Nivolumab in Treating Patients With Persistent, Recurrent, or Metastatic Cervical Cancer

NCT02257528Active, Not RecruitingPHASE2INTERVENTIONAL

Summary

This phase II trial studies the side effects and how well nivolumab works in treating patients with cervical cancer that has grown, come back, or spread to other places in the body. Monoclonal antibodies, such as nivolumab, may block tumor growth in different ways by targeting certain cells.

Key Facts

Lead Sponsor

National Cancer Institute (NCI)

Enrollment

26

Start Date

2015-05-18

Completion Date

2019-03-05

Study Type

INTERVENTIONAL

Official Title

A Phase II Evaluation of Nivolumab, a Fully Human Antibody Against PD-1, in the Treatment of Persistent or Recurrent Cervical Cancer

Interventions

Laboratory Biomarker AnalysisNivolumab

Conditions

Cervical AdenocarcinomaCervical Adenosquamous CarcinomaRecurrent Cervical CarcinomaStage IV Cervical Cancer AJCC v6 and v7Stage IVA Cervical Cancer AJCC v6 and v7Stage IVB Cervical Cancer AJCC v6 and v7

Eligibility

Age Range

18 Years+

Sex

FEMALE

Inclusion Criteria:

* Patients must have persistent, recurrent or metastatic squamous cell carcinoma, adenosquamous carcinoma or adenocarcinoma of the cervix with documented disease progression (disease not amendable to curative therapy); NOTE: the following cervical tumors are not eligible: minimal deviation/adenoma malignum, gastric type adenocarcinoma, clear cell carcinoma and mesonephric carcinoma; histologic confirmation of the original primary tumor is required via the pathology report
* All patents must have measurable disease as defined by RECIST 1.1; measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded); each lesion must be \>= 10 mm when measured by computed tomography (CT), magnetic resonance imaging (MRI) or caliper measurement by clinical exam; or \>= 20 mm when measured by chest x-ray; lymph nodes must be \>= 15 mm in short axis when measured by CT or MRI
* Patients must have at least one "target" lesion" to be used to assess response on this protocol as defined by RECIST 1.1; tumors within a previously irradiated field will be designated as "non-target" lesions unless progression is documented or a biopsy is obtained to confirm persistence at least 90 days following completion of radiation therapy
* Appropriate for study entry based on the following diagnostic workup:

  * History/physical examination within 28 days prior to registration
  * Imaging of target lesion(s) within 28 days prior to registration
  * Further protocol-specific assessments:

    * Recovery from adverse effects of recent surgery, radiotherapy or chemotherapy
    * Any other prior therapy directed at the malignant tumor including chemotherapy, biologic/targeted agents and immunologic agents must be discontinued at least three weeks prior to registration
    * Investigation agents must be discontinued for at least 30 days prior to registration
    * Any prior radiation therapy must be completed at least 4 weeks prior to registration
    * At least 4 weeks must have elapsed since any major surgery prior to registration
* Patients must have had one prior systemic chemotherapeutic regimen for management of persistent, recurrent or metastatic carcinoma of the cervix (e.g.; paclitaxel/cisplatin, paclitaxel/cisplatin/bevacizumab); chemotherapy administered concurrent with primary radiation (e.g.; weekly cisplatin) is not counted as a systemic chemotherapy regimen; adjuvant chemotherapy given following the completion of radiation therapy (or concurrent chemotherapy and radiation therapy) is not counted as a systemic chemotherapy regimen (e.g.; paclitaxel and carboplatin for up to 4 cycles); NOTE: patients who have received more than one prior regimen are NOT eligible
* Performance status of 0 or 1
* Absolute neutrophil count (ANC) \>= 1,500/ul
* Platelets \>= 100,000/ul
* Creatinine =\< 1.5 x institutional upper limit of normal (ULN) or creatinine clearance (CrCl) \>= 40 mL/min using Cockcroft-Gault formula
* Bilirubin =\< 1.5 x ULN
* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =\< 3 x ULN
* Normal thyroid function testing (thyroid stimulating hormone \[TSH\]) within 14 days prior to registration
* The patient or a legally authorized representative must provide study-specific informed consent authorization permitting release of personal health information prior to study entry

Exclusion Criteria:

* Patients who have had prior therapy with nivolumab or with an anti-PD-1, anti-PD-ligand (L)1, anti-PD-L2, anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or immune check point pathways
* History of severe hypersensitivity reaction to any monoclonal antibody
* Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years
* Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure and unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
* Patients who are pregnant or nursing; women of child-bearing potential (WOCBP) must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; WOCBP should use an adequate method to avoid pregnancy for 23 weeks after the last dose of investigational drug; WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IV/L or equivalent units of human chorionic gonadotropin \[HCG\]) within 24 hours prior to the start of nivolumab; women must not be breastfeeding

  * Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile or have undergone definitive radiation) do not require contraception
  * Women of childbearing potential (WOCBP) is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy of bilateral oophorectomy) or who is not postmenopausal; menopause is defined clinically as 12 month amenorrhea in a woman over 45 in the absence of other biological or physiological causes; in addition, women under the age of 55 must have a documented serum follicle stimulating hormone (FSH) level greater than 40 mIU/mL
  * WOCBP receiving nivolumab will be instructed to adhere to contraception for a period of 23 weeks after the last dose of investigational product
  * Should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform the treating physician immediately
* Patients with known brain metastases or leptomeningeal metastases are excluded unless the following conditions are met:

  * Metastases have been treated and there is no magnetic resonance imaging (MRI) evidence of progression for at least 4 weeks after treatment is complete (must be confirmed within 28 days prior to the first dose of nivolumab administration)
  * There must also be no requirement for immunosuppressive doses of systemic corticosteroids (\> 10 mg/day prednisone equivalents) for at least 2 weeks prior to study drug administration
* Patients should be excluded if they have known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS)

  * Patients should be excluded if they have a positive test for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (HCV antibody) indicating acute or chronic infection
* Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids, should be excluded; these include but are not limited to patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue diseases, scleroderma, inflammatory bowel disease (IRB), Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome should be excluded; patient with vitiligo, endocrine deficiencies including thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible; patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome and psoriasis controlled with topical medication and patients with positive serology, such as antinuclear antibodies (ANA), anti-thyroid antibodies should be evaluated for the presence of target organ involvement and potential need for systemic treatment but should otherwise be eligible

  * NOTE: patients are permitted to enroll if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger (precipitating event)
* Patients should be excluded if they have a condition requiring systemic treatment with either corticosteroids (\> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration; inhaled or topical steroids and adrenal replacement doses =\< 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease; patients are permitted to use topical, ocular, intra-articular, intranasal, and inhalational corticosteroids (with minimal systemic absorption); physiologic replacement doses of systemic corticosteroids are permitted, even if =\< 10 mg/day prednisone equivalents; a brief course of corticosteroids for prophylaxis (e.g., contrast dye allergy) or for treatment of non-autoimmune conditions (e.g., delayed-type hypersensitivity reaction caused by contact allergen) is permitted
* Patients who have had evidence of active or acute diverticulitis, intra-abdominal abscess, abdominal/pelvic fistula, gastrointestinal perforation, gastrointestinal (GI) obstruction and/or who require parenteral hydration and/or nutrition

Outcome Measures

Primary Outcomes

Objective Tumor Response as Assessed by RECIST 1.1 Criteria

Proportion of participants with objective tumor response. Objective tumor response is defined as complete or partial tumor response assessed by RECIST 1.1.

Time frame: The average of study treatment time was 3.8 months.

Adverse Events (Grade 3 or Higher) During Treatment Period as Assessed by CTCAE Version 4

Number of participants with a maximum grade of 3 or higher during treatment period. Adverse events are graded and categorized using CTCAE v4.0.

Time frame: Within 100 days of last protocol treatment

Secondary Outcomes

Progression-free Survival

Progression-free survival is the period of time from study entry to time of disease progression, death or date of last contact, whichever occurs first. Progression is assessed by RECIST 1.1.

Time frame: Time from study entry to time of progression or death, whichever occurs first, up to 5 years of follow-up.

Overall Survival

Overall survival is defined as the duration of time from study entry to time of death or the date of last contact.

Time frame: Time from study entry to time of death or the date of last contact, up to 5 years of follow-up

Locations

University of Alabama at Birmingham Cancer Center, Birmingham, United States

Anchorage Associates in Radiation Medicine, Anchorage, United States

Anchorage Radiation Therapy Center, Anchorage, United States

Alaska Breast Care and Surgery LLC, Anchorage, United States

Alaska Oncology and Hematology LLC, Anchorage, United States

Alaska Regional Hospital, Anchorage, United States

Alaska Women's Cancer Care, Anchorage, United States

Anchorage Oncology Centre, Anchorage, United States

Katmai Oncology Group, Anchorage, United States

Providence Alaska Medical Center, Anchorage, United States

CHI Saint Vincent Cancer Center Hot Springs, Hot Springs, United States

Sutter Auburn Faith Hospital, Auburn, United States

Sutter Cancer Centers Radiation Oncology Services-Auburn, Auburn, United States

Kaiser Permanente-Baldwin Park, Baldwin Park, United States

Alta Bates Summit Medical Center-Herrick Campus, Berkeley, United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center, Burbank, United States

Mills-Peninsula Medical Center, Burlingame, United States

Sutter Cancer Centers Radiation Oncology Services-Cameron Park, Cameron Park, United States

Eden Hospital Medical Center, Castro Valley, United States

Sutter Davis Hospital, Davis, United States

UC San Diego Moores Cancer Center, La Jolla, United States

Memorial Medical Center, Modesto, United States

Palo Alto Medical Foundation-Camino Division, Mountain View, United States

Palo Alto Medical Foundation-Gynecologic Oncology, Mountain View, United States

Palo Alto Medical Foundation Health Care, Palo Alto, United States

Sutter Cancer Centers Radiation Oncology Services-Roseville, Roseville, United States

Sutter Roseville Medical Center, Roseville, United States

Sutter Medical Center Sacramento, Sacramento, United States

Kaiser Permanente-San Diego Mission, San Diego, United States

Kaiser Permanente-San Diego Zion, San Diego, United States

California Pacific Medical Center-Pacific Campus, San Francisco, United States

Kaiser Permanente-San Marcos, San Marcos, United States

Palo Alto Medical Foundation-Santa Cruz, Santa Cruz, United States

Sutter Pacific Medical Foundation, Santa Rosa, United States

Palo Alto Medical Foundation-Sunnyvale, Sunnyvale, United States

Sutter Solano Medical Center/Cancer Center, Vallejo, United States

Yale University, New Haven, United States

Beebe Medical Center, Lewes, United States

Delaware Clinical and Laboratory Physicians PA, Newark, United States

Helen F Graham Cancer Center, Newark, United States

Medical Oncology Hematology Consultants PA, Newark, United States

Christiana Care Health System-Christiana Hospital, Newark, United States

Beebe Health Campus, Rehoboth Beach, United States

TidalHealth Nanticoke / Allen Cancer Center, Seaford, United States

Christiana Care Health System-Wilmington Hospital, Wilmington, United States

Low Country Cancer Care, Savannah, United States

Memorial Health University Medical Center, Savannah, United States

Summit Cancer Care-Memorial, Savannah, United States

Lewis Cancer and Research Pavilion at Saint Joseph's/Candler, Savannah, United States

Saint Luke's Cancer Institute - Boise, Boise, United States

Kootenai Health - Coeur d'Alene, Coeur d'Alene, United States

Saint Luke's Cancer Institute - Fruitland, Fruitland, United States

Saint Luke's Cancer Institute - Meridian, Meridian, United States

Saint Luke's Cancer Institute - Nampa, Nampa, United States

Kootenai Clinic Cancer Services - Post Falls, Post Falls, United States

Kootenai Clinic Cancer Services - Sandpoint, Sandpoint, United States

Saint Luke's Cancer Institute - Twin Falls, Twin Falls, United States

OSF Saint Joseph Medical Center, Bloomington, United States

Illinois CancerCare-Bloomington, Bloomington, United States

Illinois CancerCare-Canton, Canton, United States

Memorial Hospital of Carbondale, Carbondale, United States

Illinois CancerCare-Carthage, Carthage, United States

Centralia Oncology Clinic, Centralia, United States

Northwestern University, Chicago, United States

Cancer Care Specialists of Illinois - Decatur, Decatur, United States

Decatur Memorial Hospital, Decatur, United States

Crossroads Cancer Center, Effingham, United States

Illinois CancerCare-Eureka, Eureka, United States

Illinois CancerCare-Galesburg, Galesburg, United States

Western Illinois Cancer Treatment Center, Galesburg, United States

Sudarshan K Sharma MD Limited-Gynecologic Oncology, Hinsdale, United States

Illinois CancerCare-Kewanee Clinic, Kewanee, United States

Illinois CancerCare-Macomb, Macomb, United States

SSM Health Good Samaritan, Mount Vernon, United States

Cancer Care Center of O'Fallon, O'Fallon, United States

Illinois CancerCare-Ottawa Clinic, Ottawa, United States

Radiation Oncology of Northern Illinois, Ottawa, United States

Illinois CancerCare-Pekin, Pekin, United States

OSF Saint Francis Radiation Oncology at Pekin, Pekin, United States

Illinois CancerCare-Peoria, Peoria, United States

OSF Saint Francis Radiation Oncology at Peoria Cancer Center, Peoria, United States

Methodist Medical Center of Illinois, Peoria, United States

OSF Saint Francis Medical Center, Peoria, United States

Illinois CancerCare-Peru, Peru, United States

Valley Radiation Oncology, Peru, United States

Illinois CancerCare-Princeton, Princeton, United States

Central Illinois Hematology Oncology Center, Springfield, United States

Southern Illinois University School of Medicine, Springfield, United States

Springfield Clinic, Springfield, United States

Springfield Memorial Hospital, Springfield, United States

Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, United States

Sidney and Lois Eskenazi Hospital, Indianapolis, United States

Reid Health, Richmond, United States

Mercy Cancer Center-West Lakes, Clive, United States

UI Health Care Mission Cancer and Blood - West Des Moines Clinic, Clive, United States

Alegent Health Mercy Hospital, Council Bluffs, United States

Greater Regional Medical Center, Creston, United States

Mercy Medical Center - Des Moines, Des Moines, United States

UI Health Care Mission Cancer and Blood - Laurel Clinic, Des Moines, United States

University of Iowa/Holden Comprehensive Cancer Center, Iowa City, United States

Mercy Medical Center-West Lakes, West Des Moines, United States

Cancer Center of Kansas - Chanute, Chanute, United States

Cancer Center of Kansas - Dodge City, Dodge City, United States

Cancer Center of Kansas - El Dorado, El Dorado, United States

Cancer Center of Kansas - Fort Scott, Fort Scott, United States

Cancer Center of Kansas-Independence, Independence, United States

Cancer Center of Kansas-Kingman, Kingman, United States

Lawrence Memorial Hospital, Lawrence, United States

Cancer Center of Kansas-Liberal, Liberal, United States

Cancer Center of Kansas - Newton, Newton, United States

Cancer Center of Kansas - Parsons, Parsons, United States

Cancer Center of Kansas - Pratt, Pratt, United States

Cancer Center of Kansas - Salina, Salina, United States

Cancer Center of Kansas - Wellington, Wellington, United States

Associates In Womens Health, Wichita, United States

Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, United States

Ascension Via Christi Hospitals Wichita, Wichita, United States

Cancer Center of Kansas - Wichita, Wichita, United States

Cancer Center of Kansas - Winfield, Winfield, United States

Flaget Memorial Hospital, Bardstown, United States

Commonwealth Cancer Center-Corbin, Corbin, United States

Saint Joseph Radiation Oncology Resource Center, Lexington, United States

Saint Joseph Hospital East, Lexington, United States

Jewish Hospital, Louisville, United States

Saints Mary and Elizabeth Hospital, Louisville, United States

UofL Health Medical Center Northeast, Louisville, United States

Jewish Hospital Medical Center South, Shepherdsville, United States

MaineHealth Maine Medical Center- Scarborough, Scarborough, United States

Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, United States

Massachusetts General Hospital Cancer Center, Boston, United States

Brigham and Women's Hospital, Boston, United States

Dana-Farber Cancer Institute, Boston, United States

Lahey Hospital and Medical Center, Burlington, United States

Henry Ford Cancer Institute-Downriver, Brownstown, United States

Henry Ford Macomb Hospital-Clinton Township, Clinton Township, United States

Henry Ford Medical Center-Fairlane, Dearborn, United States

Wayne State University/Karmanos Cancer Institute, Detroit, United States

Henry Ford Hospital, Detroit, United States

Weisberg Cancer Treatment Center, Farmington Hills, United States

Henry Ford Medical Center-Columbus, Novi, United States

Henry Ford West Bloomfield Hospital, West Bloomfield, United States

Central Care Cancer Center - Bolivar, Bolivar, United States

Parkland Health Center-Bonne Terre, Bonne Terre, United States

Cox Cancer Center Branson, Branson, United States

Mercy Cancer Center - Cape Girardeau, Cape Girardeau, United States

Saint Francis Medical Center, Cape Girardeau, United States

MU Health Care Goldschmidt Cancer Center, Jefferson City, United States

Freeman Health System, Joplin, United States

Mercy Hospital Joplin, Joplin, United States

Mercy Clinic-Rolla-Cancer and Hematology, Rolla, United States

Phelps Health Delbert Day Cancer Institute, Rolla, United States

Sainte Genevieve County Memorial Hospital, Sainte Genevieve, United States

Mercy Hospital Springfield, Springfield, United States

CoxHealth South Hospital, Springfield, United States

Mercy Infusion Center - Chippewa, St Louis, United States

Missouri Baptist Medical Center, St Louis, United States

Mercy Hospital Saint Louis, St Louis, United States

Missouri Baptist Sullivan Hospital, Sullivan, United States

BJC Outpatient Center at Sunset Hills, Sunset Hills, United States

Community Hospital of Anaconda, Anaconda, United States

Billings Clinic Cancer Center, Billings, United States

Saint Vincent Healthcare, Billings, United States

Bozeman Health Deaconess Hospital, Bozeman, United States

Saint James Community Hospital and Cancer Treatment Center, Butte, United States

Benefis Sletten Cancer Institute, Great Falls, United States

Great Falls Clinic, Great Falls, United States

Saint Peter's Community Hospital, Helena, United States

Logan Health Medical Center, Kalispell, United States

Saint Patrick Hospital - Community Hospital, Missoula, United States

Community Medical Center, Missoula, United States

Nebraska Cancer Specialists/Oncology Hematology West PC, Grand Island, United States

Fred and Pamela Buffett Cancer Center - Kearney, Kearney, United States

CHI Health Good Samaritan, Kearney, United States

Saint Elizabeth Regional Medical Center, Lincoln, United States

Alegent Health Immanuel Medical Center, Omaha, United States

Hematology and Oncology Consultants PC, Omaha, United States

Alegent Health Bergan Mercy Medical Center, Omaha, United States

Alegent Health Lakeside Hospital, Omaha, United States

Creighton University Medical Center, Omaha, United States

Midlands Community Hospital, Papillion, United States

Women's Cancer Center of Nevada, Las Vegas, United States

Cooper Hospital University Medical Center, Camden, United States

Hackensack University Medical Center, Hackensack, United States

MD Anderson Cancer Center at Cooper-Voorhees, Voorhees Township, United States

Southwest Gynecologic Oncology Associates Inc, Albuquerque, United States

University of New Mexico Cancer Center, Albuquerque, United States

Memorial Sloan Kettering Cancer Center, New York, United States

Sampson Radiation Oncology, Clinton, United States

Southeastern Medical Oncology Center-Clinton, Clinton, United States

Southeastern Medical Oncology Center-Goldsboro, Goldsboro, United States

Wayne Memorial Hospital, Goldsboro, United States

Wayne Radiation Oncology, Goldsboro, United States

Onslow Memorial Hospital, Jacksonville, United States

Southeastern Medical Oncology Center-Jacksonville, Jacksonville, United States

UHHS-Chagrin Highlands Medical Center, Beachwood, United States

Strecker Cancer Center-Belpre, Belpre, United States

Dayton Physicians LLC-Miami Valley South, Centerville, United States

Miami Valley Hospital South, Centerville, United States

Adena Regional Medical Center, Chillicothe, United States

Good Samaritan Hospital - Cincinnati, Cincinnati, United States

Oncology Hematology Care Inc-Kenwood, Cincinnati, United States

Bethesda North Hospital, Cincinnati, United States

TriHealth Cancer Institute-Westside, Cincinnati, United States

TriHealth Cancer Institute-Anderson, Cincinnati, United States

Case Western Reserve University, Cleveland, United States

Cleveland Clinic Cancer Center/Fairview Hospital, Cleveland, United States

Cleveland Clinic Foundation, Cleveland, United States

Ohio State University Comprehensive Cancer Center, Columbus, United States

Mount Carmel East Hospital, Columbus, United States

Columbus Oncology and Hematology Associates Inc, Columbus, United States

Riverside Methodist Hospital, Columbus, United States

Grant Medical Center, Columbus, United States

The Mark H Zangmeister Center, Columbus, United States

Mount Carmel Health Center West, Columbus, United States

Doctors Hospital, Columbus, United States

Good Samaritan Hospital - Dayton, Dayton, United States

Miami Valley Hospital, Dayton, United States

Dayton Physician LLC - Englewood, Dayton, United States

Miami Valley Hospital North, Dayton, United States

Delaware Health Center-Grady Cancer Center, Delaware, United States

Delaware Radiation Oncology, Delaware, United States

Grady Memorial Hospital, Delaware, United States

Armes Family Cancer Center, Findlay, United States

Blanchard Valley Hospital, Findlay, United States

Orion Cancer Care, Findlay, United States

Atrium Medical Center-Middletown Regional Hospital, Franklin, United States

Dayton Physicians LLC-Atrium, Franklin, United States

Dayton Physicians LLC-Wayne, Greenville, United States

Wayne Hospital, Greenville, United States

Greater Dayton Cancer Center, Kettering, United States

Kettering Medical Center, Kettering, United States

Fairfield Medical Center, Lancaster, United States

Marietta Memorial Hospital, Marietta, United States

OhioHealth Marion General Hospital, Marion, United States

Hillcrest Hospital Cancer Center, Mayfield Heights, United States

UH Seidman Cancer Center at Landerbrook Health Center, Mayfield Heights, United States

UH Seidman Cancer Center at Lake Health Mentor Campus, Mentor, United States

Dayton Physicians LLC-Signal Point, Middletown, United States

Knox Community Hospital, Mount Vernon, United States

Licking Memorial Hospital, Newark, United States

Newark Radiation Oncology, Newark, United States

Southern Ohio Medical Center, Portsmouth, United States

Dayton Physicians LLC-Wilson, Sidney, United States

Springfield Regional Cancer Center, Springfield, United States

Springfield Regional Medical Center, Springfield, United States

Dayton Physicians LLC - Troy, Troy, United States

Upper Valley Medical Center, Troy, United States

University Hospitals Sharon Health Center, Wadsworth, United States

Saint Ann's Hospital, Westerville, United States

UHHS-Westlake Medical Center, Westlake, United States

Genesis Healthcare System Cancer Care Center, Zanesville, United States

University of Oklahoma Health Sciences Center, Oklahoma City, United States

Oklahoma Cancer Specialists and Research Institute-Tulsa, Tulsa, United States

Saint Charles Health System, Bend, United States

Clackamas Radiation Oncology Center, Clackamas, United States

Providence Cancer Institute Clackamas Clinic, Clackamas, United States

Bay Area Hospital, Coos Bay, United States

Providence Newberg Medical Center, Newberg, United States

Providence Willamette Falls Medical Center, Oregon City, United States

Providence Portland Medical Center, Portland, United States

Providence Saint Vincent Medical Center, Portland, United States

Jefferson Abington Hospital, Abington, United States

Lehigh Valley Hospital-Cedar Crest, Allentown, United States

Lehigh Valley Hospital - Muhlenberg, Bethlehem, United States

Christiana Care Health System-Concord Health Center, Chadds Ford, United States

Ephrata Cancer Center, Ephrata, United States

Adams Cancer Center, Gettysburg, United States

WellSpan Medical Oncology and Hematology, Hanover, United States

University of Pennsylvania/Abramson Cancer Center, Philadelphia, United States

Reading Hospital, West Reading, United States

WellSpan Health-York Cancer Center, York, United States

WellSpan Health-York Hospital, York, United States

Women and Infants Hospital, Providence, United States

Prisma Health Cancer Institute - Spartanburg, Boiling Springs, United States

Medical University of South Carolina, Charleston, United States

Prisma Health Cancer Institute - Easley, Easley, United States

Greenville Health System Cancer Institute-Andrews, Greenville, United States

Saint Francis Hospital, Greenville, United States

Prisma Health Cancer Institute - Butternut, Greenville, United States

Prisma Health Cancer Institute - Faris, Greenville, United States

Prisma Health Greenville Memorial Hospital, Greenville, United States

Saint Francis Cancer Center, Greenville, United States

Prisma Health Cancer Institute - Eastside, Greenville, United States

Prisma Health Cancer Institute - Greer, Greer, United States

Prisma Health Cancer Institute - Seneca, Seneca, United States

Avera Cancer Institute, Sioux Falls, United States

Memorial Hospital, Chattanooga, United States

Pulmonary Medicine Center of Chattanooga-Hixson, Hixson, United States

Memorial GYN Plus, Ooltewah, United States

M D Anderson Cancer Center, Houston, United States

Huntsman Cancer Institute/University of Utah, Salt Lake City, United States

South Jordan Health Center, South Jordan, United States

Inova Fairfax Hospital, Falls Church, United States

Providence Regional Cancer System-Aberdeen, Aberdeen, United States

Cancer Care Center at Island Hospital, Anacortes, United States

Swedish Cancer Institute-Eastside Oncology Hematology, Bellevue, United States

PeaceHealth Saint Joseph Medical Center, Bellingham, United States

Highline Medical Center-Main Campus, Burien, United States

Providence Regional Cancer System-Centralia, Centralia, United States

Swedish Cancer Institute-Edmonds, Edmonds, United States

Saint Elizabeth Hospital, Enumclaw, United States

Providence Regional Cancer Partnership, Everett, United States

Saint Francis Hospital, Federal Way, United States

Swedish Cancer Institute-Issaquah, Issaquah, United States

Providence Regional Cancer System-Lacey, Lacey, United States

Saint Clare Hospital, Lakewood, United States

PeaceHealth Saint John Medical Center, Longview, United States

Harrison HealthPartners Hematology and Oncology-Poulsbo, Poulsbo, United States

Minor and James Medical PLLC, Seattle, United States

Pacific Gynecology Specialists, Seattle, United States

Swedish Medical Center-Ballard Campus, Seattle, United States

Fred Hutchinson Cancer Center, Seattle, United States

Kaiser Permanente Washington, Seattle, United States

Swedish Medical Center-First Hill, Seattle, United States

University of Washington Medical Center - Northwest, Seattle, United States

Women's Cancer Center of Seattle, Seattle, United States

University of Washington Medical Center - Montlake, Seattle, United States

Providence Regional Cancer System-Shelton, Shelton, United States

Saint Michael Cancer Center, Silverdale, United States

MultiCare Deaconess Cancer and Blood Specialty Center - Downtown, Spokane, United States

Evergreen Hematology and Oncology PS, Spokane, United States

MultiCare Deaconess Cancer and Blood Specialty Center - Valley, Spokane Valley, United States

Franciscan Research Center-Northwest Medical Plaza, Tacoma, United States

Northwest Medical Specialties PLLC, Tacoma, United States

PeaceHealth Southwest Medical Center, Vancouver, United States

Providence Saint Mary Regional Cancer Center, Walla Walla, United States

North Star Lodge Cancer Center at Yakima Valley Memorial Hospital, Yakima, United States

Providence Regional Cancer System-Yelm, Yelm, United States

Monongalia Hospital, Morgantown, United States

Medical College of Wisconsin, Milwaukee, United States

Big Horn Basin Cancer Center, Cody, United States

Billings Clinic-Cody, Cody, United States

Welch Cancer Center, Sheridan, United States

Nivolumab in Treating Patients With Persistent, Recurrent, or Metastatic Cervical Cancer