Genomically-Guided Treatment Trial in Brain Metastases

What's the purpose of this trial?

This phase II trial studies how well genetic testing works in guiding treatment for patients with solid tumors that have spread to the brain. Several genes have been found to be altered or mutated in brain metastases such as NTRK, ROS1, CDK or PI3K. Medications that target these genes such as abemaciclib, paxalisib, and entrectinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Genetic testing may help doctors tailor treatment for each mutation.

This trial is currently open and accepting patients.

What will happen during the trial?

You may be able to join this trial if you:

The following criteria is a partial list of reasons why patients may be eligible to participate in this clinical trial. Further evaluation with a medical professional is required.

Inclusion Criteria:

PRE-REGISTRATION ELIGIBILITY CRITERIA (ALL PATIENTS) • Tissue available for biomarker testing (any brain metastasis tissue and extracranial site from any prior resection or biopsy).

REGISTRATION ELIGIBILITY CRITERIA (ALL PATIENTS)

* Participants must have histologically confirmed parenchymal metastatic disease to the brain from any solid tumor. Note: this includes patients that have controlled extracranial disease with progressive intracranial metastasis, as well as patients that have progressive intracranial and extracranial disease.
* New or progressive brain metastases are defined as any one of the following:

* Untreated measurable lesions in patients who have received surgery and/or stereotactic radiosurgery (SRS) to one or more other lesions.
* Progressive measurable lesions after radiation, surgery, or prior systemic therapy
* Residual or progressive lesions after surgery if asymptomatic.
* Patients who have had prior whole-brain radiotherapy (WBRT) and/or SRS and then whose lesions have progressed by BM-RANO criteria or there are new lesions, are eligible. Lesions treated with SRS may be eligible if there is unequivocal evidence of progression. For patients with NTRK or ROS1 mutations, entrectinib may be used for newly diagnosed brain metastases.
* Patients who have not previously been treated with cranial radiation (e.g. WBRT or SRS) are eligible, but such patients must be asymptomatic or neurologically stable from their CNS metastases.
* Measurable CNS disease (=\> 10 mm).
* Ability to obtain magnetic resonance imaging (MRI)s with contrast
* No surgery within 2 weeks prior to or after registration.
* No chemotherapy within 14 days prior to registration (Note: for abemaciclib arm, a 21-day chemotherapy washout is required).

* For melanoma, patients must have progressed after prior immune checkpoint blockade or for BRAF positive melanoma, BRAF/MEK inhibitors.
* For lung cancer, EGFR mutant patients must have failed EGFR therapies
* For HER2-positive breast cancer patients (regardless of ER/PR status), patients must have received at least one prior HER-2 directed therapy in the metastatic setting.
* For triple negative breast cancer (TNBC), patients must have received at least one chemotherapy in the metastatic setting.
* For estrogen receptor (ER) and/or progesterone receptor (PR)+ HER2-negative breast cancer, patients must have received at least one endocrine therapy in the metastatic setting.
* Patients who have received prior treatment with any of the targeted treatments on this study are not eligible for that specific treatment arm(s), but could be eligible for other arms (e.g., a patient who has had prior treatment with abemaciclib would not be eligible for the abemaciclib arm, but could be eligible for another arm).
* Presence of clinically actionable alteration in NTRK, ROS1, or CDK pathway or PI3K pathway in both a brain metastasis and extracranial site per central review.
* Not pregnant and not nursing, because this study involves investigational agents whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown. Therefore, for women of childbearing potential only, a negative pregnancy test done =\< 14 days prior to registration is required (Note: for abemaciclib arm, pregnancy test is required =\< 7 days prior to registration).
* No known current diffuse leptomeningeal involvement (diffuse defined as leptomeningeal involvement throughout the CNS axis; if there is documented positive CSF cytology, patient is ineligible).
* Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
* Adequate organ function.
* Absolute neutrophil count (ANC) \>= 1,500/mm\^3.
* Platelet count \>= 100,000/mm\^3.
* Total bilirubin =\< 1.5 x upper limit of normal (ULN) except in patients with Gilbert's disease. Patients with Gilbert's syndrome with a total bilirubin ≤2.0 times ULN and direct bilirubin within normal limits are permitted.
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 2.5 x upper limit of normal (ULN).
* Creatinine =\< 1.5 mg/dL OR calculated (Calc.) creatinine clearance \> 45 mL/min.
* No uncontrolled medical comorbidities per investigator discretion (e.g. interstitial lung disease, severe dyspnea at rest or requiring oxygen therapy, severe renal impairment \[e.g. estimated creatinine clearance \<30ml/min\], history of major surgical resection involving the stomach or small bowel, or preexisting Crohn's disease or ulcerative colitis or a preexisting chronic condition resulting in baseline Grade 2 or higher diarrhea)
* Radiation to symptomatic non-target sites within neural axis is allowed prior to registration without washout (provided there is at least one untreated target lesion for measurement on study and radiation is completed prior to registration).
* Concurrent systemic corticosteroids are allowed if stable dose of dexamethasone for 7 days prior to registration. Baseline doses and changes in steroid dosing will be captured.
* No concurrent administration of anticancer therapies (except for endocrine therapy or continuation of hormonal therapy or trastuzumab in breast cancer patients). No chemotherapy, targeted therapy or immunotherapy within 14 days prior to entering the study (Note: For abemaciclib arm, a 21-day chemotherapy washout is required).
* Chronic concomitant treatment with strong inhibitors of CYP3A4 is not allowed on this study. Patients on strong CYP3A4 inhibitors must discontinue the drug 14 days prior to registration on the study.
* Chronic concomitant treatment with strong CYP3A4 inducers is not allowed. Patients must discontinue the drug 14 days prior to the start of study treatment.

ADDITIONAL REGISTRATION ELIGIBILITY CRITERIA FOR PAXALISIB ARM

* Urine protein to creatinine (UPC) ratio \< 1 or urine protein =\< 1.
* Recent acute myocardial infarction in the last 6 months or current angina pectoris are excluded. Patients with symptomatic bradycardia should have an electrocardiogram at baseline. If QT interval \> 470 msec, the patient is excluded.
* Patients with uncontrolled type I or II diabetes mellitus should be excluded. Uncontrolled diabetes is defined as glycosylated hemoglobin (HbA1c) \> 9% in addition to fasting glucose \> 140 mg/dL on at least 2 occasions within 14 days prior to registration.

ADDITIONAL REGISTRATION ELIGIBILITY CRITERION FOR ENTRECTINIB ARM

• Concurrent use of H2 receptor antagonists, receptor antagonists, proton pump inhibitors (PPIs), and/or antacids are prohibited.

ADDITIONAL REGISTRATION ELIGIBILITY CRITERION FOR ABEMACICLIB ARM

* Hemoglobin \>= g/dL. Patients may receive erythrocyte transfusions to achieve this hemoglobin level at the discretion of the investigator. Initial treatment must not begin earlier than the day after the erythrocyte transfusion.
* Patients who received chemotherapy must have recovered (Common Terminology Criteria for Adverse Events \[CTCAE\] Grade ≤1) from the acute effects of chemotherapy except for residual alopecia or Grade 2 peripheral neuropathy prior to registration. A washout period of at least 21 days is required between last chemotherapy dose and registration (provided the patient did not receive radiotherapy).
* Patients who received adjuvant radiotherapy must have completed and fully recovered from the acute effects of radiotherapy. A washout period of at least 14 days is required between end of radiotherapy and registration.
* Breast cancer patients who have received ribociclib or palbociclib are eligible as long as there is documentation of CDK4/6 pathway alteration on a biopsy or resection at the point of progression post-ribociclib or palbociclib.
* For females of childbearing potential: A female of childbearing potential, must have a negative serum pregnancy test within 7 days prior to registration and agree to use a highly effective contraception method during the treatment period and for 3 weeks following the last dose of abemaciclib. Contraceptive methods may include an intrauterine device \[IUD\] or barrier method. If condoms are used as a barrier method, a spermicidal agent should be added as a double barrier protection. Cases of pregnancy that occur during maternal exposures to abemaciclib should be reported. If a patient or spouse/partner is determined to be pregnant following abemaciclib initiation, she must discontinue treatment immediately. Data on fetal outcome and breast-feeding are to be collected for regulatory reporting and drug safety evaluation.
* Patients with active bacterial infection (requiring intravenous \[IV\] antibiotics at time of initiating study treatment), fungal infection, or detectable viral infection (such as known human immunodeficiency virus positivity or with known active hepatitis B or C \[for example, hepatitis B surface antigen positive\] are excluded. Screening is not required for enrollment.
* Patients with personal history of any of the following conditions: syncope of cardiovascular etiology, ventricular arrhythmia of pathological origin (including, but not limited to, ventricular tachycardia and ventricular fibrillation), or sudden cardiac arrest, are excluded.

Additional Trial Information

Phase 2

Enrollment: 150 patients (estimated)

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Need Help?

Interested in joining or learning more about this trial?

(888) 828-2206

Trial Locations

All Trial Locations

View all clinical trial locations sorted by state.

Alaska

Anchorage Associates in Radiation Medicine

Anchorage, AK

Temporarily Suspended

Anchorage Radiation Therapy Center

Anchorage, AK

Temporarily Suspended

Alaska Breast Care and Surgery LLC

Anchorage, AK

Temporarily Suspended

Alaska Oncology and Hematology LLC

Anchorage, AK

Temporarily Suspended

Alaska Women's Cancer Care

Anchorage, AK

Temporarily Suspended

Anchorage Oncology Centre

Anchorage, AK

Temporarily Suspended

Katmai Oncology Group

Anchorage, AK

Temporarily Suspended

Providence Alaska Medical Center

Anchorage, AK

Temporarily Suspended

Arizona

Cancer Center at St. Joseph's

Phoenix, AZ

Temporarily Suspended

Mayo Clinic (Arizona)

Phoenix, AZ

Open and Accepting

Arkansas

Mercy Hospital Fort Smith

Fort Smith, AR

Temporarily Suspended

CHI St. Vincent Hot Springs Cancer Center

Hot Springs, AR

Temporarily Suspended

California

Dignity Health Mission Hope Cancer Center - Arroyo Grande

Arroyo Grande, CA

Temporarily Suspended

Providence Saint Joseph Medical Center

Burbank, CA

Temporarily Suspended

Epic Care (Dublin)

Dublin, CA

Open and Accepting

Bay Area Breast Surgeons

Emeryville, CA

Open and Accepting

Epic Care (Emeryville)

Emeryville, CA

Open and Accepting

Moores Cancer Center University of California UC San Diego Health

La Jolla, CA

Open and Accepting

Contra Costa Regional Medical Center

Martinez, CA

Open and Accepting

Sutter Health Alta Bates Summit Medical Center

Oakland, CA

Temporarily Suspended

Bay Area Tumor Institute

Oakland, CA

Temporarily Suspended

Chao Family Comprehensive Cancer Center University of California, Irvine

Orange, CA

Open and Accepting

Sharp Memorial Hospital (Amtower Cancer Institute)

San Diego, CA

Temporarily Suspended

SLO Oncology & Hematology Health Center Pacific Central Coast Health Center

San Luis Obispo, CA

Temporarily Suspended

Mission Hope Cancer Center (Santa Maria) Central Coast Medical Oncology

Santa Maria, CA

Temporarily Suspended

Epic Care Cyberknife Center

Walnut Creek, CA

Open and Accepting

Colorado

Littleton Adventist Hospital

Centennial, CO

Temporarily Suspended

Centura Penrose Hospital

Colorado Springs, CO

Open and Accepting

Rocky Mountain Cancer Center - Penrose Hospital Colorado Springs

Colorado Springs, CO

Open and Accepting

Porter Adventist Hospital

Denver, CO

Temporarily Suspended

Centura Mercy Hospital

Durango, CO

Temporarily Suspended

Centura Southwest Oncology

Durango, CO

Temporarily Suspended

Centura St. Anthony Hospital

Lakewood, CO

Temporarily Suspended

Centura Longmont United Hospital

Longmont, CO

Temporarily Suspended

Rocky Mountain Cancer Centers (Longmont) Longmont

Longmont, CO

Open and Accepting

Centura Parker Adventist Hospital

Parker, CO

Temporarily Suspended

Saint Mary Corwin Medical Center

Pueblo, CO

Temporarily Suspended

Florida

Lynn Cancer Institute Boca Raton Regional Hospital

Boca Raton, FL

Temporarily Suspended

Sylvester Comprehensive Cancer Center

Coral Springs, FL

Open and Accepting

Sylvester Comprehensive Cancer Center University of Miami

Deerfield Beach, FL

Open and Accepting

Michigan Cancer Research Consortium - Holy Cross Hospital Holy Cross Health, A Member of Trinity Health

Fort Lauderdale, FL

Temporarily Suspended

Mayo Clinic (Jacksonville)

Jacksonville, FL

Open and Accepting

Sylvester Comprehensive Cancer Center (Main) University of Miami Health System

Miami, FL

Open and Accepting

Georgia

Winship Cancer Institute Emory University

Atlanta, GA

Open and Accepting

Idaho

St. Luke's Cancer Institute - Boise

Boise, ID

Temporarily Suspended

Saint Alphonsus Cancer Care Center (Boise)

Boise City, ID

Open and Accepting

Saint Alphonsus Cancer Care Center (Caldwell)

Caldwell, ID

Open and Accepting

Kootenai Clinic Cancer Services - Coeur d'Alene

Coeur d'Alene, ID

Open and Accepting

Walter Knox Memorial Hospital

Emmett, ID

Temporarily Suspended

Saint Luke's Mountain States Tumor Institute (Fruitland)

Fruitland, ID

Temporarily Suspended

St. Luke's Cancer Institute (Meridian)

Meridian, ID

Temporarily Suspended

Idaho Urologic Institute

Meridian, ID

Temporarily Suspended

Saint Luke's Mountain States Tumor Institute (Nampa)

Nampa, ID

Temporarily Suspended

Saint Alphonsus Cancer Care Center (Nampa)

Nampa, ID

Open and Accepting

Kootenai Cancer Center

Post Falls, ID

Open and Accepting

Kootenai Clinic

Sandpoint, ID

Open and Accepting

Saint Luke's Mountain States Tumor Institute (Twin Falls)

Twin Falls, ID

Temporarily Suspended

Illinois

OSF Saint Anthony's Health

Alton, IL

Temporarily Suspended

Rush - Copley Medical Center

Aurora, IL

Temporarily Suspended

Advocate Good Shepherd Hospital

Barrington, IL

Open and Accepting

Robert H. Lurie Comprehensive Cancer Center Northwestern University Feinberg School of Medicine

Chicago, IL

Open and Accepting

University of Illinois at Chicago

Chicago, IL

Open and Accepting

University of Chicago Medicine Comprehensive Cancer Center

Chicago, IL

Not Yet Accepting

Carle Foundation Hospital (Vermilion)

Danville, IL

Open and Accepting

Advocate Good Samaritan Hospital

Downers Grove, IL

Open and Accepting

Carle (Effingham)

Effingham, IL

Open and Accepting

Advocate Sherman Hospital

Elgin, IL

Open and Accepting

Advocate South Suburban Hospital

Hazel Crest, IL

Open and Accepting

Carle Foundation Hospital (Mattoon)

Mattoon, IL

Open and Accepting

Good Samaritan Regional Health Center

Mount Vernon, IL

Temporarily Suspended

Advocate Christ Medical Center

Oak Lawn, IL

Open and Accepting

Carle Cancer Institute

Urbana, IL

Open and Accepting

Rush - Copley Healthcare Center

Yorkville, IL

Temporarily Suspended

Iowa

Holden Comprehensive Cancer Center - University of Iowa University of Iowa Hospitals and Clinics

Iowa City, IA

Open and Accepting

Mary Greeley Medical Center

Ames, IA

Open and Accepting

McFarland Clinic PC

Ames, IA

Open and Accepting

McFarland Clinic PC (Boone)

Boone, IA

Open and Accepting

Saint Anthony Regional Hospital

Carroll, IA

Open and Accepting

Mission Cancer & Blood (Clive) In Clive Cancer Center

Clive, IA

Temporarily Suspended

MercyOne Clive Cancer Center

Clive, IA

Temporarily Suspended

Alegent Health Mercy Hospital

Council Bluffs, IA

Temporarily Suspended

Greater Regional Medical Center

Creston, IA

Temporarily Suspended

UnityPoint Health - Iowa Methodist Medical Center

Des Moines, IA

Open and Accepting

Medical Oncology and Hematology Associates (Des Moines) in UnityPoint Health - John Stoddard Cancer Center

Des Moines, IA

Open and Accepting

Broadlawns Medical Center

Des Moines, IA

Open and Accepting

Mission Cancer MercyOne Cancer Center (Laurel)

Des Moines, IA

Temporarily Suspended

Iowa Lutheran Hospital

Des Moines, IA

Temporarily Suspended

McFarland Clinic Trinity Cancer Center

Fort Dodge, IA

Open and Accepting

UnityPoint Health - Trinity Regional Medical Center

Fort Dodge, IA

Open and Accepting

McFarland Clinic PC (Jefferson)

Jefferson, IA

Open and Accepting

McFarland Clinic PC (Marshalltown)

Marshalltown, IA

Open and Accepting

UnityPoint Health - Methodist West Hospital

West Des Moines, IA

Temporarily Suspended

MercyOne West Des Moines Medical Center

West Des Moines, IA

Temporarily Suspended

Kansas

Central Care Cancer Center (Heartland)

Garden City, KS

Temporarily Suspended

Central Care Cancer Center - Great Bend

Great Bend, KS

Temporarily Suspended

Hays Medical Center

Hays, KS

Open and Accepting

University of Kansas Cancer Center

Kansas City, KS

Open and Accepting

Lawrence Memorial Hospital

Lawrence, KS

Open and Accepting

Olathe Medical Center

Olathe, KS

Open and Accepting

University of Kansas Cancer Center (Indian Creek)

Overland Park, KS

Open and Accepting

University of Kansas Cancer Center (Overland Park)

Overland Park, KS

Open and Accepting

University of Kansas Cancer Center (Westwood)

Westwood, KS

Open and Accepting

Kentucky

Flaget Memorial Hospital

Bardstown, KY

Temporarily Suspended

Commonwealth Cancer Center (Corbin)

Corbin, KY

Temporarily Suspended

Saint Joseph Hospital

Lexington, KY

Temporarily Suspended

Saint Joseph Hospital East

Lexington, KY

Open and Accepting

UK Markey Cancer Center University of Kentucky

Lexington, KY

Temporarily Suspended

Saint Joseph (London)

London, KY

Temporarily Suspended

Jewish Hospital Medical Center Northeast

Louisville, KY

Temporarily Suspended

Saints Mary and Elizabeth Hospital

Louisville, KY

Temporarily Suspended

U of L - Brown Cancer Center University of Louisville Jewish Hospital

Louisville, KY

Temporarily Suspended

Jewish Hospital Medical Center South

Shepherdsville, KY

Temporarily Suspended

Louisiana

Ochsner LSU Health Monroe Medical Center

Monroe, LA

Temporarily Suspended

Massachusetts

Massachusetts General Hospital

Boston, MA

Temporarily Suspended

Dana-Farber Cancer Institute (Main)

Boston, MA

Temporarily Suspended

Mercy Medical Center

Springfield, MA

Temporarily Suspended

University of Massachusetts Medical School

Worcester, MA

Open and Accepting

Michigan

ProMedica Hickman Cancer Center Grace Christman Medical Building

Adrian, MI

Temporarily Suspended

University of Michigan Comprehensive Cancer Center Rogel Cancer Center

Ann Arbor, MI

Open and Accepting

Bronson Battle Creek Cancer Care Center

Battle Creek, MI

Open and Accepting

St. Joseph Mercy Brighton Health Center

Brighton, MI

Open and Accepting

IHA Hematology Oncology at St. Joe's Brighton

Brighton, MI

Open and Accepting

Henry Ford Institute - Brownstown

Brownstown Charter Township, MI

Temporarily Suspended

St. Joseph Mercy Canton Health Center

Canton, MI

Open and Accepting

IHA Hematology Oncology at St. Joe's Canton

Canton, MI

Open and Accepting

Caro Cancer Center

Caro, MI

Temporarily Suspended

Chelsea Hospital Michigan Cancer Research Consortium

Chelsea, MI

Open and Accepting

IHA Hematology Oncology at St. Joe's Chelsea

Chelsea, MI

Open and Accepting

Hematology Oncology Consultants (Clarkston)

Clarkston, MI

Temporarily Suspended

Newland Medical Associates of Clarkston

Clarkston, MI

Temporarily Suspended

Henry Ford Macomb Hospital

Clinton Township, MI

Temporarily Suspended

Henry Ford Medical Center (Fairlane)

Dearborn, MI

Temporarily Suspended

Henry Ford Hospital

Detroit, MI

Open and Accepting

Great Lakes Cancer Management Specialists (Doctors Park)

East China, MI

Open and Accepting

The Cancer & Hematology Centers

Flint, MI

Open and Accepting

Genesys Hurley Cancer Institute

Flint, MI

Open and Accepting

Hurley Medical Center

Flint, MI

Open and Accepting

Helen DeVos Children's Hospital

Grand Rapids, MI

Temporarily Suspended

Spectrum Health

Grand Rapids, MI

Open and Accepting

Mercy Health Saint Mary's

Grand Rapids, MI

Open and Accepting

Van Elslander Cancer Center

Grosse Pointe Woods, MI

Open and Accepting

Academic Hematology Oncology Specialists Ascension St. John Hospital

Grosse Pointe Woods, MI

Open and Accepting

Great Lakes Cancer Management Specialists (Van Elslander Cancer Center) Ascension St. John Hospital

Grosse Pointe Woods, MI

Open and Accepting

Ascension Medical Group Michigan Breast Specialists

Grosse Pointe Woods, MI

Open and Accepting

Allegiance Health

Jackson, MI

Temporarily Suspended

Bronson Methodist Hospital

Kalamazoo, MI

Open and Accepting

West Michigan Cancer Center

Kalamazoo, MI

Open and Accepting

Cancer Research Consortium of West Michigan - Ascension Borgess Cancer Medical Center

Kalamazoo, MI

Open and Accepting

Sparrow Hospital

Lansing, MI

Temporarily Suspended

St. Mary Mercy Hospital St. Joe's Health

Livonia, MI

Temporarily Suspended

Great Lakes Cancer Management Specialists (Macomb Medical Campus)

Macomb, MI

Open and Accepting

Michigan Cancer Research Consortium - Saint Mary's Oncology/Hematology Associates of Marlette

Marlette, MI

Temporarily Suspended

Toledo Clinic Cancer Centers (Monroe)

Monroe, MI

Temporarily Suspended

Trinity Health Muskegon Hospital

Muskegon, MI

Open and Accepting

Lakeland Community Hospital

Niles, MI

Temporarily Suspended

Cancer & Hematology Centers of Western Michigan - Muskegon

Norton Shores, MI

Open and Accepting

Assarian Cancer Center Ascension Providence Hospital

Novi, MI

Open and Accepting

Newland Medical Associates (Pontiac) The Alice Gustafson Center

Pontiac, MI

Temporarily Suspended

St. Joseph Mercy (Oakland)

Pontiac, MI

Temporarily Suspended

Spectrum Health Reed City Hospital

Reed City, MI

Temporarily Suspended

Great Lakes Cancer Management Specialists (Rochester Hills)

Rochester Hills, MI

Temporarily Suspended

Michigan Cancer Specialists

Roseville, MI

Temporarily Suspended

Ascension St. Mary's Hospital

Saginaw, MI

Open and Accepting

Oncology Hematology Associates of Saginaw Valley PC

Saginaw, MI

Open and Accepting

Henry Ford Macomb Health Center (Shelby Township)

Shelby, MI

Temporarily Suspended

Ascension Providence Hospital (Southfield) St. John Newland Medical Associates

Southfield, MI

Open and Accepting

Spectrum Health Lakeland Medical Center

St. Joseph, MI

Open and Accepting

Spectrum Health Marie Yeager Cancer Center

St. Joseph, MI

Temporarily Suspended

Bhadresh Nayak MD PC - Sterling Heights

Sterling Heights, MI

Open and Accepting

Ascension Saint Joseph Hospital

Tawas City, MI

Open and Accepting

Munson Medical Center

Traverse City, MI

Temporarily Suspended

St. John Macomb Breast Center

Warren, MI

Open and Accepting

Ascension Macomb-Oakland Hospital - Webber Cancer Center

Warren, MI

Open and Accepting

Henry Ford Medical Center (West Bloomfield)

West Bloomfield, MI

Temporarily Suspended

Ascension St. Mary's Hospital Seton Cancer Institute

West Branch, MI

Open and Accepting

Metro Health Hospital

Wyoming, MI

Open and Accepting

Trinity Health Ann Arbor Hospital

Ypsilanti, MI

Open and Accepting

Minnesota

M Health Fairview Ridges Hospital

Burnsville, MN

Temporarily Suspended

Minnesota Oncology - Burnsville

Burnsville, MN

Temporarily Suspended

Cambridge Medical Center

Cambridge, MN

Temporarily Suspended

Mercy Hospital

Coon Rapids, MN

Temporarily Suspended

Fairview Southdale Hospital

Edina, MN

Open and Accepting

Unity Hospital

Fridley, MN

Open and Accepting

Fairview Maple Grove Medical Center

Maple Grove, MN

Temporarily Suspended

Minnesota Oncology Maplewood Cancer Center

Maplewood, MN

Temporarily Suspended

M Health Fairview St. John's Hospital

Maplewood, MN

Temporarily Suspended

Abbott-Northwestern Hospital Allina Health Cancer Institute

Minneapolis, MN

Temporarily Suspended

Hennepin County Medical Center

Minneapolis, MN

Open and Accepting

Health Partners Inc.

Minneapolis, MN

Temporarily Suspended

Monticello Cancer Center

Monticello, MN

Temporarily Suspended

New Ulm Medical Center

New Ulm, MN

Temporarily Suspended

Fairview Northland Medical Center

Princeton, MN

Temporarily Suspended

North Memorial Medical Health Center

Robbinsdale, MN

Temporarily Suspended

Mayo Clinic (Rochester)

Rochester, MN

Open and Accepting

Saint Francis Regional Medical Center

Shakopee, MN

Temporarily Suspended

Park Nicollet Specialty Center at Methodist Hospital

St. Louis Park, MN

Temporarily Suspended

Regions Hospital

St. Paul, MN

Temporarily Suspended

United Hospital

St. Paul, MN

Temporarily Suspended

Lakeview Hospital

Stillwater, MN

Temporarily Suspended

Ridgeview Medical Center

Waconia, MN

Temporarily Suspended

Rice Memorial Hospital

Willmar, MN

Temporarily Suspended

Minnesota Oncology and Hematology PA (Woodbury)

Woodbury, MN

Temporarily Suspended

Fairview Lakes Medical Center

Wyoming, MN

Temporarily Suspended

Mississippi

University of Mississippi Medical Center

Jackson, MS

Open and Accepting

Missouri

Saint Louis Cancer and Breast Institute

Ballwin, MO

Temporarily Suspended

Central Care Cancer Center

Bolivar, MO

Temporarily Suspended

CoxHealth Cancer Center

Branson, MO

Temporarily Suspended

Freeman Cornell-Beshore Cancer Institute

Joplin, MO

Temporarily Suspended

Mercy Hospital Joplin

Joplin, MO

Temporarily Suspended

Kansas City Cancer Centers (North)

Kansas City, MO

Open and Accepting

Kansas City Cancer Center (Lee's Summit)

Lees Summit, MO

Open and Accepting

Phelps Health Hospital Delbert Day Cancer Institute

Rolla, MO

Temporarily Suspended

Mercy Clinic Cancer and Hematology (Rolla)

Rolla, MO

Temporarily Suspended

Mercy Hospital Springfield

Springfield, MO

Temporarily Suspended

CoxHealth South Hospital Cox Medical Center South

Springfield, MO

Temporarily Suspended

Heartland Regional Medical Center

St. Joseph, MO

Temporarily Suspended

Saint Louis Cancer and Breast Institute (South City)

St. Louis, MO

Temporarily Suspended

Mercy Hospital South

St. Louis, MO

Temporarily Suspended

Mercy Hospital St. Louis David C. Pratt Cancer Center

St. Louis, MO

Temporarily Suspended

Mercy Hospital Washington

Washington, MO

Temporarily Suspended

Montana

Community Hospital of Anaconda

Anaconda, MT

Open and Accepting

Billings Clinic Cancer Center

Billings, MT

Open and Accepting

Bozeman Deaconess Hospital

Bozeman, MT

Open and Accepting

Benefis Sletten Cancer Institute

Great Falls, MT

Open and Accepting

Great Falls Clinic Specialty Center

Great Falls, MT

Temporarily Suspended

Kalispell Regional Medical Center

Kalispell, MT

Open and Accepting

Providence St. Patrick Hospital

Missoula, MT

Open and Accepting

Community Medical Hospital

Missoula, MT

Open and Accepting

Nebraska

CHI Health St. Francis

Grand Island, NE

Temporarily Suspended

CHI Health Good Samaritan Hospital

Kearney, NE

Open and Accepting

CHI Health St. Elizabeth St. Elizabeth Regional Medical Center

Lincoln, NE

Temporarily Suspended

CHI Health Immanuel Medical Center

Omaha, NE

Temporarily Suspended

CHI Henry Lynch Cancer Center at CUMC Bergan

Omaha, NE

Temporarily Suspended

CHI Health Lakeside Hospital

Omaha, NE

Temporarily Suspended

CHI Health Creighton University Medical Center

Omaha, NE

Temporarily Suspended

CHI Health Midlands

Papillion, NE

Temporarily Suspended

New Jersey

Morristown Medical Center Atlantic Health System

Morristown, NJ

Temporarily Suspended

Capital Health Medical Center (Hopewell)

Pennington, NJ

Temporarily Suspended

Overlook Hospital

Summit, NJ

Open and Accepting

New York

NewYork-Presbyterian Brooklyn Methodist Hospital

Brooklyn, NY

Temporarily Suspended

C.R. Wood Cancer Center Glen Falls Hospital

Glens Falls, NY

Temporarily Suspended

University of Rochester Medical Center Wilmot Cancer Center Strong Memorial Hospital

Rochester, NY

Open and Accepting

North Carolina

UNC Lineberger Comprehensive Cancer Center University of North Carolina

Chapel Hill, NC

Temporarily Suspended

Duke Cancer Center Duke University Medical Center

Durham, NC

Open and Accepting

Margaret R. Pardee Memorial Hospital

Hendersonville, NC

Open and Accepting

Vidant Oncology (Kenansville)

Kenansville, NC

Open and Accepting

Vidant Oncology - Kinston

Kinston, NC

Open and Accepting

Vidant Oncology (Richlands)

Richlands, NC

Open and Accepting

Ohio

UH Minoff Health Center (Chagrin Highlands)

Beachwood, OH

Open and Accepting

Geaugra Hospital

Chardon, OH

Open and Accepting

TriHealth Cancer Institute (Good Samaritan Hospital)

Cincinnati, OH

Temporarily Suspended

TriHealth Bethesda North Hospital

Cincinnati, OH

Temporarily Suspended

Case Western Reserve University

Cleveland, OH

Open and Accepting

Miami Valley Hospital

Dayton, OH

Open and Accepting

Miami Valley Hospital North Premier Health

Dayton, OH

Open and Accepting

Dayton Physicians, LLC Miami Valley Hospital South

Dayton, OH

Open and Accepting

TriHealth Cancer Institute (Anderson)

Forestville, OH

Temporarily Suspended

Dayton Physicians (Atrium Medical Center)

Franklin, OH

Open and Accepting

UH Seidman Cancer Center (Lake Health)

Mentor, OH

Open and Accepting

UH Seidman Cancer Center at Southwest General Hospital

Middleburg Heights, OH

Open and Accepting

University Hospitals - Parma Medical Center

Parma, OH

Open and Accepting

Mercy Health Perrysburg Cancer Center

Perrysburg, OH

Temporarily Suspended

UH Portage Medical Center

Ravenna, OH

Open and Accepting

UH Seidman Cancer Center at Firelands Regional Medical Center

Sandusky, OH

Open and Accepting

Mercy Health - St. Anne Hospital

Toledo, OH

Temporarily Suspended

Toledo Clinic Cancer Centers - Toledo

Toledo, OH

Open and Accepting

Dayton Physicians - Upper Valley Medical Center

Troy, OH

Open and Accepting

UH Sharon Health Center

Wadsworth, OH

Open and Accepting

UH Seidman Cancer Center - St. John Medical Center

Westlake, OH

Open and Accepting

TriHealth Cancer Institute (Westside)

White Oak, OH

Temporarily Suspended

Oklahoma

University of Oklahoma Health Sciences Center

Oklahoma City, OK

Open and Accepting

Mercy Hospital Oklahoma City

Oklahoma City, OK

Temporarily Suspended

Oregon

Saint Alphonsus Medical Center (Baker City)

Baker City, OR

Temporarily Suspended

St. Charles (Bend Campus)

Bend, OR

Temporarily Suspended

Clackamas Radiation Oncology Center

Clackamas, OR

Temporarily Suspended

Providence Cancer Institute Clackamas Clinic

Clackamas, OR

Open and Accepting

Bay Area Hospital

Coos Bay, OR

Temporarily Suspended

Providence Newberg Medical Center

Newberg, OR

Open and Accepting

Saint Alphonsus Medical Center (Ontario)

Ontario, OR

Open and Accepting

Providence Willamette Falls Medical Center

Oregon City, OR

Open and Accepting

Providence Oncology and Hematology - Eastside Providence Cancer Institute Franz Clinic

Portland, OR

Open and Accepting

Providence Oncology and Hematology - Westside Providence St. Vincent Medical Center

Portland, OR

Open and Accepting

Saint Charles Health System (Redmond)

Redmond, OR

Temporarily Suspended

Pennsylvania

Lehigh Valley Health Network Cancer Institute

Allentown, PA

Open and Accepting

Saint Luke's Cancer Center (Allentown)

Allentown, PA

Open and Accepting

St. Luke's University Health Network (Bethlehem) Bethlehem Campus

Bethlehem, PA

Open and Accepting

Lehigh Valley Hospital - Muhlenberg

Bethlehem, PA

Open and Accepting

Pocono Medical Center

East Stroudsburg, PA

Temporarily Suspended

Saint Luke's Cancer Center (Anderson)

Easton, PA

Open and Accepting

Lehigh Valley Hospital - Hazleton

Hazleton, PA

Temporarily Suspended

Saint Luke's Hospital (Quakertown)

Quakertown, PA

Temporarily Suspended

Texas

St. Joseph Regional Cancer Center

Bryan, TX

Temporarily Suspended

Parkland Memorial Hospital

Dallas, TX

Open and Accepting

The University of Texas Southwestern Medical Center Harold C. Simmons Comprehensive Cancer Center

Dallas, TX

Temporarily Suspended

Texas Oncology - The Woodlands

The Woodlands, TX

Temporarily Suspended

Utah

Huntsman Cancer Institute University of Utah

Salt Lake City, UT

Open and Accepting

Virginia

Bon Secours St. Francis Medical Center

Midlothian, VA

Open and Accepting

Bon Secours Cancer Institute (Reynold's Crossing)

Richmond, VA

Open and Accepting

Washington

Providence Regional Cancer System (Aberdeen)

Aberdeen, WA

Temporarily Suspended

PeaceHealth Medical Group

Bellingham, WA

Temporarily Suspended

St. Michael - Harrison Medical Center

Bremerton, WA

Temporarily Suspended

Highline Medical Center (Main Campus)

Burien, WA

Temporarily Suspended

Providence Regional Cancer System (Centralia)

Centralia, WA

Temporarily Suspended

Swedish Cancer Institute Swedish Edmonds Campus

Edmonds, WA

Temporarily Suspended

Saint Elizabeth Hospital

Enumclaw, WA

Temporarily Suspended

Providence Everett Medical Center

Everett, WA

Temporarily Suspended

Saint Francis Hospital

Federal Way, WA

Temporarily Suspended

Swedish Cancer Institute

Issaquah, WA

Temporarily Suspended

Kadlec Clinic Hematology and Oncology

Kennewick, WA

Open and Accepting

Providence Regional Cancer System (Lacey)

Lacey, WA

Temporarily Suspended

Saint Clare Hospital - CHI Franciscan Health

Lakewood, WA

Temporarily Suspended

Saint John Medical Center

Longview, WA

Temporarily Suspended

Swedish Medical Center (Ballard Campus)

Seattle, WA

Temporarily Suspended

Swedish Cancer Institute - Cherry Hill Campus

Seattle, WA

Temporarily Suspended

Swedish - First Hill Campus

Seattle, WA

Temporarily Suspended

PeaceHealth United General Medical Center

Sedro-Woolley, WA

Temporarily Suspended

Providence Regional Cancer System (Shelton)

Shelton, WA

Temporarily Suspended

Virginia Mason Franciscan Health Research Center (Tacoma) CHI Franciscan

Tacoma, WA

Temporarily Suspended

Northwest Medical Specialties (Tacoma) NWMS Tacoma — Medical Oncology & Infectious Diseases

Tacoma, WA

Temporarily Suspended

PeaceHealth Southwest Medical Center

Vancouver, WA

Open and Accepting

Providence St. Mary Regional Cancer Center

Walla Walla, WA

Temporarily Suspended

Providence Regional Cancer System (Yelm)

Yelm, WA

Temporarily Suspended

Wisconsin

Medical College of Wisconsin Froedtert Hospital

Milwaukee, WI

Open and Accepting

Aurora Cancer Care - Burlington

Burlington, WI

Open and Accepting

Aurora Saint Luke's South Shore

Cudahy, WI

Temporarily Suspended

Aurora Health Care - Germantown Health Center - Advocate Aurora Healthcare

Germantown, WI

Open and Accepting

Aurora Cancer Care (Grafton)

Grafton, WI

Open and Accepting

Aurora BayCare Medical Center

Green Bay, WI

Open and Accepting

Aurora Cancer Care - Kenosha South

Kenosha, WI

Open and Accepting

Aurora Cancer Care (Marinette) Aurora Health

Marinette, WI

Open and Accepting

Aurora Cancer Care

Milwaukee, WI

Open and Accepting

Aurora St. Luke's Medical Center

Milwaukee, WI

Open and Accepting

Aurora Sinai Medical Center - Advocate Aurora Healthcare

Milwaukee, WI

Open and Accepting

Aurora Cancer Care - Racine

Mount Pleasant, WI

Open and Accepting

D. N. Greenwald Center

Mukwonago, WI

Open and Accepting

Cancer Center of Western Wisconsin

New Richmond, WI

Temporarily Suspended

ProHealth Oconomowoc Memorial Hospital

Oconomowoc, WI

Open and Accepting

Vince Lombardi Cancer Clinic (Summit) Aurora Health

Oconomowoc, WI

Open and Accepting

Vince Lombardi Cancer Clinic - Oshkosh

Oshkosh, WI

Open and Accepting

Vince Lombardi Cancer Clinic - Sheboygan

Sheboygan, WI

Open and Accepting

Vince Lombardi Cancer Clinic

Two Rivers, WI

Open and Accepting

UW Cancer Center at ProHealth Care

Waukesha, WI

Open and Accepting

Aurora Cancer Care - Milwaukee West - Advocate Aurora Healthcare

Wauwatosa, WI

Open and Accepting

Aurora West Allis Medical Center

West Allis, WI

Open and Accepting

Wyoming

Billings Clinic (Cody)

Cody, WY

Temporarily Suspended

Welch Cancer Center

Sheridan, WY

Temporarily Suspended
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