Evaluating the Addition of the Immunotherapy Drug Atezolizumab to Standard Chemotherapy Treatment for Metastatic Small Cell Neuroendocrine Carcinomas That Originate Outside the Lung
Study Details
Study Description
Brief Summary
This phase II/III trial compares the effect of immunotherapy with atezolizumab in combination with standard chemotherapy with a platinum drug (cisplatin or carboplatin) and etoposide versus standard therapy alone for the treatment of poorly differentiated extrapulmonary (originated outside the lung) small cell neuroendocrine cancer. The other aim of this trial is to compare using atezolizumab just at the beginning of treatment versus continuing it beyond the initial treatment. Immunotherapy with monoclonal antibodies, such as atezolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Cisplatin and carboplatin are in a class of medications known as platinum-containing compounds that work by killing, stopping or slowing the growth of cancer cells. Etoposide is in a class of medications known as podophyllotoxin derivatives. It blocks a certain enzyme needed for cell division and DNA repair, and it may kill cancer cells. Giving atezolizumab in combination with a platinum drug (cisplatin or carboplatin) and etoposide may work better in treating patients with poorly differentiated extrapulmonary small cell neuroendocrine cancer compared to standard therapy with a platinum drug (cisplatin or carboplatin) and etoposide alone.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2/Phase 3 |
Detailed Description
PRIMARY OBJECTIVES:
-
Compare the combination of induction platinum/etoposide and atezolizumab followed by maintenance atezolizumab (Arm 1) versus induction platinum/etoposide alone (Arm 3).
-
Compare the combination of induction platinum/etoposide and atezolizumab followed by observation (Arm 2) versus induction platinum/etoposide alone (Arm 3).
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Compare the combination of induction platinum/etoposide and atezolizumab followed by maintenance atezolizumab (Arm 1) versus the combination of induction platinum/etoposide and atezolizumab followed by observation (Arm 2).
SECONDARY OBJECTIVES:
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To compare overall survival (OS), measured from start of observation/maintenance, across arms.
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To compare progression free survival (PFS) (measured from randomization and measured from start of observation/maintenance) across arms.
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To compare objective response rate (ORR = confirmed and unconfirmed partial response [PR] + confirmed and unconfirmed complete response [CR]) across arms among patients with measurable disease at randomization.
-
To compare clinical benefit rate (CBR = confirmed and unconfirmed PR + confirmed and unconfirmed CR + stable disease [SD]) across arms among patients with measurable disease at randomization.
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To compare duration of response (DOR) across arms. VI. To evaluate the safety and tolerability of each arm.
ADDITIONAL OBJECTIVE:
- To bank tumor and blood samples for future biomarker correlative studies.
OUTLINE: Patients are randomized to 1 of 3 arms.
ARM I: During induction phase, patients receive atezolizumab intravenously (IV) over 60 minutes on day 1 of each cycle, carboplatin IV over 60 minutes or cisplatin IV over 60 minutes on day 1 of each cycle, and etoposide IV on days 1-3 of each cycle. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. During maintenance phase, patients receive atezolizumab IV over 60 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 17 cycles in the absence of disease progression or unacceptable toxicity.
ARM II: During induction phase, patients receive atezolizumab IV over 60 minutes on day 1 of each cycle, carboplatin IV over 60 minutes or cisplatin IV over 60 minutes on day 1 of each cycle, and etoposide IV on days 1-3 of each cycle. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo observation for 1 year.
ARM III: During induction phase, patients receive carboplatin IV over 60 minutes or cisplatin IV over 60 minutes on day 1 of each cycle and etoposide IV on days 1-3 of each cycle. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo observation for 1 year.
After completion of study treatment, patients are followed up for 5 years.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Arm I (atezolizumab, platinum, etoposide) During induction phase, patients receive atezolizumab IV over 60 minutes on day 1 of each cycle, carboplatin IV over 60 minutes or cisplatin IV over 60 minutes on day 1 of each cycle, and etoposide IV on days 1-3 of each cycle. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. During maintenance phase, patients receive atezolizumab IV over 60 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 17 cycles in the absence of disease progression or unacceptable toxicity. |
Biological: Atezolizumab
Given IV
Other Names:
Drug: Carboplatin
Given IV
Other Names:
Drug: Cisplatin
Given IV
Other Names:
Drug: Etoposide
Given IV
Other Names:
|
| Experimental: Arm II (atezolizumab, platinum drug, etoposide, observation) During induction phase, patients receive atezolizumab IV over 60 minutes on day 1 of each cycle, carboplatin IV over 60 minutes or cisplatin IV over 60 minutes on day 1 of each cycle, and etoposide IV on days 1-3 of each cycle. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo observation for 1 year |
Biological: Atezolizumab
Given IV
Other Names:
Drug: Carboplatin
Given IV
Other Names:
Drug: Cisplatin
Given IV
Other Names:
Drug: Etoposide
Given IV
Other Names:
Other: Patient Observation
Undergo observation
Other Names:
|
| Active Comparator: Arm III (platinum drug, etoposide, observation) During induction phase, patients receive carboplatin IV over 60 minutes or cisplatin IV over 60 minutes on day 1 of each cycle and etoposide IV on days 1-3 of each cycle. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo observation for 1 year. |
Drug: Carboplatin
Given IV
Other Names:
Drug: Cisplatin
Given IV
Other Names:
Drug: Etoposide
Given IV
Other Names:
Other: Patient Observation
Undergo observation
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Overall survival [From date of registration or from date of start of observation/maintenance therapy to date of death due to any cause, assessed up to 5 years]
Log-rank tests stratified by the randomization stratification factors will be used for null hypothesis (efficacy) tests. Cox regression models stratified by the randomization stratification factors will be used for alternative hypothesis (futility) tests.
Secondary Outcome Measures
- Progression-free survival [From date of registration or start of observation/maintenance therapy to date of first documentation of progression or symptomatic deterioration, or death due to any cause, assessed up to 5 years]
Will be estimated using the Kaplan-Meier method and compared using log-rank tests.
- Duration of response [Time from date of initial response to date of progression or death, assessed up to 5 years]
Will be estimated non-parametrically using cumulative incidence curves.
- Objective response rate (confirmed complete response [CR] and partial response [PR]) [Up to 5 years from study enrollment]
Will be tabulated and compared between arms using Fisher's exact test.
- Clinical benefit rate (confirmed CR or PR of any amount of time or stable disease for 6 months or longer) [Up to 5 years from study enrollment]
Will be tabulated and compared between arms using Fisher's exact test.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Participants must have histologically-confirmed (local site pathological confirmation sufficient) extrapulmonary poorly differentiated, small cell neuroendocrine carcinoma (NEC)
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Participants must have radiologically evaluable disease, measurable or non-measurable, per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. All measurable and non-measurable lesions must be assessed by computed tomography (CT) scan within 28 days prior to registration. For patients who received one cycle of platinum + etoposide prior to registration, at least 21 days must have elapsed between day 1 of platinum + etoposide and the pre-registration CT scan. All known sites of disease must be assessed and documented on the Baseline Tumor Assessment Form
-
Participants must have brain magnetic resonance imaging (MRI) (or CT head with contrast if there is contraindication to MRI brain) within 28 days prior to registration. Participants with asymptomatic central nervous system (CNS) metastases are eligible if one or more of the following apply:
-
Participants who have received treatment for brain metastases must have:
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No evidence of radiological progression (by MRI brain or CT head with contrast if there is contraindication to MRI brain) within 28 days prior to registration
-
Discontinued all corticosteroids at least 14 days prior to registration
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Participants with treatment-naive brain lesions must have:
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No lesion measuring > 2.0 cm in size in any axis
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MRI brain or CT head with contrast (if there is contraindication to MRI brain) demonstrating no evidence for mass effect, edema, or other impending neurological compromise within 28 days prior to registration
-
No evidence of radiological progression (by MRI brain or CT head with contrast if there is contraindication to MRI brain) within 28 days prior to registration
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No need for > 2 mg of dexamethasone (or equivalent of >1 0 mg prednisone) per day at time of registration
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Participants with prior history of non-metastatic (localized/locally advanced disease) extrapulmonary poorly differentiated small cell NEC may have had prior platinum-based therapy +/- radiation +/- surgery provided that all therapy was completed >= 6 months prior to registration
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Participants must discontinue denosumab prior to study registration and plan to replace with a bisphosphonate while on the study
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Participants must be >= 18 years of age
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Participants must have a Zubrod performance status of =< 2 within 28 days prior to registration
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Participants must have a complete medical history and physical exam within 28 days prior to registration
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Absolute neutrophil count (ANC) >= 1.5 x 10^9 /L (obtained within 14 days prior to registration. For participants who received a cycle of chemotherapy prior to registration, at least 21 days must have elapsed between day 1 of platinum + etoposide and performance of these tests)
-
Hemoglobin >= 9.0 g/dl (obtained within 14 days prior to registration. For participants who received a cycle of chemotherapy prior to registration, at least 21 days must have elapsed between day 1 of platinum + etoposide and performance of these tests)
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Platelet count >= 100 x 10^9/L (obtained within 14 days prior to registration. For participants who received a cycle of chemotherapy prior to registration, at least 21 days must have elapsed between day 1 of platinum + etoposide and performance of these tests)
-
Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x institutional upper limit of normal (ULN) (obtained within 14 days prior to registration. For participants who received a cycle of chemotherapy prior to registration, at least 21 days must have elapsed between day 1 of platinum + etoposide and performance of these tests)
-
Serum total bilirubin =< 1.5 x ULN (obtained within 14 days prior to registration. For participants who received a cycle of chemotherapy prior to registration, at least 21 days must have elapsed between day 1 of platinum + etoposide and performance of these tests)
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Measured creatinine clearance (CL) > 50 mL/min or calculated creatinine CL > 50 mL/min by the Cockcroft-Gault formula or by 24-hour urine collection for determination of creatinine clearance (obtained within 14 days prior to registration. For participants who received a cycle of chemotherapy prior to registration, at least 21 days must have elapsed between day 1 of platinum + etoposide and performance of these tests)
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Participants with evidence of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load, with testing performed as clinically indicated
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Participants with a history of hepatitis C virus (HCV) infection must have been treated and cured. Participants with active HCV infection who are currently on treatment must have an undetectable HCV viral load, with testing performed as clinically indicated
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Participants with known HIV-infection must be on effective anti-retroviral therapy at time of registration and have undetectable HIV viral load within 6 months of registration
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Participants must be offered the opportunity to participate in specimen banking. With participant consent, specimens must be collected and submitted via the Southwest Oncology Group (SWOG) Specimen Tracking System
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Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines
Exclusion Criteria:
-
Participants must not have symptomatic central nervous system (CNS) metastases
-
Participants must not have known or suspected leptomeningeal disease
-
Participants must not have small cell NEC mixed with urothelial carcinomas
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Participants must not have had prior treatment for metastatic disease EXCEPT one cycle of platinum (carboplatin/cisplatin) + etoposide is allowed prior to registration. Other chemotherapy regimens are not allowed
-
Participants must not have had prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, CD137 agonists, anti-CTLA-4 agent, or any other immune checkpoint inhibitors for any neuroendocrine neoplasm. Immune checkpoint inhibitors given for other cancer indications are allowed provided last therapy was given at least 12 months prior to study registration
-
Participants must not have received treatment with systemic immunostimulatory agents including, but not limited to, interferon and interleukin2 [IL-2] within 4 weeks or 5 half-lives of the drug (whichever is longer) prior to registration
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Participants must not have had history of known severe allergy, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies, including to Chinese hamster ovary cell products or to any component of the atezolizumab formulation, cisplatin, carboplatin, or etoposide
-
Participants must not be on active systemic therapy for another cancer with the exception of hormonal therapy including androgen deprivation therapy (e.g., gonadotropin-releasing hormone (GnRH) agonists or antagonists), which can be continued while participants are receiving protocol therapy. Use of enzalutamide or apalutamide is permitted after completion of chemotherapy; however, glucocorticoid-containing regimens, including abiraterone, are not permitted
-
Participants must not have uncontrolled or symptomatic hypercalcemia (> 1.5 mmol/L ionized calcium or calcium > 12 mg/dL or corrected serum calcium > ULN) within 14 days prior to registration. Participants who have asymptomatic hypercalcemia are eligible provided that medical therapy to treat the hypercalcemia is planned
-
Participants must not have a diagnosis of immunodeficiency nor be receiving systemic steroid therapy (equivalent of > 20 mg of hydrocortisone per day) or any other form of immunosuppressive therapy within 14 days prior to registration
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Participants must not have active or history of autoimmune disease or immune deficiency, including, but not limited to myasthesia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, antiphospholipid antibody syndrome, Wegener grandulomatosis, Sjogren syndrome, Guillian-Barre syndrome, or multiple sclerosis with the following exceptions:
-
Patients with a history of autoimmune-related hypothyroidism who are on thyroid-replacement hormone are eligible for the study
-
Patients with controlled type 1 diabetes mellitus who are on an insulin regimen are eligible for the study
-
Patients with eczema, psoriasis, lichen simplex chronicus, or vitiligo with dermatologic manifestations only (e.g., patients with psoriatic arthritis are excluded) are eligible for the study 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
-
Participants must not have 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. NOTE: History of radiation pneumonitis in the radiation field (fibrosis) is permitted
-
Participants must not have significant cardiovascular disease, such as New York Heart Association class II or greater cardiac disease, myocardial infarction within 3 months prior to registration, unstable arrythmias, or unstable angina
-
Participants must not have had a major surgical procedure other than for diagnosis within 28 days prior to registration. Participant must not plan to receive a major surgical procedure during the course of protocol treatment. NOTE: Patient port placement is not considered a major surgery
-
Participants must not have severe infections (i.e., Common Terminology Criteria for Adverse Events [CTCAE] grade >= 2) at time of registration, including but not limited to hospitalization for complications for infection, bacteremia, or severe pneumonia
-
Participants must not have active tuberculosis
-
Participants must not have prior allogeneic bone marrow transplantation or solid organ transplant
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Participants must not have received administration of a live, attenuated vaccine (e.g., FluMist) within 28 days prior to initiation of study treatment, during treatment with atezolizumab, and not plan to receive for 5 months after the last dose of atezolizumab
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Participants must not be pregnant due to the possibility of harm to the fetus. Individuals who are of reproductive potential must have agreed to use an effective contraceptive method (with details provided as a part of the consent process) during the treatment period and for 5 months after the final dose of atezolizumab. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Sutter Auburn Faith Hospital | Auburn | California | United States | 95602 |
| 2 | Sutter Cancer Centers Radiation Oncology Services-Auburn | Auburn | California | United States | 95603 |
| 3 | Alta Bates Summit Medical Center-Herrick Campus | Berkeley | California | United States | 94704 |
| 4 | Sutter Cancer Centers Radiation Oncology Services-Cameron Park | Cameron Park | California | United States | 95682 |
| 5 | Palo Alto Medical Foundation-Fremont | Fremont | California | United States | 94538 |
| 6 | Palo Alto Medical Foundation-Camino Division | Mountain View | California | United States | 94040 |
| 7 | Palo Alto Medical Foundation Health Care | Palo Alto | California | United States | 94301 |
| 8 | Sutter Cancer Centers Radiation Oncology Services-Roseville | Roseville | California | United States | 95661 |
| 9 | Sutter Roseville Medical Center | Roseville | California | United States | 95661 |
| 10 | Sutter Medical Center Sacramento | Sacramento | California | United States | 95816 |
| 11 | California Pacific Medical Center-Pacific Campus | San Francisco | California | United States | 94115 |
| 12 | Palo Alto Medical Foundation-Sunnyvale | Sunnyvale | California | United States | 94086 |
| 13 | Sutter Solano Medical Center/Cancer Center | Vallejo | California | United States | 94589 |
| 14 | Centralia Oncology Clinic | Centralia | Illinois | United States | 62801 |
| 15 | University of Chicago Comprehensive Cancer Center | Chicago | Illinois | United States | 60637 |
| 16 | Carle on Vermilion | Danville | Illinois | United States | 61832 |
| 17 | Cancer Care Specialists of Illinois - Decatur | Decatur | Illinois | United States | 62526 |
| 18 | Decatur Memorial Hospital | Decatur | Illinois | United States | 62526 |
| 19 | Carle Physician Group-Effingham | Effingham | Illinois | United States | 62401 |
| 20 | Crossroads Cancer Center | Effingham | Illinois | United States | 62401 |
| 21 | Ingalls Memorial Hospital | Harvey | Illinois | United States | 60426 |
| 22 | Carle Physician Group-Mattoon/Charleston | Mattoon | Illinois | United States | 61938 |
| 23 | UC Comprehensive Cancer Center at Silver Cross | New Lenox | Illinois | United States | 60451 |
| 24 | Cancer Care Center of O'Fallon | O'Fallon | Illinois | United States | 62269 |
| 25 | University of Chicago Medicine-Orland Park | Orland Park | Illinois | United States | 60462 |
| 26 | Southern Illinois University School of Medicine | Springfield | Illinois | United States | 62702 |
| 27 | Springfield Clinic | Springfield | Illinois | United States | 62702 |
| 28 | Memorial Medical Center | Springfield | Illinois | United States | 62781 |
| 29 | Carle Cancer Center | Urbana | Illinois | United States | 61801 |
| 30 | Mary Greeley Medical Center | Ames | Iowa | United States | 50010 |
| 31 | McFarland Clinic PC - Ames | Ames | Iowa | United States | 50010 |
| 32 | McFarland Clinic PC-Boone | Boone | Iowa | United States | 50036 |
| 33 | Medical Oncology and Hematology Associates-West Des Moines | Clive | Iowa | United States | 50325 |
| 34 | Mercy Cancer Center-West Lakes | Clive | Iowa | United States | 50325 |
| 35 | Greater Regional Medical Center | Creston | Iowa | United States | 50801 |
| 36 | Medical Oncology and Hematology Associates-Des Moines | Des Moines | Iowa | United States | 50309 |
| 37 | Medical Oncology and Hematology Associates-Laurel | Des Moines | Iowa | United States | 50314 |
| 38 | Mercy Medical Center - Des Moines | Des Moines | Iowa | United States | 50314 |
| 39 | McFarland Clinic PC-Trinity Cancer Center | Fort Dodge | Iowa | United States | 50501 |
| 40 | McFarland Clinic PC-Jefferson | Jefferson | Iowa | United States | 50129 |
| 41 | McFarland Clinic PC-Marshalltown | Marshalltown | Iowa | United States | 50158 |
| 42 | Mercy Medical Center-West Lakes | West Des Moines | Iowa | United States | 50266 |
| 43 | LSU Health Baton Rouge-North Clinic | Baton Rouge | Louisiana | United States | 70805 |
| 44 | Our Lady of the Lake Physicians Group - Medical Oncology | Baton Rouge | Louisiana | United States | 70809 |
| 45 | Saint Joseph Mercy Hospital | Ann Arbor | Michigan | United States | 48106 |
| 46 | University of Michigan Comprehensive Cancer Center | Ann Arbor | Michigan | United States | 48109 |
| 47 | Saint Joseph Mercy Brighton | Brighton | Michigan | United States | 48114 |
| 48 | Trinity Health IHA Medical Group Hematology Oncology - Brighton | Brighton | Michigan | United States | 48114 |
| 49 | Saint Joseph Mercy Canton | Canton | Michigan | United States | 48188 |
| 50 | Trinity Health IHA Medical Group Hematology Oncology - Canton | Canton | Michigan | United States | 48188 |
| 51 | Saint Joseph Mercy Chelsea | Chelsea | Michigan | United States | 48118 |
| 52 | Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital | Chelsea | Michigan | United States | 48118 |
| 53 | Genesee Cancer and Blood Disease Treatment Center | Flint | Michigan | United States | 48503 |
| 54 | Genesee Hematology Oncology PC | Flint | Michigan | United States | 48503 |
| 55 | Genesys Hurley Cancer Institute | Flint | Michigan | United States | 48503 |
| 56 | Hurley Medical Center | Flint | Michigan | United States | 48503 |
| 57 | Trinity Health Saint Mary Mercy Livonia Hospital | Livonia | Michigan | United States | 48154 |
| 58 | Huron Gastroenterology PC | Ypsilanti | Michigan | United States | 48106 |
| 59 | Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus | Ypsilanti | Michigan | United States | 48197 |
| 60 | Saint Luke's Hospital of Duluth | Duluth | Minnesota | United States | 55805 |
| 61 | Abbott-Northwestern Hospital | Minneapolis | Minnesota | United States | 55407 |
| 62 | Park Nicollet Clinic - Saint Louis Park | Saint Louis Park | Minnesota | United States | 55416 |
| 63 | Regions Hospital | Saint Paul | Minnesota | United States | 55101 |
| 64 | Saint Francis Medical Center | Cape Girardeau | Missouri | United States | 63703 |
| 65 | CoxHealth South Hospital | Springfield | Missouri | United States | 65807 |
| 66 | Dartmouth Hitchcock Medical Center | Lebanon | New Hampshire | United States | 03756 |
| 67 | Roswell Park Cancer Institute | Buffalo | New York | United States | 14263 |
| 68 | Southeastern Medical Oncology Center-Clinton | Clinton | North Carolina | United States | 28328 |
| 69 | Southeastern Medical Oncology Center-Goldsboro | Goldsboro | North Carolina | United States | 27534 |
| 70 | Southeastern Medical Oncology Center-Jacksonville | Jacksonville | North Carolina | United States | 28546 |
| 71 | FirstHealth of the Carolinas-Moore Regional Hospital | Pinehurst | North Carolina | United States | 28374 |
| 72 | Cancer Centers of Southwest Oklahoma Research | Lawton | Oklahoma | United States | 73505 |
| 73 | University of Oklahoma Health Sciences Center | Oklahoma City | Oklahoma | United States | 73104 |
| 74 | Providence Cancer Institute Clackamas Clinic | Clackamas | Oregon | United States | 97015 |
| 75 | Providence Newberg Medical Center | Newberg | Oregon | United States | 97132 |
| 76 | Providence Portland Medical Center | Portland | Oregon | United States | 97213 |
| 77 | Providence Saint Vincent Medical Center | Portland | Oregon | United States | 97225 |
| 78 | Vanderbilt University/Ingram Cancer Center | Nashville | Tennessee | United States | 37232 |
| 79 | Norris Cotton Cancer Center-North | Saint Johnsbury | Vermont | United States | 05819 |
| 80 | Gundersen Lutheran Medical Center | La Crosse | Wisconsin | United States | 54601 |
Sponsors and Collaborators
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: David B Zhen, Southwest Oncology Group
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- NCI-2021-09851
- NCI-2021-09851
- S2012
- S2012
- U10CA180888