Testing the Drug Atezolizumab or Placebo With Usual Therapy in First-Line HER2-Positive Metastatic Breast Cancer

• Sponsor: National Cancer Institute (NCI) (NIH)
• Overall Status: Active, not recruiting
• CT.gov ID: NCT03199885
• Collaborator: NRG Oncology (Other)
• Enrollment: 600
• Locations: 673
• Arms: 2
• Anticipated Duration (Months): 46.7
• Patients Per Site: 0.9
• Patients Per Site Per Month: 0

Study Details

Study Description

Brief Summary

This randomized phase III trial studies how well paclitaxel, trastuzumab, and pertuzumab with or without atezolizumab works in treating patients with breast cancer that has spread to other parts of the body (metastatic). Chemotherapy drugs, such as paclitaxel, 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. Trastuzumab is a form of "targeted therapy" because it works by attaching itself to specific molecules (receptors) on the surface of cancer cells, known as HER2 receptors. When trastuzumab attaches to HER2 receptors, the signals that tell the cells to grow are blocked and the cancer cell may be marked for destruction by the body's immune system. Monoclonal antibodies, such as pertuzumab, may interfere with the ability of cancer cells to grow and spread. Immunotherapy with monoclonal antibodies, such as atezolizumab, may induce changes in body's immune system and may interfere with the ability of tumor cells to grow and spread. It is not yet known whether giving paclitaxel, trastuzumab, and pertuzumab with or without atezolizumab may kill more tumor cells.

*NOTE: This study has a central confirmation step. The purpose of this step is to confirm by central testing that the patient's tumor has specific receptors. If the patient meets all the study requirements, the patient will join the study and begin therapy for breast cancer while the tumor is being tested.

Condition or Disease	Intervention/Treatment	Phase
Metastatic Breast Adenocarcinoma; Metastatic HER2-Positive Breast Carcinoma; Recurrent Breast Adenocarcinoma; Recurrent HER2-Positive Breast Carcinoma; Stage III Breast Cancer AJCC v7; Stage IV Breast Cancer AJCC v6 and v7; Unresectable Breast Carcinoma; Unresectable HER2-Positive Breast Carcinoma	Drug: Atezolizumab; Procedure: Biopsy; Procedure: Bone Scan; Procedure: Computed Tomography; Drug: Docetaxel; Procedure: Magnetic Resonance Imaging; Drug: Paclitaxel; Biological: Pertuzumab; Other: Placebo Administration; Other: Quality-of-Life Assessment; Biological: Trastuzumab	Phase 3

Detailed Description

PRIMARY OBJECTIVE:

1. To determine whether the addition of atezolizumab to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel) will improve the progression-free survival (PFS), assessed by investigator using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria, relative to the addition of a placebo to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel) in patients with newly documented HER2-positive measurable metastatic breast cancer.

SECONDARY OBJECTIVES:

1. To determine whether the addition of atezolizumab to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel) will improve the overall survival (OS) relative to the addition of placebo to a regimen of pertuzumab and trastuzumab, combined with a taxane (paclitaxel or docetaxel).

2. To determine whether the addition of atezolizumab to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel) will improve the overall objective response (OR) in the cohort of patients randomized 6 months or more prior to study accrual closure assessed by investigator using RECIST 1.1 criteria, relative to the addition of placebo to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel).

3. To determine the immune-related toxicity profile of the two treatment regimens.

4. To determine the cardiac safety profile of the two treatment regimens.

EXPLORATORY OBJECTIVES:

1. To determine whether the addition of atezolizumab to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel) will decrease the incidence of subsequent brain metastases in patients without known brain metastases at study entry relative to the addition of a placebo to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel).

2. To determine the utility of PD-L1 immunohistochemistry (IHC) staining as a predictive and prognostic biomarker associated with clinical response, as assessed by investigator using RECIST 1.1 criteria, to atezolizumab in combination with trastuzumab and pertuzumab combined with a taxane (paclitaxel or docetaxel).

3. To identify potential biomarkers that can predict benefit from the addition of atezolizumab in patients with newly documented HER2-positive measurable metastatic breast cancer treated with a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel).

4. To explore the toxicity profile of the two treatment regimens using patient-reported symptomatic adverse events in addition to standard adverse event reports.

5. To determine the feasibility and added value of frequent assessment of toxicity using Patient Reported Outcomes (PRO)-Common Terminology Criteria for Adverse Events (CTCAE) with electronic(e)PRO reporting.

6. To explore whether the addition of atezolizumab to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel) will contribute to increased patient-reported fatigue in comparison to the addition of placebo to a regimen of pertuzumab and trastuzumab combined with a taxane (paclitaxel or docetaxel).

OUTLINE:

STEP 1: Patients receive pertuzumab intravenously (IV) over 30-60 minutes on days 1 and 22, trastuzumab IV over 30-90 minutes on days 1 and 22, and paclitaxel IV over 60 minutes on days 1, 8, 15, 22, 29, and 36 or docetaxel IV over 60 minutes on days 1 and 22. Treatment continues for 6 weeks in the absence of disease progression or unacceptable toxicity. Patients may undergo a biopsy at baseline. Patients undergo computed tomography (CT), magnetic resonance imaging (MRI), and/or bone scan at baseline.

STEP 2: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive pertuzumab IV over 30-60 minutes on days 1 and 22 of each cycle, trastuzumab IV over 30-90 minutes on days 1 and 22 of each cycle, and paclitaxel IV over 60 minutes on days 1, 8, 15, 22, 29, and 36 of each cycle or docetaxel IV over 60 minutes on days 1 and 22 of each cycle. Cycles repeat every 6 weeks in the absence of disease progression or unacceptable toxicity. Patients also receive atezolizumab IV over 30-60 minutes on day 22 of cycle 1 and days 1 and 22 of subsequent cycles. Cycles repeat every 6 weeks for 2 years in the absence of disease progression or unacceptable toxicity. Patients undergo a CT or MRI at baseline, prior to weeks 10, 19, 28 and then at 9, 12, 15, 18, 21, and 24 months from study entry, every 3 months through year 3, every 6 months for years 4 and 5, and then every 6 months for years 6 through 10 from study entry. Patients undergo a bone scan at baseline, every 6 months from study entry, every 6 months through year 3, and every 12 months for years 4 and 5.

ARM II: Patients receive pertuzumab, trastuzumab, and paclitaxel or docetaxel as in Arm I. Patients also receive placebo IV 30-60 minutes on day 22 of cycle 1 and days 1 and 22 of subsequent cycles. Cycles repeat every 6 weeks for 2 years in the absence of disease progression or unacceptable toxicity. Patients undergo a CT or MRI at baseline, prior to weeks 10, 19, 28 and then at 9, 12, 15, 18, 21, and 24 months from study entry, every 3 months through year 3, every 6 months for years 4 and 5, and then every 6 months for years 6 through 10 from study entry. Patients undergo a bone scan at baseline, every 6 months from study entry, every 6 months through year 3, and every 12 months for years 4 and 5.

After completion of study treatment, patients are followed up at 30 days and every 3 months for 3 years and then every 6 months for 5 years.

Study Design

• Study Type: Interventional
• Anticipated Enrollment: 600 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Triple (Participant, Care Provider, Investigator)
• Primary Purpose: Treatment
• Official Title: A Randomized, Double-Blind, Phase III Trial of Taxane/Trastuzumab/Pertuzumab With Atezolizumab or Placebo in First-Line HER2-Positive Metastatic Breast Cancer
• Actual Study Start Date: Mar 12, 2019
• Anticipated Primary Completion Date: Jan 31, 2023
• Anticipated Study Completion Date: Jan 31, 2023

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Arm I (pertuzumab, trastuzumab, taxane therapy, atezolizumab) Patients receive pertuzumab IV over 30-60 minutes on days 1 and 22, trastuzumab IV over 30-90 minutes on days 1 and 22, and paclitaxel IV over 60 minutes on days 1, 8, 15, 22, 29, and 36 or docetaxel IV over 60 minutes on days 1 and 22. Cycles repeat every 6 weeks in the absence of disease progression or unacceptable toxicity. Patients also receive atezolizumab IV over 30-60 minutes on day 22 of cycle 1 and days 1 and 22 of subsequent cycles. Cycles repeat every 6 weeks for 2 years in the absence of disease progression or unacceptable toxicity. Patients may undergo a biopsy at baseline. Patients undergo a CT or MRI at baseline, prior to weeks 10, 19, 28 and then at 9, 12, 15, 18, 21, and 24 months from study entry, every 3 months through year 3, every 6 months for years 4 and 5, and then every 6 months for years 6 through 10 from study entry. Patients undergo a bone scan at baseline, every 6 months from study entry, every 6 months through year 3, and every 12 months for years 4 and 5.	Drug: Atezolizumab; Given IV; Other Names: MPDL 3280A MPDL 328OA MPDL-3280A MPDL3280A MPDL328OA RG7446 RO5541267 Tecentriq ; Procedure: Biopsy; Undergo biopsy; Other Names: BIOPSY_TYPE Bx ; Procedure: Bone Scan; Undergo bone scan; Other Names: Bone Scintigraphy ; Procedure: Computed Tomography; Undergo CT scan; Other Names: CAT CAT Scan Computed Axial Tomography Computerized Axial Tomography Computerized Tomography CT CT Scan tomography ; Drug: Docetaxel; Given IV; Other Names: Docecad RP56976 Taxotere Taxotere Injection Concentrate ; Procedure: Magnetic Resonance Imaging; Undergo MRI; Other Names: Magnetic Resonance Imaging Scan Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance MR MR Imaging MRI MRI Scan NMR Imaging NMRI Nuclear Magnetic Resonance Imaging ; Drug: Paclitaxel; Given IV; Other Names: Anzatax Asotax Bristaxol Praxel Taxol Taxol Konzentrat ; Biological: Pertuzumab; Given IV; Other Names: 2C4 2C4 Antibody HLX11 HS627 MoAb 2C4 Monoclonal Antibody 2C4 Omnitarg Perjeta Pertuzumab Biosimilar HLX11 Pertuzumab Biosimilar HS627 rhuMAb2C4 RO4368451 ; Other: Quality-of-Life Assessment; Ancillary studies; Other Names: Quality of Life Assessment ; Biological: Trastuzumab; Given IV; Other Names: ABP 980 ALT02 Anti-c-ERB-2 Anti-c-erbB2 Monoclonal Antibody Anti-ERB-2 Anti-erbB-2 Anti-erbB2 Monoclonal Antibody Anti-HER2/c-erbB2 Monoclonal Antibody Anti-p185-HER2 c-erb-2 Monoclonal Antibody HER2 Monoclonal Antibody Herceptin Herceptin Biosimilar PF-05280014 Herceptin Trastuzumab Biosimilar PF-05280014 Herzuma Kanjinti MoAb HER2 Monoclonal Antibody c-erb-2 Monoclonal Antibody HER2 Ogivri Ontruzant PF-05280014 rhuMAb HER2 RO0452317 SB3 Trastuzumab Biosimilar ABP 980 Trastuzumab Biosimilar ALT02 trastuzumab biosimilar EG12014 Trastuzumab Biosimilar HLX02 Trastuzumab Biosimilar PF-05280014 Trastuzumab Biosimilar SB3 Trastuzumab Biosimilar SIBP-01 Trastuzumab-anns Trastuzumab-dkst Trastuzumab-dttb Trastuzumab-pkrb Trastuzumab-qyyp Trazimera
Active Comparator: Arm II (pertuzumab, trastuzumab, taxane therapy, placebo) Patients receive pertuzumab, trastuzumab, and paclitaxel or docetaxel as in Arm I. Patients also receive placebo IV 30-60 minutes on day 1 of cycle 22 and days 1 and 22 of subsequent cycles. Cycles repeat every 6 weeks for 2 years in the absence of disease progression or unacceptable toxicity. Patients may undergo a biopsy at baseline. Patients undergo a CT or MRI at baseline, prior to weeks 10, 19, 28 and then at 9, 12, 15, 18, 21, and 24 months from study entry, every 3 months through year 3, every 6 months for years 4 and 5, and then every 6 months for years 6 through 10 from study entry. Patients undergo a bone scan at baseline every 6 months from study entry, every 6 months through year 3, and every 12 months for years 4 and 5.	Procedure: Biopsy; Undergo biopsy; Other Names: BIOPSY_TYPE Bx ; Procedure: Bone Scan; Undergo bone scan; Other Names: Bone Scintigraphy ; Procedure: Computed Tomography; Undergo CT scan; Other Names: CAT CAT Scan Computed Axial Tomography Computerized Axial Tomography Computerized Tomography CT CT Scan tomography ; Drug: Docetaxel; Given IV; Other Names: Docecad RP56976 Taxotere Taxotere Injection Concentrate ; Procedure: Magnetic Resonance Imaging; Undergo MRI; Other Names: Magnetic Resonance Imaging Scan Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance MR MR Imaging MRI MRI Scan NMR Imaging NMRI Nuclear Magnetic Resonance Imaging ; Drug: Paclitaxel; Given IV; Other Names: Anzatax Asotax Bristaxol Praxel Taxol Taxol Konzentrat ; Biological: Pertuzumab; Given IV; Other Names: 2C4 2C4 Antibody HLX11 HS627 MoAb 2C4 Monoclonal Antibody 2C4 Omnitarg Perjeta Pertuzumab Biosimilar HLX11 Pertuzumab Biosimilar HS627 rhuMAb2C4 RO4368451 ; Other: Placebo Administration; Given IV; Other: Quality-of-Life Assessment; Ancillary studies; Other Names: Quality of Life Assessment ; Biological: Trastuzumab; Given IV; Other Names: ABP 980 ALT02 Anti-c-ERB-2 Anti-c-erbB2 Monoclonal Antibody Anti-ERB-2 Anti-erbB-2 Anti-erbB2 Monoclonal Antibody Anti-HER2/c-erbB2 Monoclonal Antibody Anti-p185-HER2 c-erb-2 Monoclonal Antibody HER2 Monoclonal Antibody Herceptin Herceptin Biosimilar PF-05280014 Herceptin Trastuzumab Biosimilar PF-05280014 Herzuma Kanjinti MoAb HER2 Monoclonal Antibody c-erb-2 Monoclonal Antibody HER2 Ogivri Ontruzant PF-05280014 rhuMAb HER2 RO0452317 SB3 Trastuzumab Biosimilar ABP 980 Trastuzumab Biosimilar ALT02 trastuzumab biosimilar EG12014 Trastuzumab Biosimilar HLX02 Trastuzumab Biosimilar PF-05280014 Trastuzumab Biosimilar SB3 Trastuzumab Biosimilar SIBP-01 Trastuzumab-anns Trastuzumab-dkst Trastuzumab-dttb Trastuzumab-pkrb Trastuzumab-qyyp Trazimera

Outcome Measures

Primary Outcome Measures

1. Progression free survival [The time from randomization to the first documented progressive disease every 6 months, assessed up to 8 years]

   Will be determined using the current Response Evaluation Criteria in Solid Tumors 1.1 criteria. Analysis will be based on the intent to treat population. The stratified log-rank test will be used to compare the progression free survival between the two treatment arms with the following stratification factors: prior neoadjuvant or adjuvant therapy with trastuzumab (no; yes), estrogen receptor status (positive; negative), disease sites (any visceral without brain metastasis; non-visceral only without brain metastasis; brain metastasis), and choice of taxane (paclitaxel; docetaxel). The Kaplan-Meier estimates will be calculated by treatment arms. Stratified Cox proportional hazards models to estimate the hazard ratio.

Secondary Outcome Measures

1. Overall survival [The time from randomization to death from any cause every 6 months, assessed up to 8 years]

   Analysis will be based on the intent to treat population. The stratification factors are the same as what are used in the stratified log-rank test for the primary analysis on progression free survival. The Kaplan-Meier estimates will be calculated by treatment arms. Stratified Cox proportional hazards models to estimate the hazard ratio.

2. Overall objective response [Every 6 months up to 8 years]

   Defined as complete response or partial response. Will be determined using Response Evaluation Criteria in Solid Tumors 1.1 criteria. The stratified Cochran-Mantel-Haenszel test will be used to compare the object response between the treatment arms.

3. Frequency of adverse events, including late immune-related toxicities [Every 6 months up to 8 years]

   Will be categorized using the National Cancer Institute Common Terminology Criteria for Adverse Events Version 5.0. Comparisons of the adverse events between the two treatment arms will be done by the Fisher's exact test.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• The patient must have signed and dated an Institutional Review Board (IRB)-approved consent form that conforms to federal and institutional guidelines

• The trial is open to female and male patients

• Patients must be >= 18 years old

• Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

• Histologically confirmed adenocarcinoma of the breast with locally recurrent, unresectable disease or metastatic disease outside the central nervous system (CNS) confirmed as described below; eligible patients include those with either:

• De novo metastatic disease presenting without prior history of HER2-positive breast cancer:

• Diagnosis should have been made from a biopsy of a metastatic disease site, but biopsy from the breast primary or involved regional lymph nodes is acceptable if biopsy of the metastatic sites was thought to carry excessive risk for the patient

• Locally recurrent or metastatic disease following prior therapy for early breast cancer:

• Diagnosis must have been made from the biopsy of the locally recurrent or metastatic disease

• There must be an interval of >= 6 months between completion of neoadjuvant/adjuvant HER2-targeted therapy and documentation of locally recurrent or metastatic HER2-positive disease by biopsy

• Patients must have measurable disease based on RECIST 1.1, as determined by the site, which has not been irradiated to be eligible

• Patients with brain metastases are eligible if they meet ALL the following criteria:

• Four or fewer metastatic sites to CNS

• Largest unexcised tumor does not exceed 3 cm

• No metastases to brain stem, midbrain, pons, medulla or the optic nerves and chiasm

• Must have measurable disease outside the CNS, based on RECIST 1.1, as determined by the site, which has not been irradiated

• If patient presented with symptoms from CNS metastases, the symptoms must have resolved with initiation of steroids and initial local therapy (surgery, radiation therapy, or both)

• Must have been evaluated by Medical Oncologist and plan is to administer trastuzumab, pertuzumab, and a taxane as first-line systemic therapy

• May have received administration of trastuzumab OR lapatinib concurrently with radiation therapy for brain metastases. Toxicities related to lapatinib if administered, should be =< grade 1 per the CTCAE v5.0, and the lapatinib must have been completed at least 2 weeks prior to study entry

• No history of intracranial hemorrhage or spinal cord hemorrhage

• No neurosurgical resection or brain biopsy within 10 days prior to study entry

• After study entry and before randomization, send tissue for central HER2 confirmation; a tumor specimen obtained at the time of diagnosis of locally recurrent or metastatic disease must have been determined to be HER2-positive based on local testing according to American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines (Wolff 2018); HER2 status should initially be assessed using an Food and Drug Administration (FDA)-cleared IHC assay; positive is defined as IHC 3+ staining intensity; if HER2 IHC results are equivocal (2+), then HER2 status will be determined using a FDA-cleared HER2 in situ hybridization (ISH) test according to ASCO/CAP guidelines; Note: Once HER2-positive is confirmed on central testing, patients will be randomized to atezolizumab/placebo; randomization within 14 days from study entry will ensure that the Pharmaceutical Management Branch (PMB)-supplied agents will be received at the site for treatment on day 22 of cycle 1

• The tumor specimen obtained at the time of diagnosis used for HER2 testing must also have central testing for PD-L1 status; patients will be eligible irrespective of PD-L1 testing result including PD-L1 indeterminant

• The tumor specimen obtained at the time of diagnosis used for HER2 and PD-L1 testing should also have central testing for estrogen receptor (ER) and progesterone receptor (PgR) according to current ASCO/CAP guideline recommendations for hormone receptor testing; patients with < 1% ER and PgR staining by IHC will be classified as negative; if enough material for central confirmation of ER and PgR is unavailable, local testing results for ER and PgR may be used for eligibility

• Localized palliative radiation therapy to sites of non-measurable disease is allowed for symptom management and may begin prior to study entry and continue following study entry while receiving study therapy

• Patients must have imaging of the chest/abdomen/pelvis, preferably with a CT scan, and a bone scan within 5 weeks prior to study entry; (NOTE: if a patient is unable to receive CT contrast, a MRI of the abdomen/pelvis and non-contrast chest CT should be performed; positron emission tomography/computed tomography [PET/CT] is not an acceptable alternative)

• MRI of the brain (or contrast CT scan of the brain if patients are unable to undergo MRI) must be obtained in patients with symptoms suggesting possible central nervous system (CNS) metastatic disease; neuroimaging is recommended but not required in asymptomatic patients

• Absolute neutrophil count (ANC) must be >= 1200/mm^3 (within 14 days prior to study entry)

• Platelet count must be >= 100,000/mm^3 (within 14 days prior to study entry)

• Hemoglobin must be >= 8 g/dL (within 14 days prior to study entry)

• Total bilirubin must be =< 1.5 x upper limit of normal (ULN) for the lab or direct bilirubin =< ULN for patients with bilirubin levels > 1.5 x ULN (within 14 days prior to study entry)

• Aspartate aminotransferase (AST) and alanine aminotransaminase (ALT) must be =< 2.5 x ULN for the lab or =< 5 x ULN for patients with liver metastases (within 14 days prior to study entry)

• Serum creatinine =< 1.5 x ULN or measured or calculated creatinine clearance >= 50 mL/min using the Cockcroft-Gault formula for patients with creatinine levels > 1.5 x ULN for the lab (within 14 days prior to study entry)

• Patients not receiving anti-coagulant therapy must have prothrombin time (PT) and international normalized ratio (INR) =< 1.5 x ULN within 14 days prior to study entry; for laboratories that do not report an ULN for the INR assay, use =< 1.5 as the value for the ULN; patients receiving anti-coagulants should have a baseline INR assessed, but the value does not affect eligibility

• A serum thyroid-stimulating hormone (TSH) and AM (preferably in morning) cortisol must be obtained within 14 days prior to study entry 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

• Left ventricular ejection fraction (LVEF) assessment must be performed within 6 weeks prior to study entry; (LVEF assessment performed by echocardiogram is preferred; however, multigated acquisition scan (MUGA) scan may be substituted based on institutional preferences); the LVEF must be >= 50% regardless of the cardiac imaging facility's lower limit of normal

• Administration of atezolizumab may have an adverse effect on pregnancy and poses a risk to the human fetus, including embryo-lethality; women of child-bearing potential and men must agree to use adequate contraception (non-hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 5 months (150 days) after the last dose of atezolizumab/placebo and 7 months after the last dose of trastuzumab and pertuzumab; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately

• Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of study entry are eligible for this trial

Exclusion Criteria:

• Patients with brain metastases are excluded if they meet ANY of the following criteria:

• Symptoms from brain metastases have not resolved prior to study entry

• Five or more clearly identified foci of metastases to the brain

• Largest unexcised tumor exceeds 3 cm

• Spinal cord metastases

• Medical Oncologist plans to employ HER2-directed tyrosine kinase inhibitor as component of systemic therapy

• Metastatic disease limited to CNS

• Leptomeningeal carcinomatosis

• History of systemic anti-cancer therapy (e.g., chemotherapy, targeted therapy) for metastatic breast cancer (MBC) except as described in inclusion criteria

• History of exposure to cumulative doses of doxorubicin greater than 360 mg per square meter of body-surface area or its equivalent

• Prior treatment with mTOR inhibitors or CDK 4/6 inhibitors in combination with endocrine therapy for treatment of metastatic disease

• 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

• 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

• Uncontrolled hypertension defined as sustained systolic blood pressure (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)

• History of asymptomatic LVEF decline to < 40% during or after prior HER2-targeted therapy even if the current LVEF is >= 50%

• 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 current 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

• Prior myocardial infarction documented by elevated cardiac enzymes or persistent regional wall abnormalities on assessment of left ventricular (LV) function;

• History of documented congestive heart failure (CHF) defined as symptomatic heart failure with an LVEF < 40%; or

• Documented cardiomyopathy

• Nervous system disorder (paresthesia, peripheral motor neuropathy, or peripheral sensory neuropathy) >= grade 2, per the CTCAE v 5.0

• History of severe allergic, anaphylactic, or other hypersensitivity reactions to pertuzumab or trastuzumab or to any of its excipients, as well as any chimeric or humanized antibodies or fusion proteins

• Known hypersensitivity to biopharmaceuticals produced in Chinese hamster ovary cells or other recombinant antibodies

• Known allergy or hypersensitivity to the components of the atezolizumab formulation or to any of the study drugs or excipients, (e.g., Cremophor EL, polysorbate 80)

• History or risk of autoimmune disease, including, but not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjogren's syndrome, Bell's palsy, Guillain-Barre syndrome, multiple sclerosis, autoimmune thyroid disease, vasculitis, or glomerulonephritis

• Patients with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone may be eligible

• Patients with controlled type 1 diabetes mellitus on a stable insulin regimen may be eligible

• Patients with eczema, psoriasis, lichen simplex chronicus of vitiligo with dermatologic manifestations only (e.g., patients with psoriatic arthritis would be excluded) are permitted provided that they meet the following conditions:

• Patients with psoriasis must have a baseline ophthalmologic exam to rule out ocular manifestations

• Rash must cover less than 10% of body surface area (BSA)

• Disease is well controlled at baseline and only requiring low-potency topical steroids (e.g., hydrocortisone 2.5%, hydrocortisone butyrate 0.1%, fluocinolone 0.01%, desonide 0.05%, alclometasone dipropionate 0.05%)

• No acute exacerbations of underlying conditions within the last 12 months (not requiring psoralen plus ultraviolet A radiation [PUVA], methotrexate, retinoids, biologic agents, oral calcineurin inhibitors; high potency or oral steroids)

• Treatment with systemic immunomodulatory medications (including but not limited to interferons, IL-2) within 4 weeks or 5 half-lives of the drug, whichever is longer, prior to study entry

• 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 study entry or anticipation of need for systemic immunosuppressive medications during the study; Note: Intranasal and inhaled corticosteroids or systemic corticosteroids at doses that do not exceed 10 mg/day of prednisone or an equivalent corticosteroid are allowed

• Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 2 weeks prior to study entry

• 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 deoxyribonucleic acid (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 ribonucleic acid (RNA)

• Patients with clinically active tuberculosis

• Severe infection within 4 weeks prior to study entry, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia

• Prior allogeneic stem cell or solid organ transplantation

• Symptomatic peripheral ischemia

• History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis or >= grade 1 pulmonary fibrosis, per the CTCAE v5.0, on screening chest CT scan

• Administration of a live, attenuated vaccine within 4 weeks pr

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Alabama at Birmingham Cancer Center	Birmingham	Alabama	United States	35233
2	Katmai Oncology Group	Anchorage	Alaska	United States	99508
3	Banner MD Anderson Cancer Center	Gilbert	Arizona	United States	85234
4	CTCA at Western Regional Medical Center	Goodyear	Arizona	United States	85338
5	Banner-University Medical Center Phoenix	Phoenix	Arizona	United States	85006
6	Banner Boswell Medical Center	Sun City	Arizona	United States	85351
7	NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro	Jonesboro	Arkansas	United States	72401
8	Kaiser Permanente-Anaheim	Anaheim	California	United States	92806
9	Kaiser Permanente-Deer Valley Medical Center	Antioch	California	United States	94531
10	Kaiser Permanente-Baldwin Park	Baldwin Park	California	United States	91706
11	Kaiser Permanente-Bellflower	Bellflower	California	United States	90706
12	Alta Bates Summit Medical Center-Herrick Campus	Berkeley	California	United States	94704
13	UC Irvine Health Cancer Center-Newport	Costa Mesa	California	United States	92627
14	City of Hope Comprehensive Cancer Center	Duarte	California	United States	91010
15	Kaiser Permanente Dublin	Dublin	California	United States	94568
16	Kaiser Permanente-Fontana	Fontana	California	United States	92335
17	Kaiser Permanente-Fremont	Fremont	California	United States	94538
18	Palo Alto Medical Foundation-Fremont	Fremont	California	United States	94538
19	Washington Hospital	Fremont	California	United States	94538
20	Kaiser Permanente-Fresno	Fresno	California	United States	93720
21	Kaiser Permanente - Harbor City	Harbor City	California	United States	90710
22	Kaiser Permanente-Irvine	Irvine	California	United States	92618
23	Loma Linda University Medical Center	Loma Linda	California	United States	92354
24	Kaiser Permanente Los Angeles Medical Center	Los Angeles	California	United States	90027
25	Kaiser Permanente West Los Angeles	Los Angeles	California	United States	90034
26	Memorial Medical Center	Modesto	California	United States	95355
27	Kaiser Permanente-Modesto	Modesto	California	United States	95356
28	Palo Alto Medical Foundation-Camino Division	Mountain View	California	United States	94040
29	Kaiser Permanente-Oakland	Oakland	California	United States	94611
30	Kaiser Permanente-Ontario	Ontario	California	United States	91761
31	Saint Joseph Hospital - Orange	Orange	California	United States	92868
32	UC Irvine Health/Chao Family Comprehensive Cancer Center	Orange	California	United States	92868
33	Desert Regional Medical Center	Palm Springs	California	United States	92262
34	Palo Alto Medical Foundation Health Care	Palo Alto	California	United States	94301
35	Stanford Cancer Institute Palo Alto	Palo Alto	California	United States	94304
36	Kaiser Permanente - Panorama City	Panorama City	California	United States	91402
37	Kaiser Permanente-Richmond	Richmond	California	United States	94801
38	Kaiser Permanente-Riverside	Riverside	California	United States	92505
39	Kaiser Permanente-Roseville	Roseville	California	United States	95661
40	Kaiser Permanente Downtown Commons	Sacramento	California	United States	95814
41	Sutter Medical Center Sacramento	Sacramento	California	United States	95816
42	Kaiser Permanente-South Sacramento	Sacramento	California	United States	95823
43	Kaiser Permanente-San Diego Zion	San Diego	California	United States	92120
44	California Pacific Medical Center-Pacific Campus	San Francisco	California	United States	94115
45	Kaiser Permanente-San Francisco	San Francisco	California	United States	94115
46	Kaiser Permanente-Santa Teresa-San Jose	San Jose	California	United States	95119
47	Kaiser Permanente San Leandro	San Leandro	California	United States	94577
48	Kaiser Permanente-San Marcos	San Marcos	California	United States	92078
49	Kaiser San Rafael-Gallinas	San Rafael	California	United States	94903
50	Kaiser Permanente Medical Center - Santa Clara	Santa Clara	California	United States	95051
51	Palo Alto Medical Foundation-Santa Cruz	Santa Cruz	California	United States	95065
52	Kaiser Permanente-Santa Rosa	Santa Rosa	California	United States	95403
53	City of Hope South Pasadena	South Pasadena	California	United States	91030
54	Kaiser Permanente-South San Francisco	South San Francisco	California	United States	94080
55	Kaiser Permanente-Stockton	Stockton	California	United States	95210
56	Palo Alto Medical Foundation-Sunnyvale	Sunnyvale	California	United States	94086
57	City of Hope South Bay	Torrance	California	United States	90503
58	Gene Upshaw Memorial Tahoe Forest Cancer Center	Truckee	California	United States	96161
59	City of Hope Upland	Upland	California	United States	91786
60	Kaiser Permanente Medical Center-Vacaville	Vacaville	California	United States	95688
61	Kaiser Permanente-Vallejo	Vallejo	California	United States	94589
62	Sutter Solano Medical Center/Cancer Center	Vallejo	California	United States	94589
63	Kaiser Permanente-Walnut Creek	Walnut Creek	California	United States	94596
64	Kaiser Permanente-Woodland Hills	Woodland Hills	California	United States	91367
65	Rocky Mountain Cancer Centers-Aurora	Aurora	Colorado	United States	80012
66	University of Colorado Hospital	Aurora	Colorado	United States	80045
67	Rocky Mountain Cancer Centers-Boulder	Boulder	Colorado	United States	80304
68	UCHealth Memorial Hospital Central	Colorado Springs	Colorado	United States	80909
69	Memorial Hospital North	Colorado Springs	Colorado	United States	80920
70	Cancer Center of Colorado at Sloan's Lake	Denver	Colorado	United States	80204
71	SCL Health Saint Joseph Hospital	Denver	Colorado	United States	80218
72	Poudre Valley Hospital	Fort Collins	Colorado	United States	80524
73	Cancer Care and Hematology-Fort Collins	Fort Collins	Colorado	United States	80528
74	UCHealth Greeley Hospital	Greeley	Colorado	United States	80631
75	UCHealth Highlands Ranch Hospital	Highlands Ranch	Colorado	United States	80129
76	Good Samaritan Medical Center	Lafayette	Colorado	United States	80026
77	Rocky Mountain Cancer Centers-Littleton	Littleton	Colorado	United States	80120
78	Rocky Mountain Cancer Centers-Sky Ridge	Lone Tree	Colorado	United States	80124
79	Medical Center of the Rockies	Loveland	Colorado	United States	80538
80	SCL Health Lutheran Medical Center	Wheat Ridge	Colorado	United States	80033
81	Danbury Hospital	Danbury	Connecticut	United States	06810
82	Smilow Cancer Hospital-Derby Care Center	Derby	Connecticut	United States	06418
83	Smilow Cancer Hospital Care Center-Fairfield	Fairfield	Connecticut	United States	06824
84	Smilow Cancer Hospital Care Center at Greenwich	Greenwich	Connecticut	United States	06830
85	Smilow Cancer Hospital Care Center - Guiford	Guilford	Connecticut	United States	06437
86	Hartford Hospital	Hartford	Connecticut	United States	06102
87	Smilow Cancer Hospital Care Center at Saint Francis	Hartford	Connecticut	United States	06105
88	Yale University	New Haven	Connecticut	United States	06520
89	Yale-New Haven Hospital North Haven Medical Center	North Haven	Connecticut	United States	06473
90	Norwalk Hospital	Norwalk	Connecticut	United States	06856
91	Smilow Cancer Hospital-Orange Care Center	Orange	Connecticut	United States	06477
92	Smilow Cancer Hospital-Torrington Care Center	Torrington	Connecticut	United States	06790
93	Smilow Cancer Hospital Care Center-Trumbull	Trumbull	Connecticut	United States	06611
94	Smilow Cancer Hospital-Waterbury Care Center	Waterbury	Connecticut	United States	06708
95	Smilow Cancer Hospital Care Center - Waterford	Waterford	Connecticut	United States	06385
96	Beebe South Coastal Health Campus	Frankford	Delaware	United States	19945
97	Helen F Graham Cancer Center	Newark	Delaware	United States	19713
98	Medical Oncology Hematology Consultants PA	Newark	Delaware	United States	19713
99	Beebe Health Campus	Rehoboth Beach	Delaware	United States	19971
100	Kaiser Permanente-Capitol Hill Medical Center	Washington	District of Columbia	United States	20002
101	AdventHealth Altamonte	Altamonte Springs	Florida	United States	32701
102	GenesisCare USA - Aventura FP	Aventura	Florida	United States	33180
103	GenesisCare USA - Boca Ration FP06	Boca Raton	Florida	United States	33431
104	AdventHealth Celebration	Celebration	Florida	United States	34747
105	UM Sylvester Comprehensive Cancer Center at Coral Gables	Coral Gables	Florida	United States	33146
106	UM Sylvester Comprehensive Cancer Center at Deerfield Beach	Deerfield Beach	Florida	United States	33442
107	Holy Cross Hospital	Fort Lauderdale	Florida	United States	33308
108	Broward Health Medical Center	Fort Lauderdale	Florida	United States	33316
109	Mount Sinai Medical Center	Miami Beach	Florida	United States	33140
110	University of Miami Miller School of Medicine-Sylvester Cancer Center	Miami	Florida	United States	33136
111	UM Sylvester Comprehensive Cancer Center at Kendall	Miami	Florida	United States	33176
112	AdventHealth Orlando	Orlando	Florida	United States	32803
113	Orlando Health Cancer Institute	Orlando	Florida	United States	32806
114	Sacred Heart Hospital	Pensacola	Florida	United States	32504
115	UM Sylvester Comprehensive Cancer Center at Plantation	Plantation	Florida	United States	33324
116	Cleveland Clinic-Weston	Weston	Florida	United States	33331
117	Phoebe Putney Memorial Hospital	Albany	Georgia	United States	31701
118	University Cancer and Blood Center LLC	Athens	Georgia	United States	30607
119	Piedmont Hospital	Atlanta	Georgia	United States	30309
120	Northside Hospital	Atlanta	Georgia	United States	30342
121	Augusta Oncology Associates PC-D'Antignac	Augusta	Georgia	United States	30901
122	Augusta Oncology Associates PC-Wheeler	Augusta	Georgia	United States	30909
123	Northside Hospital - Duluth	Duluth	Georgia	United States	30096
124	Piedmont Fayette Hospital	Fayetteville	Georgia	United States	30214
125	Eisenhower Army Medical Center	Fort Gordon	Georgia	United States	30905-5650
126	Northside Hospital - Gwinnett	Lawrenceville	Georgia	United States	30046
127	Piedmont Newnan Hospital	Newnan	Georgia	United States	30265
128	Lewis Cancer and Research Pavilion at Saint Joseph's/Candler	Savannah	Georgia	United States	31405
129	Suburban Hematology Oncology Associates - Snellville	Snellville	Georgia	United States	30078
130	Piedmont Henry Hospital	Stockbridge	Georgia	United States	30281
131	Hawaii Cancer Care - Savio	'Aiea	Hawaii	United States	96701
132	Pali Momi Medical Center	'Aiea	Hawaii	United States	96701
133	Hawaii Cancer Care Inc - Waterfront Plaza	Honolulu	Hawaii	United States	96813
134	Queen's Cancer Cenrer - POB I	Honolulu	Hawaii	United States	96813
135	Queen's Medical Center	Honolulu	Hawaii	United States	96813
136	Straub Clinic and Hospital	Honolulu	Hawaii	United States	96813
137	Queen's Cancer Center - Kuakini	Honolulu	Hawaii	United States	96817
138	Kaiser Permanente Moanalua Medical Center	Honolulu	Hawaii	United States	96819
139	Kapiolani Medical Center for Women and Children	Honolulu	Hawaii	United States	96826
140	Saint Alphonsus Cancer Care Center-Boise	Boise	Idaho	United States	83706
141	Saint Luke's Cancer Institute - Boise	Boise	Idaho	United States	83712
142	Saint Alphonsus Cancer Care Center-Caldwell	Caldwell	Idaho	United States	83605
143	Kootenai Health - Coeur d'Alene	Coeur d'Alene	Idaho	United States	83814
144	Saint Luke's Cancer Institute - Fruitland	Fruitland	Idaho	United States	83619
145	Saint Luke's Cancer Institute - Meridian	Meridian	Idaho	United States	83642
146	Saint Alphonsus Medical Center-Nampa	Nampa	Idaho	United States	83686
147	Saint Luke's Cancer Institute - Nampa	Nampa	Idaho	United States	83686
148	Kootenai Clinic Cancer Services - Post Falls	Post Falls	Idaho	United States	83854
149	Kootenai Cancer Clinic	Sandpoint	Idaho	United States	83864
150	Saint Luke's Cancer Institute - Twin Falls	Twin Falls	Idaho	United States	83301
151	Rush - Copley Medical Center	Aurora	Illinois	United States	60504
152	Illinois CancerCare-Bloomington	Bloomington	Illinois	United States	61704
153	Illinois CancerCare-Canton	Canton	Illinois	United States	61520
154	Illinois CancerCare-Carthage	Carthage	Illinois	United States	62321
155	Northwestern University	Chicago	Illinois	United States	60611
156	Rush University Medical Center	Chicago	Illinois	United States	60612
157	University of Illinois	Chicago	Illinois	United States	60612
158	Advocate Illinois Masonic Medical Center	Chicago	Illinois	United States	60657
159	AMG Crystal Lake - Oncology	Crystal Lake	Illinois	United States	60014
160	Carle on Vermilion	Danville	Illinois	United States	61832
161	Cancer Care Specialists of Illinois - Decatur	Decatur	Illinois	United States	62526
162	Advocate Good Samaritan Hospital	Downers Grove	Illinois	United States	60515
163	Carle Physician Group-Effingham	Effingham	Illinois	United States	62401
164	Crossroads Cancer Center	Effingham	Illinois	United States	62401
165	Elmhurst Memorial Hospital	Elmhurst	Illinois	United States	60126
166	Illinois CancerCare-Eureka	Eureka	Illinois	United States	61530
167	NorthShore University HealthSystem-Evanston Hospital	Evanston	Illinois	United States	60201
168	Illinois CancerCare-Galesburg	Galesburg	Illinois	United States	61401
169	NorthShore University HealthSystem-Glenbrook Hospital	Glenview	Illinois	United States	60026
170	Ingalls Memorial Hospital	Harvey	Illinois	United States	60426
171	Advocate South Suburban Hospital	Hazel Crest	Illinois	United States	60429
172	NorthShore University HealthSystem-Highland Park Hospital	Highland Park	Illinois	United States	60035
173	Duly Health and Care Joliet	Joliet	Illinois	United States	60435
174	Illinois CancerCare-Kewanee Clinic	Kewanee	Illinois	United States	61443
175	Northwestern Medicine Lake Forest Hospital	Lake Forest	Illinois	United States	60045
176	AMG Libertyville - Oncology	Libertyville	Illinois	United States	60048
177	Condell Memorial Hospital	Libertyville	Illinois	United States	60048
178	Illinois CancerCare-Macomb	Macomb	Illinois	United States	61455
179	Carle Physician Group-Mattoon/Charleston	Mattoon	Illinois	United States	61938
180	Edward Hospital/Cancer Center	Naperville	Illinois	United States	60540
181	Cancer Care Center of O'Fallon	O'Fallon	Illinois	United States	62269
182	Advocate Christ Medical Center	Oak Lawn	Illinois	United States	60453-2699
183	Illinois CancerCare-Ottawa Clinic	Ottawa	Illinois	United States	61350
184	Advocate Lutheran General Hospital	Park Ridge	Illinois	United States	60068
185	Illinois CancerCare-Pekin	Pekin	Illinois	United States	61554
186	Illinois CancerCare-Peoria	Peoria	Illinois	United States	61615
187	Illinois CancerCare-Peru	Peru	Illinois	United States	61354
188	Edward Hospital/Cancer Center?Plainfield	Plainfield	Illinois	United States	60585
189	Illinois CancerCare-Princeton	Princeton	Illinois	United States	61356
190	SwedishAmerican Regional Cancer Center/ACT	Rockford	Illinois	United States	61114
191	Southern Illinois University School of Medicine	Springfield	Illinois	United States	62702
192	Springfield Clinic	Springfield	Illinois	United States	62702
193	Carle Cancer Center	Urbana	Illinois	United States	61801
194	Illinois CancerCare - Washington	Washington	Illinois	United States	61571
195	Midwestern Regional Medical Center	Zion	Illinois	United States	60099
196	Northwest Cancer Center - Main Campus	Crown Point	Indiana	United States	46307
197	Northwest Oncology LLC	Dyer	Indiana	United States	46311
198	Northwest Cancer Center - Hobart	Hobart	Indiana	United States	46342
199	Saint Mary Medical Center	Hobart	Indiana	United States	46342
200	Saint Catherine Hospital	Indianapolis	Indiana	United States	46312
201	The Community Hospital	Munster	Indiana	United States	46321
202	Women's Diagnostic Center - Munster	Munster	Indiana	United States	46321
203	Memorial Hospital of South Bend	South Bend	Indiana	United States	46601
204	Northwest Cancer Center - Valparaiso	Valparaiso	Indiana	United States	46383
205	Mary Greeley Medical Center	Ames	Iowa	United States	50010
206	McFarland Clinic PC - Ames	Ames	Iowa	United States	50010
207	University of Iowa Healthcare Cancer Services Quad Cities	Bettendorf	Iowa	United States	52722
208	McFarland Clinic PC-Boone	Boone	Iowa	United States	50036
209	Saint Anthony Regional Hospital	Carroll	Iowa	United States	51401
210	Mercy Hospital	Cedar Rapids	Iowa	United States	52403
211	Oncology Associates at Mercy Medical Center	Cedar Rapids	Iowa	United States	52403
212	Medical Oncology and Hematology Associates-West Des Moines	Clive	Iowa	United States	50325
213	Mercy Cancer Center-West Lakes	Clive	Iowa	United States	50325
214	Iowa Methodist Medical Center	Des Moines	Iowa	United States	50309
215	Medical Oncology and Hematology Associates-Des Moines	Des Moines	Iowa	United States	50309
216	Broadlawns Medical Center	Des Moines	Iowa	United States	50314
217	Medical Oncology and Hematology Associates-Laurel	Des Moines	Iowa	United States	50314
218	Mercy Medical Center - Des Moines	Des Moines	Iowa	United States	50314
219	Iowa Lutheran Hospital	Des Moines	Iowa	United States	50316
220	McFarland Clinic PC-Trinity Cancer Center	Fort Dodge	Iowa	United States	50501
221	Trinity Regional Medical Center	Fort Dodge	Iowa	United States	50501
222	University of Iowa/Holden Comprehensive Cancer Center	Iowa City	Iowa	United States	52242
223	McFarland Clinic PC-Jefferson	Jefferson	Iowa	United States	50129
224	McFarland Clinic PC-Marshalltown	Marshalltown	Iowa	United States	50158
225	HaysMed University of Kansas Health System	Hays	Kansas	United States	67601
226	University of Kansas Cancer Center-West	Kansas City	Kansas	United States	66112
227	Olathe Health Cancer Center	Olathe	Kansas	United States	66061
228	University of Kansas Cancer Center-Overland Park	Overland Park	Kansas	United States	66210
229	University of Kansas Hospital-Westwood Cancer Center	Westwood	Kansas	United States	66205
230	Saint Elizabeth Healthcare Edgewood	Edgewood	Kentucky	United States	41017
231	Baptist Health Lexington	Lexington	Kentucky	United States	40503
232	Saint Joseph Hospital East	Lexington	Kentucky	United States	40509
233	University of Kentucky/Markey Cancer Center	Lexington	Kentucky	United States	40536
234	Baptist Health Louisville	Louisville	Kentucky	United States	40207
235	LSU Health Baton Rouge-North Clinic	Baton Rouge	Louisiana	United States	70805
236	Louisiana Hematology Oncology Associates LLC	Baton Rouge	Louisiana	United States	70809
237	Mary Bird Perkins Cancer Center	Baton Rouge	Louisiana	United States	70809
238	Our Lady of the Lake Physicians Group - Medical Oncology	Baton Rouge	Louisiana	United States	70809
239	Our Lady of the Lake Medical Oncology	Baton Rouge	Louisiana	United States	70817
240	Woman's Hospital	Baton Rouge	Louisiana	United States	70817
241	Northshore Oncology Associates-Covington	Covington	Louisiana	United States	70433
242	Oncology Center of The South Incorporated	Houma	Louisiana	United States	70360
243	Harold Alfond Center for Cancer Care	Augusta	Maine	United States	04330
244	Waldo County General Hospital	Belfast	Maine	United States	04915
245	MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford	Biddeford	Maine	United States	04005
246	Lafayette Family Cancer Center-EMMC	Brewer	Maine	United States	04412
247	Penobscot Bay Medical Center	Rockport	Maine	United States	04856
248	MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford	Sanford	Maine	United States	04073
249	Maine Medical Partners - South Portland	South Portland	Maine	United States	04106
250	University of Maryland/Greenebaum Cancer Center	Baltimore	Maryland	United States	21201
251	Greater Baltimore Medical Center	Baltimore	Maryland	United States	21204
252	Saint Agnes Hospital	Baltimore	Maryland	United States	21229
253	Kaiser Permanente-Woodlawn Medical Center	Baltimore	Maryland	United States	21244
254	UM Upper Chesapeake Medical Center	Bel Air	Maryland	United States	21014
255	University of Maryland Shore Medical Center at Easton	Easton	Maryland	United States	21601
256	FMH James M Stockman Cancer Institute	Frederick	Maryland	United States	21702
257	Kaiser Permanente-Gaithersburg Medical Center	Gaithersburg	Maryland	United States	20879
258	Kaiser Permanente - Kensington Medical Center	Kensington	Maryland	United States	20895
259	Kaiser Permanente - Largo Medical Center	Largo	Maryland	United States	20774
260	UM Saint Joseph Medical Center	Towson	Maryland	United States	21204
261	Beverly Hospital	Beverly	Massachusetts	United States	01915
262	Lahey Hospital and Medical Center	Burlington	Massachusetts	United States	01805
263	Addison Gilbert Hospital	Gloucester	Massachusetts	United States	01930
264	UMass Memorial Medical Center - University Campus	Worcester	Massachusetts	United States	01655
265	Saint Joseph Mercy Hospital	Ann Arbor	Michigan	United States	48106
266	University of Michigan Comprehensive Cancer Center	Ann Arbor	Michigan	United States	48109
267	McLaren Cancer Institute-Bay City	Bay City	Michigan	United States	48706
268	Saint Joseph Mercy Brighton	Brighton	Michigan	United States	48114
269	Trinity Health IHA Medical Group Hematology Oncology - Brighton	Brighton	Michigan	United States	48114
270	Saint Joseph Mercy Canton	Canton	Michigan	United States	48188
271	Trinity Health IHA Medical Group Hematology Oncology - Canton	Canton	Michigan	United States	48188
272	Caro Cancer Center	Caro	Michigan	United States	48723
273	Saint Joseph Mercy Chelsea	Chelsea	Michigan	United States	48118
274	Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital	Chelsea	Michigan	United States	48118
275	Hematology Oncology Consultants-Clarkston	Clarkston	Michigan	United States	48346
276	McLaren Cancer Institute-Clarkston	Clarkston	Michigan	United States	48346
277	Newland Medical Associates-Clarkston	Clarkston	Michigan	United States	48346
278	Henry Ford Macomb Hospital-Clinton Township	Clinton Township	Michigan	United States	48038
279	Wayne State University/Karmanos Cancer Institute	Detroit	Michigan	United States	48201
280	Henry Ford Hospital	Detroit	Michigan	United States	48202
281	Ascension Saint John Hospital	Detroit	Michigan	United States	48236
282	Great Lakes Cancer Management Specialists-Doctors Park	East China Township	Michigan	United States	48054
283	Weisberg Cancer Treatment Center	Farmington Hills	Michigan	United States	48334
284	Beaumont Hospital - Farmington Hills	Farmington Hills	Michigan	United States	48336
285	Genesee Cancer and Blood Disease Treatment Center	Flint	Michigan	United States	48503
286	Genesee Hematology Oncology PC	Flint	Michigan	United States	48503
287	Genesys Hurley Cancer Institute	Flint	Michigan	United States	48503
288	McLaren Cancer Institute-Flint	Flint	Michigan	United States	48532
289	Singh and Arora Hematology Oncology PC	Flint	Michigan	United States	48532
290	Spectrum Health at Butterworth Campus	Grand Rapids	Michigan	United States	49503
291	Academic Hematology Oncology Specialists	Grosse Pointe Woods	Michigan	United States	48236
292	Great Lakes Cancer Management Specialists-Van Elslander Cancer Center	Grosse Pointe Woods	Michigan	United States	48236
293	Michigan Breast Specialists-Grosse Pointe Woods	Grosse Pointe Woods	Michigan	United States	48236
294	Allegiance Health	Jackson	Michigan	United States	49201
295	West Michigan Cancer Center	Kalamazoo	Michigan	United States	49007
296	Karmanos Cancer Institute at McLaren Greater Lansing	Lansing	Michigan	United States	48910
297	Mid-Michigan Physicians-Lansing	Lansing	Michigan	United States	48912
298	Sparrow Hospital	Lansing	Michigan	United States	48912
299	McLaren Cancer Institute-Lapeer Region	Lapeer	Michigan	United States	48446
300	Hope Cancer Clinic	Livonia	Michigan	United States	48154
301	Trinity Health Saint Mary Mercy Livonia Hospital	Livonia	Michigan	United States	48154
302	Great Lakes Cancer Management Specialists-Macomb Medical Campus	Macomb	Michigan	United States	48044
303	Michigan Breast Specialists-Macomb Township	Macomb	Michigan	United States	48044
304	Saint Mary's Oncology/Hematology Associates of Marlette	Marlette	Michigan	United States	48453
305	McLaren Cancer Institute-Macomb	Mount Clemens	Michigan	United States	48043
306	McLaren Cancer Institute-Central Michigan	Mount Pleasant	Michigan	United States	48858
307	Ascension Providence Hospitals - Novi	Novi	Michigan	United States	48374
308	McLaren Cancer Institute-Northern Michigan	Petoskey	Michigan	United States	49770
309	Newland Medical Associates-Pontiac	Pontiac	Michigan	United States	48341
310	Saint Joseph Mercy Oakland	Pontiac	Michigan	United States	48341
311	McLaren-Port Huron	Port Huron	Michigan	United States	48060
312	Great Lakes Cancer Management Specialists-Rochester Hills	Rochester Hills	Michigan	United States	48309
313	William Beaumont Hospital-Royal Oak	Royal Oak	Michigan	United States	48073
314	Ascension Saint Mary's Hospital	Saginaw	Michigan	United States	48601
315	Oncology Hematology Associates of Saginaw Valley PC	Saginaw	Michigan	United States	48604
316	Ascension Providence Hospitals - Southfield	Southfield	Michigan	United States	48075
317	Bhadresh Nayak MD PC-Sterling Heights	Sterling Heights	Michigan	United States	48312
318	Ascension Saint Joseph Hospital	Tawas City	Michigan	United States	48764
319	Munson Medical Center	Traverse City	Michigan	United States	49684
320	William Beaumont Hospital - Troy	Troy	Michigan	United States	48085
321	Great Lakes Cancer Management Specialists-Macomb Professional Building	Warren	Michigan	United States	48093
322	Michigan Breast Specialists-Warren	Warren	Michigan	United States	48093
323	Saint John Macomb-Oakland Hospital	Warren	Michigan	United States	48093
324	Saint Mary's Oncology/Hematology Associates of West Branch	West Branch	Michigan	United States	48661
325	Metro Health Hospital	Wyoming	Michigan	United States	49519
326	Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus	Ypsilanti	Michigan	United States	48197
327	Sanford Joe Lueken Cancer Center	Bemidji	Minnesota	United States	56601
328	Essentia Health Saint Joseph's Medical Center	Brainerd	Minnesota	United States	56401
329	Fairview Ridges Hospital	Burnsville	Minnesota	United States	55337
330	Mercy Hospital	Coon Rapids	Minnesota	United States	55433
331	Essentia Health - Deer River Clinic	Deer River	Minnesota	United States	56636
332	Essentia Health Cancer Center	Duluth	Minnesota	United States	55805
333	Unity Hospital	Fridley	Minnesota	United States	55432
334	Essentia Health Hibbing Clinic	Hibbing	Minnesota	United States	55746
335	Fairview Clinics and Surgery Center Maple Grove	Maple Grove	Minnesota	United States	55369
336	Abbott-Northwestern Hospital	Minneapolis	Minnesota	United States	55407
337	Hennepin County Medical Center	Minneapolis	Minnesota	United States	55415
338	Mayo Clinic in Rochester	Rochester	Minnesota	United States	55905
339	Coborn Cancer Center at Saint Cloud Hospital	Saint Cloud	Minnesota	United States	56303
340	Park Nicollet Clinic - Saint Louis Park	Saint Louis Park	Minnesota	United States	55416
341	Regions Hospital	Saint Paul	Minnesota	United States	55101
342	United Hospital	Saint Paul	Minnesota	United States	55102
343	Essentia Health Sandstone	Sandstone	Minnesota	United States	55072
344	Sanford Thief River Falls Medical Center	Thief River Falls	Minnesota	United States	56701
345	Essentia Health Virginia Clinic	Virginia	Minnesota	United States	55792
346	Ridgeview Medical Center	Waconia	Minnesota	United States	55387
347	Baptist Memorial Hospital and Cancer Center-Golden Triangle	Columbus	Mississippi	United States	39705
348	Gulfport Memorial Hospital	Gulfport	Mississippi	United States	39502
349	Baptist Memorial Hospital and Cancer Center-Desoto	Southhaven	Mississippi	United States	38671
350	Parkland Health Center-Bonne Terre	Bonne Terre	Missouri	United States	63628
351	Saint Francis Medical Center	Cape Girardeau	Missouri	United States	63703
352	University of Missouri - Ellis Fischel	Columbia	Missouri	United States	65212
353	Siteman Cancer Center at West County Hospital	Creve Coeur	Missouri	United States	63141
354	Parkland Health Center - Farmington	Farmington	Missouri	United States	63640
355	Capital Region Southwest Campus	Jefferson City	Missouri	United States	65109
356	Freeman Health System	Joplin	Missouri	United States	64804
357	Truman Medical Centers	Kansas City	Missouri	United States	64108
358	University of Kansas Cancer Center - North	Kansas City	Missouri	United States	64154
359	University of Kansas Cancer Center - Lee's Summit	Lee's Summit	Missouri	United States	64064
360	University of Kansas Cancer Center at North Kansas City Hospital	North Kansas City	Missouri	United States	64116
361	Heartland Regional Medical Center	Saint Joseph	Missouri	United States	64506
362	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
363	Siteman Cancer Center-South County	Saint Louis	Missouri	United States	63129
364	Missouri Baptist Medical Center	Saint Louis	Missouri	United States	63131
365	Siteman Cancer Center at Christian Hospital	Saint Louis	Missouri	United States	63136
366	Mercy Hospital Saint Louis	Saint Louis	Missouri	United States	63141
367	Siteman Cancer Center at Saint Peters Hospital	Saint Peters	Missouri	United States	63376
368	Sainte Genevieve County Memorial Hospital	Sainte Genevieve	Missouri	United States	63670
369	Missouri Baptist Sullivan Hospital	Sullivan	Missouri	United States	63080
370	Missouri Baptist Outpatient Center-Sunset Hills	Sunset Hills	Missouri	United States	63127
371	Billings Clinic Cancer Center	Billings	Montana	United States	59101
372	Bozeman Deaconess Hospital	Bozeman	Montana	United States	59715
373	Kalispell Regional Medical Center	Kalispell	Montana	United States	59901
374	CHI Health Saint Francis	Grand Island	Nebraska	United States	68803
375	Cancer Partners of Nebraska - Pine Lake	Lincoln	Nebraska	United States	68516
376	Southeast Nebraska Cancer Center - 68th Street Place	Lincoln	Nebraska	United States	68516
377	Nebraska Methodist Hospital	Omaha	Nebraska	United States	68114
378	Alegent Health Bergan Mercy Medical Center	Omaha	Nebraska	United States	68124
379	OptumCare Cancer Care at Charleston	Las Vegas	Nevada	United States	89102
380	OptumCare Cancer Care at MountainView	Las Vegas	Nevada	United States	89128
381	Comprehensive Cancer Centers of Nevada	Las Vegas	Nevada	United States	89148
382	OptumCare Cancer Care at Fort Apache	Las Vegas	Nevada	United States	89148
383	New Hampshire Oncology Hematology PA-Concord	Concord	New Hampshire	United States	03301
384	Exeter Hospital	Exeter	New Hampshire	United States	03833
385	Dartmouth Hitchcock Medical Center	Lebanon	New Hampshire	United States	03756
386	Solinsky Center for Cancer Care	Manchester	New Hampshire	United States	03103
387	Memorial Sloan Kettering Basking Ridge	Basking Ridge	New Jersey	United States	07920
388	Cooper Hospital University Medical Center	Camden	New Jersey	United States	08103
389	Hackensack University Medical Center	Hackensack	New Jersey	United States	07601
390	Memorial Sloan Kettering Monmouth	Middletown	New Jersey	United States	07748
391	Memorial Sloan Kettering Bergen	Montvale	New Jersey	United States	07645
392	The Valley Hospital-Luckow Pavilion	Paramus	New Jersey	United States	07652
393	Neurosurgeons of New Jersey-Ridgewood	Ridgewood	New Jersey	United States	07450
394	Valley Hospital	Ridgewood	New Jersey	United States	07450
395	Holy Name Hospital	Teaneck	New Jersey	United States	07666
396	MD Anderson Cancer Center at Cooper-Voorhees	Voorhees	New Jersey	United States	08043
397	Valley Medical Group - Wayne Multispecialty Practice	Wayne	New Jersey	United States	07470
398	Valley Health System-Hematology/Oncology	Westwood	New Jersey	United States	07675
399	University of New Mexico Cancer Center	Albuquerque	New Mexico	United States	87102
400	New Mexico Oncology Hematology Consultants	Albuquerque	New Mexico	United States	87109
401	Presbyterian Kaseman Hospital	Albuquerque	New Mexico	United States	87110
402	Memorial Medical Center - Las Cruces	Las Cruces	New Mexico	United States	88011
403	Presbyterian Rust Medical Center/Jorgensen Cancer Center	Rio Rancho	New Mexico	United States	87124
404	Hematology Oncology Associates of Central New York-Auburn	Auburn	New York	United States	13021
405	Montefiore Medical Center-Einstein Campus	Bronx	New York	United States	10461
406	Montefiore Medical Center-Weiler Hospital	Bronx	New York	United States	10461
407	Montefiore Medical Center - Moses Campus	Bronx	New York	United States	10467
408	Roswell Park Cancer Institute	Buffalo	New York	United States	14263
409	Memorial Sloan Kettering Commack	Commack	New York	United States	11725
410	Hematology Oncology Associates of Central New York-East Syracuse	East Syracuse	New York	United States	13057
411	Memorial Sloan Kettering Westchester	Harrison	New York	United States	10604
412	NYU Winthrop Hospital	Mineola	New York	United States	11501
413	Mount Sinai Union Square	New York	New York	United States	10003
414	Mount Sinai West	New York	New York	United States	10019
415	Mount Sinai Hospital	New York	New York	United States	10029
416	Memorial Sloan Kettering Cancer Center	New York	New York	United States	10065
417	University of Rochester	Rochester	New York	United States	14642
418	Stony Brook University Medical Center	Stony Brook	New York	United States	11794
419	State University of New York Upstate Medical University	Syracuse	New York	United States	13210
420	Hematology Oncology Associates of Central New York-Onondaga Hill	Syracuse	New York	United States	13215
421	Memorial Sloan Kettering Nassau	Uniondale	New York	United States	11553
422	Good Samaritan Hospital Medical Center	West Islip	New York	United States	11795
423	Atrium Health Stanly/LCI-Albemarle	Albemarle	North Carolina	United States	28002
424	Randolph Hospital	Asheboro	North Carolina	United States	27203
425	Mission Hospital	Asheville	North Carolina	United States	28801
426	AdventHealth Infusion Center Asheville	Asheville	North Carolina	United States	28803
427	Messino Cancer Centers	Asheville	North Carolina	United States	28806
428	Hope Women's Cancer Centers-Asheville	Asheville	North Carolina	United States	28816
429	Cone Health Cancer Center at Alamance Regional	Burlington	North Carolina	United States	27215
430	Carolinas Medical Center/Levine Cancer Institute	Charlotte	North Carolina	United States	28203
431	Atrium Health Pineville/LCI-Pineville	Charlotte	North Carolina	United States	28210
432	Southeastern Medical Oncology Center-Clinton	Clinton	North Carolina	United States	28328
433	AdventHealth Infusion Center Haywood	Clyde	North Carolina	United States	28721
434	Atrium Health Cabarrus/LCI-Concord	Concord	North Carolina	United States	28025
435	Levine Cancer Institute-Gaston	Gastonia	North Carolina	United States	28054
436	Southeastern Medical Oncology Center-Goldsboro	Goldsboro	North Carolina	United States	27534
437	Cone Health Cancer Center	Greensboro	North Carolina	United States	27403
438	Margaret R Pardee Memorial Hospital	Hendersonville	North Carolina	United States	28791
439	AdventHealth Hendersonville	Hendersonville	North Carolina	United States	28792
440	Southeastern Medical Oncology Center-Jacksonville	Jacksonville	North Carolina	United States	28546
441	Vidant Oncology-Kenansville	Kenansville	North Carolina	United States	28349
442	Vidant Oncology-Kinston	Kinston	North Carolina	United States	28501
443	Atrium Health Lincoln/LCI-Lincolnton	Lincolnton	North Carolina	United States	28092
444	Cone Heath Cancer Center at Mebane	Mebane	North Carolina	United States	27302
445	FirstHealth of the Carolinas-Moore Regional Hospital	Pinehurst	North Carolina	United States	28374
446	Vidant Oncology-Richlands	Richlands	North Carolina	United States	28574
447	Nash General Hospital	Rocky Mount	North Carolina	United States	27804
448	Marion L Shepard Cancer Center at Vidant Beaufort Hospital	Washington	North Carolina	United States	27889
449	Wake Forest University Health Sciences	Winston-Salem	North Carolina	United States	27157
450	Sanford Bismarck Medical Center	Bismarck	North Dakota	United States	58501
451	Sanford Broadway Medical Center	Fargo	North Dakota	United States	58122
452	Sanford Roger Maris Cancer Center	Fargo	North Dakota	United States	58122
453	Summa Health System - Akron Campus	Akron	Ohio	United States	44304
454	Summa Health System - Barberton Campus	Barberton	Ohio	United States	44203
455	UHHS-Chagrin Highlands Medical Center	Beachwood	Ohio	United States	44122
456	Strecker Cancer Center-Belpre	Belpre	Ohio	United States	45714
457	Cleveland Clinic Mercy Hospital	Canton	Ohio	United States	44708
458	Geauga Hospital	Chardon	Ohio	United States	44024
459	Adena Regional Medical Center	Chillicothe	Ohio	United States	45601
460	University of Cincinnati Cancer Center-UC Medical Center	Cincinnati	Ohio	United States	45219
461	Good Samaritan Hospital - Cincinnati	Cincinnati	Ohio	United States	45220
462	Case Western Reserve University	Cleveland	Ohio	United States	44106
463	MetroHealth Medical Center	Cleveland	Ohio	United States	44109
464	Cleveland Clinic Cancer Center/Fairview Hospital	Cleveland	Ohio	United States	44111
465	Cleveland Clinic Foundation	Cleveland	Ohio	United States	44195
466	Ohio State University Comprehensive Cancer Center	Columbus	Ohio	United States	43210
467	Mount Carmel East Hospital	Columbus	Ohio	United States	43213
468	Columbus Oncology and Hematology Associates Inc	Columbus	Ohio	United States	43214
469	Riverside Methodist Hospital	Columbus	Ohio	United States	43214
470	Grant Medical Center	Columbus	Ohio	United States	43215
471	The Mark H Zangmeister Center	Columbus	Ohio	United States	43219
472	Mount Carmel Health Center West	Columbus	Ohio	United States	43222
473	Doctors Hospital	Columbus	Ohio	United States	43228
474	Dayton Physician LLC-Miami Valley Hospital North	Dayton	Ohio	United States	45415
475	Delaware Health Center-Grady Cancer Center	Delaware	Ohio	United States	43015
476	Grady Memorial Hospital	Delaware	Ohio	United States	43015
477	Mercy Cancer Center-Elyria	Elyria	Ohio	United States	44035
478	Fairfield Medical Center	Lancaster	Ohio	United States	43130
479	OhioHealth Mansfield Hospital	Mansfield	Ohio	United States	44903
480	Cleveland Clinic Cancer Center Mansfield	Mansfield	Ohio	United States	44906
481	Marietta Memorial Hospital	Marietta	Ohio	United States	45750
482	OhioHealth Marion General Hospital	Marion	Ohio	United States	43302
483	Hillcrest Hospital Cancer Center	Mayfield Heights	Ohio	United States	44124
484	Summa Health Medina Medical Center	Medina	Ohio	United States	44256
485	UH Seidman Cancer Center at Lake Health Mentor Campus	Mentor	Ohio	United States	44060
486	UH Seidman Cancer Center at Southwest General Hospital	Middleburg Heights	Ohio	United States	44130
487	Knox Community Hospital	Mount Vernon	Ohio	United States	43050
488	Licking Memorial Hospital	Newark	Ohio	United States	43055
489	University Hospitals Parma Medical Center	Parma	Ohio	United States	44129
490	Southern Ohio Medical Center	Portsmouth	Ohio	United States	45662
491	University Hospitals Portage Medical Center	Ravenna	Ohio	United States	44266
492	North Coast Cancer Care	Sandusky	Ohio	United States	44870
493	UH Seidman Cancer Center at Firelands Regional Medical Center	Sandusky	Ohio	United States	44870
494	Cleveland Clinic Cancer Center Strongsville	Strongsville	Ohio	United States	44136
495	ProMedica Flower Hospital	Sylvania	Ohio	United States	43560
496	University Hospitals Sharon Health Center	Wadsworth	Ohio	United States	44281
497	South Pointe Hospital	Warrensville Heights	Ohio	United States	44122
498	University of Cincinnati Cancer Center-West Chester	West Chester	Ohio	United States	45069
499	Saint Ann's Hospital	Westerville	Ohio	United States	43081
500	UH Seidman Cancer Center at Saint John Medical Center	Westlake	Ohio	United States	44145
501	UHHS-Westlake Medical Center	Westlake	Ohio	United States	44145
502	Cleveland Clinic Wooster Family Health and Surgery Center	Wooster	Ohio	United States	44691
503	Genesis Healthcare System Cancer Care Center	Zanesville	Ohio	United States	43701
504	Cancer Centers of Southwest Oklahoma Research	Lawton	Oklahoma	United States	73505
505	University of Oklahoma Health Sciences Center	Oklahoma City	Oklahoma	United States	73104
506	Integris Southwest Medical Center	Oklahoma City	Oklahoma	United States	73109
507	Mercy Hospital Oklahoma City	Oklahoma City	Oklahoma	United States	73120
508	Integris Cancer Institute of Oklahoma	Oklahoma City	Oklahoma	United States	73142
509	Cancer Treatment Centers of America	Tulsa	Oklahoma	United States	74133
510	Oklahoma Cancer Specialists and Research Institute-Tulsa	Tulsa	Oklahoma	United States	74146
511	Providence Cancer Institute Clackamas Clinic	Clackamas	Oregon	United States	97015
512	Providence Newberg Medical Center	Newberg	Oregon	United States	97132
513	Saint Alphonsus Medical Center-Ontario	Ontario	Oregon	United States	97914
514	Providence Portland Medical Center	Portland	Oregon	United States	97213
515	Providence Saint Vincent Medical Center	Portland	Oregon	United States	97225
516	Saint Luke's University Hospital-Bethlehem Campus	Bethlehem	Pennsylvania	United States	18015
517	Crozer-Keystone Regional Cancer Center at Broomall	Broomall	Pennsylvania	United States	19008
518	Bryn Mawr Hospital	Bryn Mawr	Pennsylvania	United States	19010
519	Main Line Health Center-Collegeville	Collegeville	Pennsylvania	United States	19426
520	Geisinger Medical Center	Danville	Pennsylvania	United States	17822
521	Delaware County Memorial Hospital	Drexel Hill	Pennsylvania	United States	19026
522	Saint Vincent Hospital	Erie	Pennsylvania	United States	16544
523	Main Line Health Center-Exton	Exton	Pennsylvania	United States	19341
524	Crozer Regional Cancer Center at Brinton Lake	Glen Mills	Pennsylvania	United States	19342
525	UPMC Cancer Centers - Arnold Palmer Pavilion	Greensburg	Pennsylvania	United States	15601
526	UPMC Pinnacle Cancer Center/Community Osteopathic Campus	Harrisburg	Pennsylvania	United States	17109
527	Geisinger Medical Center-Cancer Center Hazleton	Hazleton	Pennsylvania	United States	18201
528	Penn State Milton S Hershey Medical Center	Hershey	Pennsylvania	United States	17033-0850
529	Jefferson Hospital	Jefferson Hills	Pennsylvania	United States	15025
530	UPMC-Johnstown/John P. Murtha Regional Cancer Center	Johnstown	Pennsylvania	United States	15901
531	Lancaster General Ann B Barshinger Cancer Institute	Lancaster	Pennsylvania	United States	17601
532	Lancaster General Hospital	Lancaster	Pennsylvania	United States	17602
533	Geisinger Medical Oncology-Lewisburg	Lewisburg	Pennsylvania	United States	17837
534	Holy Redeemer Hospital and Medical Center	Meadowbrook	Pennsylvania	United States	19046
535	Riddle Memorial Hospital	Media	Pennsylvania	United States	19063
536	Forbes Hospital	Monroeville	Pennsylvania	United States	15146
537	Paoli Memorial Hospital	Paoli	Pennsylvania	United States	19301
538	Thomas Jefferson University Hospital	Philadelphia	Pennsylvania	United States	19107
539	Eastern Regional Medical Center	Philadelphia	Pennsylvania	United States	19124
540	Allegheny General Hospital	Pittsburgh	Pennsylvania	United States	15212
541	UPMC-Magee Womens Hospital	Pittsburgh	Pennsylvania	United States	15213
542	West Penn Hospital	Pittsburgh	Pennsylvania	United States	15224
543	University of Pittsburgh Cancer Institute (UPCI)	Pittsburgh	Pennsylvania	United States	15232
544	UPMC-Passavant Hospital	Pittsburgh	Pennsylvania	United States	15237
545	Geisinger Cancer Services-Pottsville	Pottsville	Pennsylvania	United States	17901
546	Guthrie Medical Group PC-Robert Packer Hospital	Sayre	Pennsylvania	United States	18840
547	Community Medical Center	Scranton	Pennsylvania	United States	18510
548	Crozer-Chester Medical Center	Upland	Pennsylvania	United States	19013
549	Reading Hospital	West Reading	Pennsylvania	United States	19611
550	Wexford Health and Wellness Pavilion	Wexford	Pennsylvania	United States	15090
551	Geisinger Wyoming Valley/Henry Cancer Center	Wilkes-Barre	Pennsylvania	United States	18711
552	UPMC Susquehanna	Williamsport	Pennsylvania	United States	17701
553	Asplundh Cancer Pavilion	Willow Grove	Pennsylvania	United States	19090
554	Lankenau Medical Center	Wynnewood	Pennsylvania	United States	19096
555	UPMC Memorial	York	Pennsylvania	United States	17408
556	Women and Infants Hospital	Providence	Rhode Island	United States	02905
557	Saint Joseph's/Candler - Bluffton Campus	Bluffton	South Carolina	United States	29910
558	Prisma Health Cancer Institute - Spartanburg	Boiling Springs	South Carolina	United States	29316
559	Medical University of South Carolina	Charleston	South Carolina	United States	29425
560	Prisma Health Cancer Institute - Easley	Easley	South Carolina	United States	29640
561	Saint Francis Hospital	Greenville	South Carolina	United States	29601
562	Prisma Health Cancer Institute - Butternut	Greenville	South Carolina	United States	29605
563	Prisma Health Cancer Institute - Faris	Greenville	South Carolina	United States	29605
564	Saint Francis Cancer Center	Greenville	South Carolina	United States	29607
565	Prisma Health Cancer Institute - Eastside	Greenville	South Carolina	United States	29615
566	Prisma Health Cancer Institute - Greer	Greer	South Carolina	United States	29650
567	Gibbs Cancer Center-Pelham	Greer	South Carolina	United States	29651
568	South Carolina Cancer Specialists PC	Hilton Head Island	South Carolina	United States	29926-3827
569	Levine Cancer Institute-Rock Hill	Rock Hill	South Carolina	United States	29732
570	Prisma Health Cancer Institute - Seneca	Seneca	South Carolina	United States	29672
571	Spartanburg Medical Center	Spartanburg	South Carolina	United States	29303
572	Lexington Medical Center	West Columbia	South Carolina	United States	29169
573	Avera Cancer Institute-Aberdeen	Aberdeen	South Dakota	United States	57401
574	Sanford Cancer Center Oncology Clinic	Sioux Falls	South Dakota	United States	57104
575	Avera Cancer Institute	Sioux Falls	South Dakota	United States	57105
576	Sanford USD Medical Center - Sioux Falls	Sioux Falls	South Dakota	United States	57117-5134
577	Baptist Memorial Hospital and Cancer Center-Collierville	Collierville	Tennessee	United States	38017
578	Cookeville Regional Medical Center	Cookeville	Tennessee	United States	38501
579	Ballad Health Cancer Care - Kingsport	Kingsport	Tennessee	United States	37660
580	Thompson Cancer Survival Center	Knoxville	Tennessee	United States	37916
581	Thompson Cancer Survival Center - West	Knoxville	Tennessee	United States	37932
582	Thompson Oncology Group-Lenoir City	Lenoir City	Tennessee	United States	37772
583	Thompson Oncology Group-Maryville	Maryville	Tennessee	United States	37804
584	Baptist Memorial Hospital and Cancer Center-Memphis	Memphis	Tennessee	United States	38120
585	Thompson Oncology Group-Oak Ridge	Oak Ridge	Tennessee	United States	37830
586	Houston Methodist Hospital	Houston	Texas	United States	77030
587	M D Anderson Cancer Center	Houston	Texas	United States	77030
588	Doctor's Hospital of Laredo	Laredo	Texas	United States	78041
589	University of Texas Health Science Center at San Antonio	San Antonio	Texas	United States	78229
590	Huntsman Cancer Institute/University of Utah	Salt Lake City	Utah	United States	84112
591	Wellmont Medical Associates-Bristol	Bristol	Virginia	United States	24201
592	Kaiser Permanente-Burke Medical Center	Burke	Virginia	United States	22015
593	Inova Schar Cancer Institute	Fairfax	Virginia	United States	22031
594	Kaiser Permanente Tysons Corner Medical Center	McLean	Virginia	United States	22102
595	Bon Secours Memorial Regional Medical Center	Mechanicsville	Virginia	United States	23116
596	Bon Secours Saint Francis Medical Center	Midlothian	Virginia	United States	23114
597	Southwest VA Regional Cancer Center	Norton	Virginia	United States	24273
598	Bon Secours Saint Mary's Hospital	Richmond	Virginia	United States	23226
599	Virginia Cancer Institute	Richmond	Virginia	United States	23229
600	VCU Massey Cancer Center at Stony Point	Richmond	Virginia	United States	23235
601	Virginia Commonwealth University/Massey Cancer Center	Richmond	Virginia	United States	23298
602	VCU Community Memorial Health Center	South Hill	Virginia	United States	23970
603	Shenandoah Oncology PC	Winchester	Virginia	United States	22601
604	MultiCare Auburn Medical Center	Auburn	Washington	United States	98001
605	Swedish Cancer Institute-Edmonds	Edmonds	Washington	United States	98026
606	Providence Regional Cancer Partnership	Everett	Washington	United States	98201
607	MultiCare Gig Harbor Medical Park	Gig Harbor	Washington	United States	98335
608	Swedish Cancer Institute-Issaquah	Issaquah	Washington	United States	98029
609	MultiCare Good Samaritan Hospital	Puyallup	Washington	United States	98372
610	Swedish Medical Center-First Hill	Seattle	Washington	United States	98122-4307
611	MultiCare Deaconess Cancer and Blood Specialty Center - Valley	Spokane Valley	Washington	United States	99216
612	MultiCare Deaconess Cancer and Blood Specialty Center - Downtown	Spokane	Washington	United States	99204
613	MultiCare Deaconess Cancer and Blood Specialty Center - North	Spokane	Washington	United States	99218
614	MultiCare Tacoma General Hospital	Tacoma	Washington	United States	98405
615	United Hospital Center	Bridgeport	West Virginia	United States	26330
616	West Virginia University Charleston Division	Charleston	West Virginia	United States	25304
617	West Virginia University Healthcare	Morgantown	West Virginia	United States	26506
618	Camden Clark Medical Center	Parkersburg	West Virginia	United States	26101
619	Langlade Hospital and Cancer Center	Antigo	Wisconsin	United States	54409
620	ThedaCare Regional Cancer Center	Appleton	Wisconsin	United States	54911
621	Duluth Clinic Ashland	Ashland	Wisconsin	United States	54806
622	Aurora Cancer Care-Southern Lakes VLCC	Burlington	Wisconsin	United States	53105
623	Marshfield Medical Center-EC Cancer Center	Eau Claire	Wisconsin	United States	54701
624	Mayo Clinic Health System-Eau Claire Clinic	Eau Claire	Wisconsin	United States	54701
625	Aurora Health Care Germantown Health Center	Germantown	Wisconsin	United States	53022
626	Aurora Cancer Care-Grafton	Grafton	Wisconsin	United States	53024
627	Saint Vincent Hospital Cancer Center Green Bay	Green Bay	Wisconsin	United States	54301
628	Saint Vincent Hospital Cancer Center at Saint Mary's	Green Bay	Wisconsin	United States	54303
629	Aurora BayCare Medical Center	Green Bay	Wisconsin	United States	54311
630	Mercyhealth Hospital and Cancer Center - Janesville	Janesville	Wisconsin	United States	53548
631	UW Cancer Center Johnson Creek	Johnson Creek	Wisconsin	United States	53038
632	Aurora Cancer Care-Kenosha South	Kenosha	Wisconsin	United States	53142
633	Mayo Clinic Health System-Franciscan Healthcare	La Crosse	Wisconsin	United States	54601
634	Dean Hematology and Oncology Clinic	Madison	Wisconsin	United States	53717
635	University of Wisconsin Carbone Cancer Center	Madison	Wisconsin	United States	53792
636	Aurora Bay Area Medical Group-Marinette	Marinette	Wisconsin	United States	54143
637	Saint Vincent Hospital Cancer Center at Marinette	Marinette	Wisconsin	United States	54143
638	Marshfield Medical Center-Marshfield	Marshfield	Wisconsin	United States	54449
639	Aspirus Medford Hospital	Medford	Wisconsin	United States	54451
640	Aurora Cancer Care-Milwaukee	Milwaukee	Wisconsin	United States	53209
641	Aurora Saint Luke's Medical Center	Milwaukee	Wisconsin	United States	53215
642	Aurora Sinai Medical Center	Milwaukee	Wisconsin	United States	53233
643	Marshfield Clinic-Minocqua Center	Minocqua	Wisconsin	United States	54548
644	ProHealth D N Greenwald Center	Mukwonago	Wisconsin	United States	53149
645	ThedaCare Regional Medical Center - Neenah	Neenah	Wisconsin	United States	54956
646	ProHealth Oconomowoc Memorial Hospital	Oconomowoc	Wisconsin	United States	53066
647	Saint Vincent Hospital Cancer Center at Oconto Falls	Oconto Falls	Wisconsin	United States	54154
648	Vince Lombardi Cancer Clinic - Oshkosh	Oshkosh	Wisconsin	United States	54904
649	Aurora Cancer Care-Racine	Racine	Wisconsin	United States	53406
650	Marshfield Medical Center-Rice Lake	Rice Lake	Wisconsin	United States	54868
651	Vince Lombardi Cancer Clinic-Sheboygan	Sheboygan	Wisconsin	United States	53081
652	Marshfield Medical Center-River Region at Stevens Point	Stevens Point	Wisconsin	United States	54482
653	Saint Vincent Hospital Cancer Center at Sturgeon Bay	Sturgeon Bay	Wisconsin	United States	54235-1495
654	Aurora Medical Center in Summit	Summit	Wisconsin	United States	53066
655	Vince Lombardi Cancer Clinic-Two Rivers	Two Rivers	Wisconsin	United States	54241
656	ProHealth Waukesha Memorial Hospital	Waukesha	Wisconsin	United States	53188
657	UW Cancer Center at ProHealth Care	Waukesha	Wisconsin	United States	53188
658	Aspirus Regional Cancer Center	Wausau	Wisconsin	United States	54401
659	Aurora Cancer Care-Milwaukee West	Wauwatosa	Wisconsin	United States	53226
660	Aurora West Allis Medical Center	West Allis	Wisconsin	United States	53227
661	Marshfield Medical Center - Weston	Weston	Wisconsin	United States	54476
662	Aspirus Cancer Care - Wisconsin Rapids	Wisconsin Rapids	Wisconsin	United States	54494
663	Cross Cancer Institute	Edmonton	Alberta	Canada	T6G 1Z2
664	BCCA-Vancouver Cancer Centre	Vancouver	British Columbia	Canada	V5Z 4E6
665	BCCA-Vancouver Island Cancer Centre	Victoria	British Columbia	Canada	V8R 6V5
666	The Moncton Hospital	Moncton	New Brunswick	Canada	E1C 6Z8
667	Doctor H. Bliss Murphy Cancer Centre	St. John's	Newfoundland and Labrador	Canada	A1B 3V6
668	William Osler Health System-Brampton Civic Hospital	Brampton	Ontario	Canada	L6R 3J7
669	London Regional Cancer Program	London	Ontario	Canada	N6A 4L6
670	Algoma District Cancer Program Sault Area Hospital	Sault Ste Marie	Ontario	Canada	P6B 0A8
671	University Health Network-Princess Margaret Hospital	Toronto	Ontario	Canada	M5G 2M9
672	CSSS Champlain-Charles Le Moyne	Greenfield Park	Quebec	Canada	J4V 2H1
673	Allan Blair Cancer Centre	Regina	Saskatchewan	Canada	S4T 7T1

Sponsors and Collaborators

• National Cancer Institute (NCI)
• NRG Oncology

Investigators

• Principal Investigator: Charles E Geyer, NRG Oncology

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: National Cancer Institute (NCI)
• ClinicalTrials.gov Identifier: NCT03199885
• Other Study ID Numbers: NCI-2017-01119; NCI-2017-01119; NRG-BR004; NRG-BR004; U10CA180868
• First Posted: Jun 27, 2017
• Last Update Posted: Aug 25, 2022
• Last Verified: May 1, 2022

• Individual Participant Data (IPD) Sharing Statement: Yes
• Plan to Share IPD: Yes
• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Additional relevant MeSH terms: Carcinoma; Breast Neoplasms; Adenocarcinoma; Recurrence; Paclitaxel; Docetaxel; Trastuzumab; Albumin-Bound Paclitaxel; Atezolizumab; Pertuzumab; Trastuzumab biosimilar HLX02; Antineoplastic Agents, Immunological; Antibodies; Immunoglobulins; Antibodies, Monoclonal

Study Results

No Results Posted as of Aug 25, 2022