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Using Biomarker Tests to Select and Test New, Personalized Treatments for Extensive Stage Small Cell Lung Cancer, PRISM Study
NCT06769126 · SWOG Cancer Research Network
In plain English
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Official title
PRISM: PRecIsion in SCLC Via a Multicohort Study: Randomized Phase II Studies Evaluating Maintenance Durvalumab With or Without Biomarker-Directed Therapy for Extensive Stage Small Cell Lung Cancer (ES-SCLC)
About this study
PRIMARY OBJECTIVES:
I. To test participants' tissue specimens to determine their eligibility to 1 of the 3 treatment cohorts created based on their small cell lung cancer (SCLC) subtype and SLFN11 status. (Screening) II. To compare progression-free survival (PFS) in participants with extensive stage SCLC (ES-SCLC) (subtypes A or N \& SLFN11 positive) or ES-SCLC (subtype P) randomized to durvalumab (MEDI4736) with or without saruparib (AZD5305) as maintenance therapy following induction chemoimmunotherapy with platinum, etoposide, and durvalumab (MEDI4736). (Cohort A) III. To compare PFS in participants with ES-SCLC subtypes A or N \& SLFN11 negative randomized to durvalumab with or without ceralasertib (AZD6738) as maintenance therapy following induction chemoimmunotherapy with cisplatin or carboplatin, etoposide, and durvalumab (MEDI4736). (Cohort B) IV. To compare PFS participants with ES-SCLC subtype I randomized to durvalumab (MEDI4736) with or without monalizumab (IPH2201) as maintenance therapy following induction chemoimmunotherapy with cisplatin or carboplatin, etoposide, and durvalumab (MEDI4736). (Cohort C)
SECONDARY OBJECTIVES:
I. To evaluate the percentage of participant tissue that are able to have SCLC subtype status determined. (Screening) II. To evaluate the percentage of participant tissue that are able to have SLFN11 status determined. (Screening) III. To estimate the percentage of participants assigned to a cohort that register to be randomized. (Screening) IV. To evaluate the safety of saruparib (AZD5305) in combination with durvalumab by estimating the rate of dose limiting toxicities reported during the first cycle of treatment in the safety-run-in population. (Cohort A) V. To compare PFS between the arms in the subset of participants with A or N subtype and SLFN11 positive. (Cohort A) VI. To compare overall survival (OS) between the arms. (Cohort A) VII. To evaluate the frequency and severity of toxicities by Common Terminology Criteria for Adverse Events (CTCAE) within each treatment arm. (Cohort A) VIII. To compare OS between the arms. (Cohort B) IX. To evaluate the frequency and severity of toxicities by CTCAE within each arm. (Cohort B) X. To compare OS between the arms. (Cohort C) XI. To evaluate the frequency and severity of toxicities by CTCAE within each arm. (Cohort C)
TRANSLATIONAL MEDICINE OBJECTIVE:
I. To bank specimens for future correlative studies.
OUTLINE:
INDUCTION: Patients may receive a platinum compound plus etoposide per standard care as well as durvalumab intravenously (IV) over 60 minutes on day 1 of each cycle. Cycles repeat every 28 days for 4-6 cycles in the absence of disease progression or unacceptable toxicity.
CONSOLIDATION: Patients may undergo thoracic radiation as clinically indicated.
MAINTENANCE: Patients are assigned to 1 of 3 cohorts and then randomized to 1 of 2 arms within each cohort to which they were assigned.
COHORT A: Patients with ES-SCLC determined to be subtype A or N, and to be SLFN11 positive or patients with subtype P ES-SCLC.
ARM 1: Patients receive durvalumab IV over 60 minutes on day 1 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM 2: Patients receive durvalumab IV over 60 minutes on day 1 of each cycle and saruparib orally (PO) once daily (QD) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
COHORT B: Patients with ES-SCLC determined to be subtype A or N, and to be SLFN11 negative.
ARM 1: Patients receive durvalumab IV over 60 minutes on day 1 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM 2: Patients receive durvalumab IV over 60 minutes on day 8 and ceralasertib PO twice daily (BID) on days 1-7 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
COHORT C: Patients with ES-SCLC determined to be subtype I.
ARM 1: Patients receive durvalumab IV over 60 minutes on day 1 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM 2: Patients receive durvalumab IV over 60 minutes on day 1 and monalizumab IV over 60 minutes on days 1 and 15 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Additionally, patients undergo computed tomography (CT) scan or positron emission tomography (PET)/CT scan and CT scan or magnetic resonance imaging (MRI) throughout the study. Patients also undergo tissue sample collection during screening and may undergo blood sample collection throughout the study.
After completion of study treatment, patients are followed up to 3 years.
Eligibility criteria
Inclusion Criteria:
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not have a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) has the potential to interfere with the safety or efficacy assessment of the investigational regimen
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not have a history of limited stage small cell lung cancer
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must meet 1 of the following criteria prior to step 1:
* Treatment naïve and planning to receive frontline induction treatment with platinum plus etoposide in combination with durvalumab, OR,
* Have initiated frontline induction therapy and completed at least 1 (≥ 1) cycle and at most 3 (≤ 3) cycles of platinum and etoposide. At most 2 (≤ 2) of these cycles could have been given without durvalumab
* NOTE: Participants must not have received immunotherapy other than durvalumab (e.g., atezolizumab) prior to enrollment
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not have received any anti PD-1 or anti PD-L1 (including durvalumab \[MEDI4736\]) treatment for SCLC prior to starting frontline induction treatment for ES-SCLC
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not have received anti PD-1 or anti PD-L1 other than durvalumab (MEDI4736) as part of frontline induction treatment for ES-SCLC. Participants must have not received atezolizumab, pembrolizumab, or nivolumab as part of frontline induction treatment
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not have received any investigational agent for the treatment of ES-SCLC
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not be planning to receive any concurrent non-protocol directed chemotherapy, immunotherapy, biologic or hormonal therapy for SCLC treatment while receiving treatment on this study
* NOTE: If participant has bone metastases, bisphosphonates are allowed
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not have any unresolved toxicity National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) grade ≥ 2 from previous anticancer therapy with the exception of alopecia, and vitiligo
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must be ≥ 18 years old at the time of step 1 registration
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must be able to safely receive the frontline induction treatment with platinum plus etoposide in combination with durvalumab, per the current Food and Drug Administration (FDA)-approved package insert(s), institutional guidelines, and the treating investigator's discretion
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must have Zubrod performance status of 0-2 within 28 days prior to step 1 registration
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must have fully recovered from the effects of prior surgery in the opinion of the treating investigator within 28 days prior to step 1 registration
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not have had an allogenic organ transplantation
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not have medical contraindications to receiving immunotherapy, including history of non-infectious pneumonitis that required steroids or active autoimmune disease that has required systemic treatment with disease modifying agents, corticosteroids or immunosuppressive drugs in the past two years. Replacement therapy (e.g. thyroxine for pre-existing hypothyroidism, insulin for type I diabetes mellitus, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. Intra-articular steroid injections are allowed
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must not be pregnant or nursing (nursing includes breast milk fed to an infant by any means, including from the breast, milk expressed by hand, or pumped). Individuals who are of reproductive potential must have agreed to use an effective contraceptive method during protocol therapy and for 6 months following completion of protocol therapy with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen. Participants should not breastfeed during protocol therapy and for 6 months following completion of protocol therapy
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: Participants must have adequate tumor tissue available from SCLC and agree to have these tissue specimens submitted. Participants must agree to have any leftover tissue (tissue that remains after subtype and biomarker testing) retained for the use of future correlative studies.
* NOTE: After a participant has been registered to step 1 registration, the tissue must be submitted to BostonGene. Sites will receive a notification from the Southwest Oncology Group (SWOG) Statistics and Data Management Center within 19 days after tissue submission. Patients must not be registered to step 2 prior to receiving notification of cohort assignment
* NOTE: A histologic review will be performed to confirm adequate cellularity for the testing. If inadequate cellularity, additional archival unstained slides from the same participant may be submitted if it does not exceed the window of starting maintenance therapy
* STEP 1: SCREENING AND INDUCTION TREATMENT REGISTRATION: NOTE: As a part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system.
* Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines. For participants with impaired decision-making capabilities, legally authorized representatives may sign and give informed consent on behalf of study participants in accordance with applicable federal, local, and Central Institutional Review Board (CIRB) regulations
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Site must have received notification from the SWOG Statistics and Data Management Center (SDMC) of the participant's SLFN11 testing results and have been determined to have subtype A, N, I, or P: confirmed by BostonGene and assigned to a cohort
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants may have measurable or non-measurable disease per Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) and must have their disease assessed by CT of chest/abdomen/pelvis (with contrast unless contraindicated) within 28 days prior to step 2 for measurable disease or within 42 days prior to step 2 for non-measurable disease. All known sites of disease must be assessed and documented on the baseline tumor assessment form (RECIST 1.1). Any lesions assessed using a non-diagnostic PET/CT of chest/abdomen/pelvis will be considered non-measurable lesions
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must have a CT or MRI scan of the brain to evaluate for central nervous system (CNS) disease within 42 days prior to step 2 randomization. Participant must not have leptomeningeal disease, spinal cord compression, or symptomatic brain metastases unless: (1) metastases have been locally treated and have remained clinically controlled and asymptomatic for at least 14 days following treatment, and prior to step 2 randomization, AND (2) participant has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to step 2 randomization
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants with untreated brain metastases must be asymptomatic and stable off steroids prior to step 2 randomization.
* NOTE: Exceptions to corticosteroid criterion are: (1) intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra-articular injection), (2) systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent, or (3) steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication). Premedication with steroids for chemotherapy is acceptable
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must not have experienced disease progression in the opinion of treating investigator during induction treatment and prior to step 2
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must have completed frontline induction therapy. Induction therapy must have included 4-6 cycles of platinum plus etoposide and 4 cycles of durvalumab (MEDI4736); at most 2 (≤ 2) cycles of platinum plus etoposide may have been given without durvalumab (MEDI4736). Durvalumab (MEDI4736) must have been given in combination with platinum plus etoposide
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants who received consolidation thoracic radiation therapy must have completed all radiation therapy at least 14 days prior to step 2
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: For participants not receiving consolidation thoracic radiation, step 2 registration must occur at least 3 weeks but not more than 6 weeks after the last dose of frontline induction therapy (platinum plus etoposide in combination with durvalumab \[MEDI4736\])
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: For participants receiving consolidation thoracic radiation after induction therapy, step 2 registration must occur at least 3 weeks but no more than 8 weeks after the last dose of frontline induction therapy (platinum plus etoposide in combination with durvalumab \[MEDI4736\])
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must not have received atezolizumab, pembrolizumab, or nivolumab as part of their frontline induction treatment. Participants must not have received prophylactic cranial irradiation (PCI)
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must have a complete medical history and physical within 28 days prior to step 2
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must have body weight \> 30 kg
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must have Zubrod performance status of 0-2 within 28 days prior to step 2
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Hemoglobin \> 9.0 g/dL (within 28 days prior to step 2)
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Absolute neutrophil count ≥ 1.5 x 10\^3/uL (within 28 days prior to step 2)
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Platelets ≥ 100 x 10\^3/uL (within 28 days prior to step 2)
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Total bilirubin ≤ institutional upper limit of normal (ULN) unless history of Gilbert's disease. Participants with history of Gilbert's disease must have total bilirubin ≤ 5 x institutional ULN (within 28 days prior to step 2)
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Aspartate aminotransferase (AST)/alanine transaminase (ALT) ≤ 5 × institutional ULN (within 28 days prior to step 2)
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must have creatinine ≤ 1.5x the institutional upper limit of normal (IULN) OR measured OR calculated creatinine clearance ≥ 45 mL/min using the following Cockcroft-Gault Formula For creatinine clearance formula see the tools on the Cancer Research and Biostatistics (CRA) Workbench https://txwb.crab.org/TXWB/Tools.aspx
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants with a known history of human immunodeficiency virus (HIV)-infection must be on effective anti-retroviral therapy at registration and have undetectable viral load test on the most recent test results obtained within 6 months prior to step 2 registration
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants with a known history of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load while on suppressive therapy on the most recent test results obtained within 6 months prior to randomization, if indicated
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants with a known history of hepatitis C virus (HCV) infection must have been treated and cured or currently be receiving treatment for HVC. Participants currently being treated for HCV infection must have undetectable HCV viral load test on the most recent test results obtained within 6 months prior to randomization, if indicated
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must not have experienced the following during induction treatment: Any grade 3 or worse immune-mediated adverse event (irAE) (except asymptomatic nonbullous/nonexfoliative rash) or any unresolved grade 2 irAE, nor have experienced a toxicity that led to permanent discontinuation of prior durvalumab (MEDI4736). Toxicity of any grade that requires replacement therapy and has stabilized on therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is allowed
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must not be pregnant or nursing (nursing includes breast milk fed to an infant by any means, including from the breast, milk expressed by hand, or pumped). Individuals who are of reproductive potential must have agreed to use an effective contraceptive method during protocol therapy and for 6 months following completion of protocol therapy with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen. Participants should not breastfeed during protocol therapy and for 6 months following completion of protocol therapy
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must not have received a live or live attenuated vaccine within 30 days prior to step 2. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster, yellow fever rabies, Bacillus Calmette-Guerin (BCG) and typhoid vaccine. Seasonal influenza vaccines and COVID-19 vaccines are allowed, however, intranasal influenza vaccines (e.g. Flu-Mist) are live attenuated, and are not allowed
* STEP 2: COHORT REGISTRATION AND MAINTENANCE RANDOMIZATION: Participants must be offered the opportunity to participate in specimen banking
Study design
Enrollment target: 900 participants
Allocation: randomized
Masking: none
Age groups: adult, older_adult
Timeline
Starts: 2025-11-06
Estimated completion: 2029-12-31
Last updated: 2026-03-30
Interventions
Procedure: Biospecimen CollectionDrug: CeralasertibProcedure: Computed TomographyBiological: DurvalumabDrug: EtoposideProcedure: Magnetic Resonance ImagingBiological: MonalizumabDrug: Platinum CompoundProcedure: Positron Emission TomographyDrug: SaruparibRadiation: Thoracic Radiation Therapy
Primary outcomes
- • Screen success rate (Screening) (Up to 3 years)
- • Progression-free survival (PFS) (Cohort A) (From date of randomization to treatment within a cohort to date of first documentation of progression, symptomatic deterioration, or death due to any cause, assessed up to 3 years)
- • PFS (Cohort B) (From date of randomization to treatment within a cohort to date of first documentation of progression, symptomatic deterioration, or death due to any cause, assessed up to 3 years)
Sponsor
SWOG Cancer Research Network · network
With: National Cancer Institute (NCI)
Contacts & investigators
InvestigatorAnne C Chiang · principal_investigator, SWOG Cancer Research Network
All locations (148)
Loma Linda University Medical CenterRecruiting
Loma Linda, California, United States
Eisenhower Medical CenterRecruiting
Rancho Mirage, California, United States
University of California Davis Comprehensive Cancer CenterRecruiting
Sacramento, California, United States
UCHealth University of Colorado HospitalRecruiting
Aurora, Colorado, United States
UCHealth Memorial Hospital CentralRecruiting
Colorado Springs, Colorado, United States
Memorial Hospital NorthRecruiting
Colorado Springs, Colorado, United States
Poudre Valley HospitalRecruiting
Fort Collins, Colorado, United States
Cancer Care and Hematology-Fort CollinsRecruiting
Fort Collins, Colorado, United States
Lutheran Hospital - Cancer Centers of ColoradoRecruiting
Golden, Colorado, United States
UCHealth Greeley HospitalRecruiting
Greeley, Colorado, United States
Medical Center of the RockiesRecruiting
Loveland, Colorado, United States
Smilow Cancer Hospital-Derby Care CenterRecruiting
Derby, Connecticut, United States
Smilow Cancer Hospital Care Center-FairfieldRecruiting
Fairfield, Connecticut, United States
Smilow Cancer Hospital Care Center - GuilfordRecruiting
Guilford, Connecticut, United States
Yale UniversityRecruiting
New Haven, Connecticut, United States
Yale-New Haven Hospital North Haven Medical CenterRecruiting
North Haven, Connecticut, United States
Smilow Cancer Hospital-Torrington Care CenterRecruiting
Torrington, Connecticut, United States
Smilow Cancer Hospital Care Center-TrumbullRecruiting
Trumbull, Connecticut, United States
Smilow Cancer Hospital-Waterbury Care CenterRecruiting
Waterbury, Connecticut, United States
Smilow Cancer Hospital Care Center - WaterfordRecruiting
Waterford, Connecticut, United States
Helen F Graham Cancer CenterRecruiting
Newark, Delaware, United States
Medical Oncology Hematology Consultants PARecruiting
Newark, Delaware, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/CandlerRecruiting
Savannah, Georgia, United States
Kootenai Health - Coeur d'AleneRecruiting
Coeur d'Alene, Idaho, United States
Saint Alphonsus Cancer Care Center-NampaRecruiting
Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post FallsRecruiting
Post Falls, Idaho, United States
Kootenai Clinic Cancer Services - SandpointRecruiting
Sandpoint, Idaho, United States
Northwestern UniversityRecruiting
Chicago, Illinois, United States
Northwestern Medicine Cancer Center KishwaukeeRecruiting
DeKalb, Illinois, United States
Northwestern Medicine Cancer Center DelnorRecruiting
Geneva, Illinois, United States
Northwestern Medicine Glenview Outpatient CenterRecruiting
Glenview, Illinois, United States
Northwestern Medicine Grayslake Outpatient CenterRecruiting
Grayslake, Illinois, United States
Northwestern Medicine Lake Forest HospitalRecruiting
Lake Forest, Illinois, United States
Loyola University Medical CenterRecruiting
Maywood, Illinois, United States
Northwestern Medicine Oak BrookRecruiting
Oak Brook, Illinois, United States
Northwestern Medicine Orland ParkRecruiting
Orland Park, Illinois, United States
Northwestern Medicine Cancer Center WarrenvilleRecruiting
Warrenville, Illinois, United States
Mary Greeley Medical CenterRecruiting
Ames, Iowa, United States
McFarland Clinic - AmesRecruiting
Ames, Iowa, United States
UI Health Care Mission Cancer and Blood - Ankeny ClinicRecruiting
Ankeny, Iowa, United States
McFarland Clinic - BooneSuspended
Boone, Iowa, United States
Mercy HospitalRecruiting
Cedar Rapids, Iowa, United States
Oncology Associates at Mercy Medical CenterRecruiting
Cedar Rapids, Iowa, United States
UI Health Care Mission Cancer and Blood - West Des Moines ClinicRecruiting
Clive, Iowa, United States
Iowa Methodist Medical CenterRecruiting
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Des Moines ClinicRecruiting
Des Moines, Iowa, United States
Mercy Medical Center - Des MoinesRecruiting
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Laurel ClinicRecruiting
Des Moines, Iowa, United States
McFarland Clinic - Trinity Cancer CenterRecruiting
Fort Dodge, Iowa, United States
McFarland Clinic - JeffersonSuspended
Jefferson, Iowa, United States
McFarland Clinic - MarshalltownRecruiting
Marshalltown, Iowa, United States
UI Health Care Mission Cancer and Blood - Waukee ClinicRecruiting
Waukee, Iowa, United States
The Iowa Clinic PCRecruiting
West Des Moines, Iowa, United States
University of Kansas Clinical Research CenterRecruiting
Fairway, Kansas, United States
University of Kansas Cancer CenterRecruiting
Kansas City, Kansas, United States
The University of Kansas Cancer Center - OlatheRecruiting
Olathe, Kansas, United States
University of Kansas Cancer Center-Overland ParkRecruiting
Overland Park, Kansas, United States
Salina Regional Health CenterRecruiting
Salina, Kansas, United States
University of Kansas Hospital-Westwood Cancer CenterRecruiting
Westwood, Kansas, United States
Baptist Health CorbinRecruiting
Corbin, Kentucky, United States
Baptist Health LexingtonRecruiting
Lexington, Kentucky, United States
Baptist Health HamburgRecruiting
Lexington, Kentucky, United States
University of Maryland/Greenebaum Cancer CenterRecruiting
Baltimore, Maryland, United States
Tufts Medical CenterRecruiting
Boston, Massachusetts, United States
Lahey Hospital and Medical CenterRecruiting
Burlington, Massachusetts, United States
Lahey Medical Center-PeabodyRecruiting
Peabody, Massachusetts, United States
Trinity Health IHA Medical Group Hematology Oncology - BrightonRecruiting
Brighton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - CantonRecruiting
Canton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea HospitalRecruiting
Chelsea, Michigan, United States
Henry Ford Health Saint John HospitalRecruiting
Detroit, Michigan, United States
Henry Ford River District HospitalRecruiting
East China Township, Michigan, United States
Henry Ford Saint John Hospital - AcademicRecruiting
Grosse Pointe Woods, Michigan, United States
Henry Ford Saint John Hospital - BreastRecruiting
Grosse Pointe Woods, Michigan, United States
Henry Ford Saint John Hospital - Van ElslanderRecruiting
Grosse Pointe Woods, Michigan, United States
University of Michigan Health - Sparrow LansingRecruiting
Lansing, Michigan, United States
Trinity Health Saint Mary Mercy Livonia HospitalRecruiting
Livonia, Michigan, United States
Henry Ford Saint John Hospital - Macomb MedicalRecruiting
Macomb, Michigan, United States
Henry Ford Warren Hospital - Breast MacombRecruiting
Macomb, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland HospitalRecruiting
Pontiac, Michigan, United States
Henry Ford Health Warren HospitalRecruiting
Warren, Michigan, United States
Henry Ford Madison Heights Hospital - BreastRecruiting
Warren, Michigan, United States
Henry Ford Warren Hospital - GLCMSRecruiting
Warren, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor CampusRecruiting
Ypsilanti, Michigan, United States
Sanford Joe Lueken Cancer CenterRecruiting
Bemidji, Minnesota, United States
Essentia Health Saint Joseph's Medical CenterRecruiting
Brainerd, Minnesota, United States
Mercy HospitalRecruiting
Coon Rapids, Minnesota, United States
Essentia Health - Deer River ClinicRecruiting
Deer River, Minnesota, United States
Essentia Health Cancer CenterRecruiting
Duluth, Minnesota, United States
Fairview Southdale HospitalRecruiting
Edina, Minnesota, United States
Essentia Health Hibbing ClinicRecruiting
Hibbing, Minnesota, United States
Saint John's Hospital - HealtheastRecruiting
Maplewood, Minnesota, United States
Abbott-Northwestern HospitalRecruiting
Minneapolis, Minnesota, United States
Hennepin County Medical CenterRecruiting
Minneapolis, Minnesota, United States
New Ulm Medical CenterRecruiting
New Ulm, Minnesota, United States
Park Nicollet Clinic - Saint Louis ParkRecruiting
Saint Louis Park, Minnesota, United States
Regions HospitalRecruiting
Saint Paul, Minnesota, United States
United HospitalRecruiting
Saint Paul, Minnesota, United States
Essentia Health SandstoneRecruiting
Sandstone, Minnesota, United States
Essentia Health Virginia ClinicRecruiting
Virginia, Minnesota, United States
University of Kansas Cancer Center - BriarcliffRecruiting
Kansas City, Missouri, United States
University of Kansas Cancer Center - NorthRecruiting
Kansas City, Missouri, United States
University of Kansas Cancer Center - Lee's SummitRecruiting
Lee's Summit, Missouri, United States
Mercy Hospital SouthRecruiting
St Louis, Missouri, United States
Mercy Hospital Saint LouisRecruiting
St Louis, Missouri, United States
Community Hospital of AnacondaRecruiting
Anaconda, Montana, United States
Billings Clinic Cancer CenterRecruiting
Billings, Montana, United States
Bozeman Health Deaconess HospitalRecruiting
Bozeman, Montana, United States
Benefis Sletten Cancer InstituteRecruiting
Great Falls, Montana, United States
Community Medical CenterRecruiting
Missoula, Montana, United States
Roswell Park Cancer InstituteRecruiting
Buffalo, New York, United States
University of RochesterRecruiting
Rochester, New York, United States
Wilmot Cancer Institute at WebsterRecruiting
Webster, New York, United States
FirstHealth of the Carolinas-Moore Regional HospitalRecruiting
Pinehurst, North Carolina, United States
Sanford Bismarck Medical CenterRecruiting
Bismarck, North Dakota, United States
Essentia Health Cancer Center-South University ClinicRecruiting
Fargo, North Dakota, United States
Sanford Broadway Medical CenterRecruiting
Fargo, North Dakota, United States
Sanford Roger Maris Cancer CenterRecruiting
Fargo, North Dakota, United States
Aultman Health FoundationRecruiting
Canton, Ohio, United States
Miami Valley Hospital SouthRecruiting
Centerville, Ohio, United States
Miami Valley HospitalRecruiting
Dayton, Ohio, United States
Premier Blood and Cancer CenterRecruiting
Dayton, Ohio, United States
Miami Valley Hospital NorthRecruiting
Dayton, Ohio, United States
Atrium Medical Center-Middletown Regional HospitalRecruiting
Franklin, Ohio, United States
Miami Valley Cancer Care and InfusionRecruiting
Greenville, Ohio, United States
Upper Valley Medical CenterRecruiting
Troy, Ohio, United States
University of Oklahoma Health Sciences CenterRecruiting
Oklahoma City, Oklahoma, United States
Providence Newberg Medical CenterRecruiting
Newberg, Oregon, United States
Providence Willamette Falls Medical CenterRecruiting
Oregon City, Oregon, United States
Providence Portland Medical CenterRecruiting
Portland, Oregon, United States
Providence Saint Vincent Medical CenterRecruiting
Portland, Oregon, United States
Saint Joseph's/Candler - Bluffton CampusRecruiting
Bluffton, South Carolina, United States
Prisma Health Cancer Institute - SpartanburgRecruiting
Boiling Springs, South Carolina, United States
Prisma Health Cancer Institute - EasleyRecruiting
Easley, South Carolina, United States
Tidelands Georgetown Memorial HospitalRecruiting
Georgetown, South Carolina, United States
Prisma Health Cancer Institute - ButternutRecruiting
Greenville, South Carolina, United States
Prisma Health Cancer Institute - FarisRecruiting
Greenville, South Carolina, United States
Prisma Health Cancer Institute - EastsideRecruiting
Greenville, South Carolina, United States
Prisma Health Cancer Institute - GreerRecruiting
Greer, South Carolina, United States
Prisma Health Cancer Institute - SenecaRecruiting
Seneca, South Carolina, United States
Sanford Cancer Center Oncology ClinicRecruiting
Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux FallsRecruiting
Sioux Falls, South Dakota, United States
M D Anderson Cancer CenterRecruiting
Houston, Texas, United States
VCU Massey Cancer Center at Stony PointRecruiting
Richmond, Virginia, United States
VCU Massey Comprehensive Cancer CenterRecruiting
Richmond, Virginia, United States
VCU Community Memorial Health CenterRecruiting
South Hill, Virginia, United States
VCU Health Tappahannock HospitalRecruiting
Tappahannock, Virginia, United States
Duluth Clinic AshlandRecruiting
Ashland, Wisconsin, United States
Gundersen Lutheran Medical CenterRecruiting
La Crosse, Wisconsin, United States