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Brief Title: Pembrolizumab vs. Observation in People With Triple-negative Breast Cancer Who Had a Pathologic Complete Response After Chemotherapy Plus Pembrolizumab
Official Title: OptimICE-PCR: De-Escalation of Therapy in Early-Stage TNBC Patients Who Achieve pCR After Neoadjuvant Chemotherapy With Checkpoint Inhibitor Therapy
Study ID: NCT05812807
Brief Summary: The phase III trial compares the effect of pembrolizumab to observation for the treatment of patients with early-stage triple-negative breast cancer who achieved a pathologic complete response after preoperative chemotherapy in combination with pembrolizumab. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. This trial may help researchers determine if observation will result in the same risk of cancer coming back as pembrolizumab after surgery in triple-negative breast cancer patients who achieve pathologic complete response after preoperative chemotherapy with pembrolizumab.
Detailed Description: PRIMARY OBJECTIVES: I. To evaluate whether observation results in a non-inferior recurrence-free survival (RFS) compared to adjuvant pembrolizumab in early-stage triple-negative breast cancer (TNBC) patients who achieve a pathologic complete response (pCR) after neoadjuvant chemotherapy with pembrolizumab. II. To compare quality of life (QOL) at approximately 27 weeks as assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B) Trial Outcome Index between patients randomized to adjuvant pembrolizumab versus observation. (Quality of Life) III. To assess the social value of de-escalation of adjuvant breast cancer immunotherapy at approximately 27 weeks and, by modeling, over a lifetime. (Value of Care) SECONDARY OBJECTIVES: I. To evaluate whether observation compared to adjuvant pembrolizumab impacts the following: Ia. RFS by stage at presentation and by receipt of prior anthracycline therapy; Ib. Adverse event rate: difference in Grade 3 or higher adverse event rates overall and Grade 3 or higher immune-related adverse events (irAEs) rates; Ic. Overall Survival (OS); Id. Locoregional recurrence (LRR both isolated LRR as first events and LRR events simultaneous with DM); Ie. RFS, LRR, OS, adverse events, and QOL by age (=\< 45, 46-65, and \> 65), race, and ethnicity; If. Adverse events related to receipt of radiotherapy. II. To assess the value of de-escalation of breast cancer immunotherapy from the payer perspective at approximately 27 weeks and, by modelling, over a lifetime. (Value of Care) III. To compare patient out-of-pocket costs at approximately 27 weeks between patients randomized to adjuvant pembrolizumab versus observation. (Value of Care) IV. To compare financial toxicity at approximately 27 weeks between patients randomized to adjuvant pembrolizumab versus observation. (Value of Care) V. To compare work/productivity impairment at approximately 27 weeks between patients randomized to adjuvant pembrolizumab versus observation. (Value of Care) EXPLORATORY OBJECTIVES: I. To describe trajectories of QOL over time among patients randomized to adjuvant pembrolizumab versus (vs.) observation. (Quality of Life) II. To compare various QOL domains after approximately 27 weeks as assessed by the 5 subscales of the FACT-B Index between patients randomized to adjuvant pembrolizumab versus observation. (Quality of Life) III. To compare self-reported symptomatic adverse events at approximately 27 weeks assessed by the patient reported outcome Common Terminology Criteria for Adverse Events (PRO-CTCAE) between patients randomized to adjuvant pembrolizumab versus observation. (Quality of Life) IV. To describe trajectories of financial toxicity and work/productivity impairment over time from baseline to approximately 27 weeks among patients randomized to adjuvant pembrolizumab versus observation. (Value of Care) V. To develop and assess a measure of value from the patient perspective at approximately 27 weeks. (Value of Care) OUTLINE: Patients are randomized to 1 of 2 arms after completing neoadjuvant chemotherapy in combination with pembrolizumab, followed by definitive breast surgery. ARM I (PEMBROLIZUMAB): Patients receive pembrolizumab intravenously (IV) on study. Patients also undergo tumor biopsy on study, and collection of blood on study and during follow-up. ARM II (OBSERVATION): Patients undergo observation on study. Patients also undergo tumor biopsy on study, and collection of blood on study and during follow-up.
Minimum Age: 18 Years
Eligible Ages: ADULT, OLDER_ADULT
Sex: ALL
Healthy Volunteers: No
University of Alabama at Birmingham Cancer Center, Birmingham, Alabama, United States
Thomas Hospital, Fairhope, Alabama, United States
Mobile Infirmary Medical Center, Mobile, Alabama, United States
Kingman Regional Medical Center, Kingman, Arizona, United States
Cancer Center at Saint Joseph's, Phoenix, Arizona, United States
Mayo Clinic Hospital in Arizona, Phoenix, Arizona, United States
Highlands Oncology Group - Fayetteville, Fayetteville, Arkansas, United States
University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Highlands Oncology Group - Rogers, Rogers, Arkansas, United States
Highlands Oncology Group, Springdale, Arkansas, United States
PCR Oncology, Arroyo Grande, California, United States
Tower Cancer Research Foundation, Beverly Hills, California, United States
Marshall Cancer Center, Cameron Park, California, United States
Kaiser Permanente Dublin, Dublin, California, United States
Kaiser Permanente-Fremont, Fremont, California, United States
Kaiser Permanente-Fresno, Fresno, California, United States
Cedars Sinai Medical Center, Los Angeles, California, United States
Fremont - Rideout Cancer Center, Marysville, California, United States
Kaiser Permanente-Modesto, Modesto, California, United States
Kaiser Permanente-Oakland, Oakland, California, United States
Desert Regional Medical Center, Palm Springs, California, United States
Stanford Cancer Institute Palo Alto, Palo Alto, California, United States
Huntington Memorial Hospital, Pasadena, California, United States
Kaiser Permanente-Roseville, Roseville, California, United States
Kaiser Permanente Downtown Commons, Sacramento, California, United States
University of California Davis Comprehensive Cancer Center, Sacramento, California, United States
Kaiser Permanente-South Sacramento, Sacramento, California, United States
Salinas Valley Memorial, Salinas, California, United States
Zuckerberg San Francisco General Hospital, San Francisco, California, United States
Kaiser Permanente-San Francisco, San Francisco, California, United States
Kaiser Permanente-Santa Teresa-San Jose, San Jose, California, United States
Stanford Cancer Center South Bay, San Jose, California, United States
Kaiser Permanente San Leandro, San Leandro, California, United States
Kaiser San Rafael-Gallinas, San Rafael, California, United States
Kaiser Permanente Medical Center - Santa Clara, Santa Clara, California, United States
Saint John's Cancer Institute, Santa Monica, California, United States
Kaiser Permanente-Santa Rosa, Santa Rosa, California, United States
Kaiser Permanente-South San Francisco, South San Francisco, California, United States
Cedars-Sinai Cancer - Tarzana, Tarzana, California, United States
Torrance Memorial Physician Network - Cancer Care, Torrance, California, United States
Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, California, United States
Kaiser Permanente-Vallejo, Vallejo, California, United States
Kaiser Permanente-Walnut Creek, Walnut Creek, California, United States
UCHealth University of Colorado Hospital, Aurora, Colorado, United States
UCHealth Memorial Hospital Central, Colorado Springs, Colorado, United States
Memorial Hospital North, Colorado Springs, Colorado, United States
Kaiser Permanente-Franklin, Denver, Colorado, United States
UCHealth - Cherry Creek, Denver, Colorado, United States
UCHealth Highlands Ranch Hospital, Highlands Ranch, Colorado, United States
Kaiser Permanente-Rock Creek, Lafayette, Colorado, United States
Kaiser Permanente-Lone Tree, Lone Tree, Colorado, United States
UCHealth Lone Tree Health Center, Lone Tree, Colorado, United States
Danbury Hospital, Danbury, Connecticut, United States
Smilow Cancer Hospital-Derby Care Center, Derby, Connecticut, United States
Smilow Cancer Hospital Care Center-Fairfield, Fairfield, Connecticut, United States
Smilow Cancer Hospital Care Center at Glastonbury, Glastonbury, Connecticut, United States
Smilow Cancer Hospital Care Center at Greenwich, Greenwich, Connecticut, United States
Smilow Cancer Hospital Care Center - Guilford, Guilford, Connecticut, United States
Smilow Cancer Hospital Care Center at Saint Francis, Hartford, Connecticut, United States
Yale University, New Haven, Connecticut, United States
Yale-New Haven Hospital North Haven Medical Center, North Haven, Connecticut, United States
Norwalk Hospital, Norwalk, Connecticut, United States
Smilow Cancer Hospital Care Center at Long Ridge, Stamford, Connecticut, United States
Smilow Cancer Hospital-Torrington Care Center, Torrington, Connecticut, United States
Smilow Cancer Hospital Care Center-Trumbull, Trumbull, Connecticut, United States
Smilow Cancer Hospital-Waterbury Care Center, Waterbury, Connecticut, United States
Smilow Cancer Hospital Care Center - Waterford, Waterford, Connecticut, United States
Beebe South Coastal Health Campus, Frankford, Delaware, United States
Helen F Graham Cancer Center, Newark, Delaware, United States
Medical Oncology Hematology Consultants PA, Newark, Delaware, United States
Beebe Health Campus, Rehoboth Beach, Delaware, United States
MedStar Georgetown University Hospital, Washington, District of Columbia, United States
MedStar Washington Hospital Center, Washington, District of Columbia, United States
Morton Plant Hospital, Clearwater, Florida, United States
University of Florida Health Science Center - Gainesville, Gainesville, Florida, United States
Mayo Clinic in Florida, Jacksonville, Florida, United States
Orlando Health Cancer Institute, Orlando, Florida, United States
Memorial Hospital West, Pembroke Pines, Florida, United States
Mease Countryside Hospital, Safety Harbor, Florida, United States
Tallahassee Memorial HealthCare, Tallahassee, Florida, United States
Tampa General Hospital, Tampa, Florida, United States
Saint Joseph's Hospital/Children's Hospital-Tampa, Tampa, Florida, United States
Phoebe Putney Memorial Hospital, Albany, Georgia, United States
Grady Health System, Atlanta, Georgia, United States
Emory University Hospital Midtown, Atlanta, Georgia, United States
Emory University Hospital/Winship Cancer Institute, Atlanta, Georgia, United States
Emory Saint Joseph's Hospital, Atlanta, Georgia, United States
Northside Hospital, Atlanta, Georgia, United States
Augusta Oncology Associates PC-D'Antignac, Augusta, Georgia, United States
Augusta Oncology Associates PC-Wheeler, Augusta, Georgia, United States
Northside Hospital - Duluth, Duluth, Georgia, United States
Northside Hospital - Gwinnett, Lawrenceville, Georgia, United States
Hawaii Cancer Care - Westridge, 'Aiea, Hawaii, United States
Hawaii Cancer Care Inc - Waterfront Plaza, Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I, Honolulu, Hawaii, United States
Queen's Medical Center, Honolulu, Hawaii, United States
Straub Clinic and Hospital, Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini, Honolulu, Hawaii, United States
Kaiser Permanente Moanalua Medical Center, Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States
Saint Alphonsus Cancer Care Center-Boise, Boise, Idaho, United States
Saint Luke's Cancer Institute - Boise, Boise, Idaho, United States
Saint Alphonsus Cancer Care Center-Caldwell, Caldwell, Idaho, United States
Kootenai Health - Coeur d'Alene, Coeur d'Alene, Idaho, United States
Saint Luke's Cancer Institute - Fruitland, Fruitland, Idaho, United States
Saint Luke's Cancer Institute - Meridian, Meridian, Idaho, United States
Saint Luke's Cancer Institute - Nampa, Nampa, Idaho, United States
Saint Alphonsus Cancer Care Center-Nampa, Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls, Post Falls, Idaho, United States
Kootenai Cancer Clinic, Sandpoint, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls, Twin Falls, Idaho, United States
Advocate Good Shepherd Hospital, Barrington, Illinois, United States
Illinois CancerCare-Bloomington, Bloomington, Illinois, United States
Illinois CancerCare-Canton, Canton, Illinois, United States
Illinois CancerCare-Carthage, Carthage, Illinois, United States
Centralia Oncology Clinic, Centralia, Illinois, United States
Northwestern University, Chicago, Illinois, United States
University of Illinois, Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States
Advocate Illinois Masonic Medical Center, Chicago, Illinois, United States
AMG Crystal Lake - Oncology, Crystal Lake, Illinois, United States
Carle at The Riverfront, Danville, Illinois, United States
Cancer Care Specialists of Illinois - Decatur, Decatur, Illinois, United States
Decatur Memorial Hospital, Decatur, Illinois, United States
Illinois CancerCare-Dixon, Dixon, Illinois, United States
Advocate Good Samaritan Hospital, Downers Grove, Illinois, United States
Crossroads Cancer Center, Effingham, Illinois, United States
Advocate Sherman Hospital, Elgin, Illinois, United States
Illinois CancerCare-Eureka, Eureka, Illinois, United States
Illinois CancerCare-Galesburg, Galesburg, Illinois, United States
Ingalls Memorial Hospital, Harvey, Illinois, United States
Advocate South Suburban Hospital, Hazel Crest, Illinois, United States
Illinois CancerCare-Kewanee Clinic, Kewanee, Illinois, United States
AMG Libertyville - Oncology, Libertyville, Illinois, United States
Condell Memorial Hospital, Libertyville, Illinois, United States
Illinois CancerCare-Macomb, Macomb, Illinois, United States
Carle Physician Group-Mattoon/Charleston, Mattoon, Illinois, United States
Trinity Medical Center, Moline, Illinois, United States
UC Comprehensive Cancer Center at Silver Cross, New Lenox, Illinois, United States
Cancer Care Center of O'Fallon, O'Fallon, Illinois, United States
Advocate Christ Medical Center, Oak Lawn, Illinois, United States
University of Chicago Medicine-Orland Park, Orland Park, Illinois, United States
Illinois CancerCare-Ottawa Clinic, Ottawa, Illinois, United States
Advocate Lutheran General Hospital, Park Ridge, Illinois, United States
Illinois CancerCare-Pekin, Pekin, Illinois, United States
Illinois CancerCare-Peoria, Peoria, Illinois, United States
Illinois CancerCare-Peru, Peru, Illinois, United States
Illinois CancerCare-Princeton, Princeton, Illinois, United States
OSF Saint Anthony Medical Center, Rockford, Illinois, United States
SwedishAmerican Regional Cancer Center/ACT, Rockford, Illinois, United States
Southern Illinois University School of Medicine, Springfield, Illinois, United States
Springfield Clinic, Springfield, Illinois, United States
Memorial Medical Center, Springfield, Illinois, United States
Carle Cancer Center, Urbana, Illinois, United States
Illinois CancerCare - Washington, Washington, Illinois, United States
IU Health West Hospital, Avon, Indiana, United States
IU Health North Hospital, Carmel, Indiana, United States
Northwest Cancer Center - Main Campus, Crown Point, Indiana, United States
Northwest Oncology LLC, Dyer, Indiana, United States
Northwest Cancer Center - Hobart, Hobart, Indiana, United States
Saint Mary Medical Center, Hobart, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, United States
Sidney and Lois Eskenazi Hospital, Indianapolis, Indiana, United States
Saint Catherine Hospital, Indianapolis, Indiana, United States
The Community Hospital, Munster, Indiana, United States
Women's Diagnostic Center - Munster, Munster, Indiana, United States
Northwest Cancer Center - Valparaiso, Valparaiso, Indiana, United States
Physicians' Clinic of Iowa PC, Cedar Rapids, Iowa, United States
Mercy Hospital, Cedar Rapids, Iowa, United States
Oncology Associates at Mercy Medical Center, Cedar Rapids, Iowa, United States
Heartland Oncology and Hematology LLP, Council Bluffs, Iowa, United States
Methodist Jennie Edmundson Hospital, Council Bluffs, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center, Iowa City, Iowa, United States
Cancer Center of Kansas - Chanute, Chanute, Kansas, United States
Cancer Center of Kansas - Dodge City, Dodge City, Kansas, United States
Cancer Center of Kansas - El Dorado, El Dorado, Kansas, United States
HaysMed University of Kansas Health System, Hays, Kansas, United States
Cancer Center of Kansas-Independence, Independence, Kansas, United States
University of Kansas Cancer Center, Kansas City, Kansas, United States
Cancer Center of Kansas-Kingman, Kingman, Kansas, United States
Lawrence Memorial Hospital, Lawrence, Kansas, United States
Cancer Center of Kansas-Liberal, Liberal, Kansas, United States
Cancer Center of Kansas - McPherson, McPherson, Kansas, United States
Cancer Center of Kansas - Newton, Newton, Kansas, United States
Olathe Health Cancer Center, Olathe, Kansas, United States
Menorah Medical Center, Overland Park, Kansas, United States
University of Kansas Cancer Center-Overland Park, Overland Park, Kansas, United States
University of Kansas Hospital-Indian Creek Campus, Overland Park, Kansas, United States
Cancer Center of Kansas - Parsons, Parsons, Kansas, United States
Cancer Center of Kansas - Pratt, Pratt, Kansas, United States
Cancer Center of Kansas - Salina, Salina, Kansas, United States
Salina Regional Health Center, Salina, Kansas, United States
University of Kansas Health System Saint Francis Campus, Topeka, Kansas, United States
Cancer Center of Kansas - Wellington, Wellington, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center, Westwood, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, Kansas, United States
Ascension Via Christi Hospitals Wichita, Wichita, Kansas, United States
Cancer Center of Kansas - Wichita, Wichita, Kansas, United States
Cancer Center of Kansas - Winfield, Winfield, Kansas, United States
University of Kentucky/Markey Cancer Center, Lexington, Kentucky, United States
Ochsner Hematology Oncology North Shore - Covington (West Region), Covington, Louisiana, United States
Ochsner Medical Center Jefferson, New Orleans, Louisiana, United States
Anne Arundel Medical Center, Annapolis, Maryland, United States
Walter Reed National Military Medical Center, Bethesda, Maryland, United States
FMH James M Stockman Cancer Institute, Frederick, Maryland, United States
Tufts Medical Center, Boston, Massachusetts, United States
Boston Medical Center, Boston, Massachusetts, United States
Dana-Farber Cancer Institute, Boston, Massachusetts, United States
Saint Joseph Mercy Hospital, Ann Arbor, Michigan, United States
University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, United States
Bronson Battle Creek, Battle Creek, Michigan, United States
Saint Joseph Mercy Brighton, Brighton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton, Brighton, Michigan, United States
Saint Joseph Mercy Canton, Canton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Canton, Canton, Michigan, United States
Saint Joseph Mercy Chelsea, Chelsea, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital, Chelsea, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township, Clinton Township, Michigan, United States
Henry Ford Hospital, Detroit, Michigan, United States
Genesee Cancer and Blood Disease Treatment Center, Flint, Michigan, United States
Genesee Hematology Oncology PC, Flint, Michigan, United States
Genesys Hurley Cancer Institute, Flint, Michigan, United States
Hurley Medical Center, Flint, Michigan, United States
Spectrum Health at Butterworth Campus, Grand Rapids, Michigan, United States
Trinity Health Grand Rapids Hospital, Grand Rapids, Michigan, United States
Bronson Methodist Hospital, Kalamazoo, Michigan, United States
West Michigan Cancer Center, Kalamazoo, Michigan, United States
Ascension Borgess Cancer Center, Kalamazoo, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital, Livonia, Michigan, United States
Trinity Health Muskegon Hospital, Muskegon, Michigan, United States
Cancer and Hematology Centers of Western Michigan - Norton Shores, Norton Shores, Michigan, United States
Ascension Providence Hospitals - Novi, Novi, Michigan, United States
Saint Joseph Mercy Oakland, Pontiac, Michigan, United States
Corewell Health Reed City Hospital, Reed City, Michigan, United States
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center, Saint Joseph, Michigan, United States
Lakeland Medical Center Saint Joseph, Saint Joseph, Michigan, United States
Ascension Providence Hospitals - Southfield, Southfield, Michigan, United States
Munson Medical Center, Traverse City, Michigan, United States
University of Michigan Health - West, Wyoming, Michigan, United States
Huron Gastroenterology PC, Ypsilanti, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus, Ypsilanti, Michigan, United States
Sanford Joe Lueken Cancer Center, Bemidji, Minnesota, United States
Minnesota Oncology - Burnsville, Burnsville, Minnesota, United States
Mercy Hospital, Coon Rapids, Minnesota, United States
Fairview Southdale Hospital, Edina, Minnesota, United States
Abbott-Northwestern Hospital, Minneapolis, Minnesota, United States
Hennepin County Medical Center, Minneapolis, Minnesota, United States
Mayo Clinic in Rochester, Rochester, Minnesota, United States
Coborn Cancer Center at Saint Cloud Hospital, Saint Cloud, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park, Saint Louis Park, Minnesota, United States
Regions Hospital, Saint Paul, Minnesota, United States
United Hospital, Saint Paul, Minnesota, United States
Baptist Memorial Hospital and Cancer Center-Golden Triangle, Columbus, Mississippi, United States
Baptist Cancer Center-Grenada, Grenada, Mississippi, United States
University of Mississippi Medical Center, Jackson, Mississippi, United States
Baptist Memorial Hospital and Cancer Center-Union County, New Albany, Mississippi, United States
Baptist Memorial Hospital and Cancer Center-Oxford, Oxford, Mississippi, United States
Baptist Memorial Hospital and Cancer Center-Desoto, Southhaven, Mississippi, United States
Saint Francis Medical Center, Cape Girardeau, Missouri, United States
MU Health - University Hospital/Ellis Fischel Cancer Center, Columbia, Missouri, United States
Siteman Cancer Center at West County Hospital, Creve Coeur, Missouri, United States
Parkland Health Center - Farmington, Farmington, Missouri, United States
Centerpoint Medical Center LLC, Independence, Missouri, United States
Truman Medical Centers, Kansas City, Missouri, United States
Saint Luke's Hospital of Kansas City, Kansas City, Missouri, United States
Research Medical Center, Kansas City, Missouri, United States
University of Kansas Cancer Center - North, Kansas City, Missouri, United States
University of Kansas Cancer Center - Lee's Summit, Lee's Summit, Missouri, United States
Saint Luke's East - Lee's Summit, Lee's Summit, Missouri, United States
University of Kansas Cancer Center at North Kansas City Hospital, North Kansas City, Missouri, United States
Heartland Regional Medical Center, Saint Joseph, Missouri, United States
Washington University School of Medicine, Saint Louis, Missouri, United States
Siteman Cancer Center-South County, Saint Louis, Missouri, United States
Missouri Baptist Medical Center, Saint Louis, Missouri, United States
Siteman Cancer Center at Christian Hospital, Saint Louis, Missouri, United States
Mercy Hospital Saint Louis, Saint Louis, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital, Saint Peters, Missouri, United States
Sainte Genevieve County Memorial Hospital, Sainte Genevieve, Missouri, United States
Mercy Hospital Springfield, Springfield, Missouri, United States
CoxHealth South Hospital, Springfield, Missouri, United States
Missouri Baptist Sullivan Hospital, Sullivan, Missouri, United States
BJC Outpatient Center at Sunset Hills, Sunset Hills, Missouri, United States
Community Hospital of Anaconda, Anaconda, Montana, United States
Billings Clinic Cancer Center, Billings, Montana, United States
Bozeman Deaconess Hospital, Bozeman, Montana, United States
Benefis Healthcare- Sletten Cancer Institute, Great Falls, Montana, United States
Community Medical Hospital, Missoula, Montana, United States
Nebraska Medicine-Bellevue, Bellevue, Nebraska, United States
Nebraska Cancer Specialists/Oncology Hematology West PC - MECC, Omaha, Nebraska, United States
Nebraska Methodist Hospital, Omaha, Nebraska, United States
Oncology Associates PC, Omaha, Nebraska, United States
Nebraska Medicine-Village Pointe, Omaha, Nebraska, United States
University of Nebraska Medical Center, Omaha, Nebraska, United States
OptumCare Cancer Care at Seven Hills, Henderson, Nevada, United States
OptumCare Cancer Care at Charleston, Las Vegas, Nevada, United States
OptumCare Cancer Care at Fort Apache, Las Vegas, Nevada, United States
New Hampshire Oncology Hematology PA-Concord, Concord, New Hampshire, United States
Solinsky Center for Cancer Care, Manchester, New Hampshire, United States
Englewood Hospital and Medical Center, Englewood, New Jersey, United States
Hackensack University Medical Center, Hackensack, New Jersey, United States
Inspira Medical Center Mullica Hill, Mullica Hill, New Jersey, United States
University of New Mexico Cancer Center, Albuquerque, New Mexico, United States
Presbyterian Kaseman Hospital, Albuquerque, New Mexico, United States
Presbyterian Rust Medical Center/Jorgensen Cancer Center, Rio Rancho, New Mexico, United States
Roswell Park Cancer Institute, Buffalo, New York, United States
Hematology Oncology Associates of Central New York-East Syracuse, East Syracuse, New York, United States
NYU Winthrop Hospital, Mineola, New York, United States
Mount Sinai Chelsea, New York, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone, New York, New York, United States
Mount Sinai West, New York, New York, United States
Mount Sinai Hospital, New York, New York, United States
Vassar Brothers Medical Center, Poughkeepsie, New York, United States
Pluta Cancer Center, Rochester, New York, United States
University of Rochester, Rochester, New York, United States
Stony Brook University Medical Center, Stony Brook, New York, United States
Wilmot Cancer Institute at Webster, Webster, New York, United States
Randolph Health Cancer Center, Asheboro, North Carolina, United States
Cone Health Cancer Center at Alamance Regional, Burlington, North Carolina, United States
Rex Hematology Oncology Associates-Cary, Cary, North Carolina, United States
UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, United States
Novant Health Presbyterian Medical Center, Charlotte, North Carolina, United States
Rex Hematology Oncology Associates-Garner, Garner, North Carolina, United States
Cone Health Cancer Center, Greensboro, North Carolina, United States
Cone Health Cancer Center at Drawbridge Parkway, Greensboro, North Carolina, United States
East Carolina University, Greenville, North Carolina, United States
Margaret R Pardee Memorial Hospital, Hendersonville, North Carolina, United States
Novant Health Cancer Institute - Huntersville, Huntersville, North Carolina, United States
Novant Health Presbyterian Medical Center Huntersville, Huntersville, North Carolina, United States
Novant Health Cancer Institute - Kernersville, Kernersville, North Carolina, United States
Novant Health Cancer Institute - Matthews, Matthews, North Carolina, United States
Novant Health Cancer Institute - Mooresville, Mooresville, North Carolina, United States
Novant Health Cancer Institute - Mount Airy, Mount Airy, North Carolina, United States
FirstHealth of the Carolinas-Moore Regional Hospital, Pinehurst, North Carolina, United States
UNC Rex Healthcare, Raleigh, North Carolina, United States
UNC Rex Cancer Center of Wakefield, Raleigh, North Carolina, United States
Annie Penn Memorial Hospital, Reidsville, North Carolina, United States
Novant Health Cancer Institute - Rowan, Salisbury, North Carolina, United States
Rowan Regional Medical Center, Salisbury, North Carolina, United States
Novant Health Cancer Institute - Thomasville, Thomasville, North Carolina, United States
Marion L Shepard Cancer Center at Vidant Beaufort Hospital, Washington, North Carolina, United States
Novant Health Forsyth Medical Center, Winston-Salem, North Carolina, United States
Sanford Bismarck Medical Center, Bismarck, North Dakota, United States
Sanford Broadway Medical Center, Fargo, North Dakota, United States
Sanford Roger Maris Cancer Center, Fargo, North Dakota, United States
Summa Health System - Akron Campus, Akron, Ohio, United States
Summa Health System - Barberton Campus, Barberton, Ohio, United States
Strecker Cancer Center-Belpre, Belpre, Ohio, United States
Miami Valley Hospital South, Centerville, Ohio, United States
Adena Regional Medical Center, Chillicothe, Ohio, United States
Good Samaritan Hospital - Cincinnati, Cincinnati, Ohio, United States
Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
Mount Carmel East Hospital, Columbus, Ohio, United States
The Mark H Zangmeister Center, Columbus, Ohio, United States
Dayton Blood and Cancer Center, Dayton, Ohio, United States
Dayton Physician LLC-Miami Valley Hospital North, Dayton, Ohio, United States
Miami Valley Hospital North, Dayton, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital, Franklin, Ohio, United States
Mount Carmel Grove City Hospital, Grove City, Ohio, United States
Kettering Medical Center, Kettering, Ohio, United States
Fairfield Medical Center, Lancaster, Ohio, United States
Memorial Hospital, Marysville, Ohio, United States
Summa Health Medina Medical Center, Medina, Ohio, United States
Licking Memorial Hospital, Newark, Ohio, United States
Mercy Health Perrysburg Cancer Center, Perrysburg, Ohio, United States
Southern Ohio Medical Center, Portsmouth, Ohio, United States
Springfield Regional Cancer Center, Springfield, Ohio, United States
ProMedica Flower Hospital, Sylvania, Ohio, United States
Mercy Health - Saint Anne Hospital, Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo, Toledo, Ohio, United States
Upper Valley Medical Center, Troy, Ohio, United States
Saint Ann's Hospital, Westerville, Ohio, United States
Genesis Healthcare System Cancer Care Center, Zanesville, Ohio, United States
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City, Oklahoma City, Oklahoma, United States
Clackamas Radiation Oncology Center, Clackamas, Oregon, United States
Providence Cancer Institute Clackamas Clinic, Clackamas, Oregon, United States
Legacy Mount Hood Medical Center, Gresham, Oregon, United States
Providence Newberg Medical Center, Newberg, Oregon, United States
Saint Alphonsus Medical Center-Ontario, Ontario, Oregon, United States
Providence Willamette Falls Medical Center, Oregon City, Oregon, United States
Legacy Good Samaritan Hospital and Medical Center, Portland, Oregon, United States
Providence Portland Medical Center, Portland, Oregon, United States
Providence Saint Vincent Medical Center, Portland, Oregon, United States
Kaiser Permanente Northwest, Portland, Oregon, United States
Legacy Meridian Park Hospital, Tualatin, Oregon, United States
Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania, United States
Lehigh Valley Hospital - Muhlenberg, Bethlehem, Pennsylvania, United States
Geisinger Medical Center, Danville, Pennsylvania, United States
Pocono Medical Center, East Stroudsburg, Pennsylvania, United States
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
Guthrie Medical Group PC-Robert Packer Hospital, Sayre, Pennsylvania, United States
Community Medical Center, Scranton, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center, Wilkes-Barre, Pennsylvania, United States
Asplundh Cancer Pavilion, Willow Grove, Pennsylvania, United States
Rhode Island Hospital, Providence, Rhode Island, United States
Women and Infants Hospital, Providence, Rhode Island, United States
Smilow Cancer Hospital Care Center - Westerly, Westerly, Rhode Island, United States
Tidelands Georgetown Memorial Hospital, Georgetown, South Carolina, United States
Saint Francis Hospital, Greenville, South Carolina, United States
Saint Francis Cancer Center, Greenville, South Carolina, United States
Self Regional Healthcare, Greenwood, South Carolina, United States
Lexington Medical Center, West Columbia, South Carolina, United States
Avera Cancer Institute-Aberdeen, Aberdeen, South Dakota, United States
Avera Cancer Institute at Pierre, Pierre, South Dakota, United States
Sanford Cancer Center Oncology Clinic, Sioux Falls, South Dakota, United States
Avera Cancer Institute, Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls, Sioux Falls, South Dakota, United States
Baptist Memorial Hospital and Cancer Center-Collierville, Collierville, Tennessee, United States
University of Tennessee - Knoxville, Knoxville, Tennessee, United States
Baptist Memorial Hospital and Cancer Center-Memphis, Memphis, Tennessee, United States
Houston Methodist San Jacinto Hospital, Baytown, Texas, United States
MD Anderson in The Woodlands, Conroe, Texas, United States
Parkland Memorial Hospital, Dallas, Texas, United States
UT Southwestern Simmons Cancer Center - RedBird, Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas, Dallas, Texas, United States
Tarrant County Hospital District/JPS Health Network, Fort Worth, Texas, United States
UT Southwestern/Simmons Cancer Center-Fort Worth, Fort Worth, Texas, United States
Houston Methodist Hospital, Houston, Texas, United States
M D Anderson Cancer Center, Houston, Texas, United States
Methodist Willowbrook Hospital, Houston, Texas, United States
MD Anderson West Houston, Houston, Texas, United States
Houston Methodist West Hospital, Houston, Texas, United States
MD Anderson League City, League City, Texas, United States
Houston Methodist Saint John Hospital, Nassau Bay, Texas, United States
UT Southwestern Clinical Center at Richardson/Plano, Richardson, Texas, United States
MD Anderson in Sugar Land, Sugar Land, Texas, United States
Houston Methodist Sugar Land Hospital, Sugar Land, Texas, United States
Houston Methodist The Woodlands Hospital, The Woodlands, Texas, United States
Inova Schar Cancer Institute, Fairfax, Virginia, United States
Inova Fair Oaks Hospital, Fairfax, Virginia, United States
Inova Fairfax Hospital, Falls Church, Virginia, United States
Bon Secours Memorial Regional Medical Center, Mechanicsville, Virginia, United States
Bon Secours Saint Francis Medical Center, Midlothian, Virginia, United States
Bon Secours Saint Mary's Hospital, Richmond, Virginia, United States
VCU Massey Cancer Center at Stony Point, Richmond, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center, Richmond, Virginia, United States
Valley Medical Center, Renton, Washington, United States
Legacy Cancer Institute Medical Oncology and Day Treatment, Vancouver, Washington, United States
Legacy Salmon Creek Hospital, Vancouver, Washington, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital, Yakima, Washington, United States
Edwards Comprehensive Cancer Center, Huntington, West Virginia, United States
Langlade Hospital and Cancer Center, Antigo, Wisconsin, United States
ThedaCare Regional Cancer Center, Appleton, Wisconsin, United States
ThedaCare Cancer Care - Berlin, Berlin, Wisconsin, United States
Aurora Cancer Care-Southern Lakes VLCC, Burlington, Wisconsin, United States
Aurora Health Care Germantown Health Center, Germantown, Wisconsin, United States
Aurora Cancer Care-Grafton, Grafton, Wisconsin, United States
Aurora BayCare Medical Center, Green Bay, Wisconsin, United States
Mercyhealth Hospital and Cancer Center - Janesville, Janesville, Wisconsin, United States
UW Cancer Center Johnson Creek, Johnson Creek, Wisconsin, United States
Aurora Cancer Care-Kenosha South, Kenosha, Wisconsin, United States
University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, United States
Aurora Bay Area Medical Group-Marinette, Marinette, Wisconsin, United States
Aspirus Medford Hospital, Medford, Wisconsin, United States
Froedtert Menomonee Falls Hospital, Menomonee Falls, Wisconsin, United States
Aurora Cancer Care-Milwaukee, Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, United States
Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Aurora Sinai Medical Center, Milwaukee, Wisconsin, United States
ProHealth D N Greenwald Center, Mukwonago, Wisconsin, United States
ThedaCare Regional Medical Center - Neenah, Neenah, Wisconsin, United States
ThedaCare Cancer Care - New London, New London, Wisconsin, United States
Drexel Town Square Health Center, Oak Creek, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital, Oconomowoc, Wisconsin, United States
ThedaCare Cancer Care - Oshkosh, Oshkosh, Wisconsin, United States
Vince Lombardi Cancer Clinic - Oshkosh, Oshkosh, Wisconsin, United States
Aurora Cancer Care-Racine, Racine, Wisconsin, United States
Ascension Saint Mary's Hospital, Rhinelander, Wisconsin, United States
ThedaCare Cancer Care - Shawano, Shawano, Wisconsin, United States
Vince Lombardi Cancer Clinic-Sheboygan, Sheboygan, Wisconsin, United States
Ascension Saint Michael's Hospital, Stevens Point, Wisconsin, United States
Aurora Medical Center in Summit, Summit, Wisconsin, United States
Vince Lombardi Cancer Clinic-Two Rivers, Two Rivers, Wisconsin, United States
UW Cancer Center at ProHealth Care, Waukesha, Wisconsin, United States
ThedaCare Cancer Care - Waupaca, Waupaca, Wisconsin, United States
Aspirus Regional Cancer Center, Wausau, Wisconsin, United States
Aurora Cancer Care-Milwaukee West, Wauwatosa, Wisconsin, United States
Aurora West Allis Medical Center, West Allis, Wisconsin, United States
Froedtert West Bend Hospital/Kraemer Cancer Center, West Bend, Wisconsin, United States
Aspirus Cancer Care - Wisconsin Rapids, Wisconsin Rapids, Wisconsin, United States
Doctors Cancer Center, Manati, , Puerto Rico
Centro Comprensivo de Cancer de UPR, San Juan, , Puerto Rico
PROncology, San Juan, , Puerto Rico
San Juan City Hospital, San Juan, , Puerto Rico