Testing the Combination of Olaparib and Durvalumab, Cediranib and Durvalumab, Olaparib and Capivasertib, and Cediranib Alone in Recurrent or Refractory Endometrial Cancer Following the Earlier Phase of the Study That Tested Olaparib and Cediranib in Comparison to Cediranib Alone, and Olaparib Alone

NCT03660826Active, Not RecruitingPHASE2INTERVENTIONAL

Summary

This phase II trial studies the effects of the combination of olaparib and durvalumab, cediranib and durvalumab, olaparib and capivasertib, and cediranib alone in treating patients with endometrial cancer that has come back (recurrent) or does not respond to treatment (refractory). Olaparib, cediranib, and capivasertib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Durvalumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. Testing the combinations may lower the chance of endometrial cancer growing or spreading compared to usual care.

Key Facts

Lead Sponsor

National Cancer Institute (NCI)

Enrollment

288

Start Date

2018-09-27

Completion Date

2024-12-06

Study Type

INTERVENTIONAL

Official Title

A Randomized Phase II Study Comparing Single-Agent Olaparib, Single Agent Cediranib, and the Combinations of Cediranib/Olaparib, Olaparib/Durvalumab (MEDI4736), Cediranib/Durvalumab (MEDI4736), Olaparib/AZD5363 (Capivasertib) in Women With Recurrent, Persistent or Metastatic Endometrial Cancer.: A Platform Trial for Women With Recurrent or Persistent Endometrial Cancer

Interventions

Biospecimen CollectionBone Marrow AspirateBone Marrow BiopsyCapivasertibCediranib MaleateComputed TomographyDurvalumabEchocardiography TestMultigated Acquisition ScanOlaparib

Conditions

Endometrial AdenocarcinomaEndometrial Mixed Cell AdenocarcinomaEndometrial Serous AdenocarcinomaEndometrial Undifferentiated CarcinomaEndometrioid AdenocarcinomaStage IV Uterine Corpus Carcinoma or Carcinosarcoma AJCC v8

Eligibility

Age Range

18 Years+

Sex

FEMALE

Inclusion Criteria:

* Patients must have recurrent or persistent endometrial carcinoma, which is refractory to curative therapy or established treatments; histologic confirmation of the original primary tumor is required; patients with the following histologic epithelial cell types are eligible: endometrioid adenocarcinoma, serous adenocarcinoma, undifferentiated carcinoma, mixed epithelial carcinoma, adenocarcinoma not otherwise specified (N.O.S.); NOTE: clear cell and carcinosarcoma histology is excluded.
* Patients must have measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 or non-measurable (detectable) disease

  * 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 with measurable disease must have at least one "target lesion" to be used to assess response on this protocol as defined by RECIST version 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
  * Non-measurable (detectable) disease in a patient is defined in this protocol as one who does not have measurable disease but has at least one of the following conditions:

    * Ascites and/or pleural effusion attributed to tumor;
    * Solid and/or cystic abnormalities on radiographic imaging that do not meet RECIST 1.1 definitions for target lesions.
* Patients must have signed an approved informed consent and authorization permitting release of personal health information.
* Patients must have had one prior chemotherapeutic regimen for management of endometrial carcinoma; initial treatment may include chemotherapy, chemotherapy and radiation therapy, and/or consolidation/maintenance therapy; chemotherapy administered in conjunction with primary radiation as a radio-sensitizer WILL be counted as a systemic chemotherapy regimen.
* Patients are allowed to receive, but are not required to receive, one additional cytotoxic regimen for management of recurrent or persistent disease according to the following definition: cytotoxic regimens include any agent that targets the genetic and/or mitotic apparatus of dividing cells, resulting in dose-limiting toxicity to the bone marrow and/or gastrointestinal mucosa; Note: patients on this non-cytotoxic study are allowed to receive one additional cytotoxic chemotherapy regimen for management of recurrent or persistent disease, as defined above; however, patients are encouraged to enroll on second-line non-cytotoxic studies prior to receiving additional cytotoxic therapy.
* Patients may have received non cytotoxic therapy including immunotherapy (1 prior line in either upfront or recurrent setting) but excluding cediranib, olaparib, AZD5363 (capivasertib), durvalumab (MEDI4736), or the combination of lenvatinib and pembrolizumab for the management of recurrent or persistent disease; prior hormonal therapy is allowed; hormonal therapy for grade 1 endometrial cancers with low volume or indolent disease is encouraged.
* Bevacizumab, or one course of single-agent immune-checkpoint therapy, excluding durvalumab (MEDI4736), is permitted prior to enrollment on this trial.
* Body weight \> 30 kg.
* Age \>= 18.
* The trial is open to females only (including women with an intact uterus with uterine cancer); fertile females of childbearing potential need to agree to use adequate contraceptive measures from 2 weeks prior to the study and until 1 month after study treatment discontinuation, and have a negative serum or urine pregnancy test within 3 days prior to the start of study treatment.
* Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0,1 or 2 (Karnofsky \>= 60%) within 7 days prior to registration; patients should have no deterioration over the previous two weeks.
* Hemoglobin \>= 10 mg/dL with no blood transfusion in the past 28 days (within 28 days prior to administration of study drug).
* Platelet count \>= 100 x 10\^9/L (within 28 days prior to administration of study drug).
* Absolute neutrophil count (ANC) \>= 1.5 x 10\^9/L (within 28 days prior to administration of study drug).
* Patients must have creatinine clearance estimated of \>= 51 mL/min using the Cockcroft Gault equation or based on a 24-hour urine test (within 28 days prior to administration of study drug).
* Serum bilirubin =\< 1.5 X upper limit of normal (ULN) (within 28 days prior to administration of study drug).
* Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =\< 3 x ULN (within 28 days prior to administration of study drug).
* Urinalysis (dipstick) =\< 1+ proteinuria OR urine protein creatinine ratio (UPCR) \< 1 (within 28 days prior to administration of study drug).
* Patients must be able to swallow and retain oral medications and without gastrointestinal illnesses that would preclude absorption of cediranib, olaparib, or AZD5363 (capivasertib).
* Patients must have adequately controlled blood pressure (BP), with a BP no greater than 140 mmHg (systolic) and 90 mmHg (diastolic) for eligibility; patients must have a BP of =\< 140/90 mmHg taken in the clinic setting by a medical professional within 2 weeks prior to starting study; patients with hypertension may be managed with up to a maximum of three antihypertensive medications; it is strongly recommended that patients who are on three antihypertensive medications be followed by a cardiologist or blood pressure specialist for management of blood pressure while on protocol.

  * Note: Patients must be willing and able to check and record daily blood pressure readings.
* The patient or a legally authorized representative must provide study-specific informed consent prior to study entry.
* Adequately controlled thyroid function, with no symptoms of thyroid dysfunction.
* Postmenopausal or evidence of non-childbearing status for women of childbearing potential as confirmed by a negative urine or serum pregnancy test within 7 days prior to start of investigational products (IPs); postmenopausal is defined as:

  * Age \>= 60 years, or
  * Age \< 60 with any one or more of the conditions below:

    * Amenorrheic for \>= 1 year in the absence of chemotherapy and/or hormonal treatments,
    * Luteinizing hormone and/or follicle stimulating hormone and/or estradiol levels in the post-menopausal range
    * Radiation-induced oophorectomy with last menses \> 1 year ago,
    * Chemotherapy-induced menopause with \> 1 year interval since last menses,
    * Surgical sterilization (bilateral oophorectomy or hysterectomy).
* Patients must have a life expectancy of greater than 16 weeks.
* Patients with a previous diagnosis of immune or inflammatory colitis or chronic diarrhea \> 1 month without immune or inflammatory colitis are eligible with adequately controlled colitis (no diarrhea greater than grade 1 for at least 28 days) and in the absence of symptoms related to colonic dysfunction; patients who required steroids for prior immune related colitis are not eligible.
* Females of child-bearing potential should use two forms of highly reliable methods of contraception from the time of screening until 4 weeks after discontinuing study treatment.

  * Acceptable methods of contraception include:

    * Established use of oral, injected or implanted hormonal methods of contraception.
    * Placement of an intrauterine device or intrauterine system.
    * Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/suppository.
    * Male partner sterilization (with the appropriate post-vasectomy documentation of the absence of sperm in the ejaculate).
    * True abstinence (i.e., not engaging in sexual activity for the total duration of study treatment and the treatment washout period is an acceptable practice; however, periodic abstinence, the rhythm method, and the withdrawal method are not acceptable methods of birth control).
    * Bilateral tubal occlusion or salpingectomy
  * Acceptable non-hormonal birth control methods include:

    * Total/True abstinence: When the patient refrains from any form of sexual intercourse and this is in line with their usual and/or preferred lifestyle; this must continue for the total duration of the trial and for at least 1 month after the last dose of study drug \<\<for 3 months after last dose for male patients\>\>. \[Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods, or declaration of abstinence solely for the duration of a trial) and withdrawal are not acceptable methods of contraception\]
    * Vasectomised sexual partner PLUS male condom. With participant assurance that partner received post-vasectomy confirmation of azoospermia.
    * Tubal occlusion PLUS male condom
    * Intrauterine device (IUD) PLUS male condom. Provided coils are copper-banded.
  * Acceptable hormonal methods:

    * Normal and low dose combined oral pills PLUS male condom.
    * Cerazette (desogestrel) PLUS male condom. Cerazette is currently the only highly efficacious progesterone-based pill.
    * Hormonal shot or injection (e.g., Depo-Provera) PLUS male condom.
    * Etonogestrel implants (e.g., Implanon, Norplant) PLUS male condom.
    * Norelgestromin/EE transdermal system PLUS male condom
    * Intrauterine system \[IUS\] device (e.g., levonorgestrel releasing IUS -Mirena) PLUS male condom.
    * Intravaginal device (e.g., EE and etonogestrel) PLUS male condom.

Exclusion Criteria:

* Prior enrollment into a clinical trial including cediranib or olaparib; Note: prior bevacizumab is not an exclusion criterion.
* Prior enrollment into a clinical trial including cediranib, olaparib, AZD5363 (capivasertib), durvalumab (MEDI4736), or the combination of lenvatinib and pembrolizumab. Note: Prior bevacizumab or single-agent immune checkpoint blockade, excluding durvalumab (MEDI4736), is not an exclusion criterion.
* Prior chemotherapy, endocrine therapy, radiotherapy, or investigational agents within 4 weeks.
* More than one prior line of treatment with immune checkpoint blockade therapy.
* Current signs/symptoms of bowel obstruction and/or signs/symptoms of bowel obstruction within the preceding 3 months.
* History of gastrointestinal perforation; patients with a history of abdominal fistula will be considered eligible if the fistula was surgically repaired or has healed, there has been no evidence of fistula for at least 6 months, and patient is deemed to be at low risk of recurrent fistula.
* Uncontrolled intercurrent illness including, but not limited to known ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, extensive interstitial bilateral lung disease on high resolution computed tomography (HRCT) scan or psychiatric illness/social situations that would limit compliance with study requirements.
* Concomitant use of known strong cytochrome (CYP) 3A inhibitors (e.g., itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir) or moderate CYP3A inhibitors (e.g. ciprofloxacin, erythromycin, diltiazem, fluconazole, verapamil); the required washout period prior to starting study treatments is 2 weeks for strong inhibitors, and at least 1 week for moderate inhibitors.
* Concomitant use of potent inhibitors or inducers of CYP3A4 within 2 weeks before the start of study treatment (3 weeks for St John's wort), or sensitive substrates of CYP3A4, CYP2C9 and/or CYP2D6 with a narrow therapeutic window within 1 week before the start of study treatment. Concomitant use of drugs known to prolong the QT interval within 5 half-lives of the first dose of study treatment.
* Pregnant women are excluded from this study because cediranib and olaparib are agents with the potential for teratogenic or abortifacient effects; because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with cediranib and olaparib, breastfeeding should be discontinued if the mother is treated with cediranib or olaparib; these potential risks may also apply to other agents used in this study; for women of childbearing capacity a negative pregnancy test is required.
* Known human immunodeficiency virus (HIV)-positive individuals are ineligible because of the potential for pharmacokinetic interactions between many anti-HIV drugs and cediranib, olaparib, and/or AZD5363 (capivasertib); in addition, these individuals are at increased risk of lethal infections when treated with marrow-suppressive therapy.
* Known active hepatitis B or hepatitis C infection on antiviral treatment.
* Prior history of stroke or transient ischemic attack within the last 6 months.
* Left ventricular ejection fraction (LVEF) \< lower limit of normal (LLN) per institutional guidelines, or \< 55%, if threshold for normal not otherwise specified by institutional guidelines, for patients with the following risk factors:

  * Prior treatment with anthracyclines
  * Prior treatment with trastuzumab
  * Prior central thoracic radiation therapy (RT), including exposure of heart to therapeutic doses of ionizing RT
  * History of myocardial infarction within 6-12 months prior to start of IPs
  * Prior history of other significant impaired cardiac function.
* Patients with any of the following:

  * History of myocardial infarction within 6 months prior to starting treatment
  * Unstable angina
  * Resting electrocardiogram (ECG) with clinically significant abnormal findings or with corrected QT interval (QTc) \> 470 msec on 2 or more time points within a 24 hour period or family history of long QT syndrome
  * New York Heart Association functional classification of III or IV.
* Prior history of hypertensive crisis or hypertensive encephalopathy.
* Major surgical procedure within 4 weeks prior to starting treatment; patients must have recovered from any effects of any major surgery and surgical wound should have healed prior to starting treatment.
* History of intra-abdominal abscess within 3 months prior to starting treatment.
* Patients may not use any complementary or alternative medicines including natural herbal products or folk remedies as they may interfere with the effectiveness of the study treatments.
* No prior allogeneic bone marrow transplant or double umbilical cord blood transplantation (dUBCT).
* Whole blood transfusions in the last 120 days prior to entry to the study (packed red blood cells and platelet transfusions are acceptable).
* Patients with myelodysplastic syndrome (MDS)/treatment-related acute myeloid leukemia (t-AML) or with features suggestive of MDS/AML.
* Central nervous system metastases:

  * Symptomatic uncontrolled brain metastases requiring corticosteroid treatment; history of spinal cord compression unless after definitive treatment the patient has clinically stable disease (SD) for at least 28 days prior to starting IPs; in the absence of these features and in an asymptomatic patient a scan to confirm the absence of brain metastases is not required.
* Other malignancy within the last 5 years except for:

  * Curatively treated basal cell or squamous cell carcinoma of skin; in situ cancer of the cervix, ductal carcinoma in situ of the breast or stage 1, grade 1 endometrial carcinoma
  * Curatively treated other solid tumors including lymphomas (without bone marrow involvement) with no evidence of disease for \>= 5 years prior to start of IPs.
* Persisting \>= grade 2 Common Terminology Criteria for Adverse Events (CTCAE) toxicity (except alopecia and grade 2 peripheral neuropathy) from previous anti-cancer treatment(s).
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to cediranib, olaparib, AZD5363 (capivasertib), or durvalumab (MEDI4736).
* Pneumonitis or moderate-severe pre-existing pulmonary disease.
* Patients who have a diagnosis of immunodeficiency or are receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days of enrollment.

  * Premedication with steroids for CT scan contrast is allowed.
  * Inhaled or topical corticosteroids are allowed.
  * The use of mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension or adrenocortical insufficiency is allowed.
  * The use of physiologic doses of corticosteroids may be approved after consultation with the study chair.
* 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. This includes, but is 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 SLE, connective tissue diseases, scleroderma, inflammatory bowel disease (IBD), Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome because of the risk of recurrence or exacerbation of disease.
* Patients with vitiligo, endocrine deficiencies including type I diabetes mellitus, 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.
* Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and tuberculosis \[TB\] testing in line with local practice).

Outcome Measures

Primary Outcomes

Progression-free Survival

Progression-free survival is defined as the time from the date of study enrollment to the investigator-determined date of progression or death due to any cause, whichever occurs first. For individuals who are alive and progression-free, the censored time at risk will be defined as the time from the study enrollment date to the date of the patient's last radiographic disease assessment.

Time frame: Scans were done every 8 weeks for the first year and then every 12 weeks thereafter until disease progression. Vital status was assessed every 3 months for 2 years and then every 6 months for 3 years (5-years total).

Secondary Outcomes

Overall Survival

Overall survival is defined as the time from the date of study enrollment to the date of death regardless of cause. For those individuals who have no death reported at the time of the analysis, the censored time at risk will be assessed from the date of study enrollment to the date that the patient was last contacted and known to be alive.

Time frame: Vital status was assessed every 3 months for 2 years and then every 6 months for 3 years (5-years total).

Objective Tumor Response

Objective tumor response was assessed in patients with measurable disease by the site investigator using RECIST v1.1. Patients with complete or partial tumor response were considered to have a response.

Time frame: Scans were done every 8 weeks for the first year; then every 12 weeks thereafter until disease progression is confirmed or up to 33 months.

Incidence of Adverse Events

The number of patients who reported at least a grade 3 adverse event were assessed in those who initiated treatment.

Time frame: Toxicity was assessed every other week for the first 8 weeks of study therapy and every 8 weeks after the completion or termination of study therapy up to 50 months.

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 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

Fairbanks Memorial Hospital, Fairbanks, United States

CTCA at Western Regional Medical Center, Goodyear, United States

Kingman Regional Medical Center, Kingman, United States

Cancer Center at Saint Joseph's, Phoenix, United States

Mayo Clinic Hospital in Arizona, Phoenix, United States

Mayo Clinic in Arizona, Scottsdale, United States

University of Arizona Cancer Center-Orange Grove Campus, Tucson, United States

Banner University Medical Center - Tucson, Tucson, United States

University of Arizona Cancer Center-North Campus, Tucson, United States

Mercy Hospital Fort Smith, Fort Smith, United States

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

University of Arkansas for Medical Sciences, Little Rock, United States

Kaiser Permanente-Anaheim, Anaheim, United States

Mission Hope Medical Oncology - Arroyo Grande, Arroyo Grande, United States

PCR Oncology, Arroyo Grande, 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

Kaiser Permanente-Bellflower, Bellflower, United States

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

Tower Cancer Research Foundation, Beverly Hills, 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

Mercy Cancer Center - Carmichael, Carmichael, United States

Mercy San Juan Medical Center, Carmichael, United States

Eden Hospital Medical Center, Castro Valley, United States

Sutter Davis Hospital, Davis, United States

Mercy Cancer Center - Elk Grove, Elk Grove, United States

Kaiser Permanente-Fontana, Fontana, United States

Palo Alto Medical Foundation-Fremont, Fremont, United States

Kaiser Permanente South Bay, Harbor City, United States

Kaiser Permanente-Irvine, Irvine, United States

Kaiser Permanente Los Angeles Medical Center, Los Angeles, United States

Kaiser Permanente West Los Angeles, Los Angeles, United States

Cedars Sinai Medical Center, Los Angeles, 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

Providence Queen of The Valley, Napa, United States

Sutter Cancer Research Consortium, Novato, United States

Kaiser Permanente-Ontario, Ontario, United States

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

Kaiser Permanente - Panorama City, Panorama City, United States

Kaiser Permanente-Riverside, Riverside, United States

Mercy Cancer Center - Rocklin, Rocklin, United States

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

Sutter Roseville Medical Center, Roseville, United States

Mercy Cancer Center - Sacramento, Sacramento, 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

Pacific Central Coast Health Center-San Luis Obispo, San Luis Obispo, United States

Kaiser Permanente-San Marcos, San Marcos, United States

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

Mission Hope Medical Oncology - Santa Maria, Santa Maria, United States

Providence Medical Foundation - Santa Rosa, Santa Rosa, United States

Sutter Pacific Medical Foundation, Santa Rosa, United States

Providence Santa Rosa Memorial Hospital, Santa Rosa, United States

Palo Alto Medical Foundation-Sunnyvale, Sunnyvale, United States

Torrance Memorial Physician Network - Cancer Care, Torrance, United States

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

Woodland Memorial Hospital, Woodland, United States

Kaiser Permanente-Woodland Hills, Woodland Hills, United States

Rocky Mountain Cancer Centers-Aurora, Aurora, United States

The Medical Center of Aurora, Aurora, United States

UCHealth University of Colorado Hospital, Aurora, United States

Boulder Community Foothills Hospital, Boulder, United States

Rocky Mountain Cancer Centers-Boulder, Boulder, United States

Rocky Mountain Cancer Centers - Centennial, Centennial, United States

Penrose-Saint Francis Healthcare, Colorado Springs, United States

Rocky Mountain Cancer Centers-Penrose, Colorado Springs, United States

UCHealth Memorial Hospital Central, Colorado Springs, United States

Memorial Hospital North, Colorado Springs, United States

Saint Francis Cancer Center, Colorado Springs, United States

Denver Health Medical Center, Denver, United States

National Jewish Health-Main Campus, Denver, United States

The Women's Imaging Center, Denver, United States

AdventHealth Porter, Denver, United States

Colorado Blood Cancer Institute, Denver, United States

Presbyterian - Saint Lukes Medical Center - Health One, Denver, United States

Rocky Mountain Cancer Centers-Midtown, Denver, United States

Saint Joseph Hospital - Cancer Centers of Colorado, Denver, United States

Rocky Mountain Cancer Centers-Rose, Denver, United States

Rose Medical Center, Denver, United States

Western Surgical Care, Denver, United States

CommonSpirit Cancer Center Mercy, Durango, United States

Mercy Medical Center, Durango, United States

Mountain Blue Cancer Care Center - Swedish, Englewood, United States

Rocky Mountain Cancer Centers - Swedish, Englewood, United States

Swedish Medical Center, Englewood, United States

The Melanoma and Skin Cancer Institute, Englewood, United States

Poudre Valley Hospital, Fort Collins, United States

Cancer Care and Hematology-Fort Collins, Fort Collins, United States

Mountain Blue Cancer Care Center, Golden, United States

National Jewish Health-Western Hematology Oncology, Golden, United States

Saint Mary's Hospital and Regional Medical Center, Grand Junction, United States

Banner North Colorado Medical Center, Greeley, United States

UCHealth Greeley Hospital, Greeley, United States

Good Samaritan Hospital - Cancer Centers of Colorado, Lafayette, United States

Rocky Mountain Cancer Centers-Lakewood, Lakewood, United States

Saint Anthony Hospital, Lakewood, United States

Rocky Mountain Cancer Centers-Littleton, Littleton, United States

AdventHealth Littleton, Littleton, United States

Rocky Mountain Cancer Centers-Sky Ridge, Lone Tree, United States

Sky Ridge Medical Center, Lone Tree, United States

Longmont United Hospital, Longmont, United States

Rocky Mountain Cancer Centers-Longmont, Longmont, United States

Medical Center of the Rockies, Loveland, United States

Banner North Colorado Medical Center - Loveland Campus, Loveland, United States

AdventHealth Parker, Parker, United States

Rocky Mountain Cancer Centers-Parker, Parker, United States

Saint Mary Corwin Medical Center, Pueblo, United States

Rocky Mountain Cancer Centers - Pueblo, Pueblo, United States

National Jewish Health-Northern Hematology Oncology, Thornton, United States

Rocky Mountain Cancer Centers-Thornton, Thornton, United States

Intermountain Health Lutheran Hospital, Wheat Ridge, United States

Smilow Cancer Hospital-Derby Care Center, Derby, United States

Smilow Cancer Hospital Care Center-Fairfield, Fairfield, United States

Smilow Cancer Hospital Care Center - Guilford, Guilford, United States

Hartford Hospital, Hartford, United States

Smilow Cancer Hospital Care Center at Saint Francis, Hartford, United States

The Hospital of Central Connecticut, New Britain, United States

Smilow Cancer Center/Yale-New Haven Hospital, New Haven, United States

Yale University, New Haven, United States

Yale-New Haven Hospital North Haven Medical Center, North Haven, United States

Smilow Cancer Hospital-Torrington Care Center, Torrington, United States

Smilow Cancer Hospital Care Center-Trumbull, Trumbull, United States

Smilow Cancer Hospital-Waterbury Care Center, Waterbury, United States

Smilow Cancer Hospital Care Center - Waterford, Waterford, United States

Beebe Medical Center, Lewes, United States

Beebe South Coastal Health Campus, Millville, 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

Sibley Memorial Hospital, Washington D.C., United States

George Washington University Medical Center, Washington D.C., United States

Florida Cancer Specialists - Bradenton Cancer Center, Bradenton, United States

UF Health Cancer Institute - Gainesville, Gainesville, United States

Jupiter Medical Center, Jupiter, United States

Sacred Heart Hospital, Pensacola, United States

Florida Cancer Specialists - Sarasota, Sarasota, United States

Florida Cancer Specialists - Sarasota Downtown, Sarasota, United States

Sarasota Memorial Hospital, Sarasota, United States

Florida Cancer Specialists - Venice Pinebrook, Venice, United States

Florida Cancer Specialists - Venice Island, Venice, United States

Grady Health System, Atlanta, United States

Emory University Hospital Midtown, Atlanta, United States

Piedmont Hospital, Atlanta, United States

Emory University Hospital/Winship Cancer Institute, Atlanta, United States

Emory Saint Joseph's Hospital, Atlanta, United States

Piedmont Fayette Hospital, Fayetteville, United States

CTCA at Southeastern Regional Medical Center, Newnan, 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

Summit Cancer Care-Candler, Savannah, United States

Hawaii Cancer Care Inc - Waterfront Plaza, Honolulu, United States

Island Urology, Honolulu, United States

Queen's Cancer Cenrer - POB I, Honolulu, United States

Queen's Medical Center, Honolulu, United States

Straub Clinic and Hospital, Honolulu, United States

University of Hawaii Cancer Center, Honolulu, United States

Hawaii Cancer Care Inc-Liliha, Honolulu, United States

Kuakini Medical Center, Honolulu, United States

Queen's Cancer Center - Kuakini, Honolulu, United States

The Cancer Center of Hawaii-Liliha, Honolulu, United States

Kapiolani Medical Center for Women and Children, Honolulu, United States

Wilcox Memorial Hospital and Kauai Medical Clinic, Lihue, United States

Hawaii Cancer Care - Westridge, ‘Aiea, United States

Pali Momi Medical Center, ‘Aiea, United States

Queen's Cancer Center - Pearlridge, ‘Aiea, United States

The Cancer Center of Hawaii-Pali Momi, ‘Aiea, United States

Saint Alphonsus Cancer Care Center-Boise, Boise, United States

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

Saint Alphonsus Cancer Care Center-Caldwell, Caldwell, United States

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

Walter Knox Memorial Hospital, Emmett, United States

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

Idaho Urologic Institute-Meridian, Meridian, United States

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

Saint Alphonsus Cancer Care Center-Nampa, Nampa, 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 Anthony's Health Center, Alton, United States

Rush-Copley Medical Center, Aurora, United States

Advocate Good Shepherd Hospital, Barrington, United States

Carle BroMenn Outpatient Center, Bloomington, United States

Illinois CancerCare-Bloomington, Bloomington, United States

Illinois CancerCare-Canton, Canton, United States

Memorial Hospital of Carbondale, Carbondale, United States

SIH Cancer Institute, Carterville, United States

Illinois CancerCare-Carthage, Carthage, United States

Centralia Oncology Clinic, Centralia, United States

Saint Mary's Hospital, Centralia, United States

Northwestern University, Chicago, United States

John H Stroger Jr Hospital of Cook County, Chicago, United States

Rush MD Anderson Cancer Center, Chicago, United States

University of Chicago Comprehensive Cancer Center, Chicago, United States

Advocate Illinois Masonic Medical Center, Chicago, United States

AMG Crystal Lake - Oncology, Crystal Lake, United States

Carle at The Riverfront, Danville, United States

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

Decatur Memorial Hospital, Decatur, United States

Illinois CancerCare-Dixon, Dixon, United States

Advocate Good Samaritan Hospital, Downers Grove, United States

Carle Physician Group-Effingham, Effingham, United States

Crossroads Cancer Center, Effingham, United States

Advocate Sherman Hospital, Elgin, United States

Illinois CancerCare-Eureka, Eureka, United States

NorthShore University HealthSystem-Evanston Hospital, Evanston, United States

Illinois CancerCare-Galesburg, Galesburg, United States

Western Illinois Cancer Treatment Center, Galesburg, United States

Northwestern Medicine Cancer Center Delnor, Geneva, United States

NorthShore University HealthSystem-Glenbrook Hospital, Glenview, United States

Ingalls Memorial Hospital, Harvey, United States

Advocate South Suburban Hospital, Hazel Crest, United States

NorthShore University HealthSystem-Highland Park Hospital, Highland Park, United States

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

Illinois CancerCare-Kewanee Clinic, Kewanee, United States

Northwestern Medicine Lake Forest Hospital, Lake Forest, United States

Illinois CancerCare-Macomb, Macomb, United States

Carle Physician Group-Mattoon/Charleston, Mattoon, United States

SSM Health Good Samaritan, Mount Vernon, United States

UC Comprehensive Cancer Center at Silver Cross, New Lenox, United States

Carle BroMenn Medical Center, Normal, United States

Carle Cancer Institute Normal, Normal, United States

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

Advocate Christ Medical Center, Oak Lawn, United States

University of Chicago Medicine-Orland Park, Orland Park, United States

Illinois CancerCare-Ottawa Clinic, Ottawa, United States

Advocate Lutheran General Hospital, Park Ridge, United States

Illinois CancerCare-Pekin, Pekin, United States

Illinois CancerCare-Peoria, Peoria, United States

Methodist Medical Center of Illinois, Peoria, United States

Illinois CancerCare-Peru, Peru, United States

Valley Radiation Oncology, Peru, United States

Illinois CancerCare-Princeton, Princeton, United States

Southern Illinois University School of Medicine, Springfield, United States

Springfield Clinic, Springfield, United States

Springfield Memorial Hospital, Springfield, United States

Southwest Illinois Health Services LLP, Swansea, United States

Carle Cancer Center, Urbana, United States

The Carle Foundation Hospital, Urbana, United States

Northwestern Medicine Cancer Center Warrenville, Warrenville, United States

Illinois CancerCare - Washington, Washington, United States

Rush-Copley Healthcare Center, Yorkville, United States

Midwestern Regional Medical Center, Zion, United States

Northwest Cancer Center - Main Campus, Crown Point, United States

Northwest Oncology LLC, Dyer, United States

Parkview Hospital Randallia, Fort Wayne, United States

Parkview Regional Medical Center, Fort Wayne, United States

Northwest Cancer Center - Hobart, Hobart, United States

Saint Mary Medical Center, Hobart, United States

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

Sidney and Lois Eskenazi Hospital, Indianapolis, United States

Ascension Saint Vincent Indianapolis Hospital, Indianapolis, United States

Saint Catherine Hospital, Indianapolis, United States

The Community Hospital, Munster, United States

Women's Diagnostic Center - Munster, Munster, United States

Reid Health, Richmond, United States

Memorial Hospital of South Bend, South Bend, United States

Northwest Cancer Center - Valparaiso, Valparaiso, 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

Iowa Methodist Medical Center, Des Moines, United States

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

Broadlawns Medical Center, Des Moines, United States

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

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

Iowa Lutheran Hospital, Des Moines, United States

UI Healthcare Mission Cancer and Blood - Fort Dodge, Fort Dodge, United States

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

Methodist West Hospital, West Des Moines, United States

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

Central Care Cancer Center - Garden City, Garden City, United States

Central Care Cancer Center - Great Bend, Great Bend, 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

Flaget Memorial Hospital, Bardstown, United States

Baptist Health Corbin, Corbin, United States

Commonwealth Cancer Center-Corbin, Corbin, United States

Saint Elizabeth Healthcare Edgewood, Edgewood, United States

Baptist Health Lexington, Lexington, United States

Saint Joseph Hospital, Lexington, United States

Saint Joseph Radiation Oncology Resource Center, Lexington, United States

Saint Joseph Hospital East, Lexington, United States

Saint Joseph London, London, United States

Jewish Hospital, Louisville, United States

Baptist Health Louisville, Louisville, United States

Saints Mary and Elizabeth Hospital, Louisville, United States

UofL Health Medical Center Northeast, Louisville, United States

Baptist Health Madisonville/Merle Mahr Cancer Center, Madisonville, United States

Saint Joseph Mount Sterling, Mount Sterling, United States

Baptist Health Paducah, Paducah, United States

Mercy Health - Paducah Cancer Center, Paducah, United States

Baptist Health Richmond, Richmond, United States

Jewish Hospital Medical Center South, Shepherdsville, United States

Mary Bird Perkins Cancer Center, Baton Rouge, United States

Women's Cancer Care-Covington, Covington, United States

Ochsner Baptist Medical Center, New Orleans, United States

Ochsner Medical Center Jefferson, New Orleans, United States

Eastern Maine Medical Center, Bangor, United States

Lafayette Family Cancer Center-EMMC, Brewer, United States

MaineHealth Maine Medical Center- Scarborough, Scarborough, United States

Luminis Health Anne Arundel Medical Center, Annapolis, United States

Greater Baltimore Medical Center, Baltimore, United States

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

Walter Reed National Military Medical Center, Bethesda, United States

University of Maryland Shore Medical Center at Easton, Easton, United States

Christiana Care - Union Hospital, Elkton, United States

Beverly Hospital, Beverly, United States

Lahey Hospital and Medical Center, Burlington, United States

Addison Gilbert Hospital, Gloucester, United States

Lahey Medical Center-Peabody, Peabody, United States

Baystate Medical Center, Springfield, United States

Beth Israel Deaconess Medical Center/Winchester Center for Cancer Care, Winchester, United States

UMass Memorial Medical Center - Memorial Division, Worcester, United States

University of Michigan Rogel Cancer Center, Ann Arbor, United States

University of Michigan - Brighton Center for Specialty Care, Brighton, United States

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

Weisberg Cancer Treatment Center, Farmington Hills, United States

Huron Medical Center PC, Port Huron, United States

Lake Huron Medical Center, Port Huron, United States

Riverwood Healthcare Center, Aitkin, United States

Essentia Health - Baxter Clinic, Baxter, United States

Sanford Joe Lueken Cancer Center, Bemidji, United States

Essentia Health Saint Joseph's Medical Center, Brainerd, United States

Fairview Ridges Hospital, Burnsville, United States

Minnesota Oncology - Burnsville, Burnsville, United States

Cambridge Medical Center, Cambridge, United States

Mercy Hospital, Coon Rapids, United States

Essentia Health - Deer River Clinic, Deer River, United States

Essentia Health Saint Mary's - Detroit Lakes Clinic, Detroit Lakes, United States

Essentia Health Cancer Center, Duluth, United States

Essentia Health Saint Mary's Medical Center, Duluth, United States

Miller-Dwan Hospital, Duluth, United States

Fairview Southdale Hospital, Edina, United States

Essentia Health - Ely Clinic, Ely, United States

Lake Region Healthcare Corporation-Cancer Care, Fergus Falls, United States

Essentia Health - Fosston, Fosston, United States

Unity Hospital, Fridley, United States

Essentia Health Hibbing Clinic, Hibbing, United States

Essentia Health - International Falls Clinic, International Falls, United States

Fairview Clinics and Surgery Center Maple Grove, Maple Grove, United States

Minnesota Oncology Hematology PA-Maplewood, Maplewood, United States

Saint John's Hospital - Healtheast, Maplewood, United States

Abbott-Northwestern Hospital, Minneapolis, United States

Hennepin County Medical Center, Minneapolis, United States

Health Partners Inc, Minneapolis, United States

Monticello Cancer Center, Monticello, United States

Essentia Health - Moose Lake Clinic, Moose Lake, United States

New Ulm Medical Center, New Ulm, United States

Essentia Health - Park Rapids, Park Rapids, United States

Fairview Northland Medical Center, Princeton, United States

North Memorial Medical Health Center, Robbinsdale, United States

Mayo Clinic in Rochester, Rochester, United States

Park Nicollet Clinic - Saint Louis Park, Saint Louis Park, United States

Regions Hospital, Saint Paul, United States

United Hospital, Saint Paul, United States

Essentia Health Sandstone, Sandstone, United States

Saint Francis Regional Medical Center, Shakopee, United States

Lakeview Hospital, Stillwater, United States

Sanford Thief River Falls Medical Center, Thief River Falls, United States

Essentia Health Virginia Clinic, Virginia, United States

Ridgeview Medical Center, Waconia, United States

Rice Memorial Hospital, Willmar, United States

Minnesota Oncology Hematology PA-Woodbury, Woodbury, United States

Sanford Cancer Center Worthington, Worthington, United States

Fairview Lakes Medical Center, Wyoming, United States

University of Mississippi Medical Center, Jackson, United States

Mercy Oncology and Hematology - Clayton-Clarkson, Ballwin, 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 - University Hospital/Ellis Fischel Cancer Center, Columbia, United States

Parkland Health Center - Farmington, Farmington, 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

Heartland Regional Medical Center, Saint Joseph, 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

Washington University School of Medicine, St Louis, United States

Mercy Hospital South, 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

Mercy Hospital Washington, Washington, United States

Community Hospital of Anaconda, Anaconda, United States

Billings Clinic Cancer Center, Billings, United States

Saint Vincent Healthcare, Billings, United States

Saint Vincent Frontier Cancer Center, 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

Nebraska Cancer Specialists/Oncology Hematology West PC - MECC, Omaha, United States

Nebraska Methodist Hospital, Omaha, United States

Oncology Associates PC, Omaha, United States

Nebraska Medicine-Village Pointe, Omaha, 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

University of Nebraska Medical Center, Omaha, United States

Midlands Community Hospital, Papillion, United States

Carson Tahoe Regional Medical Center, Carson City, United States

Cancer and Blood Specialists-Henderson, Henderson, United States

Comprehensive Cancer Centers of Nevada - Henderson, Henderson, United States

Comprehensive Cancer Centers of Nevada-Horizon Ridge, Henderson, United States

Las Vegas Cancer Center-Henderson, Henderson, United States

OptumCare Cancer Care at Seven Hills, Henderson, United States

Comprehensive Cancer Centers of Nevada-Southeast Henderson, Henderson, United States

Las Vegas Urology - Green Valley, Henderson, United States

Las Vegas Urology - Pebble, Henderson, United States

Oncology Las Vegas - Henderson, Henderson, United States

Urology Specialists of Nevada - Green Valley, Henderson, United States

Las Vegas Urology - Pecos, Las Vegas, United States

Desert West Surgery, Las Vegas, United States

OptumCare Cancer Care at Charleston, Las Vegas, United States

University Medical Center of Southern Nevada, Las Vegas, United States

Hope Cancer Care of Nevada, Las Vegas, United States

Cancer and Blood Specialists-Shadow, Las Vegas, United States

Radiation Oncology Centers of Nevada Central, Las Vegas, United States

Urology Specialists of Nevada - Central, Las Vegas, United States

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

HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway, Las Vegas, United States

Sunrise Hospital and Medical Center, Las Vegas, United States

HealthCare Partners Medical Group Oncology/Hematology-San Martin, Las Vegas, United States

Las Vegas Prostate Cancer Center, Las Vegas, United States

Las Vegas Urology - Sunset, Las Vegas, United States

Urology Specialists of Nevada - Southwest, Las Vegas, United States

Radiation Oncology Centers of Nevada Southeast, Las Vegas, United States

Ann M Wierman MD LTD, Las Vegas, United States

Cancer and Blood Specialists-Tenaya, Las Vegas, United States

Comprehensive Cancer Centers of Nevada - Northwest, Las Vegas, United States

HealthCare Partners Medical Group Oncology/Hematology-Tenaya, Las Vegas, United States

Las Vegas Urology - Cathedral Rock, Las Vegas, United States

Las Vegas Urology - Smoke Ranch, Las Vegas, United States

Oncology Las Vegas - Tenaya, Las Vegas, United States

OptumCare Cancer Care at MountainView, Las Vegas, United States

Urology Specialists of Nevada - Northwest, Las Vegas, United States

Alliance for Childhood Diseases/Cure 4 the Kids Foundation, Las Vegas, United States

Comprehensive Cancer Centers of Nevada - Town Center, Las Vegas, United States

Comprehensive Cancer Centers of Nevada-Summerlin, Las Vegas, United States

Summerlin Hospital Medical Center, Las Vegas, United States

Las Vegas Cancer Center-Medical Center, Las Vegas, United States

Comprehensive Cancer Centers of Nevada, Las Vegas, United States

OptumCare Cancer Care at Fort Apache, Las Vegas, United States

HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills, Las Vegas, United States

Comprehensive Cancer Centers of Nevada - Central Valley, Las Vegas, United States

University Cancer Center, Las Vegas, United States

Hope Cancer Care of Nevada-Pahrump, Pahrump, United States

Renown Regional Medical Center, Reno, United States

Saint Mary's Regional Medical Center, Reno, United States

Radiation Oncology Associates, Reno, United States

Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center, Lebanon, United States

Dartmouth Cancer Center - Manchester, Manchester, United States

Dartmouth Cancer Center - Nashua, Nashua, United States

Virtua Memorial, Mount Holly, United States

Virtua Voorhees, Voorhees Township, United States

Southwest Gynecologic Oncology Associates Inc, Albuquerque, United States

University of New Mexico Cancer Center, Albuquerque, United States

Presbyterian Rust Medical Center/Jorgensen Cancer Center, Rio Rancho, United States

Women's Cancer Care Associates LLC, Albany, United States

Roswell Park Cancer Institute, Buffalo, United States

Mount Sinai Chelsea, New York, United States

Laura and Isaac Perlmutter Cancer Center at NYU Langone, New York, United States

Mount Sinai Hospital, New York, United States

University of Rochester, Rochester, United States

Montefiore Medical Center-Einstein Campus, The Bronx, United States

Montefiore Medical Center-Weiler Hospital, The Bronx, United States

Montefiore Medical Center - Moses Campus, The Bronx, United States

Dickstein Cancer Treatment Center, White Plains, United States

Randolph Hospital, Asheboro, United States

Hope Women's Cancer Centers-Asheville, Asheville, United States

Cone Health Cancer Center at Alamance Regional, Burlington, United States

Duke Cancer Center Cary, Cary, United States

UNC Lineberger Comprehensive Cancer Center, Chapel Hill, United States

Novant Health Presbyterian Medical Center, Charlotte, United States

Novant Health Carolina Surgical - Randolph, Charlotte, United States

Oncology Specialists of Charlotte, Charlotte, United States

Southern Oncology Specialists-Charlotte, Charlotte, United States

Southeastern Medical Oncology Center-Clinton, Clinton, United States

Duke University Medical Center, Durham, United States

Southeastern Medical Oncology Center-Goldsboro, Goldsboro, United States

Wayne Memorial Hospital, Goldsboro, United States

Cone Health Cancer Center, Greensboro, United States

Novant Health Cancer Institute - Huntersville, Huntersville, United States

Novant Health Presbyterian Medical Center Huntersville, Huntersville, United States

Southern Oncology Specialists-Huntersville, Huntersville, United States

Onslow Memorial Hospital, Jacksonville, United States

Southeastern Medical Oncology Center-Jacksonville, Jacksonville, United States

Novant Health Cancer Institute - Kernersville, Kernersville, United States

Matthews Radiation Oncology Center, Matthews, United States

Novant Health Cancer Institute - Matthews, Matthews, United States

Cone Heath Cancer Center at Mebane, Mebane, United States

Novant Health Cancer Institute - Mooresville, Mooresville, United States

Novant Health Cancer Institute - Mount Airy, Mount Airy, United States

Novant Health Cancer Institute - Wilkesboro, North Wilkesboro, United States

Duke Women's Cancer Care Raleigh, Raleigh, United States

Duke Cancer Center Raleigh, Raleigh, United States

Annie Penn Memorial Hospital, Reidsville, United States

Novant Health Cancer Institute - Rowan, Salisbury, United States

Rowan Regional Medical Center, Salisbury, United States

Novant Health Cancer Institute - Statesville, Statesville, United States

Novant Health Cancer Institute - Thomasville, Thomasville, United States

Novant Health Forsyth Medical Center, Winston-Salem, United States

Novant Health Oncology Specialists, Winston-Salem, United States

Sanford Bismarck Medical Center, Bismarck, United States

Essentia Health Cancer Center-South University Clinic, Fargo, United States

Sanford South University Medical Center, Fargo, United States

Sanford Medical Center Fargo, Fargo, United States

Sanford Broadway Medical Center, Fargo, United States

Sanford Roger Maris Cancer Center, Fargo, United States

Essentia Health - Jamestown Clinic, Jamestown, United States

Summa Health System - Akron Campus, Akron, United States

Aultman Alliance Community Hospital, Alliance, United States

UHHS-Chagrin Highlands Medical Center, Beachwood, United States

Indu and Raj Soin Medical Center, Beavercreek, United States

Strecker Cancer Center-Belpre, Belpre, United States

Saint Elizabeth Boardman Hospital, Boardman, United States

Aultman Health Foundation, Canton, United States

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

Miami Valley Hospital South, Centerville, United States

Geauga Hospital, Chardon, 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

MetroHealth Medical Center, 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

Columbus Oncology and Hematology Associates, Dublin, United States

Mercy Cancer Center-Elyria, Elyria, 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

Central Ohio Breast and Endocrine Surgery, Gahanna, United States

Dayton Physicians LLC-Wayne, Greenville, United States

Wayne Hospital, Greenville, United States

Mount Carmel Grove City Hospital, Grove City, United States

Zangmeister Center Grove City, Grove City, United States

Greater Dayton Cancer Center, Kettering, United States

First Dayton Cancer Care, Kettering, United States

Kettering Medical Center, Kettering, United States

Fairfield Medical Center, Lancaster, United States

Saint Rita's Medical Center, Lima, United States

OhioHealth Mansfield Hospital, Mansfield, 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 Lake Health Mentor Campus, Mentor, United States

UH Seidman Cancer Center at Southwest General Hospital, Middleburg Heights, United States

Knox Community Hospital, Mount Vernon, United States

Mount Carmel New Albany Surgical Hospital, New Albany, United States

Licking Memorial Hospital, Newark, United States

Newark Radiation Oncology, Newark, United States

Mercy Health - Perrysburg Hospital, Perrysburg, United States

Southern Ohio Medical Center, Portsmouth, United States

UH Seidman Cancer Center at Firelands Regional Medical Center, Sandusky, United States

Springfield Regional Cancer Center, Springfield, United States

Springfield Regional Medical Center, Springfield, United States

ProMedica Flower Hospital, Sylvania, United States

ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital, Toledo, United States

Mercy Health - Saint Vincent Hospital, Toledo, United States

Mercy Health - Saint Anne Hospital, Toledo, United States

Mercy Health Sylvania Radiation Oncology Center, Toledo, 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 Joseph Warren Hospital, Warren, United States

Saint Ann's Hospital, Westerville, United States

UH Seidman Cancer Center at Saint John Medical Center, Westlake, United States

UHHS-Westlake Medical Center, Westlake, United States

Saint Elizabeth Youngstown Hospital, Youngstown, United States

Genesis Healthcare System Cancer Care Center, Zanesville, United States

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

Mercy Hospital Oklahoma City, Oklahoma City, United States

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

Saint Alphonsus Cancer Care Center-Baker City, Baker City, 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

Saint Alphonsus Cancer Care Center-Ontario, Ontario, United States

Providence Willamette Falls Medical Center, Oregon City, United States

Legacy Good Samaritan Hospital and Medical Center, Portland, United States

Providence Portland Medical Center, Portland, United States

Providence Saint Vincent Medical Center, Portland, United States

Saint Charles Health System-Redmond, Redmond, United States

Legacy Meridian Park Hospital, Tualatin, United States

Jefferson Abington Hospital, Abington, United States

Bryn Mawr Hospital, Bryn Mawr, United States

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

Main Line Health Center-Collegeville, Collegeville, United States

Main Line Health Center-Exton, Exton, United States

Jefferson Hospital, Jefferson Hills, United States

Riddle Memorial Hospital, Media, United States

Forbes Hospital, Monroeville, United States

Paoli Memorial Hospital, Paoli, United States

Thomas Jefferson University Hospital, Philadelphia, United States

Allegheny General Hospital, Pittsburgh, United States

West Penn Hospital, Pittsburgh, United States

Chester County Hospital, West Chester, United States

Reading Hospital, West Reading, United States

Wexford Health and Wellness Pavilion, Wexford, United States

Asplundh Cancer Pavilion, Willow Grove, United States

Lankenau Medical Center, Wynnewood, United States

Women and Infants Hospital, Providence, United States

AnMed Health Cancer Center, Anderson, United States

Medical University of South Carolina, Charleston, United States

Gibbs Cancer Center-Gaffney, Gaffney, United States

Saint Francis Hospital, Greenville, United States

Saint Francis Cancer Center, Greenville, United States

Gibbs Cancer Center-Pelham, Greer, United States

Spartanburg Medical Center, Spartanburg, United States

SMC Center for Hematology Oncology Union, Union, United States

Sanford Cancer Center Oncology Clinic, Sioux Falls, United States

Avera Cancer Institute, Sioux Falls, United States

Sanford USD Medical Center - Sioux Falls, Sioux Falls, United States

Memorial Hospital, Chattanooga, United States

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

Memorial GYN Plus, Ooltewah, United States

Dell Seton Medical Center at The University of Texas, Austin, United States

Saint Joseph Regional Cancer Center, Bryan, United States

Parkland Memorial Hospital, Dallas, United States

UT Southwestern/Simmons Cancer Center-Dallas, Dallas, United States

Lyndon Baines Johnson General Hospital, Houston, United States

Houston Methodist Hospital, Houston, United States

M D Anderson Cancer Center, Houston, United States

Methodist Willowbrook Hospital, Houston, United States

Houston Methodist Sugar Land Hospital, Sugar Land, United States

Providence Regional Cancer System-Aberdeen, Aberdeen, United States

Overlake Medical Center, 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

Kadlec Clinic Hematology and Oncology, Kennewick, United States

Providence Regional Cancer System-Lacey, Lacey, United States

Saint Clare Hospital, Lakewood, United States

PeaceHealth Saint John Medical Center, Longview, United States

Jefferson Healthcare, Port Townsend, United States

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

Valley Medical Center, Renton, United States

Pacific Gynecology Specialists, Seattle, United States

Swedish Medical Center-Ballard Campus, Seattle, United States

Kaiser Permanente Washington, Seattle, United States

Swedish Medical Center-Cherry Hill, Seattle, United States

Swedish Medical Center-First Hill, Seattle, United States

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

PeaceHealth United General Medical Center, Sedro-Woolley, United States

Providence Regional Cancer System-Shelton, Shelton, United States

Saint Michael Cancer Center, Silverdale, 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

Legacy Salmon Creek Hospital, 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

West Virginia University Charleston Division, Charleston, United States

Duluth Clinic Ashland, Ashland, United States

Northwest Wisconsin Cancer Center, Ashland, United States

Aurora Cancer Care-Southern Lakes VLCC, Burlington, United States

Marshfield Clinic-Chippewa Center, Chippewa Falls, United States

Marshfield Medical Center-EC Cancer Center, Eau Claire, United States

Mayo Clinic Health System-Eau Claire Clinic, Eau Claire, United States

Aurora Health Center-Fond du Lac, Fond du Lac, United States

Aurora Health Care Germantown Health Center, Germantown, United States

Aurora Cancer Care-Grafton, Grafton, United States

Aurora BayCare Medical Center, Green Bay, United States

Essentia Health-Hayward Clinic, Hayward, United States

Aurora Cancer Care-Kenosha South, Kenosha, United States

Gundersen Lutheran Medical Center, La Crosse, United States

Marshfield Medical Center - Ladysmith, Ladysmith, United States

Aurora Bay Area Medical Group-Marinette, Marinette, United States

Marshfield Medical Center-Marshfield, Marshfield, United States

Aurora Cancer Care-Milwaukee, Milwaukee, United States

Aurora Saint Luke's Medical Center, Milwaukee, United States

Aurora Sinai Medical Center, Milwaukee, United States

Marshfield Medical Center - Minocqua, Minocqua, United States

Cancer Center of Western Wisconsin, New Richmond, United States

Vince Lombardi Cancer Clinic - Oshkosh, Oshkosh, United States

Aurora Cancer Care-Racine, Racine, United States

Marshfield Medical Center-Rice Lake, Rice Lake, United States

Vince Lombardi Cancer Clinic-Sheboygan, Sheboygan, United States

Essentia Health-Spooner Clinic, Spooner, United States

Marshfield Medical Center-River Region at Stevens Point, Stevens Point, United States

Aurora Medical Center in Summit, Summit, United States

Essentia Health Saint Mary's Hospital - Superior, Superior, United States

Vince Lombardi Cancer Clinic-Two Rivers, Two Rivers, United States

Marshfield Clinic-Wausau Center, Wausau, United States

Aurora Cancer Care-Milwaukee West, Wauwatosa, United States

Aurora West Allis Medical Center, West Allis, United States

Marshfield Medical Center - Weston, Weston, United States

Marshfield Clinic - Wisconsin Rapids Center, Wisconsin Rapids, United States

Cheyenne Regional Medical Center-West, Cheyenne, United States

Billings Clinic-Cody, Cody, United States

Welch Cancer Center, Sheridan, United States

Odette Cancer Centre- Sunnybrook Health Sciences Centre, Toronto, Canada

Linked Papers

2023-12-21

NRG‐GY012: Randomized phase 2 study comparing olaparib, cediranib, and the combination of cediranib/olaparib in women with recurrent, persistent, or metastatic endometrial cancer

AbstractPurposeThis paper reports the efficacy of the poly (ADP‐ribose) polymerase inhibitor olaparib alone and in combination with the antiangiogenesis agent cediranib compared with cediranib alone in patients with advanced endometrial cancer.MethodsThis was open‐label, randomized, phase 2 trial (NCT03660826). Eligible patients had recurrent endometrial cancer, received at least one (&lt;3) prior lines of chemotherapy, and were Eastern Cooperative Oncology Group performance status 0 to 2. Patients were randomly assigned (1:1:1), stratified by histology (serous vs. other) to receive cediranib alone (reference arm), olaparib, or olaparib and cediranib for 28‐day cycles until progression or unacceptable toxicity. The primary end point was progression‐free survival in the intention‐to‐treat population. Homologous repair deficiency was explored using the BROCA‐GO sequencing panel.ResultsA total of 120 patients were enrolled and all were included in the intention‐to‐treat analysis. Median age was 66 (range, 41–86) years and 47 (39.2%) had serous histology. Median progression‐free survival for cediranib was 3.8 months compared with 2.0 months for olaparib (hazard ratio, 1.45 [95% CI, 0.91‐2.3] p = .935) and 5.5 months for olaparib/cediranib (hazard ratio, 0.7 [95% CI, 0.43–1.14] p = .064). Four patients receiving the combination had a durable response lasting more than 20 months. The most common grade 3/4 toxicities were hypertension in the cediranib (36%) and olaparib/cediranib (33%) arms, fatigue (20.5% olaparib/cediranib), and diarrhea (17.9% cediranib). The BROCA‐GO panel results were not associated with response.ConclusionThe combination of cediranib and olaparib demonstrated modest clinical efficacy; however, the primary end point of the study was not met. The combination was safe without unexpected toxicity.

Linked Investigators

B J Rimel

Floor Backes

Helen MacKay