Testing the Use of Ado-Trastuzumab Emtansine Compared to the Usual Treatment (Chemotherapy With Docetaxel Plus Trastuzumab) or Trastuzumab Deruxtecan for Recurrent, Metastatic, or Unresectable HER2-Expressing Salivary Gland Cancers

Last updated: March 4, 2025
Sponsor: NRG Oncology
Overall Status: Active - Recruiting

Phase

2

Condition

Carcinoma

Treatment

Trastuzumab Emtansine

Trastuzumab

Computed Tomography

Clinical Study ID

NCT05408845
NRG-HN010
U10CA180868
NCI-2022-04353
NRG-HN010
  • Ages > 18
  • All Genders

Study Summary

This phase II trial compares the effect of usual treatment of docetaxel chemotherapy plus trastuzumab, to ado-emtansine (T-DM1) in patients with HER2-postive salivary gland cancer that has come back (recurrent), that has spread from where it first started (primary site) to other places in the body, or cannot be removed by surgery (unresectable). This trial is also testing how well trastuzumab deruxtecan works in treating patients with HER2-low recurrent or metastatic salivary gland cancer. Trastuzumab is a form of targeted therapy because it works by attaching itself to specific molecules (receptors) on the surface of cancer cells, known as HER2 receptors. When trastuzumab attaches to HER2 receptors, the signals that tell the cells to grow are blocked and the cancer cell may be marked for destruction by body's immune system. Trastuzumab emtansine contains trastuzumab, linked to a chemotherapy drug called emtansine. Trastuzumab attaches to HER2 positive cancer cells in a targeted way and delivers emtansine to kill them. Trastuzumab deruxtecan is a monoclonal antibody called traztuzumab, linked to a chemotherapy drug called deruxtecan. Trastuzumab is a form of targeted therapy because it attaches to specific molecules (receptors) on the surface of cancer cells, known as HER2 receptors and delivers deruxtecan to kill them. Docetaxel is in a class of medications called taxanes. It stops cancer cells from growing and dividing and may kill them. Trastuzumab emtansine may work better compared to usual treatment of chemotherapy with docetaxel and trastuzumab or trastuzumab deruxtecan in treating patients with recurrent, metastatic or unresectable salivary gland cancer.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Pathologically (histologically or cytologically) proven diagnosis of HER2-positiveOR HER2-low expressing recurrent/metastatic salivary gland cancer (SGC)

  • HER2-positive cohort:

  • Note: The majority of HER2-positive SGCs are salivary duct carcinoma (SDCs), but to a lesser extent, other SGC subtypes can be HER2-positive (e.g., adenocarcinomas, mucoepidermoid carcinomas, etc.) and are eligibleto be included on the study. Additionally, pathologists may sign out SDCsunder other descriptors (e.g., ex-pleomorphic adenoma, adenocarcinoma),and these would be eligible if they are HER2-positive.

  • Note: HER2 evaluation based on local site immunohistochemistry (IHC),fluorescent in-situ hybridization (FISH), or local/commercialnext-generation sequencing (NGS) is required. Any one of the followingcriteria observed in a primary tumor or metastasis would meet the studydefinition for "HER2-positive":

  • Immunohistochemistry (IHC) (3+) per the College of AmericanPathologists (CAP) breast cancer guidelines

  • Gene amplification by FISH (HER2/CEP17 ratio >= 2.0)

  • Gene amplification by NGS (fold change >= 2)

  • HER2-low expressing cohort:

  • Note: Local HER2 evaluation by immunohistochemistry (IHC) or fluorescentin-situ hybridization (FISH) is required. Any one of the followingcriteria observed in a primary tumor or metastasis would meet the studydefinition for "HER2-low":

  • IHC 1+ per the College of American Pathologists (CAP) breast cancerguidelines

  • IHC 2+ without evidence of amplification by FISH

  • Patients with unresectable disease who are not candidates for curative surgery orradiation OR recurrent OR metastatic disease that is evident on radiologic imaging

  • Patients with treated brain metastases are eligible if follow-up brain imaging aftercentral nervous system (CNS)-directed therapy shows no evidence of progression

  • Patients with new or progressive brain metastases (active brain metastases) orleptomeningeal disease are eligible if the treating physician determines thatimmediate CNS specific treatment is not required and is unlikely to be requiredduring the first cycle of therapy

  • HER2-positive cohort: Measurable or non-measurable disease by the RECIST v1.1criteria. HER2-low expressing cohort: Measurable disease by the RECIST v1.1 criteria

  • History/physical examination within 30 days prior to registration

  • The following imaging within 60 days prior to registration:

  • CT or MRI of the neck (diagnostic quality with contrast, unlesscontraindicated) AND

  • CT scan of the chest (diagnostic quality with contrast, unless contraindicated)AND

  • If clinically indicated, CT or MRI of the abdomen and pelvis (diagnosticquality with contrast, unless contraindicated)

  • Age >= 18

  • Left ventricular ejection fraction (LVEF) >= 50% assessed by echocardiogram ormultigated acquisition (MUGA) scan within 30 days prior to registration

  • Zubrod (Eastern Cooperative Oncology Group [ECOG]) Performance Status of 0-2 within 14 days prior to registration

  • Absolute neutrophil count (ANC) >= 1,500 cells/mm^3 (within 14 days prior toregistration)

  • Platelets >= 100,000 cells/mm^3 (within 14 days prior to registration)

  • Hemoglobin >= 9.0 g/dL (within 14 days prior to registration)

  • HER2-positive cohort: Note: The use of transfusion or other intervention toachieve hemoglobin [Hgb] >= 9.0 g/dL is acceptable

  • HER2-low expressing cohort: Note: Transfusion (red blood cell or platelet) orgranulocyte-colony stimulating factor (granulocyte colony-stimulating factor [G-CSF]) is not allowed

  • Serum creatinine =< 1.5 x upper limit of normal (ULN) OR calculated creatinineclearance (CrCl) >= 30 mL/min by the Cockcroft-Gault formula (within 14 days priorto registration)

  • HER2-positive cohort: Total bilirubin =< 1.5 x ULN (within 14 days prior toregistration) (Not applicable to patients with known Gilbert's syndrome) (within 14days prior to registration)

  • HER2-positive cohort: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 1.5 x ULN (within 14 days prior to registration)

  • HER2-low expressing cohort: Total bilirubin ≤ 1.5 x ULN if no liver metastases; or < 3 x ULN in the presence of documented Gilbert's Syndrome or liver metastases (within 14 days prior to registration) (within 14 days prior to registration)

  • HER2-low expressing cohort: AST and ALT ≤ 3 x ULN if no liver metastases; or < 5 xULN with liver metastases (within 14 days prior to registration)

  • HER2-low expressing cohort: Serum albumin ≥ 2.5 g/dL (within 14 days prior toregistration)

  • Known human immunodeficiency virus (HIV) infected patients on effectiveanti-retroviral therapy with undetectable viral load within 6 months prior toregistration are eligible for this trial. Testing is not required for entry intoprotocol

  • For patients with known evidence of chronic hepatitis B virus (HBV) infection, theHBV viral load must be undetectable on suppressive therapy, if indicated

  • Note: Known positive test for hepatitis B virus surface antigen (HBV sAg)indicating acute or chronic infection would make the patient ineligible unlessthe viral load becomes undetectable on suppressive therapy. Patients who areimmune to hepatitis B (anti-hepatitis B surface antibody positive) are eligible (e.g., patients immunized against hepatitis B)

  • For patients with a known history of hepatitis C virus (HCV) infection, they musthave been treated and cured. For patients with HCV infection who are currently ontreatment, they are eligible if they have an undetectable HCV viral load

  • Note: Known positive test for hepatitis C virus ribonucleic acid (HCV RNA)indicating acute or chronic infection would make the patient ineligible unlessthe viral load becomes undetectable on suppressive therapy

  • Negative urine or serum pregnancy test (in persons of childbearing potential) within 14 days prior to registration. Childbearing potential is defined as any person whohas experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal

  • Willing to use highly effective contraceptives for participants of childbearingpotential (participants who may become pregnant or who may impregnate a partner)during therapy and for 7 months following last dose of study drug; this inclusion isnecessary because the treatment in this study may be significantly teratogenic.Women must refrain from donating eggs during this same period

  • Men with partners of childbearing potential must be willing to use a highlyeffective form of non-hormonal contraception or two effective forms of non-hormonalcontraception by the patient and/or partner, and to continue the use ofcontraception for the duration of study treatment and for at least 7 months afterthe last dose of study treatment. Male patients whose partners are pregnant shoulduse condoms for the duration of the pregnancy. Men must refrain from donating spermduring this same period

  • Prior to registration, patients who have had chemotherapy or palliative-intentradiotherapy must have all toxicities related to prior treatment recovered to ≤grade 1

  • Patients with a prior or concurrent malignancy whose natural history or treatmentdoes not have the potential to interfere with the safety or efficacy assessment ofthe investigational regimen are eligible for this trial

  • The patient or a legally authorized representative must provide study-specificinformed consent prior to study entry and, for patients treated in the United States (U.S.), authorization permitting release of personal health information

Exclusion

Exclusion Criteria:

  • HER2-positive cohort: Prior systemic therapy for the study cancer in theunresectable or recurrent and/or metastatic disease setting

  • Note: Prior chemotherapy for a different cancer is allowed; prior androgenreceptor targeted therapy in any setting is allowed; prior systemic therapy,including HER2-directed therapies given as neoadjuvant therapy, adjuvanttherapy, and/or concurrently with radiation is allowed

  • HER2-low expressing cohort: HER2 directed therapy for unresectable or recurrent ormetastatic disease is not allowed

  • Severe, active co-morbidity defined as follows:

  • Unstable angina requiring hospitalization in the last 6 months

  • Myocardial infarction within the last 6 months

  • New York Heart Association Functional Classification III/IV (Note: Patientswith known history or current symptoms of cardiac disease, or history oftreatment with cardiotoxic agents, should have a clinical risk assessment ofcardiac function using the New York Heart Association FunctionalClassification.)

  • Persistent grade 3-4 (CTCAE version 5.0) electrolyte abnormalities that cannotbe reversed despite replacement as indicated by repeat testing

  • Patient must not have an active infection requiring IV antibiotics, antivirals,or antifungals

  • HER2-positive cohort only: >= grade 3 peripheral neuropathy

  • Interstitial lung disease or pulmonary fibrosis, organizing pneumonia (e.g.,bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, orevidence of active pneumonitis on chest CT scan

  • Any hemorrhage or bleeding event grade >= 3 within 28 days prior to registration

  • History of allergic reactions to compounds of similar chemical or biologiccomposition to: HER2-positive cohort: ado-trastuzumab emtansine, trastuzumab, and/ordocetaxel (or any of their excipients). HER2-low expressing cohort: DS-8201a (trastuzumab deruxtecan), trastuzumab

  • History of exposure to the following cumulative doses of anthracyclines:

  • Doxorubicin or liposomal doxorubicin > 500 mg/m^2

  • Epirubicin > 900 mg/m^2

  • Mitoxantrone > 120 mg/m^2

  • Note: If another anthracycline, or more than one anthracycline has been used,the cumulative dose must not exceed the equivalent of doxorubicin 500 mg/m^2

  • HER2-low expressing cohort only: Receipt of live, attenuated vaccine (messengerribonucleic acid [mRNA and replication deficient adenoviral vaccines are notconsidered attenuated live vaccines) within 30 days prior to the first dose ofDS-8201a (trastuzumab deruxtecan)

  • Pregnancy and individuals unwilling to discontinue nursing

Study Design

Total Participants: 146
Treatment Group(s): 11
Primary Treatment: Trastuzumab Emtansine
Phase: 2
Study Start date:
March 03, 2023
Estimated Completion Date:
July 31, 2028

Study Description

PRIMARY OBJECTIVES:

I. To determine if trastuzumab emtansine (ado-trastuzumab emtansine [T-DM1]) shows better progression-free survival (PFS) when compared to docetaxel plus trastuzumab (TH) in recurrent and/or metastatic (R/M) HER2-positive salivary gland cancer (SGC) patients who have not previously received HER2 therapy for unresectable or recurrent and/or metastatic disease, as determined by local assessment. (HER2-Positive Cohort) II. To determine the overall response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1 criteria with DS-8201a (trastuzumab deruxtecan) in R/M HER2-low expressing SGC patients. (HER2-Low Expressing Cohort)

SECONDARY OBJECTIVES:

I. To compare the overall response rate (ORR) by RECIST v1.1 criteria between arms. (HER2-Positive Cohort) II. To compare overall survival (OS) between arms. (HER2-Positive Cohort) III. To compare toxicity using Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria between arms. (HER2-Positive Cohort) IV. To assess patient-reported toxicity, as measured by the patient reported outcome (PRO)-CTCAE, between arms, and explore patient-reported symptomatic adverse events (AEs) for tolerability of each treatment arm as measured by the PRO-CTCAE. (HER2-Positive Cohort) V. To assess PFS with DS-8201a (trastuzumab deruxtecan) in HER2-low expressing SGC patients. (HER2-Low Expressing Cohort) VI. To assess OS with DS-8201a (trastuzumab deruxtecan) in HER2-low expressing SGC patients. (HER2-Low Expressing Cohort) VII. To evaluate toxicity of DS-8201a (trastuzumab deruxtecan) using CTCAE v5.0. (HER2-Low Expressing Cohort)

EXPLORATORY OBJECTIVES:

I. To assess the ORR in patients who receive crossover treatment to T-DM1/TH following disease progression on the TH arm/T-DM1 arm.

II. To collect blood and tissue specimens for future translational science studies to examine how tumor genetics, HER2 signaling output/expression, HER2 tumoral heterogeneity, and androgen receptor expression/signaling impacts H and T-DM1 efficacy in the HER2-positive cohort and DS-8201a (trastuzumab deruxtecan) efficacy in the HER2-low expressing cohort.

OUTLINE: Patients with HER2-positive disease are randomized to 1 of 2 arms. Patients with HER2-low expression disease are assigned to Arm III.

ARM I: Patients receive docetaxel intravenously (IV) over 60 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Patients also receive trastuzumab IV over 90 minutes on day 1 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients on Arm I (TH) can cross over to Arm II (T-DM1) after first progression. Patients undergo a computed tomography (CT) scan or magnetic resonance imaging (MRI) and echocardiography (ECHO) or multigated acquisition (MUGA) scan throughout the trial. Patients may also undergo blood sample collection during screening and on study, as well as a biopsy during screening.

ARM II: Patients receive trastuzumab emtansine IV over 90 minutes on day 1 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients on Arm II (T-DM1) can cross over to Arm I (TH) after first progression. Patients undergo a CT scan or MRI and ECHO or MUGA scan throughout the trial. Patients may also undergo blood sample collection and during screening and on study, as well as a biopsy during screening.

ARM III: Patients receive trastuzumab deruxtecan IV over 30-90 minutes on day 1 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo a CT scan or MRI and ECHO or MUGA scan throughout the trial. Patients may also undergo blood sample collection and during screening and on study, as well as a biopsy during screening.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for an additional 3-5 years, then annually.

Connect with a study center

  • University of Alabama at Birmingham Cancer Center

    Birmingham, Alabama 35233
    United States

    Site Not Available

  • City of Hope Comprehensive Cancer Center

    Duarte, California 91010
    United States

    Site Not Available

  • Kaiser Permanente Dublin

    Dublin, California 94568
    United States

    Active - Recruiting

  • Kaiser Permanente-Fremont

    Fremont, California 94538
    United States

    Active - Recruiting

  • Kaiser Permanente-Fresno

    Fresno, California 93720
    United States

    Active - Recruiting

  • City of Hope at Irvine Lennar

    Irvine, California 92618
    United States

    Site Not Available

  • Kaiser Permanente-Modesto

    Modesto, California 95356
    United States

    Active - Recruiting

  • Kaiser Permanente-Oakland

    Oakland, California 94611
    United States

    Active - Recruiting

  • Stanford Cancer Institute Palo Alto

    Palo Alto, California 94304
    United States

    Active - Recruiting

  • Kaiser Permanente-Roseville

    Roseville, California 95661
    United States

    Active - Recruiting

  • Kaiser Permanente Downtown Commons

    Sacramento, California 95814
    United States

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  • Kaiser Permanente-South Sacramento

    Sacramento, California 95823
    United States

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  • Kaiser Permanente-San Francisco

    San Francisco, California 94115
    United States

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  • UCSF Medical Center-Mission Bay

    San Francisco, California 94158
    United States

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  • Kaiser Permanente-Santa Teresa-San Jose

    San Jose, California 95119
    United States

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  • Kaiser Permanente San Leandro

    San Leandro, California 94577
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  • Kaiser San Rafael-Gallinas

    San Rafael, California 94903
    United States

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  • Kaiser Permanente Medical Center - Santa Clara

    Santa Clara, California 95051
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  • Kaiser Permanente-Santa Rosa

    Santa Rosa, California 95403
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    South San Francisco, California 94080
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    Vallejo, California 94589
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    Walnut Creek, California 94596
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    Aurora, Colorado 80045
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    Aurora, Colorado 80045
    United States

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  • UCHealth Highlands Ranch Hospital

    Highlands Ranch, Colorado 80129
    United States

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  • Emory University Hospital Midtown

    Atlanta, Georgia 30308
    United States

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  • Kaiser Permanente Moanalua Medical Center

    Honolulu, Hawaii 96819
    United States

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  • Saint Luke's Cancer Institute - Boise

    Boise, Idaho 83712
    United States

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  • Saint Luke's Cancer Institute - Fruitland

    Fruitland, Idaho 83619
    United States

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  • Saint Luke's Cancer Institute - Meridian

    Meridian, Idaho 83642
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    Nampa, Idaho 83687
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    Twin Falls, Idaho 83301
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  • Carle at The Riverfront

    Danville, Illinois 61832
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    Danville, Illinois 61832
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    Effingham, Illinois 62401
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    Mattoon, Illinois 61938
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  • Carle Cancer Center

    Urbana, Illinois 61801
    United States

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  • McFarland Clinic - Ames

    Ames, Iowa 50010
    United States

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    Ames, Iowa 50010
    United States

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  • Mercy Medical Center - Des Moines

    Des Moines, Iowa 50314
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  • University of Kentucky/Markey Cancer Center

    Lexington, Kentucky 40536
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  • UPMC Western Maryland

    Cumberland, Maryland 21502
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  • University of Michigan Comprehensive Cancer Center

    Ann Arbor, Michigan 48109
    United States

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  • Wayne State University/Karmanos Cancer Institute

    Detroit, Michigan 48201
    United States

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  • Weisberg Cancer Treatment Center

    Farmington Hills, Michigan 48334
    United States

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  • Sanford Joe Lueken Cancer Center

    Bemidji, Minnesota 56601
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  • Mercy Hospital

    Coon Rapids, Minnesota 55433
    United States

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  • Fairview Southdale Hospital

    Edina, Minnesota 55435
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  • Abbott-Northwestern Hospital

    Minneapolis, Minnesota 55407
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  • Mayo Clinic in Rochester

    Rochester, Minnesota 55905
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  • Park Nicollet Clinic - Saint Louis Park

    Saint Louis Park, Minnesota 55416
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  • Regions Hospital

    Saint Paul, Minnesota 55101
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  • United Hospital

    Saint Paul, Minnesota 55102
    United States

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  • Siteman Cancer Center at West County Hospital

    Creve Coeur, Missouri 63141
    United States

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  • Siteman Cancer Center at Christian Hospital

    Saint Louis, Missouri 63136
    United States

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  • Siteman Cancer Center-South County

    Saint Louis, Missouri 63129
    United States

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  • Washington University School of Medicine

    Saint Louis, Missouri 63110
    United States

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  • Siteman Cancer Center at Saint Peters Hospital

    Saint Peters, Missouri 63376
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  • Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center

    Lebanon, New Hampshire 03756
    United States

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  • Memorial Sloan Kettering Basking Ridge

    Basking Ridge, New Jersey 07920
    United States

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  • Memorial Sloan Kettering Monmouth

    Middletown, New Jersey 07748
    United States

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  • Memorial Sloan Kettering Bergen

    Montvale, New Jersey 07645
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  • Memorial Sloan Kettering Commack

    Commack, New York 11725
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  • Memorial Sloan Kettering Westchester

    Harrison, New York 10604
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  • Memorial Sloan Kettering Cancer Center

    New York, New York 10065
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  • Mount Sinai Chelsea

    New York, New York 10011
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  • Mount Sinai Hospital

    New York, New York 10029
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  • Memorial Sloan Kettering Nassau

    Uniondale, New York 11553
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  • Sanford Bismarck Medical Center

    Bismarck, North Dakota 58501
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  • Sanford Broadway Medical Center

    Fargo, North Dakota 58122
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  • Sanford Roger Maris Cancer Center

    Fargo, North Dakota 58122
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  • University of Cincinnati Cancer Center-UC Medical Center

    Cincinnati, Ohio 45219
    United States

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  • Ohio State University Comprehensive Cancer Center

    Columbus, Ohio 43210
    United States

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  • Trinity's Tony Teramana Cancer Center

    Steubenville, Ohio 43952
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  • University of Cincinnati Cancer Center-West Chester

    West Chester, Ohio 45069
    United States

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  • Cancer Centers of Southwest Oklahoma Research

    Lawton, Oklahoma 73505
    United States

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  • University of Oklahoma Health Sciences Center

    Oklahoma City, Oklahoma 73104
    United States

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  • UPMC Altoona

    Altoona, Pennsylvania 16601
    United States

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  • UPMC-Heritage Valley Health System Beaver

    Beaver, Pennsylvania 15009
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  • UPMC Hillman Cancer Center at Butler Health System

    Butler, Pennsylvania 16001
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  • UPMC Camp Hill

    Camp Hill, Pennsylvania 17011
    United States

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  • Carlisle Regional Cancer Center

    Carlisle, Pennsylvania 17015
    United States

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  • UPMC Hillman Cancer Center - Passavant - Cranberry

    Cranberry Township, Pennsylvania 16066
    United States

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  • UPMC Hillman Cancer Center Erie

    Erie, Pennsylvania 16505
    United States

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  • UPMC Cancer Center at UPMC Horizon

    Farrell, Pennsylvania 16121
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  • UPMC Cancer Centers - Arnold Palmer Pavilion

    Greensburg, Pennsylvania 15601
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  • UPMC Pinnacle Cancer Center/Community Osteopathic Campus

    Harrisburg, Pennsylvania 17109
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  • IRMC Cancer Center

    Indiana, Pennsylvania 15701
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  • UPMC-Johnstown/John P. Murtha Regional Cancer Center

    Johnstown, Pennsylvania 15901
    United States

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  • UPMC Cancer Center at UPMC McKeesport

    McKeesport, Pennsylvania 15132
    United States

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  • UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion

    Mechanicsburg, Pennsylvania 17050
    United States

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  • UPMC Hillman Cancer Center - Monroeville

    Monroeville, Pennsylvania 15146
    United States

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  • UPMC Hillman Cancer Center in Coraopolis

    Moon, Pennsylvania 15108
    United States

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  • UPMC Hillman Cancer Center - Part of Frick Hospital

    Mount Pleasant, Pennsylvania 15666
    United States

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  • Arnold Palmer Cancer Center Medical Oncology Norwin

    N. Huntingdon, Pennsylvania 15642
    United States

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  • UPMC Cancer Center-Natrona Heights

    Natrona Heights, Pennsylvania 15065
    United States

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  • UPMC Hillman Cancer Center - New Castle

    New Castle, Pennsylvania 16105
    United States

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  • UPMC-Mercy Hospital

    Pittsburgh, Pennsylvania 15219
    United States

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  • UPMC-Passavant Hospital

    Pittsburgh, Pennsylvania 15237
    United States

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  • UPMC-Saint Clair Hospital Cancer Center

    Pittsburgh, Pennsylvania 15243
    United States

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  • UPMC-Saint Margaret

    Pittsburgh, Pennsylvania 15215
    United States

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  • University of Pittsburgh Cancer Institute (UPCI)

    Pittsburgh, Pennsylvania 15232
    United States

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  • UPMC Cancer Center at UPMC Northwest

    Seneca, Pennsylvania 16346
    United States

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  • UPMC Cancer Center-Uniontown

    Uniontown, Pennsylvania 15401
    United States

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  • UPMC Cancer Center-Washington

    Washington, Pennsylvania 15301
    United States

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  • Divine Providence Hospital

    Williamsport, Pennsylvania 17754
    United States

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  • UPMC Memorial

    York, Pennsylvania 17408
    United States

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  • Medical University of South Carolina

    Charleston, South Carolina 29425
    United States

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  • Sanford Cancer Center Oncology Clinic

    Sioux Falls, South Dakota 57104
    United States

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  • Sanford USD Medical Center - Sioux Falls

    Sioux Falls, South Dakota 57117-5134
    United States

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  • Vanderbilt University/Ingram Cancer Center

    Nashville, Tennessee 37232
    United States

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  • Dartmouth Cancer Center - North

    Saint Johnsbury, Vermont 05819
    United States

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  • Norris Cotton Cancer Center-North

    Saint Johnsbury, Vermont 05819
    United States

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  • Fred Hutchinson Cancer Center

    Seattle, Washington 98109
    United States

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  • Marshfield Medical Center-EC Cancer Center

    Eau Claire, Wisconsin 54701
    United States

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  • Marshfield Medical Center-Marshfield

    Marshfield, Wisconsin 54449
    United States

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  • Medical College of Wisconsin

    Milwaukee, Wisconsin 53226
    United States

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  • Marshfield Medical Center - Minocqua

    Minocqua, Wisconsin 54548
    United States

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  • ProHealth D N Greenwald Center

    Mukwonago, Wisconsin 53149
    United States

    Active - Recruiting

  • ProHealth Oconomowoc Memorial Hospital

    Oconomowoc, Wisconsin 53066
    United States

    Active - Recruiting

  • Marshfield Medical Center-River Region at Stevens Point

    Stevens Point, Wisconsin 54482
    United States

    Active - Recruiting

  • UW Cancer Center at ProHealth Care

    Waukesha, Wisconsin 53188
    United States

    Active - Recruiting

  • Marshfield Medical Center - Weston

    Weston, Wisconsin 54476
    United States

    Active - Recruiting

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