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BRIEF TITLE: Bladder-SparIng Chemoradiation With MEDI4736 (Durvalumab) in Clinical Stage 3, Node PosItive Bladder Cancer (INSPIRE)

Phase 2 Study of Bladder-SparIng Chemoradiation With MEDI4736 (Durvalumab) in Clinical Stage 3, Node PosItive Bladder Cancer (INSPIRE)


  • Org Study ID: NCI-2019-08628
  • Secondary ID: NCI-2019-08628,EA8185,EA8185,U10CA180820
  • NCT ID: NCT04216290
  • NCT Alias:
  • Sponsor: National Cancer Institute (NCI) - NIH
  • Source: National Cancer Institute (NCI)

Brief Summary

This phase II trial studies how well chemotherapy and radiation therapy alone works compared to chemotherapy and radiation therapy plus MEDI4736 (durvalumab) immunotherapy in treating bladder cancer which has spread to the lymph nodes. Drugs used in standard chemotherapy 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. Radiation therapy uses high-energy x-rays to kill tumor cells and shrink tumors. Immunotherapy with durvalumab may induce changes in body's immune system and may interfere with the ability of tumor cells to grow and spread. Giving chemotherapy and radiation therapy with the addition of durvalumab may work better in helping tumors respond to treatment compared to chemotherapy and radiation therapy alone.

Detailed Description


PRIMARY OBJECTIVE:

I. To compare the clinical complete response rate (cCR) after chemoradiotherapy (chemoRT)
with or without MEDI4736 (durvalumab) in node-positive bladder cancer patients.

SECONDARY OBJECTIVES:

I. To compare the toxicity profile in both arms using the Common Terminology Criteria for
Adverse Events (CTCAE).

II. To estimate the progression-free survival (PFS) in both arms. III. To estimate overall
survival (OS) post randomization in both arms. IV. To estimate the bladder intact event free
survival (BIEFS) in both arms. V. To estimate the metastasis free survival (MFS) in both
arms. VI. To estimate bladder cancer specific survival in both arms. VII. To estimate the
complete clinical response duration in both arms. VIII. To estimate salvage cystectomy rates
in both arms.

EXPLORATORY OBJECTIVE:

I. Planned subgroup analyses for clinical outcome (clinical complete response [CR] rate post
chemoRT+/- MEDI4736 [durvalumab], MFS, OS, PFS) based on stratification factors.

TRANSLATIONAL OBJECTIVE:

I. To collect specimens- urine, blood, stool and tissue, at pre- and post-treatment, at 6
months and 12 months' time from completing chemoRT+/- MEDI4736 (durvalumab) to determine
predictive or prognostic markers.

OUTLINE:

STEP 1 - REGISTRATION: Patients are assigned to 1 of 2 arms.

ARM A: Patients registered after completion of >= 3 cycles of induction chemotherapy proceed
to Step 2 - Randomization.

ARM B: Chemotherapy naive patients receive 1 of 4 chemotherapy regimens: gemcitabine
hydrochloride intravenously (IV) over 30-60 minutes on days 1 and 8 every 21 days for 3
cycles; carboplatin IV over 30-60 minutes and gemcitabine hydrochloride IV over 30-60 minutes
on days 1 and 8 every 21 days for 3 cycles; gemcitabine hydrochloride IV over 30-60 minutes
on days 1 and 8 and cisplatin IV 30-60 minutes on day 1 every 21 days for 3 cycles; or
methotrexate IV over 3 minutes, vinblastine sulfate IV over 3 minutes, doxorubicin
hydrochloride IV over 5 minutes, and cisplatin IV over 30-60 minutes on day 1 every 14 days
for 3 cycles. Cycles repeat in the absence of disease progression or unacceptable toxicity.

STEP 2 - RANDOMIZATION: Patients are randomized to 1 of 2 arms.

ARM C: Patients undergo radiation therapy for 6-8 weeks. Beginning 4 days before or after
starting radiation therapy, patients receive durvalumab IV over 60 minutes on day 1. Cycles
repeat every 21 days for 3 cycles in the absence of disease progression or unacceptable
toxicity. Beginning 4 days before or after starting radiation therapy, patients also receive
gemcitabine hydrochloride IV over 30-60 minutes twice weekly for 6 weeks; cisplatin IV over
30-60 minutes for 6 weeks; or mitomycin IV over 30 minutes on day 1 of radiation and
fluorouracil IV on days 1-5 and 16-20 of radiation in the absence of disease progression or
unacceptable toxicity.

ARM D: Patients undergo radiation therapy for 6-8 weeks. Beginning 4 days before or after
starting radiation therapy, patients also receive gemcitabine hydrochloride IV over 30-60
minutes twice weekly for 6 weeks; cisplatin IV over 30-60 minutes for 6 weeks; or mitomycin
IV over 30 minutes on day 1 of radiation and fluorouracil IV on days 1-5 and 16-20 of
radiation in the absence of disease progression or unacceptable toxicity.

STEP 3 - REGISTRATION (POST CONCURRENT CHEMORT +/- DURVALUMAB): Patients are assigned to 1 of
2 arms.

ARM E: Patients previously randomized to Arm C (chemoradiation and durvalumab) who achieve
clinical CR or clinical benefit receive durvalumab IV over 60 minutes on day 1. Cycles repeat
every 28 days for 9 cycles in the absence of disease progression or unacceptable toxicity.

ARM F: Patients previously randomized to Arm D who achieve clinical CR or clinical benefit,
or patients previously randomized to Arm C with no clinical CR or clinical benefit undergo
observation.

After completion of study treatment, patients are followed up every 12 weeks for 1 year,
every 6 months for 1 year, and then annually for 1 year.

Overal Status Start Date Phase Study Type
Recruiting August 25, 2020 Phase 2 Interventional

Primary Outcomes:

Primary Outcome 1 - Measure: Clinical complete response (CR)

Primary Outcome 1 - Time Frame: Up to 6 years

Condition:

  • Bladder Urothelial Carcinoma
  • Stage III Bladder Cancer AJCC v8
  • Stage IIIA Bladder Cancer AJCC v8
  • Stage IIIB Bladder Cancer AJCC v8

Eligibility

Criteria:
Inclusion Criteria:

- Step 1 (Registration) Inclusion

- Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status of
0-2 at the time of registration

- Patient must have histologically proven pure or mixed urothelial cancer of the bladder

- NOTE: Small cell carcinoma is excluded, however other variant histologies are
permitted provided a component of urothelial carcinoma is present

- Prior to receiving any induction chemotherapy, patient must have documented
node-positive and non-metastatic disease (any T, N1-2 M0). For non-muscle invasive
disease on transurethral resection of bladder tumor (TURBT), node positive disease
MUST be biopsy proven for patient to be eligible

- Node positivity will be defined by the official interpretation of imaging
studies. Positive lymph nodes must be imaging read with suspicious lymph node
(LN) >= 1.0 cm in short axis to be eligible, with or without biopsy as documented
by a radiologist at the treating center. LN Biopsy is not mandatory but
encouraged if feasible and safe per physician discretion. Patients with a
negative biopsy of nodes determined to be suspicious on imaging are not eligible

- Patients with clinical N3 disease are ineligible

- Induction Chemotherapy Requirements

- For patients registered to this protocol post-completion of induction systemic
chemotherapy:

- Patient must have received at least 3 cycles of induction chemotherapy
(cisplatin-based chemotherapy OR non-cisplatin based chemotherapy) with no
evidence of progressive disease (PD) on post-chemotherapy imaging. The last
dose of chemotherapy must be within 12 weeks of registration

- Patient who have received more than 3 cycles of induction systemic
chemotherapy are also eligible

- Patient must have had a CR, PR or SD to induction chemotherapy on standard
imaging

- NOTE: Patients who have only received 2 cycles of induction
chemotherapy and demonstrated clinical response (complete response [CR]
OR partial response [PR], OR stable disease [SD]) may be considered for
enrollment only after consultation and approval by the study chair
under exceptional circumstances where 3rd cycle cannot be delivered.
Documentation of correspondences with the study chair must be kept on
file. We encourage all patients to get 3 cycles of induction
chemotherapy

- For patients registered to this protocol prior to starting induction systemic
chemotherapy:

- Patient must agree to a planned treatment with 3 cycles of induction
chemotherapy (physician's choice)

- Patient will again be restaged after completion of induction chemotherapy
and prior to randomization to chemoRT +/- MEDI4736 (durvalumab)

- Patient must have a CR, PR or SD to induction chemotherapy on standard
imaging prior to randomization to chemoradiotherapy

- History of previously adequately treated non-muscle invasive bladder cancer (NMIBC)
are not excluded; presence of concomitant active upper tract tumors or urethra tumors
are not allowed. Previously treated urothelial cancer or histological variant at any
site outside of the urinary bladder are allowed, provided they have been
Ta/T1/carcinoma in situ (CIS) and post treatment follow up imaging and endoscopic
evaluation shows no evidence of disease

- Previous exposure to immune checkpoint inhibitor for non-muscle invasive disease is
allowed. If given for NMIBC, the last dose must have been completed > 12 months prior
to registration

- For female patients registered on the study

- Women must not be pregnant or breast-feeding due to the potential harm to an
unborn fetus and possible risk for adverse events in nursing infants with the
treatment regimens being used

- All female of childbearing potential must have a blood test or urine study within
14 days prior to registration to rule out pregnancy

- A female of childbearing potential is defined as any woman, regardless of sexual
orientation or whether they have undergone tubal ligation, who meets the
following criteria: 1) has achieved menarche at some point, 2) has not undergone
a hysterectomy or bilateral oophorectomy; or 3) has not been naturally
postmenopausal (amenorrhea following cancer therapy does not rule out
childbearing potential) for at least 24 consecutive months (i.e., has had menses
at any time in the preceding 24 consecutive months)

- For patients registered prior to induction chemotherapy only:

- Women of childbearing potential and sexually active males must not expect to
conceive or father children by using accepted and effected method(s) of
contraception or by abstaining from sexual intercourse from the time of
registration for the duration of their participation in the study and continue
for at least 3 months after the last dose of protocol treatment

- Leukocytes >= 3,000/mcL (obtained < 14 days prior to registration)

- Absolute neutrophil count >= 1,500/mcL (obtained < 14 days prior to registration)

- Hemoglobin >= 9 g/dL (obtained < 14 days prior to registration)

- Platelets >= 100,000/mcL (obtained < 14 days prior to registration)

- Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) (obtained < 14 days
prior to registration)

- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
=< 2.5 x institutional ULN (obtained < 14 days prior to registration)

- Must have adequate renal function as evidenced by calculated (Cockcroft's formula)
creatinine clearance or 24 hours actual creatinine clearance >= 30mL/min. The
creatinine used to calculate the clearance result must have been obtained within 14
days prior to registration. Actual body weight, not ideal body weight, must be used in
the calculation

- Patients with human immunodeficiency virus (HIV) on effective anti-retroviral therapy
with undetectable viral load within 6 months of registration are eligible for this
trial

- 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 are eligible for this trial. Site is encouraged to discuss
with the chair if needed prior to enrollment

- Patients with known history or current symptoms of cardiac disease, or history of
treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac
function using the New York Heart Association Functional Classification. To be
eligible for this trial, patients should be class 2B or better

- Patient must have a life expectancy of at least 12 weeks, as determined by the
treating physician

- Patient must be willing and able to comply with the protocol for the duration of the
study, including undergoing treatment and scheduled visits and examinations, including
follow-up

- Step 2 (Randomization) Inclusion Criteria

- Patient must have an ECOG performance status of 0-1 at the time of randomization

- Patient must undergo selection of concurrent chemotherapy regimen

- Patient must agree to undergo CT simulation and treatment planning on the day of
randomization. If this is the first case registered at the site, then a pre-treatment
radiation therapy (RT) review will be required and will take up to 3 business days.
The patient cannot start radiation treatment prior to successful completion of this
pre-treatment review. Therefore, careful planning is necessary to meet the deadline of
starting radiation with approximately 3 weeks of randomization and within 12 weeks of
the end of induction chemotherapy. We anticipate that the radiation oncologist should
get at least 3 weeks of time between CT simulation and start of chemoRT

- Chemoradiotherapy should be planned to start up to 12 weeks after the end of induction
chemotherapy, but after imaging and cystoscopic restaging, randomization, and any
pretreatment radiation quality assurance (QA) that is required

- Women must not be pregnant or breast-feeding due to the potential harm to an unborn
fetus and possible risk for adverse events in nursing infants with the treatment
regimens being used

- All females of childbearing potential must have a blood test or urine study
within 14 days prior to registration to rule out pregnancy

- A female of childbearing potential is defined as any woman, regardless of sexual
orientation or whether they have undergone tubal ligation, who meets the
following criteria: 1) has achieved menarche at some point, 2) has not undergone
a hysterectomy or bilateral oophorectomy; or 3) has not been naturally
postmenopausal (amenorrhea following cancer therapy does not rule out
childbearing potential) for at least 24 consecutive months (i.e., has had menses
at any time in the preceding 24 consecutive months)

- Women of childbearing potential and sexually active males must not expect to conceive
or father children by using accepted and effective method(s) of contraception or by
abstaining from sexual intercourse at least one week prior to the start of treatment
and continue for at least 3 months after the last dose of the protocol treatment

- Leukocytes >= 3,000/mcL (obtained < 14 days prior to randomization)

- Absolute neutrophil count >= 1,500/mcL (obtained < 14 days prior to randomization)

- Hemoglobin >= 9 g/dL (obtained < 14 days prior to randomization)

- Platelets >= 100,000/mcL (obtained < 14 days prior to randomization)

- Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) (obtained < 14 days
prior to randomization)

- AST (SGOT)/ALT (SGPT) =< 2.5 x institutional ULN (obtained < 14 days prior to
randomization)

- Must have adequate renal function as evidenced by calculated (Cockcroft's formula)
creatinine clearance or 24 hours actual creatinine clearance >= 30 mL/min. The
creatinine used to calculate the clearance result must have been obtained within 14
days prior to randomization. Actual body weight, not ideal body weight, must be used
in the calculation

- Step 3 (Post chemoRT+/- MEDI4736 [durvalumab], prior to starting adjuvant MEDI4736
[durvalumab] versus [vs.] observation) Inclusion Criteria

- Patient must have evaluation to determine clinical outcome post chemoRT+/- MEDI4736
(durvalumab) with imaging and cystoscopy with biopsy confirmation to ensure no
progression and absence of >= T2 disease in the bladder

- Patient must have achieved either complete clinical response OR have demonstrated
clinical benefit prior to continuing onto adjuvant MEDI4736 (durvalumab)

- Patients who are to go on the adjuvant MEDI4736 (durvalumab) arm must have recovered
to at least grade 2 or less immune related adverse events (AE) prior to starting
treatment except for immune related alopecia, clinically asymptomatic
endocrinopathies. For patients who may have gotten immune related AEs during chemoRT+
MEDI4736 (durvalumab), registration could be delayed up to additional 4 weeks to
ensure recovery to at least grade 2 or lower prior to starting adjuvant therapy.
However patients with MEDI4736 (durvalumab) related AEs that require permanent
discontinuation of MEDI4736 (durvalumab) will not continue on the adjuvant treatment
regardless of the response

- ANC >= 1,000 mcL (within 4 weeks of start of day 1 [D1] of adjuvant treatment)

- Hemoglobin >= 8 g/dL (within 4 weeks of start of D1 of adjuvant treatment)

- Platelets >= 70,000 mcL (within 4 weeks of start of D1 of adjuvant treatment)

- Patient on the chemoRT arm must have achieved either complete clinical response OR
have demonstrated clinical benefit prior to be placed on the observation alone arm

Exclusion Criteria:

- Step 1 (Registration) Exclusion

- Patient must not have received any previous radiation therapy to the pelvic area

- Autoimmune conditions: patient must not have history of prior documented autoimmune
disease within the past 2 years

- NOTE: Patient with vitiligo, Grave's disease, eczema or psoriasis (not requiring
systemic treatment within the past 2 years) are not excluded. Patients with
history of completely resolved childhood asthma or atopy are not excluded.
Patients with asthma not requiring more than 10 mg/d or equivalent of prednisone
are not excluded. Patients with well-controlled hypothyroidism on thyroxine
replacement will be eligible as well. Patients with known history of
hypoadrenalism on maintenance steroids will be eligible. Patients with type I
diabetes mellitus will be eligible, provided their disease is well controlled.
History of autoimmune related alopecia is also not an exclusion criteria

- Patient with active or prior documented inflammatory bowel disease (e.g., Crohn's
disease, ulcerative colitis) will be excluded

- Patient with a history of and/or confirmed pneumonitis will not be eligible

- Patient with a history of primary immunodeficiency will not be eligible

- Patient with history of allogeneic organ transplant are not eligible

- Patient must not have clinically significant liver disease that precludes patient from
treatment regimens prescribed on the study (including, but not limited to, active
viral, alcoholic or other autoimmune hepatitis, cirrhosis or inherited liver disease)

- Patient must not have any unresolved toxicity (National Cancer Institute [NCI] CTCAE
grade >= 2) from previous anti-cancer therapy with the exception of alopecia,
vitiligo, and the laboratory values

- Patients with grade >= 2 neuropathy will be evaluated on a case-by-case basis
after consultation with the study chair

- Patients with irreversible toxicity not reasonably expected to be exacerbated by
treatment with MEDI4736 (durvalumab) may be included only after consultation with
the study chair. Documentation of correspondences with the study chair must be
kept on file

- Step 2 (Randomization) Exclusion Criteria

- Patient must have no signs of progression (CR/PR or SD) based on restaging imaging and
cystoscopy after completion of induction chemotherapy, which consists of:

- Computed tomography (CT) chest, abdomen, or pelvis. Magnetic resonance imaging
(MRI) pelvis can be used instead of CT per treating physician discretion. The
imaging must be done within 4 weeks prior to randomization

- Cystoscopic evaluation and attempt to perform maximal transurethral resection of
bladder tumor (TURBT) performed by the participating urologist ideally within 8
weeks but up to 10 weeks is allowed prior to randomization. If maximal TURBT is
not possible for medical reasons, the enrollment must be discussed and approved
with the study chair. Documentation of correspondences with the study chair must
be kept of file

- Autoimmune conditions: Patient must not have a history of active or prior documented
autoimmune disease within the past 2 years

- NOTE: Patient with vitiligo, Grave's disease, eczema or psoriasis (not requiring
systemic treatment within the past 2 years) are not excluded. Patients with
history of completely resolved child
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Gender: All

Minimum Age: 18 Years

Maximum Age: N/A

Healthy Volunteers: No

Official Information

Name: Monika Joshi

Role: Principal Investigator

Affiliation: ECOG-ACRIN Cancer Research Group

Locations

Facility Status Contact
Holy Cross Hospital
Fort Lauderdale, Florida 33308
United States
Recruiting Site Public Contact
954-267-7750
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho 83706
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Saint Alphonsus Cancer Care Center-Caldwell
Caldwell, Idaho 83605
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Kootenai Medical Center
Coeur d'Alene, Idaho 83814
United States
Recruiting Site Public Contact
406-969-6060
mccinfo@mtcancer.org
Idaho Urologic Institute-Meridian
Meridian, Idaho 83642
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Saint Alphonsus Medical Center-Nampa
Nampa, Idaho 83686
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Kootenai Cancer Center
Post Falls, Idaho 83854
United States
Recruiting Site Public Contact
406-969-6060
mccinfo@mtcancer.org
Rush - Copley Medical Center
Aurora, Illinois 60504
United States
Recruiting Site Public Contact
630-978-6212
Cancer.Research@rushcopley.com
Carle on Vermilion
Danville, Illinois 61832
United States
Recruiting Site Public Contact
800-446-5532
Research@carle.com
Carle Physician Group-Effingham
Effingham, Illinois 62401
United States
Recruiting Site Public Contact
800-446-5532
Research@carle.com
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois 61938
United States
Recruiting Site Public Contact
800-446-5532
Research@carle.com
Carle Cancer Center
Urbana, Illinois 61801
United States
Recruiting Site Public Contact
800-446-5532
Research@carle.com
The Carle Foundation Hospital
Urbana, Illinois 61801
United States
Recruiting Site Public Contact
800-446-5532
Research@carle.com
Mary Greeley Medical Center
Ames, Iowa 50010
United States
Recruiting Site Public Contact
515-956-4132
McFarland Clinic PC - Ames
Ames, Iowa 50010
United States
Recruiting Site Public Contact
515-239-4734
ksoder@mcfarlandclinic.com
East Jefferson General Hospital
Metairie, Louisiana 70006
United States
Recruiting Site Public Contact
504-210-3539
emede1@lsuhsc.edu
LSU Healthcare Network / Metairie Multi-Specialty Clinic
Metairie, Louisiana 70006
United States
Recruiting Site Public Contact
504-210-3539
emede1@lsuhsc.edu
Louisiana State University Health Science Center
New Orleans, Louisiana 70112
United States
Recruiting Site Public Contact
504-210-3539
emede1@lsuhsc.edu
Saint Joseph Mercy Hospital
Ann Arbor, Michigan 48106
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Saint Joseph Mercy Brighton
Brighton, Michigan 48114
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Saint Joseph Mercy Canton
Canton, Michigan 48188
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Saint Joseph Mercy Chelsea
Chelsea, Michigan 48118
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Ascension Saint John Hospital
Detroit, Michigan 48236
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Genesys Hurley Cancer Institute
Flint, Michigan 48503
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Hurley Medical Center
Flint, Michigan 48503
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Sparrow Hospital
Lansing, Michigan 48912
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Saint Mary Mercy Hospital
Livonia, Michigan 48154
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
21st Century Oncology-Pontiac
Pontiac, Michigan 48341
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Saint Joseph Mercy Oakland
Pontiac, Michigan 48341
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Ascension Saint Mary's Hospital
Saginaw, Michigan 48601
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Saint John Macomb-Oakland Hospital
Warren, Michigan 48093
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Billings Clinic Cancer Center
Billings, Montana 59101
United States
Recruiting Site Public Contact
800-996-2663
research@billingsclinic.org
Bozeman Deaconess Hospital
Bozeman, Montana 59715
United States
Recruiting Site Public Contact
406-969-6060
mccinfo@mtcancer.org
Benefis Healthcare- Sletten Cancer Institute
Great Falls, Montana 59405
United States
Recruiting Site Public Contact
406-969-6060
mccinfo@mtcancer.org
Great Falls Clinic
Great Falls, Montana 59405
United States
Recruiting Site Public Contact
406-969-6060
mccinfo@mtcancer.org
Kalispell Regional Medical Center
Kalispell, Montana 59901
United States
Recruiting Site Public Contact
406-969-6060
mccinfo@mtcancer.org
Community Medical Hospital
Missoula, Montana 59804
United States
Recruiting Site Public Contact
406-969-6060
mccinfo@mtcancer.org
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania 18103
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania 18017
United States
Recruiting Site Public Contact
734-712-3671
stephanie.couch@stjoeshealth.org
Pocono Medical Center
East Stroudsburg, Pennsylvania 18301
United States
Recruiting Site Public Contact
570-422-1700
ann.foster@lvhn.org
Welch Cancer Center
Sheridan, Wyoming 82801
United States
Recruiting Site Public Contact
406-969-6060
mccinfo@mtcancer.org