RECRUITING Phase 2 / Phase 3 ClinicalTrials.gov

Testing the Addition of MEDI4736 (Durvalumab) to Chemotherapy Before Surgery for Patients With High-Grade Upper Urinary Tract Cancer

Sponsor: National Cancer Institute (NCI) • ClinicalTrials.gov ID: NCT04628767

Registry updated: 2026-10-13

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Description

This phase II/III trial compares the effect of adding durvalumab to chemotherapy versus chemotherapy alone before surgery in treating patients with upper urinary tract cancer. Immunotherapy with monoclonal antibodies, such as durvalumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs, such as methotrexate, vinblastine, doxorubicin, cisplatin, and gemcitabine work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Durvalumab in combination with chemotherapy before surgery may enhance the shrinking of the tumor compared to chemotherapy alone.

Interventions

Biopsy Procedure (Procedure)
Undergo tissue biopsy
Biospecimen Collection (Procedure)
Undergo blood sample collection
Cisplatin (Drug)
Given IV
Computed Tomography (Procedure)
Undergo CT
Doxorubicin Hydrochloride (Drug)
Given Iv
Durvalumab (Biological)
Given IV
Gemcitabine Hydrochloride (Drug)
Given IV
Magnetic Resonance Imaging (Procedure)
Undergo MRI
Methotrexate (Drug)
Given IV
Pegfilgrastim (Biological)
Given via injection
Therapeutic Conventional Surgery (Procedure)
Undergo surgery
Vinblastine Sulfate (Drug)
Given Iv

Eligibility criteria

Inclusion Criteria: * STEP 1 REGISTRATION AND RANDOMIZATION * Patients must be \>= 18 years of age * Patient must have the ability to understand and the willingness to sign a written informed consent document. Patients with impaired decision-making capacity (IDMC) who have a legally authorized representative (LAR) or caregiver and/or family member available will also be considered eligible * Patient must have a diagnosis of high grade upper tract urothelial carcinoma expected within 14 weeks (98 days) prior to registration/randomization with one of the following: * Biopsy (gold standard, preferred) and either upper urinary tract mass on cross-sectional imaging or tumor directly visualized during upper urinary tract endoscopy * High grade cytology and clinically estimated invasive upper urinary tract mass on cross-sectional imaging (e.g., including presence of tumor-related hydronephrosis) or tumor directly visualized during upper urinary tract endoscopy * NOTE: Universal histologic testing of UTUC with additional studies, such as immunohistochemistry and/or microsatellite instability, is strongly recommended to identify patients with high probability of Lynch-related or other germline mutation related cancers whom clinicians should refer for genetic counseling and germline testing (this is not required for eligibility) * Due to the anatomy of upper urinary tract and lack of muscularis propria, pathologic evidence of cT2 on biopsy is usually not possible * Patients must not have any component of small cell/neuroendocrine carcinoma. Other histologic subtypes (variants) are permitted provided the half or predominant (\>= 50%) subtype is conventional urothelial carcinoma * Leukocytes \>= 3,000/mcL (obtained =\< 14 days prior to registration/randomization) * Platelets \>= 100,000/mcL (obtained =\< 14 days prior to registration/randomization) * Total bilirubin =\< 1.2 mg/dL (or ≤ 2 mg/dL for patients with Gilbert's disease) * Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 2 x institutional ULN (obtained =\< 14 days prior to registration/randomization) * Hemoglobin (Hgb) \>= 9 g/dL (obtained =\< 14 days prior to registration/randomization) * NOTE: Packed red blood transfusion is allowed to achieve this parameter as per treating investigator * Patients must not be pregnant or breast-feeding due to the potential harm to an unborn fetus and possible risk for adverse events in nursing infants with the treatment regimens being used. All patients of childbearing potential must have a blood test or urine study within 14 days prior to registration to rule out pregnancy. A patient of childbearing potential is defined as any patient, regardless of whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months) * Patients of childbearing potential and sexually active patients must not expect to conceive or father children, either by using accepted and effective method(s) of contraception or by abstaining from sexual intercourse from the time of registration, while on study treatment and for at least 6 months after the last dose of protocol treatment * Patients must have no evidence of metastatic disease or clinically enlarged regional lymph nodes (\>= 1.5 cm short axis) on imaging required within 28 days prior to registration (Non-regional findings \>=1.5 cm short axis that in the opinion of the investigator are not concerning for involvement based on radiographic characteristics, chronicity, avidity on positron emission tomography (PET) scan or other imaging or other criteria can be eligible based on investigator discretion). * NOTE: Patients with elevated alkaline phosphatase, calcium or suspicious bone pain/tenderness can also undergo baseline bone scan to evaluate for bone metastasis at the discretion of local provider. * Patient must meet below criteria for prior/current malignancy history: * Non-urothelial cancer malignancy history: * Patient must not have another active (or within two years) second malignancy other than resected non-melanoma skin cancers, resected in situ breast, cervical or other in situ carcinoma, and either clinically insignificant per the investigator (e.g. =\< Gleason 3+4) on active surveillance (or watchful waiting) or previously treated prostate cancer with no rising prostate specific antigen (PSA) and no plan to treat * NOTE: Patients with prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial. * Urothelial cancer malignancy history: * Patient may have a history of resectable urothelial cancer as long as patients meet one of the following: * T0, Ta or Tis at any time * T1-4a N0 and no evidence of disease (NED) for more than 2 years from the latest therapy \[e.g., radical surgery, transurethral resection of bladder tumor (TURBT), radiation, chemotherapy (neoadjuvant or adjuvant, or with radiation)\]. Prior systemic immune checkpoint inhibitor is not allowed. * Patient with history of \>= pT4b, N+, and/or M1 UC is not eligible. * NOTE: Patients in whom concomitant or prior bladder/urethra predominant (\>= 50%) urothelial carcinoma have been surgically resected and demonstrated to be only Ta or carcinoma in situ (CIS) (\< cT1 N0) are eligible regardless of time elapsed * Patient must not have any uncontrolled illness including, but not limited to, ongoing or active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and tuberculosis testing in line with local practice), symptomatic congestive heart failure (CHF), myocardial infarction (MI) or unstable angina pectoris, significant uncontrolled cardiac arrhythmia, clinically relevant liver cirrhosis, interstitial lung disease, or psychiatric illness/social situations in the three months prior to registration that would limit compliance with study requirements * Patient must not have received prior radiation therapy to \>= 25% of the bone marrow for other diseases * Patient must not have received prior systemic anthracycline therapy * NOTE: Patients who have received prior intravesical therapy at any time for non-muscle invasive urothelial carcinoma of the bladder are eligible * Patient must not have either history of or active autoimmune disease requiring immunosuppressive therapy within 2 years prior to registration/randomization or any history of inflammatory bowel disease (inflammatory bowel disease \[IBD\], e.g. ulcerative colitis, or Crohn's disease), neuromuscular autoimmune condition, immune-related pneumonitis or interstitial lung disease. Patients with well-controlled hyper/hypothyroidism, celiac controlled by diet alone, diabetes mellitus type I, vitiligo, alopecia, psoriasis, eczema, lichen planus, or similar skin/mucosa condition are eligible * Patient must not be on or have used immunosuppressive medication within 14 days prior to the first dose of durvalumab. The following are exceptions to this criterion and are allowed: * Intranasal, inhaled, intra-auricular, topical steroids, or local steroid injections (e.g. intra-articular injection * Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent at the time of enrollment * Steroids as pre-medications for hypersensitivity reactions (e.g. computed tomography \[CT\] pre-medication) * Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months prior to registration/randomization are eligible for this trial * NOTE: These patients must be stable on their anti-retroviral regimen with evidence of at least two undetectable viral loads within the past 6 months on the same regimen; the most recent undetectable viral load must be within the past 12 weeks. They must have a CD4 count of greater than 250 cells/mcL over the past 6 months on this same anti-retroviral regimen and must not have had a CD4 count \< 200 cells/mcL over the past 2 years, unless it was deemed related to the cancer and/or chemotherapy induced bone marrow suppression. They must not be currently receiving prophylactic therapy for an opportunistic infection and must not have had an opportunistic infection within the past 6 months * NOTE: For patients who have received chemotherapy in the past 6 months, a CD4 count \< 250 cells/mcL during chemotherapy is permitted as long as viral loads were undetectable during this same chemotherapy. They must have an undetectable viral load and a CD4 count \>= 250 cells/mcL within 7 days of registration/randomization * For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated * NOTE: Testing for HIV, hepatitis B or hepatitis C is not required unless clinically indicated * Patients with a history of hepatitis C virus (HCV) infection must have been treated and have undetectable viral load. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load * Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better * Patient must not have received live attenuated vaccine within 30 days prior to the first dose of durvalumab, while on protocol treatment and within 30 days after the last dose of durvalumab * Patient must not have had a major surgical procedure within 28 days prior to registration/randomization * NOTE: Cystoscopy/ureteroscopy/TURBT, stent placement or nephrostomy tube is not considered major surgery * Patient must not have history of allogenic organ transplantation * Patient must have a body weight of \> 30 kg * Patient must have life expectancy of \>= 12 weeks * Patient must have creatinine clearance \> 15 ml/min as estimated by Cockcroft-Gault formula or glomerular filtration rate (GFR) \> 15 ml/min/1.73m\^2 within 28 days prior to registration/randomization * NOTE: Patients will be assigned to cisplatin-ineligible and cisplatin-eligible cohorts based on their creatinine clearance, Eastern Cooperative Oncology Group (ECOG) performance status, and grade (if any) of peripheral neuropathy and/or hearing loss in keeping with recommended cisplatin contraindications. Patients who are cisplatin-eligible will be randomized to either Arm A or Arm B and patients who are cisplatin-ineligible will be registered to Arm C * Patients that meet any of the following four criteria will be registered to the cisplatin-ineligible Arm C if they meet other eligibility criteria: * Creatinine clearance \> 15 ml/min and =\< 50 ml/min (estimated by Cockcroft-Gault formula) or GFR \> 15ml/min/1.73m\^2 and ≤ 50 ml/min/1.73 m\^2 * Hearing loss \>= 3 * Neuropathy \>= 2 * ECOG performance status 2 * In addition, the patient must have an absolute neutrophil count (ANC) \>= 1,000/mcL obtained =\< 14 days prior to registration * Patients that meet all of the following four criteria will be randomized to the cisplatin-eligible Arm A or Arm B: * Creatinine clearance \> 50ml/min (estimated by Cockcroft-Gault formula) or GFR \> 50ml/min/1.73m\^2 * ECOG performance status 0-1 * Hearing loss grade 0-2 * Neuropathy 0-1 * In addition, the patient must have an absolute neutrophil count (ANC) \>= 1,500/mcL obtained =\< 14 days prior to randomization * Also, the patient must have left ventricular ejection fraction (LVEF) \>= 50% by (either multigated acquisition scan \[MUGA\] or 2-D echocardiogram) obtained within obtained within 28 days prior to randomization

Conditions

Renal Pelvis and Ureter Urothelial Carcinoma

Locations

Kingman Regional Medical Center — Kingman, Arizona, United States
Mercy Hospital Fort Smith — Fort Smith, Arkansas, United States
University of Arkansas for Medical Sciences — Little Rock, Arkansas, United States
Sutter Auburn Faith Hospital — Auburn, California, United States
Alta Bates Summit Medical Center-Herrick Campus — Berkeley, California, United States
City of Hope Comprehensive Cancer Center — Duarte, California, United States
Palo Alto Medical Foundation-Fremont — Fremont, California, United States
UC San Diego Moores Cancer Center — La Jolla, California, United States
Memorial Medical Center — Modesto, California, United States
Palo Alto Medical Foundation-Camino Division — Mountain View, California, United States
Palo Alto Medical Foundation Health Care — Palo Alto, California, United States
Stanford Cancer Institute Palo Alto — Palo Alto, California, United States
Sutter Roseville Medical Center — Roseville, California, United States
Sutter Medical Center Sacramento — Sacramento, California, United States
UC San Diego Medical Center - Hillcrest — San Diego, California, United States
California Pacific Medical Center-Pacific Campus — San Francisco, California, United States
Palo Alto Medical Foundation-Santa Cruz — Santa Cruz, California, United States
Sutter Pacific Medical Foundation — Santa Rosa, California, United States
Palo Alto Medical Foundation-Sunnyvale — Sunnyvale, California, United States
Sutter Solano Medical Center/Cancer Center — Vallejo, California, United States
UCHealth University of Colorado Hospital — Aurora, Colorado, United States
UCHealth - Cherry Creek — Denver, Colorado, United States
Poudre Valley Hospital — Fort Collins, Colorado, United States
Cancer Care and Hematology-Fort Collins — Fort Collins, Colorado, United States
UCHealth Greeley Hospital — Greeley, Colorado, United States
UCHealth Highlands Ranch Hospital — Highlands Ranch, Colorado, United States
UCHealth Lone Tree Health Center — Lone Tree, Colorado, United States
Medical Center of the Rockies — Loveland, Colorado, United States
MedStar Washington Hospital Center — Washington D.C., District of Columbia, United States
Sibley Memorial Hospital — Washington D.C., District of Columbia, United States
Mayo Clinic in Florida — Jacksonville, Florida, 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
Emory Decatur Hospital — Decatur, Georgia, United States
Saint Alphonsus Cancer Care Center-Nampa — Nampa, Idaho, United States
OSF Saint Anthony's Health Center — Alton, Illinois, United States
Advocate Good Shepherd Hospital — Barrington, Illinois, United States
Illinois CancerCare-Bloomington — Bloomington, Illinois, United States
Loyola Center for Health at Burr Ridge — Burr Ridge, Illinois, United States
Illinois CancerCare-Canton — Canton, Illinois, United States
Memorial Hospital of Carbondale — Carbondale, Illinois, United States
SIH Cancer Institute — Carterville, Illinois, United States
Illinois CancerCare-Carthage — Carthage, Illinois, United States
Centralia Oncology Clinic — Centralia, 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
Carle Physician Group-Effingham — Effingham, 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
Western Illinois Cancer Treatment Center — Galesburg, Illinois, United States
Advocate South Suburban Hospital — Hazel Crest, Illinois, United States
Loyola Medicine Homer Glen — Homer Glen, Illinois, United States
Illinois CancerCare-Kewanee Clinic — Kewanee, Illinois, United States
AMG Libertyville - Oncology — Libertyville, Illinois, United States
Illinois CancerCare-Macomb — Macomb, Illinois, United States
Carle Physician Group-Mattoon/Charleston — Mattoon, Illinois, United States
Loyola University Medical Center — Maywood, Illinois, United States
Marjorie Weinberg Cancer Center at Loyola-Gottlieb — Melrose Park, Illinois, United States
SSM Health Good Samaritan — Mount Vernon, Illinois, United States
Cancer Care Center of O'Fallon — O'Fallon, Illinois, United States
Advocate Christ Medical Center — Oak Lawn, 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
Methodist Medical Center of Illinois — Peoria, Illinois, United States
Illinois CancerCare-Peru — Peru, Illinois, United States
Valley Radiation Oncology — Peru, Illinois, United States
Illinois CancerCare-Princeton — Princeton, Illinois, United States
Southern Illinois University School of Medicine — Springfield, Illinois, United States
Springfield Clinic — Springfield, Illinois, United States
Springfield Memorial Hospital — Springfield, Illinois, United States
Carle Cancer Center — Urbana, Illinois, United States
Illinois CancerCare - Washington — Washington, Illinois, United States
Reid Health — Richmond, Indiana, United States
Mary Greeley Medical Center — Ames, Iowa, United States
McFarland Clinic - Ames — Ames, Iowa, United States
University of Iowa Healthcare Cancer Services Quad Cities — Bettendorf, Iowa, United States
McFarland Clinic - Boone — Boone, Iowa, United States
McFarland Clinic - Trinity Cancer Center — Fort Dodge, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center — Iowa City, Iowa, United States
McFarland Clinic - Jefferson — Jefferson, Iowa, United States
McFarland Clinic - Marshalltown — Marshalltown, Iowa, United States
Central Care Cancer Center - Garden City — Garden City, Kansas, United States
Central Care Cancer Center - Great Bend — Great Bend, Kansas, United States
University of Kentucky/Markey Cancer Center — Lexington, Kentucky, United States
Mary Bird Perkins Cancer Center — Baton Rouge, Louisiana, United States
Mary Bird Perkins Cancer Center - Metairie — Metairie, Louisiana, United States
East Jefferson General Hospital — Metairie, Louisiana, United States
LSU Healthcare Network / Metairie Multi-Specialty Clinic — Metairie, Louisiana, United States
University Medical Center New Orleans — New Orleans, Louisiana, United States
Harold Alfond Center for Cancer Care — Augusta, Maine, United States
MaineHealth Maine Medical Center - Biddeford — Biddeford, Maine, United States
MaineHealth Cancer Care and IV Therapy - Sanford — Sanford, Maine, United States
MaineHealth Cancer Care Center of York County — Sanford, Maine, United States
MaineHealth Maine Medical Center- Scarborough — Scarborough, Maine, United States
MaineHealth Cancer Care and IV Therapy - South Portland — South Portland, Maine, United States
Johns Hopkins University/Sidney Kimmel Cancer Center — Baltimore, Maryland, United States
UMass Memorial Medical Center - University Campus — Worcester, Massachusetts, United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor — Ann Arbor, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton — Brighton, Michigan, United States
Trinity Health Medical Center - Brighton — Brighton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Canton — Canton, Michigan, United States
Trinity Health Medical Center - Canton — Canton, Michigan, United States
Chelsea Hospital — Chelsea, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital — Chelsea, Michigan, United States
Hematology Oncology Consultants-Clarkston — Clarkston, Michigan, United States
Newland Medical Associates-Clarkston — Clarkston, Michigan, United States
Cancer Hematology Centers - Flint — 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
Hope Cancer Clinic — Livonia, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital — Livonia, Michigan, United States
Henry Ford Saint John Hospital - Macomb Medical — Macomb, Michigan, United States
Michigan Healthcare Professionals Pontiac — Pontiac, Michigan, United States
Newland Medical Associates-Pontiac — Pontiac, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland Hospital — Pontiac, Michigan, United States
MyMichigan Medical Center Saginaw — Saginaw, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC — Saginaw, Michigan, United States
MyMichigan Medical Center Tawas — Tawas City, Michigan, United States
Saint Mary's Oncology/Hematology Associates of West Branch — West Branch, Michigan, United States
Huron Gastroenterology PC — Ypsilanti, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus — Ypsilanti, Michigan, United States
Fairview Ridges Hospital — Burnsville, Minnesota, United States
Minnesota Oncology - Burnsville — Burnsville, Minnesota, United States
Cambridge Medical Center — Cambridge, Minnesota, United States
Mercy Hospital — Coon Rapids, Minnesota, United States
Fairview Southdale Hospital — Edina, Minnesota, United States
Unity Hospital — Fridley, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove — Maple Grove, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood — Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast — Maplewood, Minnesota, United States
Abbott-Northwestern Hospital — Minneapolis, Minnesota, United States
Hennepin County Medical Center — Minneapolis, Minnesota, United States
Health Partners Inc — Minneapolis, Minnesota, United States
Monticello Cancer Center — Monticello, Minnesota, United States
New Ulm Medical Center — New Ulm, Minnesota, United States
Fairview Northland Medical Center — Princeton, Minnesota, United States
North Memorial Medical Health Center — Robbinsdale, Minnesota, United States
Mayo Clinic in Rochester — Rochester, 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
Saint Francis Regional Medical Center — Shakopee, Minnesota, United States
Lakeview Hospital — Stillwater, Minnesota, United States
Ridgeview Medical Center — Waconia, Minnesota, United States
Rice Memorial Hospital — Willmar, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury — Woodbury, Minnesota, United States
Fairview Lakes Medical Center — Wyoming, Minnesota, United States
Mercy Oncology and Hematology - Clayton-Clarkson — Ballwin, Missouri, United States
Central Care Cancer Center - Bolivar — Bolivar, Missouri, United States
Mercy Cancer Center - Cape Girardeau — Cape Girardeau, Missouri, United States
Saint Francis Medical Center — Cape Girardeau, Missouri, United States
Parkland Health Center - Farmington — Farmington, Missouri, United States
MU Health Care Goldschmidt Cancer Center — Jefferson City, Missouri, United States
Freeman Health System — Joplin, Missouri, United States
Mercy Hospital Joplin — Joplin, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology — Rolla, Missouri, United States
Phelps Health Delbert Day Cancer Institute — Rolla, Missouri, United States
Heartland Regional Medical Center — Saint Joseph, 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
Mercy Infusion Center - Chippewa — St Louis, Missouri, United States
Mercy Hospital South — St Louis, Missouri, United States
Missouri Baptist Medical Center — St Louis, Missouri, United States
Mercy Hospital Saint Louis — St Louis, Missouri, United States
Missouri Baptist Sullivan Hospital — Sullivan, Missouri, United States
Mercy Hospital Washington — Washington, Missouri, United States
OptumCare Cancer Care at Charleston — Las Vegas, Nevada, United States
OptumCare Cancer Care at Fort Apache — Las Vegas, Nevada, United States
Hackensack University Medical Center — Hackensack, New Jersey, United States
Cooperman Barnabas Medical Center — Livingston, New Jersey, United States
Rutgers Cancer Institute of New Jersey — New Brunswick, New Jersey, United States
Community Medical Center — Toms River, New Jersey, United States
University of New Mexico Cancer Center — Albuquerque, New Mexico, United States
Roswell Park Cancer Institute — Buffalo, New York, United States
Southeastern Medical Oncology Center-Clinton — Clinton, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro — Goldsboro, North Carolina, United States
Southeastern Medical Oncology Center-Jacksonville — Jacksonville, North Carolina, United States
Wake Forest University Health Sciences — Winston-Salem, North Carolina, United States
Dayton Physicians LLC-Miami Valley South — Centerville, Ohio, United States
Miami Valley Hospital South — Centerville, Ohio, United States
Miami Valley Hospital — Dayton, Ohio, United States
Premier Blood and Cancer Center — Dayton, Ohio, United States
Dayton Physician LLC - Englewood — Dayton, Ohio, United States
Miami Valley Hospital North — Dayton, Ohio, United States
Armes Family Cancer Center — Findlay, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital — Franklin, Ohio, United States
Dayton Physicians LLC-Atrium — Franklin, Ohio, United States
Miami Valley Cancer Care and Infusion — Greenville, Ohio, United States
Greater Dayton Cancer Center — Kettering, Ohio, United States
Kettering Medical Center — Kettering, Ohio, United States
Springfield Regional Cancer Center — Springfield, Ohio, United States
ProMedica Flower Hospital — Sylvania, Ohio, United States
Upper Valley Medical Center — Troy, Ohio, United States
Cancer Centers of Southwest Oklahoma Research — Lawton, Oklahoma, United States
University of Oklahoma Health Sciences Center — Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City — Oklahoma City, Oklahoma, United States
UPMC Hillman Cancer Center Erie — Erie, Pennsylvania, United States
UPMC Cancer Centers - Arnold Palmer Pavilion — Greensburg, Pennsylvania, United States
Penn State Milton S Hershey Medical Center — Hershey, Pennsylvania, United States
UPMC Hillman Cancer Center - Monroeville — Monroeville, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center — Philadelphia, Pennsylvania, United States
Thomas Jefferson University Hospital — Philadelphia, Pennsylvania, United States
UPMC Hillman Cancer Center — Pittsburgh, Pennsylvania, United States
UPMC-Passavant Hospital — Pittsburgh, Pennsylvania, United States
UPMC-Saint Clair Hospital Cancer Center — Pittsburgh, Pennsylvania, United States
UPMC Cancer Center-Washington — Washington, Pennsylvania, United States
Reading Hospital — West Reading, Pennsylvania, United States
Medical University of South Carolina — Charleston, South Carolina, 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
UT Southwestern/Simmons Cancer Center-Fort Worth — Fort Worth, Texas, United States
UT Southwestern Clinical Center at Richardson/Plano — Richardson, Texas, United States
Fred Hutchinson Cancer Center — Seattle, Washington, United States
University of Washington Medical Center - Montlake — Seattle, Washington, United States
Vandalia Health/CAMC Institute for Academic Medicine — Charleston, West Virginia, United States
ThedaCare Regional Cancer Center — Appleton, Wisconsin, United States
Aurora Cancer Care-Southern Lakes VLCC — Burlington, Wisconsin, United States
Marshfield Medical Center-EC Cancer Center — Eau Claire, 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
Aurora Cancer Care-Kenosha South — Kenosha, Wisconsin, United States
Aurora Bay Area Medical Group-Marinette — Marinette, Wisconsin, United States
Marshfield Medical Center-Marshfield — Marshfield, Wisconsin, United States
Aurora Cancer Care-Milwaukee — Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center — Milwaukee, Wisconsin, United States
Aurora Sinai Medical Center — Milwaukee, Wisconsin, United States
Marshfield Medical Center - Minocqua — Minocqua, Wisconsin, United States
ProHealth D N Greenwald Center — Mukwonago, Wisconsin, United States
Cancer Center of Western Wisconsin — New Richmond, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital — Oconomowoc, Wisconsin, United States
Vince Lombardi Cancer Clinic - Oshkosh — Oshkosh, Wisconsin, United States
Aurora Cancer Care-Racine — Racine, Wisconsin, United States
Marshfield Medical Center-Rice Lake — Rice Lake, Wisconsin, United States
Vince Lombardi Cancer Clinic-Sheboygan — Sheboygan, Wisconsin, United States
Marshfield Medical Center-River Region at Stevens Point — 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
ProHealth Waukesha Memorial Hospital — Waukesha, Wisconsin, United States
UW Cancer Center at ProHealth Care — Waukesha, Wisconsin, United States
ThedaCare Cancer Care - Waupaca — Waupaca, Wisconsin, United States
Aurora Cancer Care-Milwaukee West — Wauwatosa, Wisconsin, United States
Aurora West Allis Medical Center — West Allis, Wisconsin, United States
Marshfield Medical Center - Weston — Weston, Wisconsin, United States

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