |
|
Phase
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans. Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data. Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs. Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use. |
Phase 3 |
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Lead Sponsor
The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data. |
National Cancer Institute (NCI) |
|
Principal Investigator
The person who is responsible for the scientific and technical direction of the entire clinical study. |
Steven G DuBois |
| Principal Investigator Affiliation | Children's Oncology Group |
|
Agency Class
Category of organization(s) involved as sponsor (and collaborator) supporting the trial. |
NIH |
| Overall Status | Active, not recruiting |
| Countries | Canada, Puerto Rico, United States |
|
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied. |
Metastatic Ewing Sarcoma, Metastatic Malignant Neoplasm in the Bone, Metastatic Malignant Neoplasm in the Bone Marrow, Metastatic Malignant Neoplasm in the Lung, Metastatic Peripheral Primitive Neuroectodermal Tumor of Bone, Peripheral Primitive Neuroectodermal Tumor of Soft Tissues |
| Study Website: | View Trial Website |
PRIMARY OBJECTIVES:
- I. To determine if event-free survival (EFS) in patients with newly diagnosed metastatic Ewing sarcoma treated with multiagent chemotherapy is improved with the addition of ganitumab (AMG 479).
- I. To describe the toxicity of the addition of ganitumab to multimodality therapy for patients with newly diagnosed metastatic Ewing sarcoma.
- II. To compare overall survival in patients with newly diagnosed metastatic Ewing sarcoma treated with multiagent chemotherapy with and without the addition of ganitumab.
- I. To compare bone marrow response rates in patients with newly diagnosed metastatic Ewing sarcoma treated with multiagent chemotherapy with and without the addition of ganitumab.
- II. To describe the toxicity of 6 months of ganitumab monotherapy as maintenance therapy following multimodality therapy in patients with newly diagnosed metastatic Ewing sarcoma.
- III. To describe trough levels of ganitumab in a cohort of patients with Ewing sarcoma < 21 years of age treated with 18 mg/kg.
- IV. To describe the feasibility of and local failure rates following hypofractionated stereotactic body radiotherapy (SBRT) directed at bone metastases in patients with newly diagnosed metastatic Ewing sarcoma.
- V. To determine if EFS, overall survival, bone marrow response rates, and toxicity differ based on serum markers of the insulin-like growth factor 1 (IGF-1) pathway in patients with newly diagnosed metastatic Ewing sarcoma treated with interval compressed chemotherapy with and without the addition of ganitumab.
- VI. To determine if EFS, overall survival, and bone marrow response rates differ based on protein, deoxyribose nucleic acid (DNA), and ribonucleic acid (RNA) marker in patients with newly diagnosed metastatic Ewing sarcoma treated with interval compressed chemotherapy with and without the addition of ganitumab.
- VII. To evaluate bone marrow micrometastatic disease and tumor cell surface IGF-1R expression at diagnosis and after 3 and 6 cycles of study therapy in patients with newly diagnosed metastatic Ewing sarcoma.
- VIII. To determine if the presence of germline polymorphisms in EGFR correlate with response to multiagent therapy with and without ganitumab.
- IX. To investigate the ability of fludeoxyglucose F 18-positron emission tomography (FDG-PET) to augment conventional response assessment of primary Ewing sarcoma tumors by magnetic resonance imaging (MRI).
- X. To explore FDG-PET response at the primary tumor as a prognostic marker and as a predictive biomarker of clinical activity of IGF-1R inhibition in patients with newly diagnosed metastatic Ewing sarcoma.
Arms
Experimental: Regimen A (VDC/IE)
See Design Details.
Experimental: Regimen B (VDC/IE + ganitumab)
INDUCTION THERAPY: Patients receive Induction therapy as in Regimen A and receive ganitumab IV over 30-60 minutes or 60-120 minutes on day 1 of weeks 1, 3, 5, 7, 9, and 11. LOCAL CONTROL THERAPY: Between weeks 13-18, patients undergo surgery and/or radiation therapy. CONSOLIDATION THERAPY: Patients receive Consolidation therapy as in Regimen A and receive ganitumab IV over 30-60 minutes or 60-120 minutes on day 1 of weeks 7, 9, 11, 13, and 15. METASTATIC SITE IRRADIATION: Patients with lung metastases undergo whole lung radiation and patients with bone metastases undergo definitive SBRT or EBRT. MAINTENANCE: Patients receive ganitumab IV over 30-60 minutes or 60-120 minutes every 3 weeks for 8 cycles.
Interventions
Drug: - Cyclophosphamide
Given IV
Drug: - Doxorubicin
Given IV
Drug: - Doxorubicin Hydrochloride
Given IV
Drug: - Etoposide
Given IV
Drug: - Etoposide Phosphate
Given IV
Radiation: - External Beam Radiation Therapy
Undergo EBRT
Biological: - Ganitumab
Given IV
Drug: - Ifosfamide
Given IV
Radiation: - Stereotactic Radiosurgery
Undergo SBRT
Procedure: - Therapeutic Surgical Procedure
Undergo surgery
Drug: - Vincristine
Given IV
Drug: - Vincristine Sulfate
Given IV
Contact a Trial Team
If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.
Status
Address
Children's Hospital of Alabama
Birmingham, Alabama, 35233
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USA Health Strada Patient Care Center
Mobile, Alabama, 36604
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Address
Providence Alaska Medical Center
Anchorage, Alaska, 99508
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Address
Banner Children's at Desert
Mesa, Arizona, 85202
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Address
Phoenix Childrens Hospital
Phoenix, Arizona, 85016
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Address
Banner University Medical Center - Tucson
Tucson, Arizona, 85719
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Address
Onvida Health Yuma Medical Center
Yuma, Arizona, 85364
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Address
CHI Saint Vincent Cancer Center Hot Springs
Hot Springs, Arkansas, 71913
Status
Address
Arkansas Children's Hospital
Little Rock, Arkansas, 72202-3591
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Address
Kaiser Permanente Downey Medical Center
Downey, California, 90242
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Address
City of Hope Comprehensive Cancer Center
Duarte, California, 91010
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Address
Loma Linda University Medical Center
Loma Linda, California, 92354
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Address
Miller Children's and Women's Hospital Long Beach
Long Beach, California, 90806
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Address
Children's Hospital Los Angeles
Los Angeles, California, 90027
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Address
Valley Children's Hospital
Madera, California, 93636
Status
Address
UCSF Benioff Children's Hospital Oakland
Oakland, California, 94609
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Address
Kaiser Permanente-Oakland
Oakland, California, 94611
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Address
Children's Hospital of Orange County
Orange, California, 92868
Status
Address
Lucile Packard Children's Hospital Stanford University
Palo Alto, California, 94304
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Address
Sutter Medical Center Sacramento
Sacramento, California, 95816
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Address
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
Status
Address
Rady Children's Hospital - San Diego
San Diego, California, 92123
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Address
UCSF Medical Center-Parnassus
San Francisco, California, 94143
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Address
UCSF Medical Center-Mission Bay
San Francisco, California, 94158
Status
Address
Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
Torrance, California, 90502
Status
Address
Children's Hospital Colorado
Aurora, Colorado, 80045
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Address
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado, 80907
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Address
Rocky Mountain Cancer Centers-Penrose
Colorado Springs, Colorado, 80907
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Address
AdventHealth Porter
Denver, Colorado, 80210
Status
Address
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
Denver, Colorado, 80218
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Address
Mercy Medical Center
Durango, Colorado, 81301
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Address
Southwest Oncology PC
Durango, Colorado, 81301
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Address
Mountain Blue Cancer Care Center
Golden, Colorado, 80401
Status
Address
Rocky Mountain Cancer Centers-Lakewood
Lakewood, Colorado, 80228
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Address
Saint Anthony Hospital
Lakewood, Colorado, 80228
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Address
AdventHealth Littleton
Littleton, Colorado, 80122
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Address
Longmont United Hospital
Longmont, Colorado, 80501
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Address
Rocky Mountain Cancer Centers-Longmont
Longmont, Colorado, 80501
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Address
AdventHealth Parker
Parker, Colorado, 80138
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Address
Rocky Mountain Cancer Centers-Parker
Parker, Colorado, 80138
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Address
Saint Mary Corwin Medical Center
Pueblo, Colorado, 81004
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Address
Rocky Mountain Cancer Centers - Pueblo
Pueblo, Colorado, 81008
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Address
Rocky Mountain Cancer Centers-Thornton
Thornton, Colorado, 80260
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Address
Connecticut Children's Medical Center
Hartford, Connecticut, 06106
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Address
Yale University
New Haven, Connecticut, 06520
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Address
Alfred I duPont Hospital for Children
Wilmington, Delaware, 19803
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Address
MedStar Georgetown University Hospital
Washington, District of Columbia, 20007
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Address
Children's National Medical Center
Washington, District of Columbia, 20010
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Address
Golisano Children's Hospital of Southwest Florida
Fort Myers, Florida, 33908
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Address
University of Florida Health Science Center - Gainesville
Gainesville, Florida, 32610
Status
Address
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
Hollywood, Florida, 33021
Status
Address
Nemours Children's Clinic-Jacksonville
Jacksonville, Florida, 32207
Status
Address
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
Status
Address
Nicklaus Children's Hospital
Miami, Florida, 33155
Status
Address
AdventHealth Orlando
Orlando, Florida, 32803
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Address
Arnold Palmer Hospital for Children
Orlando, Florida, 32806
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Address
Nemours Children's Hospital
Orlando, Florida, 32827
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Address
Nemours Children's Clinic - Pensacola
Pensacola, Florida, 32504
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Address
Johns Hopkins All Children's Hospital
Saint Petersburg, Florida, 33701
Status
Address
Saint Joseph's Hospital/Children's Hospital-Tampa
Tampa, Florida, 33607
Status
Address
Saint Mary's Medical Center
West Palm Beach, Florida, 33407
Status
Address
Children's Healthcare of Atlanta - Arthur M Blank Hospital
Atlanta, Georgia, 30329
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Address
Augusta University Medical Center
Augusta, Georgia, 30912
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Address
Memorial Health University Medical Center
Savannah, Georgia, 31404
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Address
Straub Clinic and Hospital
Honolulu, Hawaii, 96813
Status
Address
Kaiser Permanente Moanalua Medical Center
Honolulu, Hawaii, 96819
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Address
Kapiolani Medical Center for Women and Children
Honolulu, Hawaii, 96826
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Address
Saint Luke's Cancer Institute - Boise
Boise, Idaho, 83712
Status
Address
Rush - Copley Medical Center
Aurora, Illinois, 60504
Status
Address
Lurie Children's Hospital-Chicago
Chicago, Illinois, 60611
Status
Address
University of Illinois
Chicago, Illinois, 60612
Status
Address
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, 60637
Status
Address
Carle at The Riverfront
Danville, Illinois, 61832
Status
Address
Carle Physician Group-Effingham
Effingham, Illinois, 62401
Status
Address
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
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Address
Loyola University Medical Center
Maywood, Illinois, 60153
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Address
SSM Health Good Samaritan
Mount Vernon, Illinois, 62864
Status
Address
Advocate Children's Hospital-Oak Lawn
Oak Lawn, Illinois, 60453
Status
Address
Advocate Children's Hospital-Park Ridge
Park Ridge, Illinois, 60068
Status
Address
Saint Jude Midwest Affiliate
Peoria, Illinois, 61637
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Address
Saint John's Hospital
Springfield, Illinois, 62702
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Address
Southern Illinois University School of Medicine
Springfield, Illinois, 62702
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Address
Springfield Memorial Hospital
Springfield, Illinois, 62781
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Address
Carle Cancer Center
Urbana, Illinois, 61801
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Address
The Carle Foundation Hospital
Urbana, Illinois, 61801
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Address
Rush-Copley Healthcare Center
Yorkville, Illinois, 60560
Status
Address
Deaconess Clinic Downtown
Evansville, Indiana, 47713
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Address
Riley Hospital for Children
Indianapolis, Indiana, 46202
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Address
Ascension Saint Vincent Indianapolis Hospital
Indianapolis, Indiana, 46260
Status
Address
Franciscan Saint Anthony Health-Michigan City
Michigan City, Indiana, 46360
Status
Address
Woodland Cancer Care Center
Michigan City, Indiana, 46360
Status
Address
Chancellor Center for Oncology
Newburgh, Indiana, 47630
Status
Address
Mercy Cancer Center-West Lakes
Clive, Iowa, 50325
Status
Address
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive, Iowa, 50325
Status
Address
Alegent Health Mercy Hospital
Council Bluffs, Iowa, 51503
Status
Address
Greater Regional Medical Center
Creston, Iowa, 50801
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Address
Blank Children's Hospital
Des Moines, Iowa, 50309
Status
Address
Mercy Medical Center - Des Moines
Des Moines, Iowa, 50314
Status
Address
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines, Iowa, 50314
Status
Address
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, 52242
Status
Address
Mercy Medical Center-West Lakes
West Des Moines, Iowa, 50266
Status
Address
Flaget Memorial Hospital
Bardstown, Kentucky, 40004
Status
Address
Commonwealth Cancer Center-Corbin
Corbin, Kentucky, 40701
Status
Address
Saint Joseph Radiation Oncology Resource Center
Lexington, Kentucky, 40504
Status
Address
Saint Joseph Hospital East
Lexington, Kentucky, 40509
Status
Address
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
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Address
Saint Joseph London
London, Kentucky, 40741
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Address
Jewish Hospital
Louisville, Kentucky, 40202
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Address
Norton Children's Hospital
Louisville, Kentucky, 40202
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Address
Saints Mary and Elizabeth Hospital
Louisville, Kentucky, 40215
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Address
UofL Health Medical Center Northeast
Louisville, Kentucky, 40245
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Address
Jewish Hospital Medical Center South
Shepherdsville, Kentucky, 40165
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Address
Children's Hospital New Orleans
New Orleans, Louisiana, 70118
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Address
Ochsner Medical Center Jefferson
New Orleans, Louisiana, 70121
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Address
Eastern Maine Medical Center
Bangor, Maine, 04401
Status
Address
Maine Children's Cancer Program
Scarborough, Maine, 04074
Status
Address
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
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Address
Sinai Hospital of Baltimore
Baltimore, Maryland, 21215
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Address
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, 21287
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Address
Walter Reed National Military Medical Center
Bethesda, Maryland, 20889-5600
Status
Address
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, 02114
Status
Address
Dana-Farber Cancer Institute
Boston, Massachusetts, 02215
Status
Address
Baystate Medical Center
Springfield, Massachusetts, 01199
Status
Address
UMass Memorial Medical Center - University Campus
Worcester, Massachusetts, 01655
Status
Address
C S Mott Children's Hospital
Ann Arbor, Michigan, 48109
Status
Address
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, 48109
Status
Address
Bronson Battle Creek
Battle Creek, Michigan, 49017
Status
Address
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan, 48201
Status
Address
Henry Ford Health Saint John Hospital
Detroit, Michigan, 48236
Status
Address
Hurley Medical Center
Flint, Michigan, 48503
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Address
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids, Michigan, 49503
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Address
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids, Michigan, 49503
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Address
Trinity Health Grand Rapids Hospital
Grand Rapids, Michigan, 49503
Status
Address
Bronson Methodist Hospital
Kalamazoo, Michigan, 49007
Status
Address
West Michigan Cancer Center
Kalamazoo, Michigan, 49007
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Address
Ascension Borgess Hospital
Kalamazoo, Michigan, 49048
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Address
Trinity Health Muskegon Hospital
Muskegon, Michigan, 49444
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Address
Corewell Health Lakeland Hospitals - Niles Hospital
Niles, Michigan, 49120
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Address
Huron Medical Center PC
Port Huron, Michigan, 48060
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Address
Lake Huron Medical Center
Port Huron, Michigan, 48060
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Address
Corewell Health Reed City Hospital
Reed City, Michigan, 49677
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Address
Corewell Health Children's
Royal Oak, Michigan, 48073
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Address
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
Saint Joseph, Michigan, 49085
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Address
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
Saint Joseph, Michigan, 49085
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Address
Munson Medical Center
Traverse City, Michigan, 49684
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Address
Essentia Health Cancer Center
Duluth, Minnesota, 55805
Status
Address
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis, Minnesota, 55404
Status
Address
University of Minnesota/Masonic Cancer Center
Minneapolis, Minnesota, 55455
Status
Address
Mayo Clinic in Rochester
Rochester, Minnesota, 55905
Status
Address
University of Mississippi Medical Center
Jackson, Mississippi, 39216
Status
Address
Central Care Cancer Center - Bolivar
Bolivar, Missouri, 65613
Status
Address
Cox Cancer Center Branson
Branson, Missouri, 65616
Status
Address
University of Missouri Children's Hospital
Columbia, Missouri, 65212
Status
Address
Freeman Health System
Joplin, Missouri, 64804
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Address
Mercy Hospital Joplin
Joplin, Missouri, 64804
Status
Address
Children's Mercy Hospitals and Clinics
Kansas City, Missouri, 64108
Status
Address
Mercy Clinic-Rolla-Cancer and Hematology
Rolla, Missouri, 65401
Status
Address
Phelps Health Delbert Day Cancer Institute
Rolla, Missouri, 65401
Status
Address
Heartland Regional Medical Center
Saint Joseph, Missouri, 64506
Status
Address
Cardinal Glennon Children's Medical Center
Saint Louis, Missouri, 63104
Status
Address
Saint Louis Cancer and Breast Institute-South City
Saint Louis, Missouri, 63109
Status
Address
Washington University School of Medicine
Saint Louis, Missouri, 63110
Status
Address
Mercy Hospital Saint Louis
Saint Louis, Missouri, 63141
Status
Address
Mercy Hospital Springfield
Springfield, Missouri, 65804
Status
Address
CoxHealth South Hospital
Springfield, Missouri, 65807
Status
Address
Nebraska Medicine-Bellevue
Bellevue, Nebraska, 68123
Status
Address
Nebraska Cancer Specialists/Oncology Hematology West PC
Grand Island, Nebraska, 68803
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Address
Nebraska Medicine Heartland Hematology Oncology
Kearney, Nebraska, 68845
Status
Address
CHI Health Good Samaritan
Kearney, Nebraska, 68847
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Address
Saint Elizabeth Regional Medical Center
Lincoln, Nebraska, 68510
Status
Address
Children's Hospital and Medical Center of Omaha
Omaha, Nebraska, 68114
Status
Address
Nebraska Medicine-Village Pointe
Omaha, Nebraska, 68118
Status
Address
Alegent Health Immanuel Medical Center
Omaha, Nebraska, 68122
Status
Address
Hematology and Oncology Consultants PC
Omaha, Nebraska, 68122
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Address
Alegent Health Bergan Mercy Medical Center
Omaha, Nebraska, 68124
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Address
Alegent Health Lakeside Hospital
Omaha, Nebraska, 68130
Status
Address
Creighton University Medical Center
Omaha, Nebraska, 68131
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Address
University of Nebraska Medical Center
Omaha, Nebraska, 68198
Status
Address
Midlands Community Hospital
Papillion, Nebraska, 68046
Status
Address
Carson Tahoe Regional Medical Center
Carson City, Nevada, 89703
Status
Address
Comprehensive Cancer Centers of Nevada-Horizon Ridge
Henderson, Nevada, 89052
Status
Address
University Medical Center of Southern Nevada
Las Vegas, Nevada, 89102
Status
Address
Sunrise Hospital and Medical Center
Las Vegas, Nevada, 89109
Status
Address
Ann M Wierman MD LTD
Las Vegas, Nevada, 89128
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Address
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas, Nevada, 89135
Status
Address
Summerlin Hospital Medical Center
Las Vegas, Nevada, 89144
Status
Address
Hope Cancer Care of Nevada-Pahrump
Pahrump, Nevada, 89048
Status
Address
Renown Regional Medical Center
Reno, Nevada, 89502
Status
Address
Saint Mary's Regional Medical Center
Reno, Nevada, 89503
Status
Address
Radiation Oncology Associates
Reno, Nevada, 89509
Status
Address
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
Status
Address
Hackensack University Medical Center
Hackensack, New Jersey, 07601
Status
Address
Morristown Medical Center
Morristown, New Jersey, 07960
Status
Address
Saint Peter's University Hospital
New Brunswick, New Jersey, 08901
Status
Address
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
New Brunswick, New Jersey, 08903
Status
Address
Newark Beth Israel Medical Center
Newark, New Jersey, 07112
Status
Address
Saint Joseph's Regional Medical Center
Paterson, New Jersey, 07503
Status
Address
Albany Medical Center
Albany, New York, 12208
Status
Address
Montefiore Medical Center-Einstein Campus
Bronx, New York, 10461
Status
Address
Montefiore Medical Center-Weiler Hospital
Bronx, New York, 10461
Status
Address
Children's Hospital at Montefiore
Bronx, New York, 10467
Status
Address
Montefiore Medical Center - Moses Campus
Bronx, New York, 10467
Status
Address
Roswell Park Cancer Institute
Buffalo, New York, 14263
Status
Address
Glens Falls Hospital
Glens Falls, New York, 12801
Status
Address
NYU Langone Hospital - Long Island
Mineola, New York, 11501
Status
Address
The Steven and Alexandra Cohen Children's Medical Center of New York
New Hyde Park, New York, 11040
Status
Address
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, 10016
Status
Address
Mount Sinai Hospital
New York, New York, 10029
Status
Address
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, 10032
Status
Address
University of Rochester
Rochester, New York, 14642
Status
Address
Stony Brook University Medical Center
Stony Brook, New York, 11794
Status
Address
State University of New York Upstate Medical University
Syracuse, New York, 13210
Status
Address
New York Medical College
Valhalla, New York, 10595
Status
Address
Mission Hospital
Asheville, North Carolina, 28801
Status
Address
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, 27599
Status
Address
Carolinas Medical Center/Levine Cancer Institute
Charlotte, North Carolina, 28203
Status
Address
Duke University Medical Center
Durham, North Carolina, 27710
Status
Address
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
Status
Address
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
Status
Address
Children's Hospital Medical Center of Akron
Akron, Ohio, 44308
Status
Address
Good Samaritan Hospital - Cincinnati
Cincinnati, Ohio, 45220
Status
Address
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229
Status
Address
Bethesda North Hospital
Cincinnati, Ohio, 45242
Status
Address
TriHealth Cancer Institute-Westside
Cincinnati, Ohio, 45247
Status
Address
TriHealth Cancer Institute-Anderson
Cincinnati, Ohio, 45255
Status
Address
Rainbow Babies and Childrens Hospital
Cleveland, Ohio, 44106
Status
Address
Cleveland Clinic Foundation
Cleveland, Ohio, 44195
Status
Address
Nationwide Children's Hospital
Columbus, Ohio, 43205
Status
Address
Dayton Children's Hospital
Dayton, Ohio, 45404
Status
Address
ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
Toledo, Ohio, 43606
Status
Address
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Status
Address
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma, 73120
Status
Address
Legacy Emanuel Children's Hospital
Portland, Oregon, 97227
Status
Address
Oregon Health and Science University
Portland, Oregon, 97239
Status
Address
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania, 18103
Status
Address
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania, 18017
Status
Address
Geisinger Medical Center
Danville, Pennsylvania, 17822
Status
Address
Penn State Children's Hospital
Hershey, Pennsylvania, 17033
Status
Address
Drexel University School of Medicine
Philadelphia, Pennsylvania, 19102
Status
Address
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104
Status
Address
Saint Christopher's Hospital for Children
Philadelphia, Pennsylvania, 19134
Status
Address
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, 15224
Status
Address
Rhode Island Hospital
Providence, Rhode Island, 02903
Status
Address
Medical University of South Carolina
Charleston, South Carolina, 29425
Status
Address
Prisma Health Richland Hospital
Columbia, South Carolina, 29203
Status
Address
Saint Francis Hospital
Greenville, South Carolina, 29601
Status
Address
BI-LO Charities Children's Cancer Center
Greenville, South Carolina, 29605
Status
Address
Saint Francis Cancer Center
Greenville, South Carolina, 29607
Status
Address
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Status
Address
T C Thompson Children's Hospital
Chattanooga, Tennessee, 37403
Status
Address
Memorial Hospital
Chattanooga, Tennessee, 37404
Status
Address
Pulmonary Medicine Center of Chattanooga-Hixson
Hixson, Tennessee, 37343
Status
Address
East Tennessee Childrens Hospital
Knoxville, Tennessee, 37916
Status
Address
Saint Jude Children's Research Hospital
Memphis, Tennessee, 38105
Status
Address
The Children's Hospital at TriStar Centennial
Nashville, Tennessee, 37203
Status
Address
Vanderbilt University/Ingram Cancer Center
Nashville, Tennessee, 37232
Status
Address
Memorial GYN Plus
Ooltewah, Tennessee, 37363
Status
Address
Dell Children's Medical Center of Central Texas
Austin, Texas, 78723
Status
Address
Saint Joseph Regional Cancer Center
Bryan, Texas, 77802
Status
Address
Driscoll Children's Hospital
Corpus Christi, Texas, 78411
Status
Address
Medical City Dallas Hospital
Dallas, Texas, 75230
Status
Address
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
Status
Address
El Paso Children's Hospital
El Paso, Texas, 79905
Status
Address
Cook Children's Medical Center
Fort Worth, Texas, 76104
Status
Address
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston, Texas, 77030
Status
Address
M D Anderson Cancer Center
Houston, Texas, 77030
Status
Address
Covenant Children's Hospital
Lubbock, Texas, 79410
Status
Address
UMC Cancer Center / UMC Health System
Lubbock, Texas, 79415
Status
Address
Texas Tech University Health Sciences Center-Lubbock
Lubbock, Texas, 79430
Status
Address
Children's Hospital of San Antonio
San Antonio, Texas, 78207
Status
Address
Methodist Children's Hospital of South Texas
San Antonio, Texas, 78229
Status
Address
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
Status
Address
Scott and White Memorial Hospital
Temple, Texas, 76508
Status
Address
Primary Children's Hospital
Salt Lake City, Utah, 84113
Status
Address
Central Vermont Medical Center/National Life Cancer Treatment
Berlin, Vermont, 05602
Status
Address
University of Vermont Medical Center
Burlington, Vermont, 05401
Status
Address
University of Vermont and State Agricultural College
Burlington, Vermont, 05405
Status
Address
Inova Fairfax Hospital
Falls Church, Virginia, 22042
Status
Address
Children's Hospital of The King's Daughters
Norfolk, Virginia, 23507
Status
Address
Naval Medical Center - Portsmouth
Portsmouth, Virginia, 23708-2197
Status
Address
Virginia Commonwealth University/Massey Cancer Center
Richmond, Virginia, 23298
Status
Address
Carilion Children's
Roanoke, Virginia, 24014
Status
Address
Highline Medical Center-Main Campus
Burien, Washington, 98166
Status
Address
Saint Elizabeth Hospital
Enumclaw, Washington, 98022
Status
Address
Saint Francis Hospital
Federal Way, Washington, 98003
Status
Address
Saint Clare Hospital
Lakewood, Washington, 98499
Status
Address
Harrison HealthPartners Hematology and Oncology-Poulsbo
Poulsbo, Washington, 98370
Status
Address
Seattle Children's Hospital
Seattle, Washington, 98105
Status
Address
Saint Michael Cancer Center
Silverdale, Washington, 98383
Status
Address
Providence Sacred Heart Medical Center and Children's Hospital
Spokane, Washington, 99204
Status
Address
Franciscan Research Center-Northwest Medical Plaza
Tacoma, Washington, 98405
Status
Address
Mary Bridge Children's Hospital and Health Center
Tacoma, Washington, 98405
Status
Address
Northwest Medical Specialties PLLC
Tacoma, Washington, 98405
Status
Address
Madigan Army Medical Center
Tacoma, Washington, 98431
Status
Address
West Virginia University Healthcare
Morgantown, West Virginia, 26506
Status
Address
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin, 54301
Status
Address
Saint Vincent Hospital Cancer Center at Marinette
Marinette, Wisconsin, 54143
Status
Address
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
Status
Address
Children's Hospital of Wisconsin
Milwaukee, Wisconsin, 53226
International Sites
Status
Address
Alberta Children's Hospital
Calgary, Alberta, T3B 6A8
Status
Address
University of Alberta Hospital
Edmonton, Alberta, T6G 2B7
Status
Address
British Columbia Children's Hospital
Vancouver, British Columbia, V6H 3V4
Status
Address
CancerCare Manitoba
Winnipeg, Manitoba, R3E 0V9
Status
Address
Janeway Child Health Centre
Saint John's, Newfoundland and Labrador, A1B 3V6
Status
Address
IWK Health Centre
Halifax, Nova Scotia, B3K 6R8
Status
Address
McMaster Children's Hospital at Hamilton Health Sciences
Hamilton, Ontario, L8N 3Z5
Status
Address
Kingston Health Sciences Centre
Kingston, Ontario, K7L 2V7
Status
Address
Children's Hospital
London, Ontario, N6A 5W9
Status
Address
Children's Hospital of Eastern Ontario
Ottawa, Ontario, K1H 8L1
Status
Address
Hospital for Sick Children
Toronto, Ontario, M5G 1X8
Status
Address
The Montreal Children's Hospital of the MUHC
Montreal, Quebec, H3H 1P3
Status
Address
Centre Hospitalier Universitaire Sainte-Justine
Montreal, Quebec, H3T 1C5
Status
Address
CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)
Quebec, , G1V 4G2
Status
Address
San Jorge Children's Hospital
San Juan, , 00912
Status
Address
University Pediatric Hospital
San Juan, , 00926
