Testing the Addition of the Pill Chemotherapy, Cabozantinib, to the Standard Immune Therapy Nivolumab Compared to Standard Chemotherapy for Non-small Cell Lung Cancer

• Sponsor: National Cancer Institute (NCI) (NIH)
• Overall Status: Recruiting
• CT.gov ID: NCT04310007
• Collaborator: (none)
• Enrollment: 142
• Locations: 593
• Arms: 3
• Anticipated Duration (Months): 35.3
• Patients Per Site: 0.2
• Patients Per Site Per Month: 0

Study Details

Study Description

Brief Summary

This phase II trial compares cabozantinib alone and the combination of cabozantinib and nivolumab to standard chemotherapy in the treatment of patients with non-squamous non-small cell lung cancer (NSCLC). Cabozantinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Ramucirumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs, such as docetaxel, gemcitabine hydrochloride, paclitaxel, and nab-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. Giving cabozantinib alone or in combination with nivolumab may be more effective than standard chemotherapy in treating patients with non-small cell lung cancer.

Condition or Disease	Intervention/Treatment	Phase
Metastatic Lung Non-Squamous Non-Small Cell Carcinoma; Recurrent Lung Non-Squamous Non-Small Cell Carcinoma; Stage III Lung Cancer AJCC v8; Stage IIIA Lung Cancer AJCC v8; Stage IIIB Lung Cancer AJCC v8; Stage IIIC Lung Cancer AJCC v8; Stage IVA Lung Cancer AJCC v8; Unresectable Lung Non-Squamous Non-Small Cell Carcinoma	Drug: Cabozantinib S-malate; Drug: Docetaxel; Drug: Gemcitabine Hydrochloride; Drug: Nab-paclitaxel; Biological: Nivolumab; Drug: Paclitaxel; Biological: Ramucirumab	Phase 2

Detailed Description

PRIMARY OBJECTIVE:

1. To determine whether cabozantinib alone, or the combination of nivolumab and cabozantinib, as compared to standard chemotherapy alone, extends progression-free survival (PFS) for this patient population with non squamous NSCLC.

SECONDARY OBJECTIVES:

1. To evaluate the progression free survival (PFS) and best overall radiographic response rate of the targeted therapy arm of the trial.

2. To determine the overall survival for each arm of the trial. III. To evaluate the best overall radiographic response rate for each arm of the trial.

3. To evaluate and describe the toxicity profile of monotherapy with cabozantinib, and the combination of nivolumab and cabozantinib in this patient population with non-squamous NSCLC.

EXPLORATORY IMAGING OBJECTIVES:

1. To describe time point tumor response assessment, overall best response, progression-free survival and overall survival using the conventional Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria and the exploratory revised CHOI criteria with all measurements performed by the central review.

2. To compare the progression-free survival using the RECIST1.1 imaging response assessment measurements by site study personnel to those performed by central review.

EXPLORATORY CORRELATIVE OBJECTIVE:

1. To perform correlative biomarker research on tissue and blood biospecimens collected within this trial.

OUTLINE: Patients without known molecular alterations are randomly assigned to 1 of 3 arms. Patients with known molecular alterations are assigned to Arm B.

ARM A: Patients receive cabozantinib S-malate orally (PO) once daily (QD). Cycles repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.

ARM B: Patients receive cabozantinib S-malate PO QD and nivolumab intravenously (IV) over 30 minutes on day 1. Cycles repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.

ARM C:

STEP 1: Patients receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on day 1 or on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1, 8, and 15. Cycles repeat every 3 weeks in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.

STEP 2: Patients receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day

1. Cycles repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.

After the completion of study treatment, patients are followed up every 3 months for up to 3 years.

Study Design

• Study Type: Interventional
• Anticipated Enrollment: 142 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Randomized Phase II Trial of Cabozantinib and Cabozantinib Plus Nivolumab Versus Standard Chemotherapy in Patients With Previously Treated Non-Squamous NSCLC
• Actual Study Start Date: May 22, 2020
• Anticipated Primary Completion Date: May 1, 2023
• Anticipated Study Completion Date: May 1, 2023

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Arm A (cabozantinib S-malate) Patients receive cabozantinib S-malate PO QD. Cycles repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.	Drug: Cabozantinib S-malate; Given PO; Other Names: BMS-907351 Cabometyx Cometriq XL-184 XL184
Experimental: Arm B (cabozantinib S-malate, nivolumab) Patients receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.	Drug: Cabozantinib S-malate; Given PO; Other Names: BMS-907351 Cabometyx Cometriq XL-184 XL184 ; Biological: Nivolumab; Given IV; Other Names: BMS-936558 CMAB819 MDX-1106 NIVO Nivolumab Biosimilar CMAB819 ONO-4538 Opdivo
Active Comparator: Arm C (standard chemotherapy,cabozantinib S-malate, nivolumab) See Detailed Description	Drug: Cabozantinib S-malate; Given PO; Other Names: BMS-907351 Cabometyx Cometriq XL-184 XL184 ; Drug: Docetaxel; Given IV; Other Names: Docecad RP56976 Taxotere Taxotere Injection Concentrate ; Drug: Gemcitabine Hydrochloride; Given PO; Other Names: dFdCyd Difluorodeoxycytidine Hydrochloride FF 10832 FF-10832 FF10832 Gemcitabine HCI Gemzar LY-188011 LY188011 ; Drug: Nab-paclitaxel; Given IV; Other Names: ABI 007 ABI-007 Abraxane Albumin-bound Paclitaxel Albumin-Stabilized Nanoparticle Paclitaxel Nanoparticle Albumin-bound Paclitaxel Nanoparticle Paclitaxel Paclitaxel Albumin paclitaxel albumin-stabilized nanoparticle formulation Protein-bound Paclitaxel ; Biological: Nivolumab; Given IV; Other Names: BMS-936558 CMAB819 MDX-1106 NIVO Nivolumab Biosimilar CMAB819 ONO-4538 Opdivo ; Drug: Paclitaxel; Given IV; Other Names: Anzatax Asotax Bristaxol Praxel Taxol Taxol Konzentrat ; Biological: Ramucirumab; Given IV; Other Names: Anti-VEGFR-2 Fully Human Monoclonal Antibody IMC-1121B Cyramza IMC-1121B LY3009806 Monoclonal Antibody HGS-ETR2

Outcome Measures

Primary Outcome Measures

1. Progression-free survival (PFS) for patient population with non-squamous no-small cell lung cancer (NSCLC) [After 58 events (From time of randomization to documented disease progression [site review of imaging] or death from any cause, whichever occurs first)]

   The final analysis of PFS will be performed when the full information of PFS is reached (i.e., 58 events for each of the two primary comparisons). The two primary comparisons of PFS will each use a logrank test stratified on the randomization stratification factors with a one-sided type I error rate of 10%. Estimates of PFS including medians and confidence intervals, will be calculated using the Kaplan-Meier method. Cox proportional hazards models, stratified, on the same factors, will be used to estimate the treatment hazard ratios. At the final analyses, in the event that both primary PFS comparisons of the combination of nivolumab with cabozantinib and cabozantinib alone versus the standard chemotherapy are statistically significant, PFS will be compared between the two experimental arms (combination of nivolumab with cabozantinib versus [vs.] cabozantinib alone), using a stratified log rank test with a one-sided type I error rate of 10%.

Secondary Outcome Measures

1. Overall survival (OS) for each arm [From time of randomization to documented disease progression (site review of imaging) or death from any cause, whichever occurs first, assessed up to 3 years]

   The final analysis of OS will be performed when the full information of PFS is reached (i.e., 58 events for each of the two primary comparisons). OS will be tested in a hierarchical fashion if the primary comparison of PFS between treatment arms is statistically significant, using a log rank test stratified on the randomization stratification factors with a one-sided type I error rate of 10%. Estimates of OS, including medians and confidence intervals, will be calculated using the Kaplan-Meier method. Cox proportional hazards models, stratified, on the same factors, will be used to estimate the treatment hazard ratios. OS will be further tested in a hierarchical fashion if the comparison of PFS between the two experimental arms is statistically significant. Point estimates of all endpoints will be accompanied by the corresponding two-sided 80% confidence intervals. Subset analyses of PFS and OS by treatment arm will be estimated and compared within subsets.

2. Best objective response for each arm [Every 6 weeks for the first year on study, and then every 12 weeks after year one]

   Will be evaluated via Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Response rates (complete response [CR] + partial response [PR]) and toxicity will be compared using Fisher's exact tests with a one-sided type I error rate of 10%; multivariable logistic regression modeling will be used to adjust for the effect of any covariates that are associated with these categorical outcomes. Modeling procedures will implement backward selection; variables significant at the 0.10 level in the univariate setting will be chosen for inclusion in an initial full model, and at each step the least significant variable will be removed from the model. Only those covariates with p < 0.05 will remain in any final models, unless there are factors identified by the study team as crucial to model interpretation. Point estimates of all endpoints will be accompanied by the corresponding two-sided 80% confidence intervals.

3. Toxicity profile of monotherapy with cabozantinib, and the combination of nivolumab and cabozantinib [Up to 3 years after completion of study treatment]

   Will be determined using the Common Terminology Criteria for Adverse Events (CTCAE) criteria. Response rates (complete response [CR] + pathologic response [PR]) and toxicity will be compared using Fisher's exact tests with a one-sided type I error rate of 10%; multivariable logistic regression modeling will be used to adjust for the effect of any covariates that are associated with these categorical outcomes. Modeling procedures will implement backward selection; variables significant at the 0.10 level in the univariate setting will be chosen for inclusion in an initial full model, and at each step the least significant variable will be removed from the model. Only those covariates with p < 0.05 will remain in any final models, unless there are factors identified by the study team as crucial to model interpretation. Point estimates of all endpoints will be accompanied by the corresponding two-sided 80% confidence intervals.

Other Outcome Measures

1. The RECIST1.1 response at each time point [Every 6 weeks for the first year on study, and then every 12 weeks after year one]

   The measurement of each time point will be performed using the revised CHOI criteria will be only applied to arms A, B, and T, which will include anti-angiogenic therapy. Both the RECIST1.1 and revised CHOI criteria will assess the overall best response as CR, partial PR, stable disease (SD), or progressive disease (PD). Their concordance will be assessed using the weighted Cohen's kappa coefficient (k) with quadratic weights. As a rule of thumb, the level of concordance between the two criteria will be considered poor (k <0), slight (k 0-0.20), fair (k 0.21-0.40), moderate (k 0.41-0.60), substantial (k 0.61-0.80), and almost perfect (k 0.81 - 1).

2. Agreement between central view and site review in terms of progression-free survival [After the completion of study treatment]

   The progression status and the progression time will be assessed in agreement. The progression status is a binary measurement and the agreement will be assessed using the Cohen's kappa coefficient. For progression time, will assess the temporal agreement using the method developed by Zeng et al.

3. Correlative biomarker research [After the completion of study treatment]

   Correlative biomarker research will be performed on tissue and blood specimens collected within this trial.

Eligibility Criteria

Criteria

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

Inclusion Criteria:

• ELIGIBILITY CRITERIA FOR STEP 0 (PRE-REGISTRATION): Patient must have pathologically confirmed non-squamous non-small cell lung carcinoma (NSCLC)

• ELIGIBILITY CRITERIA FOR STEP 0 (PRE-REGISTRATION): Patient must have stage IV disease (includes M1a, M1b, or recurrent earlier stage disease), according to the 8th edition of the lung cancer Tumor Node Metastasis (TNM) classification system

• ELIGIBILITY CRITERIA FOR STEP 0 (PRE-REGISTRATION): Patient must have predominant non-squamous histology (patients with NSCLC no otherwise specified [NOS] are eligible). Mixed tumors will be categorized by the predominant cell type. If small cell elements are present the patient is ineligible

• ELIGIBILITY CRITERIA FOR STEP 0 (PRE-REGISTRATION): Patient's tumor(s) must be tested and known negative for EGFR tyrosinase kinase inhibitor (TKI) sensitizing mutations (EGFR Exon 19 deletions, L858R, L861Q, G719X) and ALK gene rearrangements (by fluorescence in situ hybridization [FISH], next generation sequencing [NGS], or immunohistochemistry [IHC]) by routine Clinical Laboratory Improvement Act (CLIA)-certified clinical testing methods. Negative circulating tumor deoxyribonucleic acid (DNA) results alone are not acceptable. Prior testing for tumor PD-L1 status is not required

• ELIGIBILITY CRITERIA FOR STEP 0 (PRE-REGISTRATION): Patients WITHOUT tumors with known molecular alterations in ROS1, MET, RET, or must have progressed radiographically (per local investigator assessment) following one, but only one, line of platinum-based chemotherapy AND one, but only one, line of prior immunotherapy. Lines of therapy are defined by clinical or radiographic progression. Patients may have received chemotherapy and immunotherapy either concurrently or sequentially in either order. Patient must have received at least 2 prior doses of checkpoint inhibitor therapy in an every 2, 3, or 4 week schedule. No submission of molecular testing is required and patients may be registered for Step 0 then proceed directly to Step 1 screening OR Patients with tumors with known molecular alterations in ROS1, MET, and RET must have progressed radiographically (per local investigator clinical assessment) on at least one line of prior chemotherapy or targeted therapy, but there is no limit on number of prior number. Reciept of prior immunotherapy is allowed but not required.

• Known molecular alterations in ROS1 , MET, and RET are defined as below ROS1 gene rearrangement by FISH or DNA analysis. In addition to above requirements, these patients must have progressed on at least one prior ROS1 TKI therapy

• MET exon 14 splice mutations on DNA analysis. In addition to above requirements, prior MET directed TKI therapy is optional

• MET mutations predicted to be sensitive to MET inhibitor. In addition to above requirements, prior MET directed TKI therapy is optional

• High MET amplification by FISH (characterized by a fluorescence in situ hybridization MET/CEP7 ratio of 5 or greater); OR MET amplification by DNA NGS CLIA certified assay. In addition to above requirements, prior MET directed TKI therapy is optional

• RET gene rearrangement by FISH or DNA analysis. In addition to above requirements, prior RET directed TKI therapy is optional

• During Step 0 screening, CLIA reports of the testing results must be submitted via Medidata Rave for central review for instructions. The central review will be performed by the study chair, co-chair, biology co-chair, and/or a delegate to determine that the results indicate a patient's eligibility for targeted therapy. CLIA reports that contain information pertaining to any of the above mutations will be uploaded to Medidata Rave for central review of documentation for determination of patient eligibility for targeted therapy (Arm T). Central testing of tissue will not be performed. Institutions will be notified of the patient's eligibility status for Arm T within two (2) business days of submission of the molecular testing reports. Patients with tumors with the above known molecular alterations are eligible for cohort Arm Z following Step 1 eligibility review. Patients without tumors with the above known molecular alterations for randomization to Arm A, B or C following Step 1 eligibility review

• ELIGIBILITY CRITERIA FOR STEP 0 (PRE-REGISTRATION): NOTE: Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen (in the opinion of the treating physician) are eligible for this trial

• ELIGIBILITY CRITERIA FOR STEP 0 (PRE-REGISTRATION): Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents (such as anthracycline or human epidermal growth factor receptor (HER2)-directed antibody therapy, but not prior checkpoint inhibitor therapy), must have a clinical risk assessment of cardiac function using the New York Heart Association functional classification. To be eligible for this trial, patients must be class 2B or better

• ELIGIBILITY CRITERIA FOR STEP 0 (PRE-REGISTRATION): Patient must have Eastern Cooperative Oncology Group (ECOG) performance status 0-1

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patient must have met the eligibility criteria outlined above

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patient must have measurable disease as defined by RECIST version (v) 1.1 criteria. Measurements must be obtained within 4 weeks prior to randomization/registration

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patient must have an anticipated life expectancy greater than 3 months

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Any prior chemotherapy (based on administration schedule) must have been completed in greater than or equal to the following times prior to randomization/registration:

• Chemotherapy/targeted oral therapy administered in a daily or weekly schedule must be completed >= 1 week prior to randomization/registration

• Any chemotherapy administered in an every 2 week or greater schedule must be completed >= 2 weeks prior to randomization/registration

• Additionally, patient should be recovered to equal to or less than grade 1 toxicities related to any prior treatment, unless adverse events (AE[s]) are clinically non significant and/or stable on supportive therapy (as determined by the treating physician)

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Leukocytes >= 3,000/mcL (obtained within 2 weeks prior to randomization/registration)

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Absolute neutrophil count >= 1,500/mcL (obtained within 2 weeks prior to randomization/registration)

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Platelets >= 100,000/mcL (obtained within 2 weeks prior to randomization/registration)

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Hemoglobin >= 9 g/dL (obtained within 2 weeks prior to randomization/registration)

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) (obtained within 2 weeks prior to randomization/registration)

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x ULN (obtained within 2 weeks prior to randomization/registration)

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Creatinine =< 1.5 x ULN OR calculated (Cockcroft-Gault formula) or measured creatinine clearance >= 50 mL/min/1.73 m^{2 (normalized to body surface area [BSA]) for patients with creatinine levels greater than 1.5 times the institutional normal creatinine =< 1.5 x ULN or creatinine clearance >= 50 ml/min/1.73 m}2 (obtained within 2 weeks prior to randomization/registration)

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patient must have corrected QT interval calculated by the Fridericia formula QTc corrected by Fridericia (QTcF) =< 500 ms within 28 days prior to randomization/registration

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patient must be able to swallow tablets

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patients with treated brain metastases are eligible if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patients with new or progressive brain metastases (active brain metastases) are eligible if the treating physician determines that immediate CNS specific treatment is not required and is unlikely to be required during the first cycle of study treatment.

• Patient must meet one of the following criteria with respect to brain metastases: Patients with no known brain metastasis must have baseline brain imaging within 12 weeks prior to study randomization/registration not demonstrating brain metastases OR patients with known brain metastases must have baseline brain imaging and completed treatment to all symptomatic brain metastases (with whole brain radiation or radiosurgery; or complete neurosurgical resection >= 3 months prior to randomization/registration) >= 4 weeks prior to randomization/registration. They must be clinically stable. Known leptomeningeal disease is not allowed

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Known human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of registration are eligible for this trial

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: For patients with known history of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy at time of registration/randomization, if indicated

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patients with a known history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load at time of registration/randomization

• ADDITIONAL ELIGIBILITY CRITERIA FOR STEP 1 (REGISTRATION) TARGETED ARM T: Patient was registered to step 0, targeted arm and central review results report the patient is eligible for arm T

• ADDITIONAL ELIGIBILITY CRITERIA FOR STEP 1 (REGISTRATION) TARGETED ARM T: Patients with ROS1 gene rearrangements must have progressed on at least one prior ROS1 targeted therapy such as crizotinib

• ADDITIONAL ELIGIBILITY CRITERIA FOR STEP 1 (REGISTRATION) TARGETED ARM T: Patient must have progressed radiographically (per local investigator clinical assessment) on at least one line of prior chemotherapy or targeted therapy, but there is no limit on number of prior number. Prior immunotherapy is allowed but not required. Prior bevacizumab with chemo is allowed.

• NOTE: The requirement for prior chemotherapy will be met if patients have recurrence within 6 months after prior adjuvant platinum based chemotherapy for early stage disease, or recurrence within 6 months after prior radiotherapy plus platinum based chemotherapy for locally advanced disease

• NOTE: Patients with unresectable stage III NSCLC who have received chemo and radiation then consolidation durvalumab, followed by progression are eligible if progression happens after > 2 doses of durvalumab. Prior bevacizumab with chemo is also allowed

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Patients must have met all eligibility requirements for Step 1 at time of registration to Step 1 to be eligible for Step 2

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Patients must have radiographic progressive disease per RECIST criteria after >= 2 cycles of therapy on arm C

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Patients must be registered to step 2 within 4 weeks of the last dose of treatment administration from step 1

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Patients must have an ECOG performance status between 0-2

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Patients must have recovered to baseline (pre-step 1) or Common Terminology Criteria for Adverse Events (CTCAE) v.5.0 =< grade 1 from toxicity due to all prior therapies except alopecia and other non-clinically significant adverse events (AEs)

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Leukocytes >= 3,000/mcL (obtained within 2 weeks prior to randomization/registration)

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Absolute neutrophil count >= 1,500/mcL (obtained within 2 weeks prior to randomization/registration)

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Platelets >= 100,000/mcL (obtained within 2 weeks prior to randomization/registration)

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Hemoglobin >= 9 g/dL (obtained within 2 weeks prior to randomization/registration)

• Total bilirubin =< 1.5 x institutional ULN (obtained within 2 weeks prior to randomization/registration)

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x ULN (obtained within 2 weeks prior to randomization/registration)

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Creatinine =< 1.5 x ULN OR calculated (Cockcroft-Gault formula) or measured creatinine clearance >= 50 mL/min/1.73 m^{2 (normalized to BSA) for patients with creatinine levels greater than 1.5 times the institutional normal creatinine =< 1.5 x ULN or creatinine clearance >= 50 ml/min/1.73 m}2 (obtained within 2 weeks prior to randomization/registration)

• STEP 2 ELIGIBILITY CRITERIA (CROSSOVER ARM Z): Patients must have corrected QT interval calculated by the Fridericia formula (QTcF) =< 500 ms within 28 days before registration

Exclusion Criteria:

• ELIGIBILITY CRITERIA FOR STEP 1 (RANDOMIZATION/REGISTRATION) FOR ALL TREATMENT ARMS: Patient must not have had any prior radiation therapy for bone metastasis within 2 weeks, or any other radiation therapy within 4 weeks prior to randomization/registration

• ELIGIBILITY CRITERIA FOR STEP

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Veterans Administration Medical Center - Birmingham	Birmingham	Alabama	United States	35233
2	Anchorage Associates in Radiation Medicine	Anchorage	Alaska	United States	98508
3	Anchorage Radiation Therapy Center	Anchorage	Alaska	United States	99504
4	Alaska Breast Care and Surgery LLC	Anchorage	Alaska	United States	99508
5	Alaska Oncology and Hematology LLC	Anchorage	Alaska	United States	99508
6	Alaska Women's Cancer Care	Anchorage	Alaska	United States	99508
7	Anchorage Oncology Centre	Anchorage	Alaska	United States	99508
8	Katmai Oncology Group	Anchorage	Alaska	United States	99508
9	Providence Alaska Medical Center	Anchorage	Alaska	United States	99508
10	Fairbanks Memorial Hospital	Fairbanks	Alaska	United States	99701
11	CTCA at Western Regional Medical Center	Goodyear	Arizona	United States	85338
12	Kingman Regional Medical Center	Kingman	Arizona	United States	86401
13	Cancer Center at Saint Joseph's	Phoenix	Arizona	United States	85004
14	Banner University Medical Center - Tucson	Tucson	Arizona	United States	85719
15	University of Arizona Cancer Center-North Campus	Tucson	Arizona	United States	85719
16	Mercy Hospital Fort Smith	Fort Smith	Arkansas	United States	72903
17	CHI Saint Vincent Cancer Center Hot Springs	Hot Springs	Arkansas	United States	71913
18	Mission Hope Medical Oncology - Arroyo Grande	Arroyo Grande	California	United States	93420
19	PCR Oncology	Arroyo Grande	California	United States	93420
20	Providence Saint Joseph Medical Center/Disney Family Cancer Center	Burbank	California	United States	91505
21	Washington Hospital	Fremont	California	United States	94538
22	Fremont - Rideout Cancer Center	Marysville	California	United States	95901
23	Saint Joseph Hospital - Orange	Orange	California	United States	92868
24	Stanford Cancer Institute Palo Alto	Palo Alto	California	United States	94304
25	University of California Davis Comprehensive Cancer Center	Sacramento	California	United States	95817
26	Pacific Central Coast Health Center-San Luis Obispo	San Luis Obispo	California	United States	93401
27	Mission Hope Medical Oncology - Santa Maria	Santa Maria	California	United States	93444
28	Rocky Mountain Cancer Centers-Aurora	Aurora	Colorado	United States	80012
29	The Medical Center of Aurora	Aurora	Colorado	United States	80012
30	Boulder Community Foothills Hospital	Boulder	Colorado	United States	80303
31	Rocky Mountain Cancer Centers-Boulder	Boulder	Colorado	United States	80304
32	Rocky Mountain Cancer Centers - Centennial	Centennial	Colorado	United States	80112
33	Penrose-Saint Francis Healthcare	Colorado Springs	Colorado	United States	80907
34	Rocky Mountain Cancer Centers-Penrose	Colorado Springs	Colorado	United States	80907
35	Saint Francis Cancer Center	Colorado Springs	Colorado	United States	80923
36	Cancer Center of Colorado at Sloan's Lake	Denver	Colorado	United States	80204
37	National Jewish Health-Main Campus	Denver	Colorado	United States	80206
38	The Women's Imaging Center	Denver	Colorado	United States	80209
39	Porter Adventist Hospital	Denver	Colorado	United States	80210
40	Colorado Blood Cancer Institute	Denver	Colorado	United States	80218
41	Presbyterian - Saint Lukes Medical Center - Health One	Denver	Colorado	United States	80218
42	Rocky Mountain Cancer Centers-Midtown	Denver	Colorado	United States	80218
43	SCL Health Saint Joseph Hospital	Denver	Colorado	United States	80218
44	Rocky Mountain Cancer Centers-Rose	Denver	Colorado	United States	80220
45	Rose Medical Center	Denver	Colorado	United States	80220
46	Western Surgical Care	Denver	Colorado	United States	80220
47	Mercy Medical Center	Durango	Colorado	United States	81301
48	Southwest Oncology PC	Durango	Colorado	United States	81301
49	Mountain Blue Cancer Care Center - Swedish	Englewood	Colorado	United States	80113
50	Rocky Mountain Cancer Centers - Swedish	Englewood	Colorado	United States	80113
51	Swedish Medical Center	Englewood	Colorado	United States	80113
52	The Melanoma and Skin Cancer Institute	Englewood	Colorado	United States	80113
53	Poudre Valley Hospital	Fort Collins	Colorado	United States	80524
54	Cancer Care and Hematology-Fort Collins	Fort Collins	Colorado	United States	80528
55	National Jewish Health-Western Hematology Oncology	Golden	Colorado	United States	80401
56	Saint Mary's Hospital and Regional Medical Center	Grand Junction	Colorado	United States	81501
57	North Colorado Medical Center	Greeley	Colorado	United States	80631
58	UCHealth Greeley Hospital	Greeley	Colorado	United States	80631
59	UCHealth Highlands Ranch Hospital	Highlands Ranch	Colorado	United States	80129
60	Good Samaritan Medical Center	Lafayette	Colorado	United States	80026
61	Rocky Mountain Cancer Centers-Lakewood	Lakewood	Colorado	United States	80228
62	Saint Anthony Hospital	Lakewood	Colorado	United States	80228
63	Rocky Mountain Cancer Centers-Littleton	Littleton	Colorado	United States	80120
64	Littleton Adventist Hospital	Littleton	Colorado	United States	80122
65	Rocky Mountain Cancer Centers-Sky Ridge	Lone Tree	Colorado	United States	80124
66	Sky Ridge Medical Center	Lone Tree	Colorado	United States	80124
67	Longmont United Hospital	Longmont	Colorado	United States	80501
68	Rocky Mountain Cancer Centers-Longmont	Longmont	Colorado	United States	80501
69	Medical Center of the Rockies	Loveland	Colorado	United States	80538
70	McKee Medical Center	Loveland	Colorado	United States	80539
71	Parker Adventist Hospital	Parker	Colorado	United States	80138
72	Saint Mary Corwin Medical Center	Pueblo	Colorado	United States	81004
73	National Jewish Health-Northern Hematology Oncology	Thornton	Colorado	United States	80260
74	Rocky Mountain Cancer Centers-Thornton	Thornton	Colorado	United States	80260
75	Veterans Affairs Connecticut Healthcare System-West Haven Campus	West Haven	Connecticut	United States	06516
76	Mount Sinai Comprehensive Cancer Center at Aventura	Aventura	Florida	United States	33180
77	Holy Cross Hospital	Fort Lauderdale	Florida	United States	33308
78	Mount Sinai Medical Center	Miami Beach	Florida	United States	33140
79	Emory University Hospital Midtown	Atlanta	Georgia	United States	30308
80	Emory University Hospital/Winship Cancer Institute	Atlanta	Georgia	United States	30322
81	Lewis Cancer and Research Pavilion at Saint Joseph's/Candler	Savannah	Georgia	United States	31405
82	Saint Alphonsus Cancer Care Center-Boise	Boise	Idaho	United States	83706
83	Saint Luke's Cancer Institute - Boise	Boise	Idaho	United States	83712
84	Saint Alphonsus Cancer Care Center-Caldwell	Caldwell	Idaho	United States	83605
85	Kootenai Health - Coeur d'Alene	Coeur d'Alene	Idaho	United States	83814
86	Walter Knox Memorial Hospital	Emmett	Idaho	United States	83617
87	Saint Luke's Cancer Institute - Fruitland	Fruitland	Idaho	United States	83619
88	Idaho Urologic Institute-Meridian	Meridian	Idaho	United States	83642
89	Saint Luke's Cancer Institute - Meridian	Meridian	Idaho	United States	83642
90	Saint Alphonsus Medical Center-Nampa	Nampa	Idaho	United States	83686
91	Saint Luke's Cancer Institute - Nampa	Nampa	Idaho	United States	83686
92	Kootenai Clinic Cancer Services - Post Falls	Post Falls	Idaho	United States	83854
93	Kootenai Cancer Clinic	Sandpoint	Idaho	United States	83864
94	Saint Luke's Cancer Institute - Twin Falls	Twin Falls	Idaho	United States	83301
95	Saint Anthony's Health	Alton	Illinois	United States	62002
96	Rush - Copley Medical Center	Aurora	Illinois	United States	60504
97	Advocate Good Shepherd Hospital	Barrington	Illinois	United States	60010
98	Illinois CancerCare-Bloomington	Bloomington	Illinois	United States	61704
99	Illinois CancerCare-Canton	Canton	Illinois	United States	61520
100	Memorial Hospital of Carbondale	Carbondale	Illinois	United States	62902
101	SIH Cancer Institute	Carterville	Illinois	United States	62918
102	Illinois CancerCare-Carthage	Carthage	Illinois	United States	62321
103	Centralia Oncology Clinic	Centralia	Illinois	United States	62801
104	University of Illinois	Chicago	Illinois	United States	60612
105	Advocate Illinois Masonic Medical Center	Chicago	Illinois	United States	60657
106	AMG Crystal Lake - Oncology	Crystal Lake	Illinois	United States	60014
107	Carle on Vermilion	Danville	Illinois	United States	61832
108	Cancer Care Specialists of Illinois - Decatur	Decatur	Illinois	United States	62526
109	Decatur Memorial Hospital	Decatur	Illinois	United States	62526
110	Illinois CancerCare-Dixon	Dixon	Illinois	United States	61021
111	Advocate Good Samaritan Hospital	Downers Grove	Illinois	United States	60515
112	Carle Physician Group-Effingham	Effingham	Illinois	United States	62401
113	Crossroads Cancer Center	Effingham	Illinois	United States	62401
114	Advocate Sherman Hospital	Elgin	Illinois	United States	60123
115	Illinois CancerCare-Eureka	Eureka	Illinois	United States	61530
116	Illinois CancerCare-Galesburg	Galesburg	Illinois	United States	61401
117	Western Illinois Cancer Treatment Center	Galesburg	Illinois	United States	61401
118	Advocate South Suburban Hospital	Hazel Crest	Illinois	United States	60429
119	Edward Hines Jr VA Hospital	Hines	Illinois	United States	60141
120	Illinois CancerCare-Kewanee Clinic	Kewanee	Illinois	United States	61443
121	AMG Libertyville - Oncology	Libertyville	Illinois	United States	60048
122	Condell Memorial Hospital	Libertyville	Illinois	United States	60048
123	Illinois CancerCare-Macomb	Macomb	Illinois	United States	61455
124	Carle Physician Group-Mattoon/Charleston	Mattoon	Illinois	United States	61938
125	Good Samaritan Regional Health Center	Mount Vernon	Illinois	United States	62864
126	Cancer Care Center of O'Fallon	O'Fallon	Illinois	United States	62269
127	Advocate Christ Medical Center	Oak Lawn	Illinois	United States	60453-2699
128	Illinois CancerCare-Ottawa Clinic	Ottawa	Illinois	United States	61350
129	Advocate Lutheran General Hospital	Park Ridge	Illinois	United States	60068
130	Illinois CancerCare-Pekin	Pekin	Illinois	United States	61554
131	Illinois CancerCare-Peoria	Peoria	Illinois	United States	61615
132	Methodist Medical Center of Illinois	Peoria	Illinois	United States	61636
133	Illinois CancerCare-Peru	Peru	Illinois	United States	61354
134	Valley Radiation Oncology	Peru	Illinois	United States	61354
135	Illinois CancerCare-Princeton	Princeton	Illinois	United States	61356
136	SwedishAmerican Regional Cancer Center/ACT	Rockford	Illinois	United States	61114
137	Southern Illinois University School of Medicine	Springfield	Illinois	United States	62702
138	Springfield Clinic	Springfield	Illinois	United States	62702
139	Memorial Medical Center	Springfield	Illinois	United States	62781
140	Southwest Illinois Health Services LLP	Swansea	Illinois	United States	62226
141	Carle Cancer Center	Urbana	Illinois	United States	61801
142	The Carle Foundation Hospital	Urbana	Illinois	United States	61801
143	Illinois CancerCare - Washington	Washington	Illinois	United States	61571
144	Rush-Copley Healthcare Center	Yorkville	Illinois	United States	60560
145	Reid Health	Richmond	Indiana	United States	47374
146	Memorial Hospital of South Bend	South Bend	Indiana	United States	46601
147	Mary Greeley Medical Center	Ames	Iowa	United States	50010
148	McFarland Clinic PC - Ames	Ames	Iowa	United States	50010
149	University of Iowa Healthcare Cancer Services Quad Cities	Bettendorf	Iowa	United States	52722
150	McFarland Clinic PC-Boone	Boone	Iowa	United States	50036
151	Saint Anthony Regional Hospital	Carroll	Iowa	United States	51401
152	Medical Oncology and Hematology Associates-West Des Moines	Clive	Iowa	United States	50325
153	Mercy Cancer Center-West Lakes	Clive	Iowa	United States	50325
154	Jennie Edmundson Memorial Hospital	Council Bluffs	Iowa	United States	51502
155	Alegent Health Mercy Hospital	Council Bluffs	Iowa	United States	51503
156	Heartland Oncology and Hematology LLP	Council Bluffs	Iowa	United States	51503
157	Greater Regional Medical Center	Creston	Iowa	United States	50801
158	Iowa Methodist Medical Center	Des Moines	Iowa	United States	50309
159	Medical Oncology and Hematology Associates-Des Moines	Des Moines	Iowa	United States	50309
160	Broadlawns Medical Center	Des Moines	Iowa	United States	50314
161	Medical Oncology and Hematology Associates-Laurel	Des Moines	Iowa	United States	50314
162	Mercy Medical Center - Des Moines	Des Moines	Iowa	United States	50314
163	Iowa Lutheran Hospital	Des Moines	Iowa	United States	50316
164	McFarland Clinic PC-Trinity Cancer Center	Fort Dodge	Iowa	United States	50501
165	Trinity Regional Medical Center	Fort Dodge	Iowa	United States	50501
166	University of Iowa/Holden Comprehensive Cancer Center	Iowa City	Iowa	United States	52242
167	McFarland Clinic PC-Jefferson	Jefferson	Iowa	United States	50129
168	McFarland Clinic PC-Marshalltown	Marshalltown	Iowa	United States	50158
169	Methodist West Hospital	West Des Moines	Iowa	United States	50266-7700
170	Mercy Medical Center-West Lakes	West Des Moines	Iowa	United States	50266
171	Central Care Cancer Center - Garden City	Garden City	Kansas	United States	67846
172	Central Care Cancer Center - Great Bend	Great Bend	Kansas	United States	67530
173	HaysMed University of Kansas Health System	Hays	Kansas	United States	67601
174	Lawrence Memorial Hospital	Lawrence	Kansas	United States	66044
175	Olathe Health Cancer Center	Olathe	Kansas	United States	66061
176	Saint Luke's South Hospital	Overland Park	Kansas	United States	66213
177	Ascension Via Christi - Pittsburg	Pittsburg	Kansas	United States	66762
178	Salina Regional Health Center	Salina	Kansas	United States	67401
179	University of Kansas Health System Saint Francis Campus	Topeka	Kansas	United States	66606
180	Flaget Memorial Hospital	Bardstown	Kentucky	United States	40004
181	Commonwealth Cancer Center-Corbin	Corbin	Kentucky	United States	40701
182	Saint Joseph Radiation Oncology Resource Center	Lexington	Kentucky	United States	40504
183	Saint Joseph Hospital East	Lexington	Kentucky	United States	40509
184	Saint Joseph London	London	Kentucky	United States	40741
185	Jewish Hospital	Louisville	Kentucky	United States	40202
186	Saints Mary and Elizabeth Hospital	Louisville	Kentucky	United States	40215
187	UofL Health Medical Center Northeast	Louisville	Kentucky	United States	40245
188	Owensboro Health Mitchell Memorial Cancer Center	Owensboro	Kentucky	United States	42303
189	Jewish Hospital Medical Center South	Shepherdsville	Kentucky	United States	40165
190	LSU Health Baton Rouge-North Clinic	Baton Rouge	Louisiana	United States	70805
191	Our Lady of The Lake	Baton Rouge	Louisiana	United States	70808
192	Louisiana Hematology Oncology Associates LLC	Baton Rouge	Louisiana	United States	70809
193	Mary Bird Perkins Cancer Center	Baton Rouge	Louisiana	United States	70809
194	Our Lady of the Lake Physicians Group - Medical Oncology	Baton Rouge	Louisiana	United States	70809
195	Northshore Oncology Associates-Covington	Covington	Louisiana	United States	70433
196	Terrebonne General Medical Center	Houma	Louisiana	United States	70360
197	Harold Alfond Center for Cancer Care	Augusta	Maine	United States	04330
198	MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford	Biddeford	Maine	United States	04005
199	MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford	Sanford	Maine	United States	04073
200	Maine Medical Partners - South Portland	South Portland	Maine	United States	04106
201	Saint Agnes Hospital	Baltimore	Maryland	United States	21229
202	Boston Medical Center	Boston	Massachusetts	United States	02118
203	UMass Memorial Medical Center - University Campus	Worcester	Massachusetts	United States	01655
204	Hickman Cancer Center	Adrian	Michigan	United States	49221
205	Saint Joseph Mercy Hospital	Ann Arbor	Michigan	United States	48106
206	Bronson Battle Creek	Battle Creek	Michigan	United States	49017
207	Saint Joseph Mercy Brighton	Brighton	Michigan	United States	48114
208	Trinity Health IHA Medical Group Hematology Oncology - Brighton	Brighton	Michigan	United States	48114
209	Saint Joseph Mercy Canton	Canton	Michigan	United States	48188
210	Trinity Health IHA Medical Group Hematology Oncology - Canton	Canton	Michigan	United States	48188
211	Caro Cancer Center	Caro	Michigan	United States	48723
212	Saint Joseph Mercy Chelsea	Chelsea	Michigan	United States	48118
213	Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital	Chelsea	Michigan	United States	48118
214	Hematology Oncology Consultants-Clarkston	Clarkston	Michigan	United States	48346
215	Newland Medical Associates-Clarkston	Clarkston	Michigan	United States	48346
216	Ascension Saint John Hospital	Detroit	Michigan	United States	48236
217	Great Lakes Cancer Management Specialists-Doctors Park	East China Township	Michigan	United States	48054
218	Genesee Cancer and Blood Disease Treatment Center	Flint	Michigan	United States	48503
219	Genesee Hematology Oncology PC	Flint	Michigan	United States	48503
220	Genesys Hurley Cancer Institute	Flint	Michigan	United States	48503
221	Hurley Medical Center	Flint	Michigan	United States	48503
222	Helen DeVos Children's Hospital at Spectrum Health	Grand Rapids	Michigan	United States	49503
223	Mercy Health Saint Mary's	Grand Rapids	Michigan	United States	49503
224	Spectrum Health at Butterworth Campus	Grand Rapids	Michigan	United States	49503
225	Academic Hematology Oncology Specialists	Grosse Pointe Woods	Michigan	United States	48236
226	Great Lakes Cancer Management Specialists-Van Elslander Cancer Center	Grosse Pointe Woods	Michigan	United States	48236
227	Michigan Breast Specialists-Grosse Pointe Woods	Grosse Pointe Woods	Michigan	United States	48236
228	Bronson Methodist Hospital	Kalamazoo	Michigan	United States	49007
229	West Michigan Cancer Center	Kalamazoo	Michigan	United States	49007
230	Ascension Borgess Cancer Center	Kalamazoo	Michigan	United States	49009
231	Borgess Medical Center	Kalamazoo	Michigan	United States	49048
232	Sparrow Hospital	Lansing	Michigan	United States	48912
233	Hope Cancer Clinic	Livonia	Michigan	United States	48154
234	Trinity Health Saint Mary Mercy Livonia Hospital	Livonia	Michigan	United States	48154
235	Great Lakes Cancer Management Specialists-Macomb Medical Campus	Macomb	Michigan	United States	48044
236	Michigan Breast Specialists-Macomb Township	Macomb	Michigan	United States	48044
237	Saint Mary's Oncology/Hematology Associates of Marlette	Marlette	Michigan	United States	48453
238	Toledo Clinic Cancer Centers-Monroe	Monroe	Michigan	United States	48162
239	Mercy Health Mercy Campus	Muskegon	Michigan	United States	49444
240	Lakeland Hospital Niles	Niles	Michigan	United States	49120
241	Cancer and Hematology Centers of Western Michigan - Norton Shores	Norton Shores	Michigan	United States	49444
242	Ascension Providence Hospitals - Novi	Novi	Michigan	United States	48374
243	21st Century Oncology-Pontiac	Pontiac	Michigan	United States	48341
244	Hope Cancer Center	Pontiac	Michigan	United States	48341
245	Newland Medical Associates-Pontiac	Pontiac	Michigan	United States	48341
246	Saint Joseph Mercy Oakland	Pontiac	Michigan	United States	48341
247	Spectrum Health Reed City Hospital	Reed City	Michigan	United States	49677
248	Great Lakes Cancer Management Specialists-Rochester Hills	Rochester Hills	Michigan	United States	48309
249	Ascension Saint Mary's Hospital	Saginaw	Michigan	United States	48601
250	Oncology Hematology Associates of Saginaw Valley PC	Saginaw	Michigan	United States	48604
251	Lakeland Medical Center Saint Joseph	Saint Joseph	Michigan	United States	49085
252	Marie Yeager Cancer Center	Saint Joseph	Michigan	United States	49085
253	Ascension Providence Hospitals - Southfield	Southfield	Michigan	United States	48075
254	Bhadresh Nayak MD PC-Sterling Heights	Sterling Heights	Michigan	United States	48312
255	Ascension Saint Joseph Hospital	Tawas City	Michigan	United States	48764
256	Munson Medical Center	Traverse City	Michigan	United States	49684
257	Advanced Breast Care Center PLLC	Warren	Michigan	United States	48088
258	Great Lakes Cancer Management Specialists-Macomb Professional Building	Warren	Michigan	United States	48093
259	Macomb Hematology Oncology PC	Warren	Michigan	United States	48093
260	Michigan Breast Specialists-Warren	Warren	Michigan	United States	48093
261	Saint John Macomb-Oakland Hospital	Warren	Michigan	United States	48093
262	Saint Mary's Oncology/Hematology Associates of West Branch	West Branch	Michigan	United States	48661
263	Metro Health Hospital	Wyoming	Michigan	United States	49519
264	Huron Gastroenterology PC	Ypsilanti	Michigan	United States	48106
265	Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus	Ypsilanti	Michigan	United States	48197
266	Riverwood Healthcare Center	Aitkin	Minnesota	United States	56431
267	Essentia Health - Baxter Clinic	Baxter	Minnesota	United States	56425
268	Essentia Health Saint Joseph's Medical Center	Brainerd	Minnesota	United States	56401
269	Fairview Ridges Hospital	Burnsville	Minnesota	United States	55337
270	Minnesota Oncology - Burnsville	Burnsville	Minnesota	United States	55337
271	Cambridge Medical Center	Cambridge	Minnesota	United States	55008
272	Mercy Hospital	Coon Rapids	Minnesota	United States	55433
273	Essentia Health - Deer River Clinic	Deer River	Minnesota	United States	56636
274	Essentia Health Saint Mary's - Detroit Lakes Clinic	Detroit Lakes	Minnesota	United States	56501
275	Essentia Health Cancer Center	Duluth	Minnesota	United States	55805
276	Essentia Health Saint Mary's Medical Center	Duluth	Minnesota	United States	55805
277	Miller-Dwan Hospital	Duluth	Minnesota	United States	55805
278	Fairview Southdale Hospital	Edina	Minnesota	United States	55435
279	Essentia Health - Ely Clinic	Ely	Minnesota	United States	55731
280	Lake Region Healthcare Corporation-Cancer Care	Fergus Falls	Minnesota	United States	56537
281	Essentia Health - Fosston	Fosston	Minnesota	United States	56542
282	Unity Hospital	Fridley	Minnesota	United States	55432
283	Essentia Health Hibbing Clinic	Hibbing	Minnesota	United States	55746
284	Essentia Health - International Falls Clinic	International Falls	Minnesota	United States	56649
285	Fairview Clinics and Surgery Center Maple Grove	Maple Grove	Minnesota	United States	55369
286	Minnesota Oncology Hematology PA-Maplewood	Maplewood	Minnesota	United States	55109
287	Saint John's Hospital - Healtheast	Maplewood	Minnesota	United States	55109
288	Abbott-Northwestern Hospital	Minneapolis	Minnesota	United States	55407
289	Hennepin County Medical Center	Minneapolis	Minnesota	United States	55415
290	Health Partners Inc	Minneapolis	Minnesota	United States	55454
291	Monticello Cancer Center	Monticello	Minnesota	United States	55362
292	Essentia Health - Moose Lake Clinic	Moose Lake	Minnesota	United States	55767
293	New Ulm Medical Center	New Ulm	Minnesota	United States	56073
294	Essentia Health - Park Rapids	Park Rapids	Minnesota	United States	56470
295	Fairview Northland Medical Center	Princeton	Minnesota	United States	55371
296	North Memorial Medical Health Center	Robbinsdale	Minnesota	United States	55422
297	Park Nicollet Clinic - Saint Louis Park	Saint Louis Park	Minnesota	United States	55416
298	Regions Hospital	Saint Paul	Minnesota	United States	55101
299	United Hospital	Saint Paul	Minnesota	United States	55102
300	Essentia Health Sandstone	Sandstone	Minnesota	United States	55072
301	Saint Francis Regional Medical Center	Shakopee	Minnesota	United States	55379
302	Lakeview Hospital	Stillwater	Minnesota	United States	55082
303	Essentia Health Virginia Clinic	Virginia	Minnesota	United States	55792
304	Ridgeview Medical Center	Waconia	Minnesota	United States	55387
305	Rice Memorial Hospital	Willmar	Minnesota	United States	56201
306	Minnesota Oncology Hematology PA-Woodbury	Woodbury	Minnesota	United States	55125
307	Fairview Lakes Medical Center	Wyoming	Minnesota	United States	55092
308	Saint Louis Cancer and Breast Institute-Ballwin	Ballwin	Missouri	United States	63011
309	Central Care Cancer Center - Bolivar	Bolivar	Missouri	United States	65613
310	Cox Cancer Center Branson	Branson	Missouri	United States	65616
311	Saint Francis Medical Center	Cape Girardeau	Missouri	United States	63703
312	Southeast Cancer Center	Cape Girardeau	Missouri	United States	63703
313	University of Missouri - Ellis Fischel	Columbia	Missouri	United States	65212
314	Siteman Cancer Center at West County Hospital	Creve Coeur	Missouri	United States	63141
315	Parkland Health Center - Farmington	Farmington	Missouri	United States	63640
316	Capital Region Southwest Campus	Jefferson City	Missouri	United States	65109
317	Freeman Health System	Joplin	Missouri	United States	64804
318	Mercy Hospital Joplin	Joplin	Missouri	United States	64804
319	Truman Medical Centers	Kansas City	Missouri	United States	64108
320	Saint Luke's Hospital of Kansas City	Kansas City	Missouri	United States	64111
321	Saint Luke's East - Lee's Summit	Lee's Summit	Missouri	United States	64086
322	Delbert Day Cancer Institute at PCRMC	Rolla	Missouri	United States	65401
323	Mercy Clinic-Rolla-Cancer and Hematology	Rolla	Missouri	United States	65401
324	Heartland Regional Medical Center	Saint Joseph	Missouri	United States	64506
325	Saint Louis Cancer and Breast Institute-South City	Saint Louis	Missouri	United States	63109
326	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
327	Mercy Hospital South	Saint Louis	Missouri	United States	63128
328	Siteman Cancer Center-South County	Saint Louis	Missouri	United States	63129
329	Missouri Baptist Medical Center	Saint Louis	Missouri	United States	63131
330	Siteman Cancer Center at Christian Hospital	Saint Louis	Missouri	United States	63136
331	Mercy Hospital Saint Louis	Saint Louis	Missouri	United States	63141
332	Siteman Cancer Center at Saint Peters Hospital	Saint Peters	Missouri	United States	63376
333	Sainte Genevieve County Memorial Hospital	Sainte Genevieve	Missouri	United States	63670
334	Mercy Hospital Springfield	Springfield	Missouri	United States	65804
335	CoxHealth South Hospital	Springfield	Missouri	United States	65807
336	Missouri Baptist Sullivan Hospital	Sullivan	Missouri	United States	63080
337	Missouri Baptist Outpatient Center-Sunset Hills	Sunset Hills	Missouri	United States	63127
338	Mercy Hospital Washington	Washington	Missouri	United States	63090
339	Community Hospital of Anaconda	Anaconda	Montana	United States	59711
340	Billings Clinic Cancer Center	Billings	Montana	United States	59101
341	Saint Vincent Healthcare	Billings	Montana	United States	59101
342	Saint Vincent Frontier Cancer Center	Billings	Montana	United States	59102
343	Bozeman Deaconess Hospital	Bozeman	Montana	United States	59715
344	Benefis Healthcare- Sletten Cancer Institute	Great Falls	Montana	United States	59405
345	Great Falls Clinic	Great Falls	Montana	United States	59405
346	Kalispell Regional Medical Center	Kalispell	Montana	United States	59901
347	Saint Patrick Hospital - Community Hospital	Missoula	Montana	United States	59802
348	Community Medical Hospital	Missoula	Montana	United States	59804
349	Nebraska Medicine-Bellevue	Bellevue	Nebraska	United States	68123
350	CHI Health Saint Francis	Grand Island	Nebraska	United States	68803
351	CHI Health Good Samaritan	Kearney	Nebraska	United States	68847
352	Saint Elizabeth Regional Medical Center	Lincoln	Nebraska	United States	68510
353	Nebraska Methodist Hospital	Omaha	Nebraska	United States	68114
354	Oncology Associates PC	Omaha	Nebraska	United States	68114
355	Nebraska Medicine-Village Pointe	Omaha	Nebraska	United States	68118
356	Alegent Health Immanuel Medical Center	Omaha	Nebraska	United States	68122
357	Alegent Health Bergan Mercy Medical Center	Omaha	Nebraska	United States	68124
358	Alegent Health Lakeside Hospital	Omaha	Nebraska	United States	68130
359	Creighton University Medical Center	Omaha	Nebraska	United States	68131
360	University of Nebraska Medical Center	Omaha	Nebraska	United States	68198
361	Midlands Community Hospital	Papillion	Nebraska	United States	68046
362	Carson Tahoe Regional Medical Center	Carson City	Nevada	United States	89703
363	Cancer and Blood Specialists-Henderson	Henderson	Nevada	United States	89052
364	Comprehensive Cancer Centers of Nevada - Henderson	Henderson	Nevada	United States	89052
365	Comprehensive Cancer Centers of Nevada-Horizon Ridge	Henderson	Nevada	United States	89052
366	Las Vegas Cancer Center-Henderson	Henderson	Nevada	United States	89052
367	OptumCare Cancer Care at Seven Hills	Henderson	Nevada	United States	89052
368	Comprehensive Cancer Centers of Nevada-Southeast Henderson	Henderson	Nevada	United States	89074
369	GenesisCare USA - Henderson	Henderson	Nevada	United States	89074
370	Las Vegas Urology - Green Valley	Henderson	Nevada	United States	89074
371	Las Vegas Urology - Pebble	Henderson	Nevada	United States	89074
372	Urology Specialists of Nevada - Green Valley	Henderson	Nevada	United States	89074
373	Las Vegas Urology - Pecos	Las Vegas	Nevada	United States	89074
374	Desert West Surgery	Las Vegas	Nevada	United States	89102
375	OptumCare Cancer Care at Charleston	Las Vegas	Nevada	United States	89102
376	University Medical Center of Southern Nevada	Las Vegas	Nevada	United States	89102
377	Hope Cancer Care of Nevada	Las Vegas	Nevada	United States	89103
378	Cancer and Blood Specialists-Shadow	Las Vegas	Nevada	United States	89106
379	Radiation Oncology Centers of Nevada Central	Las Vegas	Nevada	United States	89106
380	Urology Specialists of Nevada - Central	Las Vegas	Nevada	United States	89106
381	GenesisCare USA - Las Vegas	Las Vegas	Nevada	United States	89109
382	HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway	Las Vegas	Nevada	United States	89109
383	Sunrise Hospital and Medical Center	Las Vegas	Nevada	United States	89109
384	HealthCare Partners Medical Group Oncology/Hematology-San Martin	Las Vegas	Nevada	United States	89113
385	Las Vegas Prostate Cancer Center	Las Vegas	Nevada	United States	89113
386	Las Vegas Urology - Sunset	Las Vegas	Nevada	United States	89113
387	Urology Specialists of Nevada - Southwest	Las Vegas	Nevada	United States	89113
388	Radiation Oncology Centers of Nevada Southeast	Las Vegas	Nevada	United States	89119
389	Ann M Wierman MD LTD	Las Vegas	Nevada	United States	89128
390	Cancer and Blood Specialists-Tenaya	Las Vegas	Nevada	United States	89128
391	Comprehensive Cancer Centers of Nevada - Northwest	Las Vegas	Nevada	United States	89128
392	GenesisCare USA - Vegas Tenaya	Las Vegas	Nevada	United States	89128
393	HealthCare Partners Medical Group Oncology/Hematology-Tenaya	Las Vegas	Nevada	United States	89128
394	Las Vegas Urology - Cathedral Rock	Las Vegas	Nevada	United States	89128
395	Las Vegas Urology - Smoke Ranch	Las Vegas	Nevada	United States	89128
396	OptumCare Cancer Care at MountainView	Las Vegas	Nevada	United States	89128
397	Urology Specialists of Nevada - Northwest	Las Vegas	Nevada	United States	89128
398	Alliance for Childhood Diseases/Cure 4 the Kids Foundation	Las Vegas	Nevada	United States	89135
399	Comprehensive Cancer Centers of Nevada - Town Center	Las Vegas	Nevada	United States	89144
400	Comprehensive Cancer Centers of Nevada-Summerlin	Las Vegas	Nevada	United States	89144
401	Summerlin Hospital Medical Center	Las Vegas	Nevada	United States	89144
402	Las Vegas Cancer Center-Medical Center	Las Vegas	Nevada	United States	89148-2405
403	Comprehensive Cancer Centers of Nevada	Las Vegas	Nevada	United States	89148
404	GenesisCare USA - Fort Apache	Las Vegas	Nevada	United States	89148
405	OptumCare Cancer Care at Fort Apache	Las Vegas	Nevada	United States	89148
406	HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills	Las Vegas	Nevada	United States	89149
407	Comprehensive Cancer Centers of Nevada - Central Valley	Las Vegas	Nevada	United States	89169
408	University Cancer Center	Las Vegas	Nevada	United States	89169
409	Hope Cancer Care of Nevada-Pahrump	Pahrump	Nevada	United States	89048
410	Renown Regional Medical Center	Reno	Nevada	United States	89502
411	Saint Mary's Regional Medical Center	Reno	Nevada	United States	89503
412	Radiation Oncology Associates	Reno	Nevada	United States	89509
413	New Hampshire Oncology Hematology PA-Concord	Concord	New Hampshire	United States	03301
414	Elliot Hospital	Manchester	New Hampshire	United States	03103
415	Solinsky Center for Cancer Care	Manchester	New Hampshire	United States	03103
416	Virtua Samson Cancer Center	Moorestown	New Jersey	United States	08057
417	Virtua Memorial	Mount Holly	New Jersey	United States	08060
418	Virtua Voorhees	Voorhees	New Jersey	United States	08043
419	University of New Mexico Cancer Center	Albuquerque	New Mexico	United States	87102
420	Montefiore Medical Center-Einstein Campus	Bronx	New York	United States	10461
421	Montefiore Medical Center-Weiler Hospital	Bronx	New York	United States	10461
422	Montefiore Medical Center - Moses Campus	Bronx	New York	United States	10467
423	Glens Falls Hospital	Glens Falls	New York	United States	12801
424	Vidant Oncology-Kenansville	Kenansville	North Carolina	United States	28349
425	Vidant Oncology-Kinston	Kinston	North Carolina	United States	28501
426	FirstHealth of the Carolinas-Moore Regional Hospital	Pinehurst	North Carolina	United States	28374
427	Vidant Oncology-Richlands	Richlands	North Carolina	United States	28574
428	Marion L Shepard Cancer Center at Vidant Beaufort Hospital	Washington	North Carolina	United States	27889
429	Essentia Health Cancer Center-South University Clinic	Fargo	North Dakota	United States	58103
430	Essentia Health - Jamestown Clinic	Jamestown	North Dakota	United States	58401
431	Aultman Alliance Community Hospital	Alliance	Ohio	United States	44601
432	Indu and Raj Soin Medical Center	Beavercreek	Ohio	United States	45431
433	Saint Elizabeth Boardman Hospital	Boardman	Ohio	United States	44512
434	Cleveland Clinic Mercy Hospital	Canton	Ohio	United States	44708
435	Mercy Hematology and Oncology Associates Inc	Canton	Ohio	United States	44708
436	Aultman Health Foundation	Canton	Ohio	United States	44710
437	Dayton Physicians LLC-Miami Valley South	Centerville	Ohio	United States	45459
438	Miami Valley Hospital South	Centerville	Ohio	United States	45459
439	Good Samaritan Hospital - Cincinnati	Cincinnati	Ohio	United States	45220
440	Oncology Hematology Care Inc-Kenwood	Cincinnati	Ohio	United States	45236
441	Bethesda North Hospital	Cincinnati	Ohio	United States	45242
442	TriHealth Cancer Institute-Westside	Cincinnati	Ohio	United States	45247
443	TriHealth Cancer Institute-Anderson	Cincinnati	Ohio	United States	45255
444	Cleveland Clinic Cancer Center/Fairview Hospital	Cleveland	Ohio	United States	44111
445	Miami Valley Hospital	Dayton	Ohio	United States	45409
446	Dayton Physician LLC-Miami Valley Hospital North	Dayton	Ohio	United States	45415
447	Miami Valley Hospital North	Dayton	Ohio	United States	45415
448	Armes Family Cancer Center	Findlay	Ohio	United States	45840
449	Blanchard Valley Hospital	Findlay	Ohio	United States	45840
450	Orion Cancer Care	Findlay	Ohio	United States	45840
451	Atrium Medical Center-Middletown Regional Hospital	Franklin	Ohio	United States	45005-1066
452	Dayton Physicians LLC-Atrium	Franklin	Ohio	United States	45005
453	Dayton Physicians LLC-Wayne	Greenville	Ohio	United States	45331
454	Wayne Hospital	Greenville	Ohio	United States	45331
455	Greater Dayton Cancer Center	Kettering	Ohio	United States	45409
456	First Dayton Cancer Care	Kettering	Ohio	United States	45420
457	Kettering Medical Center	Kettering	Ohio	United States	45429
458	Cleveland Clinic Cancer Center Mansfield	Mansfield	Ohio	United States	44906
459	Hillcrest Hospital Cancer Center	Mayfield Heights	Ohio	United States	44124
460	Mercy Health Perrysburg Cancer Center	Perrysburg	Ohio	United States	43551
461	North Coast Cancer Care	Sandusky	Ohio	United States	44870
462	Springfield Regional Cancer Center	Springfield	Ohio	United States	45504
463	Springfield Regional Medical Center	Springfield	Ohio	United States	45505
464	Mercy Health - Saint Anne Hospital	Toledo	Ohio	United States	43623
465	Toledo Clinic Cancer Centers-Toledo	Toledo	Ohio	United States	43623
466	Dayton Physicians LLC-Upper Valley	Troy	Ohio	United States	45373
467	Upper Valley Medical Center	Troy	Ohio	United States	45373
468	South Pointe Hospital	Warrensville Heights	Ohio	United States	44122
469	Saint Joseph Warren Hospital	Warren	Ohio	United States	44484
470	Cleveland Clinic Wooster Family Health and Surgery Center	Wooster	Ohio	United States	44691
471	Wright-Patterson Medical Center	Wright-Patterson Air Force Base	Ohio	United States	45433
472	Saint Elizabeth Youngstown Hospital	Youngstown	Ohio	United States	44501
473	Mercy Hospital Oklahoma City	Oklahoma City	Oklahoma	United States	73120
474	Saint Alphonsus Medical Center-Baker City	Baker City	Oregon	United States	97814
475	Saint Charles Health System	Bend	Oregon	United States	97701
476	Clackamas Radiation Oncology Center	Clackamas	Oregon	United States	97015
477	Providence Cancer Institute Clackamas Clinic	Clackamas	Oregon	United States	97015
478	Bay Area Hospital	Coos Bay	Oregon	United States	97420
479	Providence Newberg Medical Center	Newberg	Oregon	United States	97132
480	Saint Alphonsus Medical Center-Ontario	Ontario	Oregon	United States	97914
481	Providence Portland Medical Center	Portland	Oregon	United States	97213
482	Providence Saint Vincent Medical Center	Portland	Oregon	United States	97225
483	Oregon Health and Science University	Portland	Oregon	United States	97239
484	Saint Charles Health System-Redmond	Redmond	Oregon	United States	97756
485	Lehigh Valley Hospital-Cedar Crest	Allentown	Pennsylvania	United States	18103
486	Lehigh Valley Hospital - Muhlenberg	Bethlehem	Pennsylvania	United States	18017
487	Bryn Mawr Hospital	Bryn Mawr	Pennsylvania	United States	19010
488	Chambersburg Hospital	Chambersburg	Pennsylvania	United States	17201
489	WellSpan Medical Oncology and Hematology	Chambersburg	Pennsylvania	United States	17201
490	Main Line Health Center-Collegeville	Collegeville	Pennsylvania	United States	19426
491	Pocono Medical Center	East Stroudsburg	Pennsylvania	United States	18301
492	Ephrata Cancer Center	Ephrata	Pennsylvania	United States	17522
493	Main Line Health Center-Exton	Exton	Pennsylvania	United States	19341
494	Adams Cancer Center	Gettysburg	Pennsylvania	United States	17325
495	Cherry Tree Cancer Center	Hanover	Pennsylvania	United States	17331
496	Lehigh Valley Hospital-Hazleton	Hazleton	Pennsylvania	United States	18201
497	Sechler Family Cancer Center	Lebanon	Pennsylvania	United States	17042
498	Riddle Memorial Hospital	Media	Pennsylvania	United States	19063
499	Bryn Mawr Health Center	Newtown Square	Pennsylvania	United States	19073
500	Paoli Memorial Hospital	Paoli	Pennsylvania	United States	19301
501	Penn Presbyterian Medical Center	Philadelphia	Pennsylvania	United States	19104
502	University of Pennsylvania/Abramson Cancer Center	Philadelphia	Pennsylvania	United States	19104
503	Pottstown Hospital	Pottstown	Pennsylvania	United States	19464
504	Guthrie Medical Group PC-Robert Packer Hospital	Sayre	Pennsylvania	United States	18840
505	Lankenau Medical Center	Wynnewood	Pennsylvania	United States	19096
506	Cancer Care Associates of York	York	Pennsylvania	United States	17403
507	WellSpan Health-York Cancer Center	York	Pennsylvania	United States	17403
508	WellSpan Health-York Hospital	York	Pennsylvania	United States	17403
509	Self Regional Healthcare	Greenwood	South Carolina	United States	29646
510	Saint Joseph Regional Cancer Center	Bryan	Texas	United States	77802
511	Bon Secours Memorial Regional Medical Center	Mechanicsville	Virginia	United States	23116
512	Bon Secours Westchester Emergency Center	Midlothian	Virginia	United States	23113
513	Bon Secours Saint Francis Medical Center	Midlothian	Virginia	United States	23114
514	Bon Secours DePaul Medical Center	Norfolk	Virginia	United States	23505
515	Bon Secours Maryview Medical Center	Portsmouth	Virginia	United States	23707
516	Bon Secours Saint Mary's Hospital	Richmond	Virginia	United States	23226
517	Bon Secours Cancer Institute at Reynolds Crossing	Richmond	Virginia	United States	23230
518	VCU Massey Cancer Center at Stony Point	Richmond	Virginia	United States	23235
519	Virginia Commonwealth University/Massey Cancer Center	Richmond	Virginia	United States	23298
520	Bon Secours Health Center at Harbour View	Suffolk	Virginia	United States	23435
521	Providence Regional Cancer System-Aberdeen	Aberdeen	Washington	United States	98520
522	Overlake Medical Center	Bellevue	Washington	United States	98004
523	PeaceHealth Saint Joseph Medical Center	Bellingham	Washington	United States	98225
524	Harrison HealthPartners Hematology and Oncology-Bremerton	Bremerton	Washington	United States	98310
525	Harrison Medical Center	Bremerton	Washington	United States	98310
526	Highline Medical Center-Main Campus	Burien	Washington	United States	98166
527	Providence Regional Cancer System-Centralia	Centralia	Washington	United States	98531
528	Swedish Cancer Institute-Edmonds	Edmonds	Washington	United States	98026
529	Saint Elizabeth Hospital	Enumclaw	Washington	United States	98022
530	Providence Regional Cancer Partnership	Everett	Washington	United States	98201
531	Saint Francis Hospital	Federal Way	Washington	United States	98003
532	Swedish Cancer Institute-Issaquah	Issaquah	Washington	United States	98029
533	Kadlec Clinic Hematology and Oncology	Kennewick	Washington	United States	99336
534	Providence Regional Cancer System-Lacey	Lacey	Washington	United States	98503
535	Saint Clare Hospital	Lakewood	Washington	United States	98499
536	PeaceHealth Saint John Medical Center	Longview	Washington	United States	98632
537	Jefferson Healthcare	Port Townsend	Washington	United States	98368
538	Harrison HealthPartners Hematology and Oncology-Poulsbo	Poulsbo	Washington	United States	98370
539	Valley Medical Center	Renton	Washington	United States	98055
540	Pacific Gynecology Specialists	Seattle	Washington	United States	98104
541	Swedish Medical Center-Ballard Campus	Seattle	Washington	United States	98107
542	Swedish Medical Center-First Hill	Seattle	Washington	United States	98122-4307
543	Swedish Medical Center-Cherry Hill	Seattle	Washington	United States	98122-5711
544	PeaceHealth United General Medical Center	Sedro-Woolley	Washington	United States	98284
545	Providence Regional Cancer System-Shelton	Shelton	Washington	United States	98584
546	Franciscan Research Center-Northwest Medical Plaza	Tacoma	Washington	United States	98405
547	Northwest Medical Specialties PLLC	Tacoma	Washington	United States	98405
548	PeaceHealth Southwest Medical Center	Vancouver	Washington	United States	98664
549	Providence Saint Mary Regional Cancer Center	Walla Walla	Washington	United States	99362
550	North Star Lodge Cancer Center at Yakima Valley Memorial Hospital	Yakima	Washington	United States	98902
551	Providence Regional Cancer System-Yelm	Yelm	Washington	United States	98597
552	Edwards Comprehensive Cancer Center	Huntington	West Virginia	United States	25701
553	ThedaCare Regional Cancer Center	Appleton	Wisconsin	United States	54911
554	Duluth Clinic Ashland	Ashland	Wisconsin	United States	54806
555	Northwest Wisconsin Cancer Center	Ashland	Wisconsin	United States	54806
556	Aurora Cancer Care-Southern Lakes VLCC	Burlington	Wisconsin	United States	53105
557	Marshfield Clinic-Chippewa Center	Chippewa Falls	Wisconsin	United States	54729
558	Aurora Saint Luke's South Shore	Cudahy	Wisconsin	United States	53110
559	Marshfield Medical Center-EC Cancer Center	Eau Claire	Wisconsin	United States	54701
560	Aurora Health Care Germantown Health Center	Germantown	Wisconsin	United States	53022
561	Aurora Cancer Care-Grafton	Grafton	Wisconsin	United States	53024
562	Aurora BayCare Medical Center	Green Bay	Wisconsin	United States	54311
563	Essentia Health-Hayward Clinic	Hayward	Wisconsin	United States	54843
564	Aurora Cancer Care-Kenosha South	Kenosha	Wisconsin	United States	53142
565	Gundersen Lutheran Medical Center	La Crosse	Wisconsin	United States	54601
566	Marshfield Clinic - Ladysmith Center	Ladysmith	Wisconsin	United States	54848
567	Aurora Bay Area Medical Group-Marinette	Marinette	Wisconsin	United States	54143
568	Marshfield Medical Center-Marshfield	Marshfield	Wisconsin	United States	54449
569	Aurora Cancer Care-Milwaukee	Milwaukee	Wisconsin	United States	53209
570	Aurora Saint Luke's Medical Center	Milwaukee	Wisconsin	United States	53215
571	Aurora Sinai Medical Center	Milwaukee	Wisconsin	United States	53233
572	Marshfield Clinic-Minocqua Center	Minocqua	Wisconsin	United States	54548
573	ProHealth D N Greenwald Center	Mukwonago	Wisconsin	United States	53149
574	Cancer Center of Western Wisconsin	New Richmond	Wisconsin	United States	54017
575	ProHealth Oconomowoc Memorial Hospital	Oconomowoc	Wisconsin	United States	53066
576	Vince Lombardi Cancer Clinic - Oshkosh	Oshkosh	Wisconsin	United States	54904
577	Aurora Cancer Care-Racine	Racine	Wisconsin	United States	53406
578	Marshfield Medical Center-Rice Lake	Rice Lake	Wisconsin	United States	54868
579	Vince Lombardi Cancer Clinic-Sheboygan	Sheboygan	Wisconsin	United States	53081
580	Essentia Health-Spooner Clinic	Spooner	Wisconsin	United States	54801
581	Marshfield Medical Center-River Region at Stevens Point	Stevens Point	Wisconsin	United States	54482
582	Aurora Medical Center in Summit	Summit	Wisconsin	United States	53066
583	Essentia Health Saint Mary's Hospital - Superior	Superior	Wisconsin	United States	54880
584	Vince Lombardi Cancer Clinic-Two Rivers	Two Rivers	Wisconsin	United States	54241
585	ProHealth Waukesha Memorial Hospital	Waukesha	Wisconsin	United States	53188
586	UW Cancer Center at ProHealth Care	Waukesha	Wisconsin	United States	53188
587	Marshfield Clinic-Wausau Center	Wausau	Wisconsin	United States	54401
588	Aurora Cancer Care-Milwaukee West	Wauwatosa	Wisconsin	United States	53226
589	Marshfield Medical Center - Weston	Weston	Wisconsin	United States	54476
590	Marshfield Clinic - Wisconsin Rapids Center	Wisconsin Rapids	Wisconsin	United States	54494
591	Cheyenne Regional Medical Center-West	Cheyenne	Wyoming	United States	82001
592	Billings Clinic-Cody	Cody	Wyoming	United States	82414
593	Welch Cancer Center	Sheridan	Wyoming	United States	82801

Sponsors and Collaborators

• National Cancer Institute (NCI)

Investigators

• Principal Investigator: Joel W Neal, ECOG-ACRIN Cancer Research Group

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: National Cancer Institute (NCI)
• ClinicalTrials.gov Identifier: NCT04310007
• Other Study ID Numbers: NCI-2020-01541; NCI-2020-01541; EA5191; EA5191; U10CA180820
• First Posted: Mar 17, 2020
• Last Update Posted: Aug 24, 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; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Gemcitabine; Paclitaxel; Docetaxel; Albumin-Bound Paclitaxel; Nivolumab; Ramucirumab; Antineoplastic Agents, Immunological; Antibodies; Immunoglobulins; Antibodies, Monoclonal; Lexatumumab

Study Results

No Results Posted as of Aug 24, 2022