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ACTIVE NOT RECRUITING

NCT03281954

PHASE3

Clinical Trial of Neoadjuvant Chemotherapy With Atezolizumab or Placebo in Patients With Triple-Negative Breast Cancer Followed After Surgery by Atezolizumab or Placebo

Sponsor: NSABP Foundation Inc

View on ClinicalTrials.gov

Summary

The main purpose of this study is to learn if the usual chemotherapy given before surgery (neoadjuvant therapy) for breast cancer plus the experimental drug, atezolizumab, is better than the usual chemotherapy plus a placebo. (A placebo is a drug that looks like the study drug but contains no medication.) The usual chemotherapy in this study is paclitaxel (WP) and carboplatin followed by doxorubicin and cyclophosphamide (AC) or epirubicin and cyclophosphamide (EC). Usually, after neoadjuvant therapy and surgery for triple negative breast cancer, no additional treatment is given unless the cancer returns. This study will also look at continuing treatment after surgery with atezolizumab or the placebo. To be better, atezolizumab given with the neoadjuvant therapy should be better at: 1) decreasing the amount of tumor in the breast than the placebo given with the usual chemotherapy and 2) decreasing the chance of the cancer from returning after surgery. Another purpose of this study is to test the good and bad effects of atezolizumab when added to the usual chemotherapy. Atezolizumab may keep your cancer from growing but it can also cause side effects.

Official title: A Randomized, Double-Blind, Phase III Clinical Trial of Neoadjuvant Chemotherapy With Atezolizumab or Placebo in Patients With Triple-Negative Breast Cancer Followed by Adjuvant Continuation of Atezolizumab or Placebo

Key Details

Gender

All

Age Range

18 Years - Any

Study Type

INTERVENTIONAL

Enrollment

1550

Start Date

2017-12-19

Completion Date

2027-11-30

Last Updated

2024-04-08

Healthy Volunteers

Conditions

Triple Negative Breast Cancer

Interventions

DRUG

Placebo

Following randomization, patients will receive Paclitaxel 80 mg/m2 IV weekly x 12 doses + Carboplatin AUC of 5 IV Day 1 every 3 weeks for 4 cycles + placebo IV Day 1 every 3 weeks for 4 doses. Followed 2-3 weeks later by Doxorubicin (A) 60 mg/m2 IV + cyclophosphamide (C) 600 mg/m2 IV Day 1 every 2 or 3 weeks for 4 cycles OR Epirubicin (E) 90 mg/m2 IV + cyclophosphamide (C) 600 mg/m2 IV Day 1 every 2 or 3 weeks for 4 cycles. \+ placebo IV Day 1 every 3 weeks for 3 to 4 doses depending on AC/EC schedule used. Approximately 3-4 weeks later: Surgery (Lumpectomy or mastectomy and axillary staging), followed by placebo IV Day 1 every 3 weeks after surgery until 1 year after the first dose.

DRUG

Atezolizumab

Following randomization, patients will receive Paclitaxel 80 mg/m2 IV weekly x 12 doses + Carboplatin AUC of 5 IV Day 1 every 3 weeks for 4 cycles + Atezolizumab 1200 mg Day 1 every 3 weeks for 4 doses. Followed 2-3 weeks later by Doxorubicin (A) 60 mg/m2 IV + cyclophosphamide (C) 600 mg/m2 IV Day 1 every 2 or 3 weeks for 4 cycles OR Epirubicin (E) 90 mg/m2 IV + cyclophosphamide (C) 600 mg/m2 IV Day 1 every 2 or 3 weeks for 4 cycles. \+ Atezolizumab 1200 mg Day 1 every 3 weeks for 3 to 4 doses depending on AC/EC schedule used. Approximately 3-4 weeks later: Surgery (Lumpectomy or mastectomy and axillary staging), followed by Atezolizumab 1200 mg Day 1 every 3 weeks after surgery until 1 year after the first dose.

Inclusion Criteria: * The patient must have consented to participate and, prior to beginning specific study procedures, must have signed and dated an appropriate IRB-approved consent form that conforms to federal and institutional guidelines for study treatment and for submission of tumor samples from a research biospy as required by NSABP B-59/GBG 96-GeparDouze for baseline correlative science studies. * The diagnosis of invasive adenocarcinoma of the breast must have been made by core needle biopsy. * Local testing on the diagnostic core must have determined the tumor to be ER-negative, PgR-negative, and HER2-negative by current ASCO/CAP guidelines. (If local testing has determined a tumor to be HER2 equivocal or to have a borderline ER/PgR status (% IHC staining \< 10% for both) and other eligibility criteria are met, material may be submitted for central testing to determine eligibility.) * Central testing for ER, PgR, and HER2 will be performed, and the tumor must be determined to be ER-negative, PgR-negative, and HER2-negative by current ASCO/CAP Guidelines Recommendations. * The tumor specimen used for central ER, PgR, and HER2 testing must also be used for central testing of PD-L1 status using the Ventana PD-L1 testing result including PD-L1 indeterminate Patients will be classifies as positive, negative, or indeterminate for stratification purposes. * Patients must be ≥ 18 years old. * Patient may be female or male. * The ECOG performance status must be 0-1. * The primary tumor can be clinical stage T2 or T3, if clinically node negative according to AJCC 7th Edition. If the regional lymph nodes are cN1 and cytologically or histologically positive or cN2-N3 with or without a biopsy, the primary breast tumor can be clinically T1c, T2, or T3. * Ipsilateral axillary lymph nodes must be evaluated by imaging (mammogram, ultrasound, and/or MRI) within 84 days prior to study entry. If suspicious or abnormal, FNA or core biopsy is recommended. Findings of these evaluations will be used to define the nodal status prior to study entry according to the following criteria: * Nodal status - negative (Imaging of the axilla is negative; Imaging is suspicious or abnormal but the FNA or core biopsy of the questionable node\[s\] on imaging is negative) * Nodal status - positive (FNA or core biopsy of the node\[s\] is cytologically or histologically suspicious or positive; Imaging is suspicious or abnormal but FNA or core biopsy was not performed.) * Patients with synchronous bilateral or multicentric HER2-negative breast cancer are eligible as long as the highest risk tumor is ER-negative and PgR-negative and meets stage eligibility criteria. All of the other invasive tumors must also be HER2-negative by ASCO/CAP Guidelines based on local testing. Central testing to confirm TNBC status is only required for the highest risk tumor. * Blood counts performed within 28 days prior to randomization must meet the following criteria: * ANC must be ≥ 1500/mm3; * platelet count must be ≥ 100,000/mm3; and * hemoglobin must be ≥10 g/dL. * The following criteria for evidence of adequate hepatic function performed within 28 days prior to randomization must be met: * total bilirubin must be ≤ ULN for the lab unless the patient has a bilirubin elevation \> ULN to 1.5 x ULN due to Gilbert's disease or similar syndrome involving slow conjugation of bilirubin; and * alkaline phosphatase must be ≤ 2.5 x ULN for the lab; and * AST and ALT must be ≤ 1.5 x ULN for the lab. * Patients with AST or ALT or alkaline phosphatase \> ULN are eligible for inclusion in the study if liver imaging (CT, MRI, abdominal ultrasound, PET-CT, or PET scan) performed within 28 days prior to randomization does not demonstrate metastatic disease and the requirements in criterion (just above) are met. * Patients with alkaline phosphatase that is \> ULN but less than or equal to 2.5 x ULN or with unexplained bone pain are eligible for inclusion in the study if bone imaging (bone scan, PET-CT scan, or PET scan) supported by additional studies when indicated (CT, x-ray, MRI) performed within 28 days prior to randomization does not demonstrate metastatic disease. * Patients with N2 or N3 nodal disease or T3 primary disease must undergo liver and bone imaging (as described in 4.1.13 and 4.1.14) within 28 days prior to randomization, irrespective of baseline lab results, and studies must not demonstrate metastatic disease. Chest imaging with chest x-ray PA and Lateral, CT of the chest, or PET-CT must also be performed. * Creatinine clearance ≥ 50 mL/min (see Section 7.2.1 for instructions regarding calculation of creatinine clearance) performed within 28 days prior to randomization. * PT/INR ≤ ULN within 28 days of randomization. Patients receiving therapeutic anti-coagulants are not eligible. * A serum TSH and AM (morning) cortisol performed within 28 days prior to randomization to obtain a baseline value. Patients with abnormal TSH or AM cortisol baseline levels should be further evaluated and managed per institutional standards. Asymptomatic patients who require initiation or adjustment of medication or are followed without initiating treatment based on endocrinologist's recommendations are eligible. * LVEF assessment must be performed within 42 days prior to randomization. (LVEF assessment performed by echocardiogram is preferred; however, MUGA scan may be substituted based on institutional preferences.) The LVEF must be ≥ 55% regardless of the cardiac imaging facility's lower limit of normal. * For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods that result in a failure rate of \< 1% per year during the treatment period and for at least 5 months after the last dose of atezolizumab/placebo or 12 months after the last dose of chemotherapy. * A woman is considered to be of childbearing potential if she is not postmenopausal, has not reached a postmenopausal state (≥ 12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus). * Examples of contraceptive methods with a failure rate of \< 1% per year include: bilateral tubal ligation; male partner sterilization; hormonal contraceptives that inhibit ovulation; hormone-releasing intrauterine devices; copper intrauterine devices. * The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical study and the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception. * Patient must be willing and able to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures. Exclusion Criteria: * Excisional biopsy or lumpectomy performed prior to study entry. * FNA alone to diagnose the breast cancer. * Surgical axillary staging procedure prior to randomization. Exception: FNA or core biopsy of an axillary node is permitted for any patient. A pre-neoadjuvant therapy sentinel lymph node biopsy for patients with clinically negative axillary nodes is prohibited. * Definitive clinical or radiologic evidence of metastatic disease. * Previous history of contralateral invasive breast cancer. (Patients with synchronous and/or previous contralateral DCIS or LCIS are eligible.) * Previous history of ipsilateral invasive breast cancer or ipsilateral DCIS. (Patients with synchronous or previous ipsilateral LCIS are eligible.) * History of non-breast malignancies (except for in situ cancers treated only by local excision and basal cell and squamous cell carcinomas of the skin) within 5 years prior to study entry. * Treatment including radiation therapy, chemotherapy, or targeted therapy, for the currently diagnosed breast cancer prior to randomization. * Previous therapy with anthracyclines or taxanes for any malignancy. * Cardiac disease (history of and/or active disease) that would preclude the use of the drugs included in the treatment regimens. This includes but is not confined to: * Active cardiac disease: angina pectoris that requires the use of anti-anginal medication; ventricular arrhythmias except for benign premature ventricular contractions; supraventricular and nodal arrhythmias requiring a pacemaker or not controlled with medication; conduction abnormality requiring a pacemaker; valvular disease with documented compromise in cardiac function; or symptomatic pericarditis. * History of cardiac disease: myocardial infarction documented by elevated cardiac enzymes or persistent regional wall abnormalities on assessment of left ventricular function within 6 months prior to randomization; history of documented CHF; or documented cardiomyopathy. * Uncontrolled hypertension defined as sustained systolic BP \> 150 mmHg or diastolic BP \> 90 mmHg. (Patients with initial BP elevations are eligible if initiation or adjustment of BP medication lowers pressure to meet entry criteria.) Patients requiring ≥ 3 BP medications are not eligible. * History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins. * Known hypersensitivity to biopharmaceuticals produced in Chinese hamster ovary cells. * Known allergy or hypersensitivity to the components of the atezolizumab formulation. * Known allergy or hypersensitivity to the components of the doxorubicin, epirubicin, cyclophosphamide, carboplatin, or paclitaxel formulations. * Known allergy or hypersensitivity to liposomal or pegylated G-CSF formulations. * Active or history of autoimmune disease or immune deficiency, including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, antiphospholipid syndrome, Wegener granulomatosis, Sjögren syndrome, Guillain-Barré syndrome, or multiple sclerosis for a more comprehensive list of autoimmune diseases and immune deficiencies) with the following exceptions: * Patients with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone may be eligible for this study. * Patients with controlled Type 1 diabetes mellitus on a stable dose of insulin regimen may be eligible for this study. * Patients with eczema, psoriasis, lichen simplex chronicus, or vitiligo with dermatologic manifestations only (e.g., patients with psoriatic arthritis are excluded) are permitted provided all of following conditions are met: Rash must cover \< 10% of body surface area; Disease is well controlled at baseline and requires only low-potency topical corticosteroids; No occurrence of acute exacerbations of the underlying condition requiring psoralen plus ultraviolet A radiation, methotrexate, retinoids, biologic agents, oral calcineurin inhibitors, or high-potency or oral corticosteroids within the previous 12 months. * History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan. * Patients known to be HIV positive. * Active hepatitis B virus (HBV) infection, defined as having a positive hepatitis B surface antigen (HBsAg) test at screening. Patients with a past or resolved HBV infection, defined as having a negative HBsAg test and a positive total hepatitis B core antibody (HBcAb) test at screening, are eligible for the study if active HBV infection is ruled out on the basis of HBV DNA viral load per local guidelines. * Active hepatitis C virus (HCV) infection, defined as having a positive HCV antibody test at screening confirmed by a polymerase chain reaction (PCR) positive for HCV RNA. * Patients with clinically active tuberculosis. * Severe infection within 28 days prior to randomization, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia. * Prior allogeneic stem cell or solid organ transplantation. * Administration of a live, attenuated vaccine within 28 days prior to randomization or anticipation that such vaccine will be required during the study. Patients must agree not to receive live, attenuated influenza vaccine (e.g., FluMist) within 28 days prior to randomization, during treatment or within 5 months following the last dose of atezolizumab/placebo. * Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complications. * Prior treatment with CD137 agonists or immune checkpoint-blockade therapies, including anti-CD40, anti-CTLA-4, anti-PD-1, and anti-PD-L1 therapeutic antibodies. * Treatment with systemic immunosuppressive medications (including but not limited to interferons, IL-2) within 28 days or 5 half-lives of the drug, whichever is longer, prior to randomization. * Treatment with systemic immunosuppressive medications (including but not limited to prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis \[anti-TNF\] factor agents) within 14 days prior to randomization or anticipation of need for systemic immunosuppressive medications during the study. * Nervous system disorder (paresthesias, peripheral motor neuropathy, or peripheral sensory neuropathy) ≥ Grade 2, per the CTCAE v4.0. * Symptomatic peripheral ischemia. * Pregnancy or lactation at the time of randomization or intention to become pregnant during the study. (Note: Negative serum pregnancy test must be obtained within 14 days prior to randomization). * Use of any investigational agent within 28 days prior to randomization.

Locations (217)

University of South Alabama Mitchell Cancer Institute

Mobile, Alabama, United States

Katmai Oncology Group

Anchorage, Alaska, United States

St. Bernard's Medical Center

Jonesboro, Arkansas, United States

St. Bernard's Medical Center

Paragould, Arkansas, United States

Kaiser Permanente-Anaheim

Anaheim, California, United States

Kaiser Permanente-Baldwin Park

Baldwin Park, California, United States

Kaiser Permanente-Bellflower

Bellflower, California, United States

Arrowhead Regional Medical Center

Colton, California, United States

City of Hope

Duarte, California, United States

Kaiser Permanente-Fontana

Fontana, California, United States

Kaiser Permanente-Harbor City

Harbor City, California, United States

Kaiser Permanente-Irvine

Irvine, California, United States

Cancer and Blood Specialty Clinic

Los Alamitos, California, United States

Kaiser Permanente-Sunset

Los Angeles, California, United States

Kaiser Permanente-West Los Angeles

Los Angeles, California, United States

Kaiser Permanente-Panorama City

Panorama City, California, United States

Kaiser Permanente-Riverside

Riverside, California, United States

Kaiser Permanente Medical Group

San Diego, California, United States

Kaiser Permanente-Zion

San Diego, California, United States

Kaiser Permanente - Otay

San Diego, California, United States

Kaiser Permanente- San Marcos

San Marcos, California, United States

City of Hope - South Pasadena

South Pasadena, California, United States

Torrance Memorial Physician Network

Torrance, California, United States

City of Hope - Upland

Upland, California, United States

PIH Health

Whittier, California, United States

Kaiser Permanente-Woodland Hills

Woodland Hills, California, United States

Mount Sinai Comprehensive Cancer Center Aventura

Aventura, Florida, United States

Memorial Healthcare System Office of Human Research

Hollywood, Florida, United States

Mount Sinai Comprehensive Cancer Center

Miami Beach, Florida, United States

UF Health Cancer Center at Orlando Health

Orlando, Florida, United States

Gwinnett Hospital System Center for Cancer Care

Duluth, Georgia, United States

Gwinnett Hospital System Center for Cancer Care

Lawrenceville, Georgia, United States

Gwinnett Hospital System Center for Cancer Care

Snellville, Georgia, United States

Illinois Cancer Care-Bloomington

Bloomington, Illinois, United States

John H. Stroger, Jr. Hospital of Cook County

Chicago, Illinois, United States

Rush University Medical Center

Chicago, Illinois, United States

Affiliated Oncologists

Chicago Ridge, Illinois, United States

Cancer Care Specialists of Central Illinois

Decatur, Illinois, United States

Decatur Memorial Hospital

Decatur, Illinois, United States

Crossroads Cancer Center

Effingham, Illinois, United States

Emhurst Memorial Nancy W. Knowles Cancer Center

Elmhurst, Illinois, United States

Illinois Cancer Care-Galesburg

Galesburg, Illinois, United States

Edward Cancer Center

Naperville, Illinois, United States

Illinois Cancer Care-Ottawa

Ottawa, Illinois, United States

Illinois Cancer Care PC

Peoria, Illinois, United States

Illinois Cancer Care-Peru

Peru, Illinois, United States

Edward Cancer Center Plainfield

Plainfield, Illinois, United States

Cancer Care Specialists of Central Illinois-Swansea

Swansea, Illinois, United States

Fort Wayne Medical Oncology and Hematology Inc (W. Jefferson Blvd)

Fort Wayne, Indiana, United States

Fort Wayne Medical Oncology and Hematology Inc (Parkview Plaza)

Fort Wayne, Indiana, United States

Mercy Medical Center Hall-Perrine Cancer Center

Cedar Rapids, Iowa, United States

Cancer Center of Kansas - Chanute

Chanute, Kansas, United States

Cancer Center of Kansas - Dodge City

Dodge City, Kansas, United States

Susan B. Allen Memorial Hosptial

El Dorado, Kansas, United States

Cancer Center at Mercy - W. Laurel

Independence, Kansas, United States

Kingman Community Hospital

Kingman, Kansas, United States

Southwest Medical Center

Liberal, Kansas, United States

McPherson Center for Health

McPherson, Kansas, United States

Newton Medical Center

Newton, Kansas, United States

Labette Health

Parsons, Kansas, United States

Pratt Regional Medical Center

Pratt, Kansas, United States

Cancer Center of Kansas - Salina

Salina, Kansas, United States

Cancer Center of Kansas - Wichita

Wichita, Kansas, United States

Cancer Center of Kansas

Wichita, Kansas, United States

Winfield Healthcare Center

Winfield, Kansas, United States

Norton Cancer Institute-Downtown

Louisville, Kentucky, United States

Norton Cancer Institute-Norton Healthcare Pavilion

Louisville, Kentucky, United States

University of Louisville-James Graham Brown Cancer Center

Louisville, Kentucky, United States

Baptist Health Louisville; Consultants in Blood Disorders and Cancer

Louisville, Kentucky, United States

Norton Cancer Institute-St Matthews

Louisville, Kentucky, United States

Norton Cancer Institute-Brownsboro

Louisville, Kentucky, United States

Ochsner Medical Center-Kenner

Kenner, Louisiana, United States

West Jefferson Medical Center Cancer Center

Marrero, Louisiana, United States

University Medical Center New Orleans

New Orleans, Louisiana, United States

Ochsner Medical Center

New Orleans, Louisiana, United States

Greater Baltimore Medical Center

Baltimore, Maryland, United States

Medstar Union Memorial Hospital

Baltimore, Maryland, United States

Harry and Jeanette Weinberg Cancer Center at Franklin Square

Baltimore, Maryland, United States

Maryland Oncology Hematology

Bethesda, Maryland, United States

Maryland Oncology - Hematology Brandywine

Brandywine, Maryland, United States

Maryland Oncology - Hematology PA

Columbia, Maryland, United States

Maryland Oncology - Hematology Frederick

Frederick, Maryland, United States

Meritus Center for Clinical Research

Hagerstown, Maryland, United States

Maryland Oncology - Hematology PA

Lanham, Maryland, United States

Maryland Oncology Hematology

Rockville, Maryland, United States

Capital Hematology Oncology Associates

Silver Spring, Maryland, United States

Holy Cross Hospital

Silver Spring, Maryland, United States

University of Maryland, St. Joseph Medical Center

Towson, Maryland, United States

Maryland Oncology Hematology

Wheaton, Maryland, United States

Berkshire Hematology Oncology Services at Berkshire Medical Center Cancer and Infusion Center

Pittsfield, Massachusetts, United States

Henry Ford Cancer Institute Brownstown

Brownstown, Michigan, United States

Henry Ford Cancer Institute Macomb Hospital

Clinton Township, Michigan, United States

Henry Ford Medical Center Fairlane

Dearborn, Michigan, United States

Henry Ford Hospital

Detroit, Michigan, United States

Michigan State University

East Lansing, Michigan, United States

Henry Ford Allegiance Health

Jackson, Michigan, United States

Michigan State University-Breslin Cancer Center

Lansing, Michigan, United States

Henry Ford Medical Center Columbus

Novi, Michigan, United States

Henry Ford Hospital W Bloomfield

West Bloomfield, Michigan, United States

Henry Ford Cancer Institute Wyandotte Hospital

Wyandotte, Michigan, United States

University of Missouri-Ellis Fischel Cancer Center

Columbia, Missouri, United States

Newark Beth Israel Medical Center

Newark, New Jersey, United States

MD Anderson Cancer Center at Cooper

Voorhees Township, New Jersey, United States

New York Oncology Hematology PC

Albany, New York, United States

Broome Oncolgy

Binghamton, New York, United States

Broome Oncology

Johnson City, New York, United States

Health Quest Medical Practice

Poughkeepsie, New York, United States

Vassar Brothers Medical Center

Poughkeepsie, New York, United States

RHOA of Cary

Cary, North Carolina, United States

Waverly Hematology Oncology

Cary, North Carolina, United States

Carolinas Medical Center-Levine Cancer Insitute

Charlotte, North Carolina, United States

Levine Cancer Center Institute Pineville

Charlotte, North Carolina, United States

RHOA of Garner

Garner, North Carolina, United States

UNC Regional Physicians Hematology and Oncolgoy

High Point, North Carolina, United States

FirstHealth of the Carolinas FirstHealth Outpatient Cancer Center

Pinehurst, North Carolina, United States

Rex Cancer Center

Raleigh, North Carolina, United States

RHOA of Blue Ridge

Raleigh, North Carolina, United States

RCC of Wakefield

Raleigh, North Carolina, United States

Nash UNC Health Care - Danny Talbott Cancer Center

Rocky Mount, North Carolina, United States

Sanford Roger Maris Cancer Center

Fargo, North Dakota, United States

Aultman Alliance Cancer Center

Alliance, Ohio, United States

Aultman Hospital

Canton, Ohio, United States

Aultman Medical Group Hematology and Oncology

Canton, Ohio, United States

The Ohio State University Wexner Medical Center-Investigational Drug Service Oncology

Columbus, Ohio, United States

The Stephanie Speilman Comprehensive Breast Center

Columbus, Ohio, United States

Willamette Valley Cancer Institute and Research Center

Eugene, Oregon, United States

Kaiser Permanente Northwest-Oncology/Hematology

Portland, Oregon, United States

Northwest Cancer Specialists

Tigard, Oregon, United States

UPMC Hillman Cancer Center-Beaver

Beaver, Pennsylvania, United States

UPMC Hillman Cancer Center - Passavant North

Cranberry Township, Pennsylvania, United States

Ephrata Cancer Center

Ephrata, Pennsylvania, United States

Allegheny Cancer Institute St. Vincent

Erie, Pennsylvania, United States

St. Vincent Hospital

Erie, Pennsylvania, United States

UPMC Cancer Center Horizon

Farrell, Pennsylvania, United States

Wellspan Medical Oncology

Gettysburg, Pennsylvania, United States

UPMC Hillman Cancer Center- Mountain View

Greensburg, Pennsylvania, United States

UPMC Cancer Center Greenville

Greenville, Pennsylvania, United States

AHN Cancer Institute at Jefferson

Jefferson Hills, Pennsylvania, United States

Seechler Family Cancer Center

Lebanon, Pennsylvania, United States

Forbes Regional Hospital

Monroeville, Pennsylvania, United States

UPMC Hillman Cancer Center UPMC East-Monroeville

Monroeville, Pennsylvania, United States

UPMC Hillman Cancer Center Norwin

N. Huntingdon, Pennsylvania, United States

UPMC Hillman Cancer Center New Castle

New Castle, Pennsylvania, United States

Allegheny General Hospital