Testing Olaparib Either Alone or in Combination With Atezolizumab in BRCA Mutant Non-HER2-positive Breast Cancer
Study Details
Study Description
Brief Summary
This randomized phase II trial studies how well olaparib with or without atezolizumab work in treating patients with non-HER2-positive breast cancer that has spread from its original site of growth to nearby tissues or lymph nodes and is not amenable to surgical resection (locally advanced unresectable) or has spread to other places in the body (metastatic). Olaparib is an inhibitor of PARP, an enzyme that helps repair deoxyribonucleic acid (DNA) when it becomes damaged. Blocking PARP may help keep cancer cells from repairing their damaged DNA, causing them to die. PARP inhibitors are a type of targeted therapy. Immunotherapy with monoclonal antibodies, such as atezolizumab, may help the body's immune system attack the tumor, and may interfere with the ability of tumor cells to grow and spread. It is not known whether giving olaparib with or without atezolizumab will work better in patients with non-HER2-positive breast cancer.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Detailed Description
PRIMARY OBJECTIVE:
- To compare the progression free survival (PFS) between two study arms, i.e., olaparib monotherapy (arm 1) and olaparib + atezolizumab in combination (arm 2) based on normal Response Evaluation Criteria in Solid Tumors (RECIST) criteria in patients with locally advanced or metastatic non-HER2-positive breast cancer harboring homologous deoxyribonucleic acid (DNA) repair (HDR) through BRCA 1/2 mutation.
SECONDARY OBJECTIVES:
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To compare the progression free survival (PFS) between the two study arms based on immune response criteria.
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To compare the time to treatment failure (TTF) between the two study arms based on immune response criteria and normal RECIST.
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To compare the overall response rate (ORR) between the two study arms based on immune response criteria and normal RECIST.
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To compare the duration of response (DoR) between the two study arms based on immune response criteria and normal RECIST.
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Determine the changes in extent of mutational burden in BRCA 1/2 mutated tumors at baseline and at progression.
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Evaluate and characterize changes in the extent of PD-L1 expression and tumor immune infiltrates.
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Retrospectively evaluate tumors with limited immune infiltrate (e.g. "non-inflamed") to determine if PARPi increased immune infiltration.
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Determine the immune-related best overall response (irBOR) of olaparib in combination with atezolizumab in locally advanced or metastatic non-HER2+ breast cancer harboring HDR through BRCA 1/2 mutation.
EXPLORATORY OBJECTIVES:
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Evaluate changes in candidate neoantigen profiles and immune/inflammation signatures using DNA and ribonucleic acid (RNA)-sequencing in serial tumor biopsies.
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Evaluate and characterize circulating tumor DNA (ctDNA) and immune parameters in blood.
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Test the hypothesis that DNA repair status affects the tumor-immune interaction.
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Characterize mechanism of action of the PARP inhibitor olaparib. V. To explore the inclusion of patient reported symptomatic adverse events. VI. To use anti-Kynurenine antibodies for immunohistochemistry (IHC) as well as unbiased metabolome studies on plasma to understand the metabolic consequences of PARP-inhibition and their effects on immune infiltrates.
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To explore pharmacodynamic transcriptional changes induced by treatment in different immune cell populations and with high resolution in single cell RNA sequencing of peripheral blood mononuclear cell (PBMC) preparations.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients receive olaparib orally (PO) twice daily (BID) on days 1-21 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients with disease progression may cross-over to Arm II.
ARM II: Patients receive olaparib as Arm I and atezolizumab intravenously (IV) over 30-60 minutes on day 1 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up monthly.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Arm I (olaparib) Patients receive olaparib PO BID on days 1-21 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients with disease progression may cross-over to Arm II. |
Drug: Olaparib
Given PO
Other Names:
Other: Questionnaire Administration
Ancillary studies
|
| Experimental: Arm II (olaparib, atezolizumab) Patients receive olaparib as Arm I and atezolizumab IV over 30-60 minutes on day 1 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. |
Drug: Atezolizumab
Given IV
Other Names:
Drug: Olaparib
Given PO
Other Names:
Other: Questionnaire Administration
Ancillary studies
|
Outcome Measures
Primary Outcome Measures
- Progression-free survival (PFS) [Time measured from randomization, assessed up to 3 years]
The study arms will be compared for duration of response survival with Kaplan-Meier estimates and log-rank tests. The Rothman confidence interval (CI), which is based on Greenwood's variance, Thomas and Grunkemeier CI, and the simultaneous confidence bands by Nair and Hall and Wellner, will be reported. In addition, the possible risk factors will be compared for survival with log-rank test. For multivariate analysis, the proportional hazards Cox model will be applied to investigate potential prognostic factors, such as age and stage of disease of the PFS data. The adjusted p-values of the hazard ratios and the adjusted 95% confidence interval will be reported.
Secondary Outcome Measures
- Overall response rate (ORR) [Up to 3 years]
Evaluated by immune response criteria and normal Response Evaluation Criteria in Solid Tumors criteria. The ORR will be estimated using the 95% CI based on Wilson's method. The Fisher's exact test will be applied to examine the difference between two arms. The Wilcoxon rank sum test and Fisher's exact test will be applied to study the association between the response status and the continuous and categorical variables, respectively. The generalized non-linear model and logistic regression will be applied for multivariable data analysis. The adjusted p-value and 95% CI of the odds ratios (OR) will be reported.
- Duration of response (DoR) [Time from documentation of tumor response to disease progression, assessed up to 3 years]
The study arms will be compared for duration of response survival with Kaplan-Meier estimates and log-rank tests. The Rothman CI, which is based on Greenwood's variance, Thomas and Grunkemeier CI, and the simultaneous confidence bands by Nair and Hall and Wellner, will be reported. In addition, the possible risk factors will be compared for survival with log-rank test. For multivariate analysis, the proportional hazards Cox model will be applied to investigate potential prognostic factors, such as age and stage of disease of the DoR data. The adjusted p-values of the hazard ratios and the adjusted 95% confidence interval will be reported.
Other Outcome Measures
- Change in level of tumor infiltrating lymphocytes (TILs) [Baseline up to 3 years]
Differences between groups will be statistically tested using t-test or Wilcoxon rank sum test for continuous variables (quantitative multiplexed TIL scores) and chi-square test or Fisher's exact test for categorical variables (positive/negative using hematoxylin & eosin). Linear and non-linear restricted cubic spline regression coefficients will also be calculated to determine the association between TIL subtypes in the quadriplegia index of function (QIF) evaluation using continuous scores.
- Changes of biomarkers expression using deoxyribonucleic acid (DNA) and ribonucleic acid (RNA)-sequencing [Baseline to up to 3 years]
Will be analyzed using Lasso-based elastic net method. The elastic net method is a variable selection procedure by L1 and L2 penalized estimation that enforces variable selection and shrinkage simultaneously. The penalty parameter that controls the shrinkage of fixed terms and the variable selection will be determined by k-fold cross validation. The statistical analyses will be completed by either R 3.2.1 or statistical analysis system (SAS) 9.4 statistical program in this project.
- Changes in extent of mutational burden in BRCA1/2 [Baseline to up to 3 years]
Will be analyzed using Lasso-based elastic net method. The elastic net method is a variable selection procedure by L1 and L2 penalized estimation that enforces variable selection and shrinkage simultaneously. The penalty parameter that controls the shrinkage of fixed terms and the variable selection will be determined by k-fold cross validation. The statistical analyses will be completed by either R 3.2.1 or SAS 9.4 statistical program in this project.
- Change in PD-L1 [Baseline to up to 3 years]
Will be analyzed using Lasso-based elastic net method. The elastic net method is a variable selection procedure by L1 and L2 penalized estimation that enforces variable selection and shrinkage simultaneously. The penalty parameter that controls the shrinkage of fixed terms and the variable selection will be determined by k-fold cross validation. The statistical analyses will be completed by either R 3.2.1 or SAS 9.4 statistical program in this project.
- Change in PARPi [Baseline to up to 3 years]
Will be analyzed using Lasso-based elastic net method. The elastic net method is a variable selection procedure by L1 and L2 penalized estimation that enforces variable selection and shrinkage simultaneously. The penalty parameter that controls the shrinkage of fixed terms and the variable selection will be determined by k-fold cross validation. The statistical analyses will be completed by either R 3.2.1 or SAS 9.4 statistical program in this project.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients must have histologically documented unresectable locally advanced or metastatic non-HER2-positive breast cancer and a known BRCA 1/2 mutation present; both germline and somatic mutations are acceptable, however somatic mutations must be identified by either tumor sequencing of tumor tissue or ctDNA in plasma; patients with BRCA mutations of unknown significance are not allowed
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Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >= 20 mm (>= 2 cm) by chest x-ray or as >= 10 mm (>= 1 cm) with computed tomography (CT) scan, magnetic resonance imaging (MRI), or calipers by clinical exam
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Prior chemotherapy is allowed, including platinum therapy; patients must not have received chemotherapy for 4 weeks prior to the initiation of study treatment and must have recovery =< grade 1 from any adverse events from any prior chemotherapy (other than alopecia); patients must not have had nitrosoureas or mitomycin C for 6 weeks prior to the initiation of study treatment
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Prior radiation therapy is allowed; patients must not have received minimal radiation therapy (=< 5% of their total marrow volume) within 3 weeks prior to the initiation of study treatment; otherwise, patients must not have received radiation therapy (> 5% of their total marrow volume) within 4 weeks prior to the initiation of study treatment; patients who have received prior radiation to 50% or more of their total marrow volume will be excluded
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Patients who have received prior treatment with anti-CTLA-4 may be enrolled, provided the following requirements are met: minimum of 12 weeks from the first dose of anti-CTLA-4 and > 6 weeks from the last dose, and no history of severe immune-related adverse effects from anti-CTLA-4 (National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events [CTCAE] grade 3 and 4)
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Treatment with systemic immunosuppressive medications (including, but not limited to, prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF] agents) is allowed, provided the following is met: minimum of 2 weeks prior to cycle 1, day 1; patients who have received acute, low dose, systemic immunosuppressant medications (e.g., a one-time dose of dexamethasone for nausea) may be enrolled; the use of corticosteroids and mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension or adrenocortical insufficiency is allowed
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Prior treatment with systemic immunostimulatory agents (including, but not limited to, interferon [IFN]-alpha or interleukin [IL]-2) is allowed, provided the following is met: minimum of 4 weeks or 5 half-lives of the drug (whichever is longer) prior to cycle 1, day 1
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Patients taking bisphosphonate therapy for symptomatic hypercalcemia are NOT allowed; use of bisphosphonate therapy for other reasons (e.g., bone metastasis or osteoporosis) is allowed
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Prior hormone therapy is allowed; patients must not have received hormone therapy for breast cancer for 2 weeks prior to the initiation of study treatment and must have recovery =< grade 1 from any adverse events related to these therapies (other than alopecia)
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Prior experimental (non-Food and Drug Administration [FDA] approved) therapies and immunotherapies are allowed; patients must not have received these therapies for 4 weeks prior to the initiation of study treatment and must have recovery =< grade 1 from any adverse events of these therapies (other than alopecia); prior treatment with any PARP inhibitor or any anti-PD-1/anti-PD-L1 antibody is NOT allowed
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Other therapies (e.g. targeted therapy such as cyclin-dependent kinase [CDK] inhibitors): patients should have recovered to =< grade 1 drug related toxicity; they must have completed therapy for either a total of duration equivalent to 5 half-lives of the drug or 28 days, whichever is shorter
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Age >= 18 years. No dosing or adverse event data are currently available on the use of olaparib in combination with atezolizumab in patients < 18 years of age; hence, children are excluded from this study, but will be eligible for future pediatric trials
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Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
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Life expectancy of greater than 6 months
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Absolute neutrophil count >= 1,500/mcL
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Leukocytes >= 3,000/mcL
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Platelets >= 100,000/mcL
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Hemoglobin >= 8 g/dL
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Total bilirubin =< 1.5 x upper limit of normal (ULN) (however, patients with known Gilbert disease who have serum bilirubin level =< 3 x ULN may be enrolled)
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Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2.5 x upper limit of normal (ULN) if no liver metastasis; =< 5 x upper ULN if liver metastasis present
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Alkaline phosphatase =< 2.5 x ULN (=< 5 x ULN for patients with documented liver involvement or bone metastases)
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Creatinine clearance >= 51 mL/min/1.73 m^2 by Cockcroft-Gault
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International normalized ratio (INR) and activated partial thromboplastin time (aPTT) =< 1.5 x ULN (this applies only to patients who do not receive therapeutic anticoagulation; patients receiving therapeutic anticoagulation, such as low-molecular-weight heparin or warfarin, should be on a stable dose)
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No features suggestive of myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) on peripheral blood smear when performed as clinically indicated
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Patients must have tumors determined to be easily accessible for biopsy and must be willing to have serial biopsies (with a third biopsy upon evidence of disease progression)
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Administration of atezolizumab and/or olaparib 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 highly effective contraception prior to study entry, for the duration of study participation, and for at least 5 months (150 days) after the last dose of study agent; 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; men treated or enrolled on this protocol must also agree to use two highly effective forms of contraception in combination prior to the study, for the duration of study participation, and for at least 5 months (150 days) after completion of atezolizumab and/or olaparib administration; women of child-bearing potential: negative serum pregnancy test within 14 days of study treatment and confirmed prior to treatment on day 1; postmenopausal or evidence of non-childbearing status for women of childbearing potential; postmenopausal is defined as:
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Amenorrheic for 1 year or more following cessation of exogenous hormonal treatments
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Luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels in the post-menopausal range for women under 50
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Radiation-induced oophorectomy with last menses > 1 year ago
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Chemotherapy-induced menopause with > 1 year interval since last menses
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Surgical sterilization (bilateral oophorectomy or hysterectomy)
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Ability to understand and the willingness to sign a written informed consent document
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Subject is able to swallow and retain oral medication and does not have uncontrolled emesis or gastrointestinal disorders likely to interfere with absorption of the study medication
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Patients crossing over from monotherapy to combination therapy do not have to be fully rescreened; however, they do need to meet performance status, organ function, and blood parameters and not meet any of the exclusion criteria
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Patients positive for human immunodeficiency virus (HIV) are NOT excluded from this study, but HIV-positive patients must have:
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A stable regimen of highly active anti-retroviral therapy (HAART)
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No requirement for concurrent antibiotics or antifungal agents for the prevention of opportunistic infections
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A CD4 count above 250 cells/mcL and an undetectable HIV viral load on standard polymerase chain reaction (PCR)-based test
Exclusion Criteria:
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Patients with prior allogeneic bone marrow transplantation, double umbilical cord blood transplantation (dUCBT) or prior solid organ transplantation
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Patients with known brain metastases should be excluded from this clinical trial except as those described below, because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events
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Patients with known primary central nervous system (CNS) malignancy or symptomatic CNS metastases are excluded, with the following exceptions:
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Patients with asymptomatic untreated CNS disease may be enrolled, provided all of the following criteria are met:
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Evaluable or measurable disease outside the CNS
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No metastases to brain stem, midbrain, pons, medulla, cerebellum, or within 10 mm of the optic apparatus (optic nerves and chiasm)
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No history of intracranial hemorrhage unless it is confined within a lesion previously noted and secondary to gamma knife or another equivalent radiologic therapeutic
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No history of spinal cord hemorrhage
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No ongoing requirement for dexamethasone for CNS disease; patients on a stable dose of anticonvulsants are permitted
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No neurosurgical resection or brain biopsy within 28 days prior to cycle 1, day 1
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Patients with asymptomatic treated CNS metastases may be enrolled, provided all the criteria listed above are met as well as the following:
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Radiographic demonstration of improvement upon the completion of CNS directed therapy and no evidence of interim progression between the completion of CNS directed therapy and the screening radiographic study
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No stereotactic radiation or whole-brain radiation within 28 days prior to cycle 1, day 1
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Screening CNS radiographic study >= 4 weeks from completion of radiotherapy and >= 2 weeks from discontinuation of corticosteroids
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Known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies
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History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
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History of allergic reactions attributed to compounds of similar chemical or biologic composition to olaparib and atezolizumab; patients with a known hypersensitivity to olaparib or any of the excipients of the product
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Prior treatment with any PARP inhibitor or any anti-PD-1/anti-PD-L1 antibody
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Known clinically significant liver disease, including active viral, alcoholic, or other hepatitis; cirrhosis; fatty liver; and inherited liver disease
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Patients with past or resolved hepatitis B infection (defined as having a negative hepatitis B surface antigen [HBsAg] test and a positive anti-HBc [antibody to hepatitis B core antigen] antibody test) are eligible
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Patients positive for hepatitis C virus (HCV) antibody are eligible only if PCR is negative for HCV RNA
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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, lichen sclerosis, or glomerulonephritis
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Patients with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone may be eligible
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Patients with controlled type 1 diabetes mellitus on a stable insulin regimen may be eligible
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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:
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Patients with psoriasis must have a baseline ophthalmologic exam to rule out ocular manifestations
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Rash must cover less than 10% of body surface area (BSA)
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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%)
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No acute exacerbations of underlying condition 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)
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History of idiopathic pulmonary fibrosis, pneumonitis (including drug induced), organizing pneumonia (i.e., bronchiolitis obliterans, cryptogenic organizing pneumonia, etc.), or evidence of active pneumonitis on screening chest computed tomography (CT) scan; history of radiation pneumonitis in the radiation field (fibrosis) is permitted if recovered
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Major surgical procedure within 28 days prior to cycle 1, day 1 and patients must have recovered from any effects of any major surgery; anticipation of need for a major surgical procedure during the course of the study
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Administration of a live, attenuated vaccine within 4 weeks before cycle 1, day 1 or anticipation that such a live, attenuated vaccine will be required during the study and up to 5 months after the last dose of atezolizumab
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Influenza vaccination should be given during influenza season only (approximately October to March); patients must not receive live, attenuated influenza vaccine within 4 weeks prior to cycle 1, day 1 or at any time during the study
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Patients considered a poor medical risk due to a serious, uncontrolled medical disorder, non-malignant systemic disease or active, uncontrolled infection; examples include, but are not limited to, uncontrolled ventricular arrhythmia, recent (within 3 months) myocardial infarction, unstable spinal cord compression, superior vena cava syndrome, symptomatic congestive heart failure, unstable angina pectoris, extensive interstitial bilateral lung disease on high resolution computed tomography (HRCT) scan or any psychiatric disorder that prohibits obtaining informed consent and would limit compliance with study requirements
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Pregnant women are excluded from this study because olaparib and atezolizumab are have the potential for teratogenic or abortifacient effects; because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with olaparib and atezolizumab, breastfeeding should be discontinued if the mother is treated with olaparib and atezolizumab
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Any prior grade >= 3 immune-related adverse event (irAE) while receiving any previous immunotherapy agent, or any unresolved irAE > grade 1
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Mayo Clinic Hospital in Arizona | Phoenix | Arizona | United States | 85054 |
| 2 | Mayo Clinic in Arizona | Scottsdale | Arizona | United States | 85259 |
| 3 | UC San Diego Moores Cancer Center | La Jolla | California | United States | 92093 |
| 4 | University of California Davis Comprehensive Cancer Center | Sacramento | California | United States | 95817 |
| 5 | UC San Diego Medical Center - Hillcrest | San Diego | California | United States | 92103 |
| 6 | UCSF Medical Center-Mount Zion | San Francisco | California | United States | 94115 |
| 7 | University of Colorado Hospital | Aurora | Colorado | United States | 80045 |
| 8 | Smilow Cancer Hospital-Derby Care Center | Derby | Connecticut | United States | 06418 |
| 9 | Smilow Cancer Hospital Care Center-Fairfield | Fairfield | Connecticut | United States | 06824 |
| 10 | Smilow Cancer Hospital Care Center - Guiford | Guilford | Connecticut | United States | 06437 |
| 11 | Smilow Cancer Hospital Care Center at Saint Francis | Hartford | Connecticut | United States | 06105 |
| 12 | Smilow Cancer Center/Yale-New Haven Hospital | New Haven | Connecticut | United States | 06510 |
| 13 | Yale University | New Haven | Connecticut | United States | 06520 |
| 14 | Smilow Cancer Hospital-Orange Care Center | Orange | Connecticut | United States | 06477 |
| 15 | Smilow Cancer Hospital-Torrington Care Center | Torrington | Connecticut | United States | 06790 |
| 16 | Smilow Cancer Hospital Care Center-Trumbull | Trumbull | Connecticut | United States | 06611 |
| 17 | Smilow Cancer Hospital-Waterbury Care Center | Waterbury | Connecticut | United States | 06708 |
| 18 | Mayo Clinic in Florida | Jacksonville | Florida | United States | 32224-9980 |
| 19 | Moffitt Cancer Center-International Plaza | Tampa | Florida | United States | 33607 |
| 20 | Moffitt Cancer Center | Tampa | Florida | United States | 33612 |
| 21 | University of Chicago Comprehensive Cancer Center | Chicago | Illinois | United States | 60637 |
| 22 | UC Comprehensive Cancer Center at Silver Cross | New Lenox | Illinois | United States | 60451 |
| 23 | University of Chicago Medicine-Orland Park | Orland Park | Illinois | United States | 60462 |
| 24 | University of Kansas Clinical Research Center | Fairway | Kansas | United States | 66205 |
| 25 | Johns Hopkins University/Sidney Kimmel Cancer Center | Baltimore | Maryland | United States | 21287 |
| 26 | Massachusetts General Hospital Cancer Center | Boston | Massachusetts | United States | 02114 |
| 27 | Brigham and Women's Hospital | Boston | Massachusetts | United States | 02115 |
| 28 | Beth Israel Deaconess Medical Center | Boston | Massachusetts | United States | 02215 |
| 29 | Dana-Farber Cancer Institute | Boston | Massachusetts | United States | 02215 |
| 30 | Wayne State University/Karmanos Cancer Institute | Detroit | Michigan | United States | 48201 |
| 31 | Weisberg Cancer Treatment Center | Farmington Hills | Michigan | United States | 48334 |
| 32 | Mayo Clinic in Rochester | Rochester | Minnesota | United States | 55905 |
| 33 | Siteman Cancer Center at West County Hospital | Creve Coeur | Missouri | United States | 63141 |
| 34 | Washington University School of Medicine | Saint Louis | Missouri | United States | 63110 |
| 35 | Siteman Cancer Center-South County | Saint Louis | Missouri | United States | 63129 |
| 36 | Siteman Cancer Center at Christian Hospital | Saint Louis | Missouri | United States | 63136 |
| 37 | Siteman Cancer Center at Saint Peters Hospital | Saint Peters | Missouri | United States | 63376 |
| 38 | Nebraska Medicine-Bellevue | Bellevue | Nebraska | United States | 68123 |
| 39 | Nebraska Medicine-Village Pointe | Omaha | Nebraska | United States | 68118 |
| 40 | University of Nebraska Medical Center | Omaha | Nebraska | United States | 68198 |
| 41 | Rutgers Cancer Institute of New Jersey | New Brunswick | New Jersey | United States | 08903 |
| 42 | Montefiore Medical Center-Einstein Campus | Bronx | New York | United States | 10461 |
| 43 | Montefiore Medical Center-Weiler Hospital | Bronx | New York | United States | 10461 |
| 44 | Montefiore Medical Center - Moses Campus | Bronx | New York | United States | 10467 |
| 45 | NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center | New York | New York | United States | 10032 |
| 46 | UNC Lineberger Comprehensive Cancer Center | Chapel Hill | North Carolina | United States | 27599 |
| 47 | Duke University Medical Center | Durham | North Carolina | United States | 27710 |
| 48 | Case Western Reserve University | Cleveland | Ohio | United States | 44106 |
| 49 | Ohio State University Comprehensive Cancer Center | Columbus | Ohio | United States | 43210 |
| 50 | University of Pittsburgh Cancer Institute (UPCI) | Pittsburgh | Pennsylvania | United States | 15232 |
| 51 | Vanderbilt Breast Center at One Hundred Oaks | Nashville | Tennessee | United States | 37204 |
| 52 | Vanderbilt University/Ingram Cancer Center | Nashville | Tennessee | United States | 37232 |
| 53 | UT Southwestern/Simmons Cancer Center-Dallas | Dallas | Texas | United States | 75390 |
| 54 | Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center | Houston | Texas | United States | 77030 |
| 55 | Farmington Health Center | Farmington | Utah | United States | 84025 |
| 56 | University of Utah Sugarhouse Health Center | Salt Lake City | Utah | United States | 84106 |
| 57 | Huntsman Cancer Institute/University of Utah | Salt Lake City | Utah | United States | 84112 |
| 58 | South Jordan Health Center | South Jordan | Utah | United States | 84009 |
Sponsors and Collaborators
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Patricia M LoRusso, Yale University Cancer Center LAO
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- NCI-2016-01130
- NCI-2016-01130
- 1608018258
- 10020
- 10020
- UM1CA186644
- UM1CA186686
- UM1CA186688
- UM1CA186689
- UM1CA186691
- UM1CA186709