NADIR: Niraparib With Standard Combination Radiation Therapy and Androgen Deprivation Therapy in Treating Patients With High Risk Prostate Cancer
Study Details
Study Description
Brief Summary
This phase II trial studies the side effects and best dose of niraparib, and to see how well it works in combination with standard of care radiation therapy and hormonal therapy (androgen deprivation therapy) in treating patients with prostate cancer that has a high chance of coming back (high risk). Niraparib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Adding niraparib to the usual treatments of radiation therapy and hormonal therapy may lower the chance of prostate cancer growing or returning.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 2 |
Detailed Description
PRIMARY OBJECTIVES:
- To establish the preferred dose of niraparib in combination with radiation and antiandrogen therapy (ADT). (Phase I) II. To compare the disease-free state, defined as PSA remaining < 0.1 ng/ml at the end of ADT therapy in men with high risk prostate cancer treated with standard therapy with or without the addition of niraparib. (Phase IIR)
SECONDARY OBJECTIVES:
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To further establish the safety and toxicity profile of standard treatment with radiation and androgen deprivation therapy specifically, two years from initiation of ADT, plus niraparib at the phase II dose.
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To compare the overall survival, prostate cancer-specific survival, local/regional or distant progression, and distant metastatic disease rates of standard therapy with or without the addition of niraparib.
EXPLORATORY OBJECTIVES:
- To identify genomic biomarkers of response to combination therapy with radiation, ADT and PARP inhibition.
OUTLINE: This is a phase I, dose-escalation study of niraparib, followed by a phase II study.
PHASE I: Patients receive niraparib orally (PO) once daily (QD) and receive standard of care gonadotrophin releasing hormone (GnRH) agonist androgen suppression therapy. Treatment with niraparib continues for 12 months, and GnRH agonist therapy for 24 months in the absence of disease progression or unacceptable toxicity. Beginning 8 weeks after starting niraparib and GnRH agonist, patients undergo standard of care intensity-modulated radiation therapy (IMRT) 5 days per week for about 6-9 weeks, depending on type of radiation therapy given, in the absence of disease progression or unacceptable toxicity.
PHASE II: Patients are randomized to 1 of 2 arms:
ARM I: Patients undergo standard of care GnRH agonist androgen suppression therapy for 24 months in the absence of disease progression or unacceptable toxicity. Beginning 8-28 weeks after starting GnRH agonist, patients undergo IMRT 5 days per week for about 6-9 weeks depending on type of radiation therapy given in the absence of disease progression or unacceptable toxicity.
ARM II: Patients undergo standard of care GnRH agonist androgen suppression therapy for 24 months, and niraparib PO QD for 12 months in the absence of disease progression or unacceptable toxicity. Beginning 8 weeks after starting niraparib, patients undergo standard of care IMRT 5 days per week for about 6-9 weeks depending on type of radiation therapy given in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 6 months for 3 years, then annually for 3 years.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Phase I (niraparib, GnRH, IMRT) Patients receive niraparib PO QD and receive standard of care GnRH agonist androgen suppression therapy. Treatment with niraparib continues for 12 months, and GnRH agonist therapy for 24 months in the absence of disease progression or unacceptable toxicity. Beginning 8 weeks after starting niraparib and GnRH agonist, patients undergo standard of care IMRT 5 days per week for about 6-9 weeks, depending on type of radiation therapy given, in the absence of disease progression or unacceptable toxicity. |
Biological: Gonadotrophin Releasing Hormone
Receive standard of care GnRH agonist androgen suppression therapy
Other Names:
Radiation: Intensity-Modulated Radiation Therapy
Undergo standard of care IMRT
Other Names:
Drug: Niraparib
Given PO
Other Names:
|
Active Comparator: Phase II, Arm I (GnRH, IMRT) Patients undergo standard of care GnRH agonist androgen suppression therapy for 24 months in the absence of disease progression or unacceptable toxicity. Beginning 8-28 weeks after starting GnRH agonist, patients undergo IMRT 5 days per week for about 6-9 weeks depending on type of radiation therapy given in the absence of disease progression or unacceptable toxicity. |
Biological: Gonadotrophin Releasing Hormone
Receive standard of care GnRH agonist androgen suppression therapy
Other Names:
Radiation: Intensity-Modulated Radiation Therapy
Undergo standard of care IMRT
Other Names:
|
Experimental: Phase II, Arm II (niraparib, GnRH, IMRT) Patients undergo standard of care GnRH agonist androgen suppression therapy for 24 months, and niraparib PO QD for 12 months in the absence of disease progression or unacceptable toxicity. Beginning 8 weeks after starting niraparib, patients undergo standard of care IMRT 5 days per week for about 6-9 weeks depending on type of radiation therapy given in the absence of disease progression or unacceptable toxicity. |
Biological: Gonadotrophin Releasing Hormone
Receive standard of care GnRH agonist androgen suppression therapy
Other Names:
Radiation: Intensity-Modulated Radiation Therapy
Undergo standard of care IMRT
Other Names:
Drug: Niraparib
Given PO
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Maintenance of disease-free state [Up to 2 years following the start of antiandrogen therapy]
Will be characterized by PSA values sustained below 0.1 ng/ml. A modified intent-to-treat analysis will be conducted. The proportion of patients disease-free at 24 months will be compared in the two treatment arms using a non continuity-corrected chi-square test. As a secondary analysis, a logistic regression model will be fit to adjust for the stratification factors (risk group and type of radiation therapy).
Secondary Outcome Measures
- Overall Survival [From randomization until death from any cause, assessed up to 3 years]
Will consist of comparison of Kaplan-Meier (Kaplan 1958) curves using a logrank test.
- Prostate cancer-specific survival [From randomization until death from prostate cancer, assessed up to 3 years]
Will consist of comparison of Kaplan-Meier (Kaplan 1958) curves using a logrank test.
- Pathologic Complete Response (pCR) [At 24 months]
Will be assessed among patients undergoing 12-core biopsy. Will be compared using a chi-square test.
- Time to local/regional or distant progression [Up to 3 years]
Cumulative incidence curves will be compared using the Fine-Gray test (Dignam 2008).
- Time to distant metastases [From randomization until detection of distant metastatic disease, assessed up to 3 years]
Cumulative incidence curves will be compared using the Fine-Gray test (Dignam 2008).
- Biochemical Progression-Free Survival [Up to 3 years]
Will be defined as PSA >= 2 ng/ml over the nadir PSA, the presence of local, regional, or distant recurrence, or death from prostate cancer. Will consist of comparison of Kaplan-Meier (Kaplan 1958) curves using a logrank test.
- Incidence of Adverse Events (Phase II) [Up to 3 years]
Adverse event (AE) rates in the two treatment arms will be summarized by time of occurrence (early versus late), type, grade, and attribution to treatment. For each type of AE, the worst grade occurring during the early treatment period, late treatment period, or entire treatment period will be determined. For each time period, treatment group comparisons will be conducted using chi-square or Fisher exact tests.
Other Outcome Measures
- Exome sequencing of deoxyribonucleic acid (DNA) repair genes and detected alterations [Up to 3 years]
Descriptive statistics will be generated summarizing the frequency of gene alterations, mutations, and gene expression levels. The percentage of patients with baseline or post-therapy alterations in targeted genes will be reported and the association between the occurrence of reversion mutations in DNA repair genes and clinical outcomes will be assessed using logistic regression models for dichotomous endpoints (disease-free state, pCR), and Cox regression or competing risk regression modeling for time-to-event data.
- Transcription-wide analysis of gene expression [Up to 3 years]
Will be assessed using a high-density Affymetrix oligonucleotide array to profile the transcriptome of tumor samples. Descriptive statistics will be generated summarizing the frequency of gene alterations, mutations, and gene expression levels. The percentage of patients with baseline or post-therapy alterations in targeted genes will be reported and the association between the occurrence of reversion mutations in DNA repair genes and clinical outcomes will be assessed using logistic regression models for dichotomous endpoints (disease-free state, pCR), and Cox regression or competing risk regression modeling for time-to-event data.
- Single nucleotide polymorphisms [Up to 3 years]
Will be analyzed in whole blood samples previously associated with prostate risk. Plasma samples will be assessed for baseline and post-therapy alterations in a targeted gene panel and for reversion mutations in DNA repair genes as early biomarkers of treatment resistance. Descriptive statistics will be generated summarizing the frequency of gene alterations, mutations, and gene expression levels. The percentage of patients with baseline or post-therapy alterations in targeted genes will be reported and the association between the occurrence of reversion mutations in DNA repair genes and clinical outcomes will be assessed using logistic regression models for dichotomous endpoints (disease-free state, pCR), and Cox regression or competing risk regression modeling for time-to-event data.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Histologically confirmed (within 180 days prior to registration) adenocarcinoma of the prostate at high risk for recurrence as determined by the following criteria, according to American Joint Committee on Cancer (AJCC) 8th edition:
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Phase I enrollment
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Gleason >= 9, PSA =< 150 ng/mL, any T-stage
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Phase II enrollment
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Gleason >= 9, PSA =< 150 ng/mL, any T-stage
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Gleason 8, PSA < 20 ng/mL, and >= T2
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Gleason 8, PSA >= 20-150 ng/mL, any T-stage
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Gleason 7, PSA >= 20-150 ng/mL, any T-stage
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No distant metastases as evaluated by:
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Bone scan 90 days prior to registration
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Lymph node assessment by computed tomography (CT) or magnetic resonance (MR) of pelvis or nodal sampling within 90 days prior to registration (Please note: Lymph nodes will be considered negative (N0) if they are < 1.5 cm short axis)
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History/physical examination within 90 days prior to registration
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Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 within 180 days prior to registration
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Pretreatment serum PSA, obtained prior to any androgen suppression therapy and within 180 days of registration
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Phase I patients: Prior androgen suppression for prostate cancer is not allowed prior to registration
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Phase II patients: Prior androgen suppression for prostate cancer is allowed =< 45 days prior to registration
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Hemoglobin >= 9.0 g/dL (within 90 days prior to registration)
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Platelets >= 100,000 cells/mm^3 (within 90 days prior to registration)
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Absolute neutrophil count (ANC) >= 1.5 x 10^9/L (within 90 days prior to registration)
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Serum creatinine =<1.5 x upper limit of normal (ULN) OR a calculated creatinine clearance >= 30 mL/min estimated using Cockcroft-Gault equation (within 90 days prior to registration)
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Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3.0 x ULN (within 90 days prior to registration)
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Serum albumin >= 3 g/dL (within 90 days prior to registration)
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Serum potassium >= 3.5 mg/dL (within 90 days prior to registration)
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Serum total bilirubin =< 1.5 x ULN or direct bilirubin =< 1 x ULN (Note: in subjects with Gilberts syndrome, if total bilirubin is > 1.5 x ULN, measure direct and indirect bilirubin, and if direct bilirubin is =< 1.5 x ULN, subject may be eligible) (within 90 days prior to registration)
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Men of child-producing potential must be willing to consent to use effective contraception while on treatment and for at least 3 months afterwards
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The patient or a legally authorized representative must provide study-specific informed consent prior to study entry
Exclusion Criteria:
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PSA > 150 ng/mL
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Definitive clinical or radiologic evidence of metastatic disease
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Pathologically positive lymph nodes or nodes > 1.5 cm short axis on CT or MR imaging
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Prior radical prostatectomy, cryosurgery for prostate cancer, or bilateral orchiectomy for any reason
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Any active malignancy within 2 years of study registration that may alter the course of prostate cancer treatment.
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Prior systemic therapy for prostate cancer; note that prior therapy for a different cancer is allowable
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Prior radiotherapy, including brachytherapy, to the region of the prostate that would result in overlap of radiation therapy fields
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Current treatment with first generation anti-androgens (bicalutamide, nilutamide, flutamide). For patients enrolled to phase II, if prior anti-androgens were administered, a washout period of >= 30 days is required prior to enrollment
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Severe, active co-morbidity, defined as follows:
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Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
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Transmural myocardial infarction within the last 6 months
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Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
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Uncontrolled acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition
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Presence of uncontrolled hypertension (persistent systolic blood pressure [BP]
=160 mmHg or diastolic BP >= 100 mmHg). Subjects with a history of hypertension are allowed, provided that BP is controlled to within these limits by anti-hypertensive treatment
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Prior allergic reaction to the drugs involved in this protocol (including known allergies, hypersensitivity or intolerance to the excipients of niraparib. Please see Niraparib IB for details.)
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Human immunodeficiency virus (HIV) positive with CD4 count < 200 cells/microliter
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Note that patients who are HIV positive are eligible, provided they have a CD4 count >= 200 cells/microliter within 90 days prior to registration. Patients receiving treatment with highly active antiretroviral therapy (HAART) will not be eligible due to concern for radiosensitization
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Note also that HIV testing is not required for eligibility for this protocol. This exclusion criterion is necessary because the treatments involved in this protocol may be affected by these drugs.
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Any history or current diagnosis of Myelodysplasitc Syndromes (MDS)/ Acute Myeloid Leukemia (AML).
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Prior or current treatment with PARP inhibitor
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Banner MD Anderson Cancer Center | Gilbert | Arizona | United States | 85234 |
2 | University of Arizona Cancer Center-Orange Grove Campus | Tucson | Arizona | United States | 85704 |
3 | University of Arizona Cancer Center-North Campus | Tucson | Arizona | United States | 85719 |
4 | City of Hope Comprehensive Cancer Center | Duarte | California | United States | 91010 |
5 | Cedars Sinai Medical Center | Los Angeles | California | United States | 90048 |
6 | Fremont - Rideout Cancer Center | Marysville | California | United States | 95901 |
7 | University of California Davis Comprehensive Cancer Center | Sacramento | California | United States | 95817 |
8 | City of Hope Upland | Upland | California | United States | 91786 |
9 | George Washington University Medical Center | Washington | District of Columbia | United States | 20037 |
10 | Grady Health System | Atlanta | Georgia | United States | 30303 |
11 | Emory University Hospital/Winship Cancer Institute | Atlanta | Georgia | United States | 30322 |
12 | Emory Saint Joseph's Hospital | Atlanta | Georgia | United States | 30342 |
13 | CTCA at Southeastern Regional Medical Center | Newnan | Georgia | United States | 30265 |
14 | Northwestern University | Chicago | Illinois | United States | 60611 |
15 | Rush University Medical Center | Chicago | Illinois | United States | 60612 |
16 | Carle Cancer Center | Urbana | Illinois | United States | 61801 |
17 | University of Iowa/Holden Comprehensive Cancer Center | Iowa City | Iowa | United States | 52242 |
18 | University of Kansas Cancer Center | Kansas City | Kansas | United States | 66160 |
19 | University of Kansas Cancer Center-Overland Park | Overland Park | Kansas | United States | 66210 |
20 | University of Kansas Hospital-Westwood Cancer Center | Westwood | Kansas | United States | 66205 |
21 | University of Maryland/Greenebaum Cancer Center | Baltimore | Maryland | United States | 21201 |
22 | Central Maryland Radiation Oncology in Howard County | Columbia | Maryland | United States | 21044 |
23 | UM Baltimore Washington Medical Center/Tate Cancer Center | Glen Burnie | Maryland | United States | 21061 |
24 | Massachusetts General Hospital Cancer Center | Boston | Massachusetts | United States | 02114 |
25 | McLaren Cancer Institute-Bay City | Bay City | Michigan | United States | 48706 |
26 | Henry Ford Cancer Institute-Downriver | Brownstown | Michigan | United States | 48183 |
27 | McLaren Cancer Institute-Clarkston | Clarkston | Michigan | United States | 48346 |
28 | Henry Ford Macomb Hospital-Clinton Township | Clinton Township | Michigan | United States | 48038 |
29 | Henry Ford Medical Center-Fairlane | Dearborn | Michigan | United States | 48126 |
30 | Wayne State University/Karmanos Cancer Institute | Detroit | Michigan | United States | 48201 |
31 | Henry Ford Hospital | Detroit | Michigan | United States | 48202 |
32 | Weisberg Cancer Treatment Center | Farmington Hills | Michigan | United States | 48334 |
33 | McLaren Cancer Institute-Flint | Flint | Michigan | United States | 48532 |
34 | Singh and Arora Hematology Oncology PC | Flint | Michigan | United States | 48532 |
35 | Karmanos Cancer Institute at McLaren Greater Lansing | Lansing | Michigan | United States | 48910 |
36 | Mid-Michigan Physicians-Lansing | Lansing | Michigan | United States | 48912 |
37 | McLaren Cancer Institute-Lapeer Region | Lapeer | Michigan | United States | 48446 |
38 | McLaren Cancer Institute-Macomb | Mount Clemens | Michigan | United States | 48043 |
39 | Henry Ford Medical Center-Columbus | Novi | Michigan | United States | 48377 |
40 | McLaren Cancer Institute-Northern Michigan | Petoskey | Michigan | United States | 49770 |
41 | McLaren-Port Huron | Port Huron | Michigan | United States | 48060 |
42 | Henry Ford Macomb Health Center - Shelby Township | Shelby | Michigan | United States | 48315 |
43 | Henry Ford West Bloomfield Hospital | West Bloomfield | Michigan | United States | 48322 |
44 | University of Mississippi Medical Center | Jackson | Mississippi | United States | 39216 |
45 | Siteman Cancer Center at West County Hospital | Creve Coeur | Missouri | United States | 63141 |
46 | University of Kansas Cancer Center - North | Kansas City | Missouri | United States | 64154 |
47 | University of Kansas Cancer Center - Lee's Summit | Lee's Summit | Missouri | United States | 64064 |
48 | Washington University School of Medicine | Saint Louis | Missouri | United States | 63110 |
49 | Siteman Cancer Center-South County | Saint Louis | Missouri | United States | 63129 |
50 | Siteman Cancer Center at Saint Peters Hospital | Saint Peters | Missouri | United States | 63376 |
51 | Benefis Healthcare- Sletten Cancer Institute | Great Falls | Montana | United States | 59405 |
52 | AtlantiCare Health Park-Cape May Court House | Cape May Court House | New Jersey | United States | 08210 |
53 | AtlantiCare Surgery Center | Egg Harbor Township | New Jersey | United States | 08234 |
54 | Rutgers New Jersey Medical School | Newark | New Jersey | United States | 07101 |
55 | Holy Name Hospital | Teaneck | New Jersey | United States | 07666 |
56 | Roswell Park Cancer Institute | Buffalo | New York | United States | 14263 |
57 | The New York Hospital Medical Center of Queens | Flushing | New York | United States | 11355 |
58 | Highland Hospital | Rochester | New York | United States | 14620 |
59 | University of Rochester | Rochester | New York | United States | 14642 |
60 | Stony Brook University Medical Center | Stony Brook | New York | United States | 11794 |
61 | Summa Health System - Akron Campus | Akron | Ohio | United States | 44304 |
62 | Summa Health System - Barberton Campus | Barberton | Ohio | United States | 44203 |
63 | University of Cincinnati Cancer Center-UC Medical Center | Cincinnati | Ohio | United States | 45219 |
64 | Case Western Reserve University | Cleveland | Ohio | United States | 44106 |
65 | University of Cincinnati Cancer Center-West Chester | West Chester | Ohio | United States | 45069 |
66 | University of Oklahoma Health Sciences Center | Oklahoma City | Oklahoma | United States | 73104 |
67 | Geisinger Medical Center | Danville | Pennsylvania | United States | 17822 |
68 | Geisinger Medical Oncology-Lewisburg | Lewisburg | Pennsylvania | United States | 17837 |
69 | Lewistown Hospital | Lewistown | Pennsylvania | United States | 17044 |
70 | Eastern Regional Medical Center | Philadelphia | Pennsylvania | United States | 19124 |
71 | UPMC-Shadyside Hospital | Pittsburgh | Pennsylvania | United States | 15232 |
72 | Geisinger Wyoming Valley/Henry Cancer Center | Wilkes-Barre | Pennsylvania | United States | 18711 |
73 | Medical University of South Carolina | Charleston | South Carolina | United States | 29425 |
74 | Prisma Health Cancer Institute - Faris | Greenville | South Carolina | United States | 29605 |
75 | Saint Francis Cancer Center | Greenville | South Carolina | United States | 29607 |
76 | Prisma Health Cancer Institute - Eastside | Greenville | South Carolina | United States | 29615 |
77 | Self Regional Healthcare | Greenwood | South Carolina | United States | 29646 |
78 | Prisma Health Cancer Institute - Greer | Greer | South Carolina | United States | 29650 |
79 | Prisma Health Cancer Institute - Seneca | Seneca | South Carolina | United States | 29672 |
80 | West Virginia University Healthcare | Morgantown | West Virginia | United States | 26506 |
81 | Froedtert Menomonee Falls Hospital | Menomonee Falls | Wisconsin | United States | 53051 |
82 | Medical College of Wisconsin | Milwaukee | Wisconsin | United States | 53226 |
83 | Zablocki Veterans Administration Medical Center | Milwaukee | Wisconsin | United States | 53295 |
84 | Drexel Town Square Health Center | Oak Creek | Wisconsin | United States | 53154 |
85 | ProHealth Oconomowoc Memorial Hospital | Oconomowoc | Wisconsin | United States | 53066 |
86 | UW Cancer Center at ProHealth Care | Waukesha | Wisconsin | United States | 53188 |
87 | Froedtert West Bend Hospital/Kraemer Cancer Center | West Bend | Wisconsin | United States | 53095 |
Sponsors and Collaborators
- NRG Oncology
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: M. D Michaelson, NRG Oncology
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- NRG-GU007
- NCI-2019-02260
- NRG-GU007
- NRG-GU007
- U10CA180868