Testing MK-3475 (Pembrolizumab) as Adjuvant Therapy for Triple Receptor-Negative Breast Cancer
Invasive Breast Carcinoma, Stage 0 Breast Cancer AJCC v6 and v7, Stage I Breast Cancer AJCC v7
About this trial
This is an interventional treatment trial for Invasive Breast Carcinoma
Eligibility Criteria
Inclusion Criteria:
- STEP 1 REGISTRATION
Patients must have histologically confirmed estrogen receptor (ER)-, progesterone receptor (PR)- and HER2-negative (triple-negative, TNBC) or ER-, PR- weakly positive and/or HER2- equivocal status and must not have received and not be planning to receive adjuvant anti-HER2 or endocrine therapies after completion of neoadjuvant chemotherapy; patients who are HER2-positive by American Society of Clinical Oncology (ASCO) College of American Pathologists (CAP) guidelines are ineligible; HER2-negative and HER2-equivocal cases as per ASCO CAP guidelines that do not receive HER2-targeted therapy are eligible; patients with weakly ER or PR positive disease, defined as ER and/or PR less than or equal to (=<) 5% by immunohistochemistry, are eligible if the treating physician considers the patient not eligible for adjuvant endocrine therapy; residual disease must be >= 1 cm in greatest dimension, and/or have positive lymph nodes (ypN1mi, ypN1, ypN2, ypN3) observed on pathologic exam
- NOTE: If the ER and/or HER2 results are discordant between the initial, pre-chemotherapy, and post-chemotherapy surgical tissue, the receptor status of the residual disease has to be used to determine eligibility. Immunohistochemistry (IHC)-positive isolated tumor cells in the lymph node (N0 [i+]) are not considered node-positive and these patients also must have >= 1 cm residual invasive cancer in the breast to be eligible.
- Patients must not have metastatic disease (i.e., must be clinically M0 or Mx; systemic staging studies with imaging should follow routine practice as per National Comprehensive Cancer Network [NCCN] and ASCO guidelines); patients must not have locally recurrent disease
It is preferred that axillary lymph node sampling is performed after completion of neoadjuvant chemotherapy to allow more accurate assessment of pathologic response; complete axillary lymph node dissection (ALND) after neoadjuvant chemotherapy is recommended in the following situations:
- Patients had documented pathologic involvement of the axillary nodes (fine needle aspiration [FNA] or core biopsy) before neoadjuvant chemotherapy and had sentinel node biopsy after neoadjuvant chemotherapy with positive sentinel node(s)
Patient had documented pathologic involvement of the axillary nodes (FNA or core biopsy) before neoadjuvant chemotherapy and had only 1 sentinel lymph node removed after neoadjuvant chemotherapy
- Except for (i) patients participating in the Alliance A11202 trial) or (ii) if the treating surgeon determines that a complete ALND is not in the best interest of the patient
- NOTE: Patients who undergo sentinel node biopsy before starting neoadjuvant treatment and do not undergo post neoadjuvant assessment of the axillary nodes or who have negative axillary nodes on post neoadjuvant assessment must have >= 1 cm residual invasive cancer in the breast after completion of neoadjuvant chemotherapy
Patients must have a minimum of five, available unstained formalin-fixed paraffin-embedded (FFPE) slides (4-5 micron thickness) from the residual (post-neoadjuvant) invasive tumor in primary site or lymph node; (these will be submitted to a central laboratory to determine PD-L1 expression); the tumor tissue must be adequate for PD-L1 testing, which typically requires a minimum of 100 cancer cells per slide; local PD-L1 results, even if available, will not substitute for central testing
- NOTE: Initial order for specimen kits should be placed at least two weeks prior to registering the first patient at each site
- Patients must be offered the opportunity to participate in specimen banking
- The BAHO substudy was permanently closed to accrual on June 23, 2020, and willingness of English-speaking patients to participate in the BAHO substudy is no longer applicable
- Patients must have had neoadjuvant chemotherapy followed by surgery; the choice of neoadjuvant chemotherapy is determined by the treating physician; we recommend following the National Comprehensive Cancer Network (NCCN) treatment guidelines for TNBC; patients who cannot complete all planned treatment cycles for any reason are considered high risk and therefore are eligible for the study if they have residual disease; patients must have resolution of adverse event(s) of the most recent prior chemotherapy to grade 1 or less, except alopecia and =< grade 2 neuropathy which are allowed
- Patients may receive post-operative (adjuvant) chemotherapy for up to 24 weeks of duration (e.g. 8 cycles of capecitabine as in the Capecitabine for Residual Cancer as Adjuvant Therapy (CREATE-X) trial; the 24-week duration does not include treatment delays) after completion of surgery at the discretion of the treating physician; co-enrollment to EA1131 is allowed, provided that patients complete or discontinue adjuvant chemotherapy prior to step 1 registration; at the time of step 1 registration, patients must have resolution of adverse event(s) of the most recent prior chemotherapy to =< grade 1, except alopecia and =< grade 2 neuropathy which are allowed; patients that have received adjuvant chemotherapy (including via co-enrollment to EA1131) must be registered to step 1 within 35 days after final dose of adjuvant chemotherapy
Patients must have completed their final breast surgery (rendering them free from disease) with clear resection margins for invasive cancer and DCIS within the following timelines:
- 90 days prior to step 1 screening registration for patients not receiving post-operative (adjuvant) chemotherapy OR
- 270 days prior to step 1 screening registration for patients who have received post-operative (adjuvant) chemotherapy Positive margins are allowed only if the surgical team of the patient deems further resection impossible
- Patients for whom radiation therapy (RT) to the affected breast or chest wall and regional nodal areas is clinically indicated as per NCCN treatment guidelines, should receive routine RT after randomization when possible, and receive MK-3475 (pembrolizumab) concurrent with RT, if randomized to the experimental arm; however, routine RT administered, or initiated, prior to registration is also allowed; MK-3475 (pembrolizumab) may be added to ongoing radiation, or started after its completion, if randomized to the experimental arm, provided there are no > grade 1 radiation-related skin toxicities and provided that no radiosensitizing chemotherapy is being administered; co-enrollment in the Alliance A221505 (NCT03414970) and A011202 (NCT01901094) trials or in the NSABP-B51 (NCT01872975) trial is allowed, but patients must not be planning to receive radiation therapy given on these trials concurrently with MK-3475 (pembrolizumab) treatment on S1418/BR006; whether or not patient will receive RT and the extent of intended RT must be specified at time of registration; NOTE: Patients who receive post-operative chemotherapy may receive radiation therapy before or after the chemotherapy; a short course of reduced dose chemotherapy or other agents concomitant with radiation for radiation sensitization is not considered to be adjuvant chemotherapy
- Patients must not have had prior immunotherapy with anti-PD-L1, anti-PD-1, anti-CTLA4 or similar drugs; patients must not be planning to receive any of the prohibited therapies during the screening or treatment phases of the study
- Patients must not be planning to receive concomitantly other biologic therapy, hormonal therapy, other chemotherapy, surgery or other anti-cancer therapy except radiation therapy while receiving treatment on this protocol; however, patients receiving extended adjuvant endocrine therapy for an earlier ER positive breast cancer treated with curative intent and without recurrence for at least 5 years may continue with their endocrine therapy; elective surgery or surgery that is not related to cancer therapy is allowed, at the discretion of the treating investigator
- Patients must have Zubrod performance status =< 2
- Patients must not have a history of (non-infectious) pneumonitis that required steroids or evidence of active pneumonitis within 2 years prior to registration
- Patients must not have active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs); replacement therapy (e.g., thyroxine for pre-existing hypothyroidism, insulin for type I diabetes mellitus, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
- Patients must not have received live vaccines within 30 days prior to registration; examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, chicken pox, shingles, yellow fever, rabies, Bacillus Calmette-Guerin (BCG), and typhoid (oral) vaccine; seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g., Flu-Mist) are live attenuated vaccines, and are not allowed
Patients must not have known active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection prior to registration; patients who have completed curative therapy for HCV are eligible; patients with known human immunodeficiency virus (HIV) infection are eligible if they meet each of the following 3 criteria:
- CD4 counts >= 350 mm^3
- Serum HIV viral load of < 25,000 IU/ml and
- Treated on a stable antiretroviral regimen
- No other prior invasive malignancy is allowed except for the following: adequately treated basal (or squamous cell) skin cancer, in situ breast or cervical cancer; stage I or II invasive cancer treated with a curative intent without evidence of disease recurrence for at least five years
- Patients must have complete history and physical examination within 28 days prior to registration
- Patients must be informed of the investigational nature of this study and must sign and give written informed consent for this protocol in accordance with institutional and federal guidelines
- As a part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system
- STEP 2 REGISTRATION
- Patients must not be registered to step 2 until receiving confirmation from the Southwest Oncology Group (SWOG) Statistical and Data Management Center that the patient's tissue specimen was adequate for PD-L1 testing; patients must be registered within 14 days of receiving the e-mail notification confirming submission was evaluable for PD-L1 status
- Absolute neutrophil count (ANC) >= 1,500 microliter (mcL) (obtained within 28 days prior to step 2 registration)
- Platelets >= 100,000/mcL (obtained within 28 days prior to step 2 registration)
- Hemoglobin >= 9 g/dL (obtained within 28 days prior to step 2 registration)
- A serum thyroid-stimulating hormone (TSH) and/or free T4 must be obtained within 28 days prior to step 2 registration to obtain a baseline value
- Total bilirubin =< 1.5 x institutional upper limit of normal (IULN) (except Gilbert's syndrome, who must have a total bilirubin < 3.0 mg/dL) (obtained within 28 days prior to step 2 registration)
- Serum glutamic-oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 2.5 x IULN (obtained within 28 days prior to step 2 registration)
- Alkaline phosphatase =< 2.5 x IULN (obtained within 28 days prior to step 2 registration)
- Serum creatinine =< IULN OR measured or calculated creatinine clearance >= 60 mL/min (obtained within 28 days prior to step 2 registration)
- Women of childbearing potential must have a negative urine or serum pregnancy test within 28 day prior to registration; women/men of reproductive potential must have agreed to use an effective contraceptive method for the course of the study through 120 days after the last dose of study medication; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; a woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months; in addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy, bilateral tubal ligation, or vasectomy; however, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures; patients must not be pregnant or nursing; women of childbearing potential must plan to have a urine or serum pregnancy test within 72 hours prior to receiving the first dose of study medication; if the urine test is positive or cannot be confirmed as negative, a negative serum pregnancy test will be required
- Patients must not have an active infection requiring systemic therapy at the time of starting therapy
- Site must verify that there is no known change in the step 1 eligibility since initial registration
Sites / Locations
- University of Alabama at Birmingham Cancer Center
- Southern Cancer Center PC-Daphne
- Southern Cancer Center PC-Mobile
- Southern Cancer Center PC-Providence
- Southern Cancer Center PC-Springhill
- University of South Alabama Mitchell Cancer Institute
- Alaska Oncology and Hematology LLC
- Anchorage Oncology Centre
- Katmai Oncology Group
- Providence Alaska Medical Center
- Fairbanks Memorial Hospital
- Banner MD Anderson Cancer Center
- CTCA at Western Regional Medical Center
- Banner University Medical Center - Tucson
- University of Arizona Cancer Center-North Campus
- NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
- University of Arkansas for Medical Sciences
- Highlands Oncology Group - Rogers
- Kaiser Permanente-Anaheim
- Kaiser Permanente-Deer Valley Medical Center
- PCR Oncology
- Sutter Auburn Faith Hospital
- AIS Cancer Center at San Joaquin Community Hospital
- Kaiser Permanente-Baldwin Park
- Kaiser Permanente-Bellflower
- Alta Bates Summit Medical Center-Herrick Campus
- Mills-Peninsula Medical Center
- Community Cancer Institute
- City of Hope Corona
- UC Irvine Health Cancer Center-Newport
- City of Hope Comprehensive Cancer Center
- Epic Care-Dublin
- Bay Area Breast Surgeons Inc
- Epic Care Partners in Cancer Care
- Kaiser Permanente-Fontana
- Kaiser Permanente-Fremont
- Palo Alto Medical Foundation-Fremont
- Washington Hospital
- Kaiser Permanente-Fresno
- Saint Jude Medical Center
- Marin Cancer Care Inc
- Kaiser Permanente - Harbor City
- Kaiser Permanente-Irvine
- Loma Linda University Medical Center
- Kaiser Permanente Los Angeles Medical Center
- Los Angeles County-USC Medical Center
- USC / Norris Comprehensive Cancer Center
- Kaiser Permanente West Los Angeles
- Contra Costa Regional Medical Center
- Fremont - Rideout Cancer Center
- City of Hope Mission Hills
- Memorial Medical Center
- Kaiser Permanente-Modesto
- Community Hospital of Monterey Peninsula
- Palo Alto Medical Foundation-Camino Division
- Palo Alto Medical Foundation-Gynecologic Oncology
- USC Norris Oncology/Hematology-Newport Beach
- Sutter Cancer Research Consortium
- Alta Bates Summit Medical Center - Summit Campus
- Bay Area Tumor Institute
- Kaiser Permanente-Oakland
- Kaiser Permanente-Ontario
- Saint Joseph Hospital - Orange
- UC Irvine Health/Chao Family Comprehensive Cancer Center
- Desert Regional Medical Center
- Palo Alto Medical Foundation Health Care
- Stanford Cancer Institute Palo Alto
- Kaiser Permanente - Panorama City
- Huntington Memorial Hospital
- Kaiser Permanente-Redwood City
- Kaiser Permanente-Richmond
- Kaiser Permanente-Riverside
- Kaiser Permanente-Roseville
- Sutter Roseville Medical Center
- Kaiser Permanente Downtown Commons
- Sutter Medical Center Sacramento
- University of California Davis Comprehensive Cancer Center
- Kaiser Permanente - Sacramento
- Salinas Valley Memorial
- Kaiser Permanente-San Diego Mission
- Kaiser Permanente-San Diego Zion
- California Pacific Medical Center-Pacific Campus
- Kaiser Permanente-San Francisco
- Kaiser Permanente-Santa Teresa-San Jose
- Stanford Cancer Center South Bay
- Kaiser Permanente San Leandro
- Pacific Central Coast Health Center-San Luis Obispo
- Kaiser Permanente-San Marcos
- Kaiser Permanente Medical Center - Santa Clara
- Palo Alto Medical Foundation-Santa Cruz
- Mission Hope Medical Oncology - Santa Maria
- Kaiser Permanente-Santa Rosa
- Providence Medical Foundation - Santa Rosa
- City of Hope South Pasadena
- Kaiser Permanente-South San Francisco
- Kaiser Permanente-Stockton
- Palo Alto Medical Foundation-Sunnyvale
- Gene Upshaw Memorial Tahoe Forest Cancer Center
- City of Hope Upland
- Kaiser Permanente Medical Center-Vacaville
- Kaiser Permanente-Vallejo
- Sutter Solano Medical Center/Cancer Center
- Kaiser Permanente-Walnut Creek
- Presbyterian Intercommunity Hospital
- Kaiser Permanente-Woodland Hills
- Rocky Mountain Cancer Centers-Aurora
- UCHealth University of Colorado Hospital
- Rocky Mountain Cancer Centers-Boulder
- Penrose-Saint Francis Healthcare
- UCHealth Memorial Hospital Central
- Memorial Hospital North
- Kaiser Permanente-Franklin
- National Jewish Health-Main Campus
- Porter Adventist Hospital
- Rocky Mountain Cancer Centers-Midtown
- SCL Health Saint Joseph Hospital
- Rocky Mountain Cancer Centers-Rose
- Mountain Blue Cancer Care Center - Swedish
- Swedish Medical Center
- Poudre Valley Hospital
- Cancer Care and Hematology-Fort Collins
- National Jewish Health-Western Hematology Oncology
- Grand Valley Oncology
- North Colorado Medical Center
- UCHealth Greeley Hospital
- Good Samaritan Medical Center
- Kaiser Permanente-Rock Creek
- Saint Anthony Hospital
- Rocky Mountain Cancer Centers-Littleton
- Littleton Adventist Hospital
- Kaiser Permanente-Lone Tree
- Rocky Mountain Cancer Centers-Sky Ridge
- Longmont United Hospital
- Medical Center of the Rockies
- McKee Medical Center
- Parker Adventist Hospital
- National Jewish Health-Northern Hematology Oncology
- SCL Health Lutheran Medical Center
- Danbury Hospital
- Smilow Cancer Hospital-Derby Care Center
- Smilow Cancer Hospital Care Center-Fairfield
- Greenwich Hospital
- Smilow Cancer Hospital Care Center at Greenwich
- Hartford Hospital
- Smilow Cancer Hospital Care Center at Saint Francis
- Midstate Medical Center
- The Hospital of Central Connecticut
- Smilow Cancer Center/Yale-New Haven Hospital
- Yale University
- Yale-New Haven Hospital North Haven Medical Center
- Norwalk Hospital
- Smilow Cancer Hospital-Orange Care Center
- Smilow Cancer Hospital-Torrington Care Center
- Smilow Cancer Hospital Care Center-Trumbull
- Smilow Cancer Hospital-Waterbury Care Center
- Beebe South Coastal Health Campus
- Helen F Graham Cancer Center
- Medical Oncology Hematology Consultants PA
- Beebe Health Campus
- TidalHealth Nanticoke / Allen Cancer Center
- Sibley Memorial Hospital
- AdventHealth Altamonte
- AdventHealth Celebration
- Morton Plant Hospital
- UM Sylvester Comprehensive Cancer Center at Coral Gables
- Halifax Health Medical Center-Centers for Oncology
- UM Sylvester Comprehensive Cancer Center at Deerfield Beach
- University of Florida Health Science Center - Gainesville
- Baptist MD Anderson Cancer Center
- Mount Sinai Medical Center
- University of Miami Miller School of Medicine-Sylvester Cancer Center
- UM Sylvester Comprehensive Cancer Center at Kendall
- AdventHealth Orlando
- Orlando Health Cancer Institute
- Sacred Heart Hospital
- UM Sylvester Comprehensive Cancer Center at Plantation
- Tallahassee Memorial HealthCare
- Saint Joseph's Hospital/Children's Hospital-Tampa
- Cleveland Clinic-Weston
- Phoebe Putney Memorial Hospital
- Emory University Hospital Midtown
- Emory University Hospital/Winship Cancer Institute
- Emory Saint Joseph's Hospital
- Northside Hospital
- Augusta Oncology Associates PC-D'Antignac
- Augusta Oncology Associates PC-Wheeler
- Dekalb Medical Center
- Northside Hospital - Duluth
- Northside Hospital - Gwinnett
- CTCA at Southeastern Regional Medical Center
- Memorial Health University Medical Center
- Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
- Suburban Hematology Oncology Associates - Snellville
- South Georgia Medical Center/Pearlman Cancer Center
- Hawaii Cancer Care - Westridge
- Hawaii Cancer Care Inc - Waterfront Plaza
- Queen's Cancer Cenrer - POB I
- Queen's Medical Center
- Queen's Cancer Center - Kuakini
- Kapiolani Medical Center for Women and Children
- Saint Alphonsus Cancer Care Center-Boise
- Saint Luke's Cancer Institute - Boise
- Saint Alphonsus Cancer Care Center-Caldwell
- Kootenai Health - Coeur d'Alene
- Walter Knox Memorial Hospital
- Saint Luke's Cancer Institute - Fruitland
- Idaho Urologic Institute-Meridian
- Saint Luke's Cancer Institute - Meridian
- Saint Luke's Cancer Institute - Nampa
- Saint Alphonsus Cancer Care Center-Nampa
- Kootenai Clinic Cancer Services - Post Falls
- Kootenai Cancer Clinic
- Saint Luke's Cancer Institute - Twin Falls
- Northwest Community Hospital
- Rush - Copley Medical Center
- Mac Neal Hospital
- Illinois CancerCare-Bloomington
- Illinois CancerCare-Canton
- SIH Cancer Institute
- Illinois CancerCare-Carthage
- Centralia Oncology Clinic
- Mount Sinai Hospital Medical Center
- Northwestern University
- Rush University Medical Center
- University of Illinois
- University of Chicago Comprehensive Cancer Center
- Weiss Memorial Hospital
- Carle at The Riverfront
- Cancer Care Specialists of Illinois - Decatur
- Decatur Memorial Hospital
- Northwestern Medicine Cancer Center Kishwaukee
- Carle Physician Group-Effingham
- Crossroads Cancer Center
- Illinois CancerCare-Eureka
- NorthShore University HealthSystem-Evanston Hospital
- Freeport Memorial Hospital/Leonard C Ferguson Cancer Center
- Illinois CancerCare-Galesburg
- Northwestern Medicine Cancer Center Delnor
- NorthShore University HealthSystem-Glenbrook Hospital
- Ingalls Memorial Hospital
- NorthShore University HealthSystem-Highland Park Hospital
- Duly Health and Care Joliet
- Presence Saint Mary's Hospital
- Illinois CancerCare-Kewanee Clinic
- Northwestern Medicine Lake Forest Hospital
- Illinois CancerCare-Macomb
- Carle Physician Group-Mattoon/Charleston
- Loyola University Medical Center
- Good Samaritan Regional Health Center
- UC Comprehensive Cancer Center at Silver Cross
- Cancer Care Center of O'Fallon
- University of Chicago Medicine-Orland Park
- Illinois CancerCare-Ottawa Clinic
- Advocate Lutheran General Hospital
- Illinois CancerCare-Pekin
- Illinois CancerCare-Peoria
- Illinois CancerCare-Peru
- Illinois CancerCare-Princeton
- West Suburban Medical Center
- SwedishAmerican Regional Cancer Center/ACT
- Genesis Cancer Center - Silvis
- Southern Illinois University School of Medicine
- Springfield Clinic
- Memorial Medical Center
- Carle Cancer Center
- Northwestern Medicine Cancer Center Warrenville
- Rush-Copley Healthcare Center
- IU Health North Hospital
- Deaconess Clinic Downtown
- Parkview Regional Medical Center
- Goshen Center for Cancer Care
- Indiana University/Melvin and Bren Simon Cancer Center
- Sidney and Lois Eskenazi Hospital
- Community Cancer Center East
- Community Cancer Center South
- Franciscan Health Indianapolis
- Community Cancer Center North
- Springmill Medical Center
- Community Howard Regional Health
- Franciscan Saint Elizabeth Health - Lafayette East
- Memorial Regional Cancer Center Day Road
- Baptist Health Floyd
- Chancellor Center for Oncology
- Memorial Hospital of South Bend
- Union Hospital
- Mary Greeley Medical Center
- McFarland Clinic - Ames
- University of Iowa Healthcare Cancer Services Quad Cities
- McFarland Clinic - Boone
- Physicians' Clinic of Iowa PC
- Mercy Hospital
- Oncology Associates at Mercy Medical Center
- Medical Oncology and Hematology Associates-West Des Moines
- Mercy Cancer Center-West Lakes
- Greater Regional Medical Center
- Genesis Medical Center - East Campus
- Genesis Cancer Care Institute
- Iowa Cancer Specialists
- Iowa Methodist Medical Center
- Medical Oncology and Hematology Associates-Des Moines
- Broadlawns Medical Center
- Mercy Medical Center - Des Moines
- Mission Cancer and Blood - Laurel
- Iowa Lutheran Hospital
- McFarland Clinic - Trinity Cancer Center
- Trinity Regional Medical Center
- University of Iowa/Holden Comprehensive Cancer Center
- McFarland Clinic - Jefferson
- McFarland Clinic - Marshalltown
- Methodist West Hospital
- Mercy Medical Center-West Lakes
- Cancer Center of Kansas - Chanute
- Cancer Center of Kansas - Dodge City
- Cancer Center of Kansas - Fort Scott
- Central Care Cancer Center - Garden City
- Central Care Cancer Center - Great Bend
- HaysMed University of Kansas Health System
- University of Kansas Cancer Center-West
- University of Kansas Cancer Center
- Cancer Center of Kansas-Kingman
- Lawrence Memorial Hospital
- Kansas Institute of Medicine Cancer and Blood Center
- Minimally Invasive Surgery Hospital
- Cancer Center of Kansas-Liberal
- Cancer Center of Kansas - McPherson
- Cancer Center of Kansas - Newton
- Olathe Health Cancer Center
- Menorah Medical Center
- University of Kansas Cancer Center-Overland Park
- Cancer Center of Kansas - Parsons
- Ascension Via Christi - Pittsburg
- Cancer Center of Kansas - Pratt
- Salina Regional Health Center
- Cotton O'Neil Cancer Center / Stormont Vail Health
- University of Kansas Health System Saint Francis Campus
- Cancer Center of Kansas - Wellington
- University of Kansas Hospital-Westwood Cancer Center
- Cancer Center of Kansas-Wichita Medical Arts Tower
- Ascension Via Christi Hospitals Wichita
- Cancer Center of Kansas - Wichita
- Cancer Center of Kansas - Winfield
- Flaget Memorial Hospital
- Baptist Health Corbin
- Baptist Health Lexington
- Saint Joseph Hospital East
- University of Kentucky/Markey Cancer Center
- Saint Joseph London
- Baptist Health Louisville
- Christus Saint Frances Cabrini Hospital
- LSU Health Baton Rouge-North Clinic
- Hematology/Oncology Clinic PLLC
- Louisiana Hematology Oncology Associates LLC
- Mary Bird Perkins Cancer Center
- Ochsner Health Center-Summa
- Our Lady of the Lake Physicians Group - Medical Oncology
- Medical Center of Baton Rouge
- Woman's Hospital
- Ochsner High Grove
- Northshore Oncology Associates-Covington
- Ochsner Hematology Oncology North Shore - Covington (West Region)
- Oncology Center of The South Incorporated
- Terrebonne General Medical Center
- Ochsner Medical Center Kenner
- CHRISTUS Saint Patrick Hospital
- East Jefferson General Hospital
- University Medical Center New Orleans
- Ochsner Medical Center Jefferson
- LSU Health Sciences Center at Shreveport
- Harold Alfond Center for Cancer Care
- Eastern Maine Medical Center
- Waldo County General Hospital
- MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford
- Lafayette Family Cancer Center-EMMC
- Maine Center for Cancer Medicine-Kennebunk
- Stephens Memorial Hospital
- Penobscot Bay Medical Center
- MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford
- Maine Center for Cancer Medicine-Scarborough
- Maine Medical Partners - South Portland
- Maine Center for Cancer Medicine-Topsham
- York Hospital
- Anne Arundel Medical Center
- University of Maryland/Greenebaum Cancer Center
- Mercy Medical Center
- Greater Baltimore Medical Center
- Saint Agnes Hospital
- MedStar Franklin Square Medical Center/Weinberg Cancer Institute
- MedStar Good Samaritan Hospital
- Johns Hopkins University/Sidney Kimmel Cancer Center
- UM Upper Chesapeake Medical Center
- Frederick Memorial Hospital
- FMH James M Stockman Cancer Institute
- TidalHealth Richard A Henson Cancer Institute
- TidalHealth Peninsula Regional
- UM Saint Joseph Medical Center
- Boston Medical Center
- Lahey Hospital and Medical Center
- Lowell General Hospital
- Baystate Medical Center
- Winchester Hospital
- Saint Joseph Mercy Hospital
- University of Michigan Comprehensive Cancer Center
- Bronson Battle Creek
- McLaren Cancer Institute-Bay City
- Saint Joseph Mercy Brighton
- Trinity Health IHA Medical Group Hematology Oncology - Brighton
- Henry Ford Cancer Institute-Downriver
- Saint Joseph Mercy Canton
- Trinity Health IHA Medical Group Hematology Oncology - Canton
- Caro Cancer Center
- Saint Joseph Mercy Chelsea
- Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
- Hematology Oncology Consultants-Clarkston
- McLaren Cancer Institute-Clarkston
- Newland Medical Associates-Clarkston
- Henry Ford Macomb Hospital-Clinton Township
- Beaumont Hospital - Dearborn
- Henry Ford Medical Center-Fairlane
- Wayne State University/Karmanos Cancer Institute
- Henry Ford Hospital
- Ascension Saint John Hospital
- Great Lakes Cancer Management Specialists-Doctors Park
- Michigan State University Clinical Center
- Weisberg Cancer Treatment Center
- Beaumont Hospital - Farmington Hills
- Genesee Cancer and Blood Disease Treatment Center
- Genesee Hematology Oncology PC
- Genesys Hurley Cancer Institute
- Hurley Medical Center
- McLaren Cancer Institute-Flint
- Singh and Arora Hematology Oncology PC
- Spectrum Health at Butterworth Campus
- Trinity Health Grand Rapids Hospital
- Academic Hematology Oncology Specialists
- Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
- Bronson Methodist Hospital
- West Michigan Cancer Center
- Karmanos Cancer Institute at McLaren Greater Lansing
- Mid-Michigan Physicians-Lansing
- Sparrow Hospital
- McLaren Cancer Institute-Lapeer Region
- Trinity Health Saint Mary Mercy Livonia Hospital
- Great Lakes Cancer Management Specialists-Macomb Medical Campus
- Saint Mary's Oncology/Hematology Associates of Marlette
- UP Health System Marquette
- MyMichigan Medical Center Midland
- Monroe Cancer Center
- McLaren Cancer Institute-Macomb
- McLaren Cancer Institute-Central Michigan
- Trinity Health Muskegon Hospital
- Ascension Providence Hospitals - Novi
- Henry Ford Medical Center-Columbus
- McLaren Cancer Institute-Northern Michigan
- 21st Century Oncology-Pontiac
- Hope Cancer Center
- Newland Medical Associates-Pontiac
- Saint Joseph Mercy Oakland
- McLaren-Port Huron
- Spectrum Health Reed City Hospital
- Great Lakes Cancer Management Specialists-Rochester Hills
- William Beaumont Hospital-Royal Oak
- Ascension Saint Mary's Hospital
- Oncology Hematology Associates of Saginaw Valley PC
- Marie Yeager Cancer Center
- Ascension Providence Hospitals - Southfield
- Munson Medical Center
- William Beaumont Hospital - Troy
- Great Lakes Cancer Management Specialists-Macomb Professional Building
- Saint John Macomb-Oakland Hospital
- Henry Ford West Bloomfield Hospital
- Saint Mary's Oncology/Hematology Associates of West Branch
- University of Michigan Health - West
- Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
- Sanford Joe Lueken Cancer Center
- Essentia Health Saint Joseph's Medical Center
- Fairview Ridges Hospital
- Minnesota Oncology - Burnsville
- Mercy Hospital
- Essentia Health - Deer River Clinic
- Essentia Health Cancer Center
- Essentia Health Saint Mary's Medical Center
- Miller-Dwan Hospital
- Fairview Southdale Hospital
- Unity Hospital
- Essentia Health Hibbing Clinic
- Fairview Clinics and Surgery Center Maple Grove
- Minnesota Oncology Hematology PA-Maplewood
- Saint John's Hospital - Healtheast
- Abbott-Northwestern Hospital
- Hennepin County Medical Center
- Health Partners Inc
- New Ulm Medical Center
- North Memorial Medical Health Center
- Coborn Cancer Center at Saint Cloud Hospital
- Park Nicollet Clinic - Saint Louis Park
- Regions Hospital
- United Hospital
- Essentia Health Sandstone
- Saint Francis Regional Medical Center
- Lakeview Hospital
- Essentia Health Virginia Clinic
- Ridgeview Medical Center
- Rice Memorial Hospital
- Minnesota Oncology Hematology PA-Woodbury
- Fairview Lakes Medical Center
- Baptist Memorial Hospital and Cancer Center-Golden Triangle
- Baptist Cancer Center-Grenada
- Baptist Memorial Hospital and Cancer Center-Union County
- Baptist Memorial Hospital and Cancer Center-Oxford
- Singing River Hospital
- Baptist Memorial Hospital and Cancer Center-Desoto
- Saint Louis Cancer and Breast Institute-Ballwin
- Central Care Cancer Center - Bolivar
- Saint Francis Medical Center
- Southeast Cancer Center
- Centerpoint Medical Center LLC
- Capital Region Southwest Campus
- Freeman Health System
- Truman Medical Centers
- Research Medical Center
- University of Kansas Cancer Center - North
- University of Kansas Cancer Center at North Kansas City Hospital
- Heartland Regional Medical Center
- Saint Louis Cancer and Breast Institute-South City
- Missouri Baptist Medical Center
- Mercy Hospital Saint Louis
- Mercy Hospital Springfield
- CoxHealth South Hospital
- Community Hospital of Anaconda
- Billings Clinic Cancer Center
- Bozeman Deaconess Hospital
- Saint James Community Hospital and Cancer Treatment Center
- Benefis Healthcare- Sletten Cancer Institute
- Great Falls Clinic
- Saint Peter's Community Hospital
- Kalispell Regional Medical Center
- Community Medical Hospital
- CHI Health Saint Francis
- CHI Health Good Samaritan
- Nebraska Methodist Hospital
- Alegent Health Immanuel Medical Center
- Alegent Health Bergan Mercy Medical Center
- Alegent Health Lakeside Hospital
- University of Nebraska Medical Center
- OptumCare Cancer Care at Seven Hills
- OptumCare Cancer Care at Charleston
- OptumCare Cancer Care at MountainView
- OptumCare Cancer Care at Fort Apache
- Renown Regional Medical Center
- Saint Mary's Regional Medical Center
- New Hampshire Oncology Hematology PA-Concord
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
- Norris Cotton Cancer Center-Manchester
- Solinsky Center for Cancer Care
- Saint Joseph Hospital
- Dartmouth Cancer Center - Nashua
- Ocean University Medical Center
- Trinitas Hospital and Comprehensive Cancer Center - Williamson Street Campus
- Hackensack University Medical Center
- The Cancer Institute of New Jersey Hamilton
- Saint Barnabas Medical Center
- Monmouth Medical Center
- Southern Ocean County Medical Center
- Virtua Memorial
- Jersey Shore Medical Center
- Rutgers Cancer Institute of New Jersey
- Newark Beth Israel Medical Center
- The Valley Hospital-Luckow Pavilion
- Riverview Medical Center/Booker Cancer Center
- Valley Hospital
- Robert Wood Johnson University Hospital Somerset
- Sparta Cancer Treatment Center
- MD Anderson Cancer Center at Cooper-Voorhees
- Virtua Voorhees
- Valley Health System-Hematology/Oncology
- Lovelace Medical Center-Saint Joseph Square
- University of New Mexico Cancer Center
- New Mexico Oncology Hematology Consultants
- Presbyterian Kaseman Hospital
- Memorial Medical Center - Las Cruces
- Presbyterian Rust Medical Center/Jorgensen Cancer Center
- Christus Saint Vincent Regional Cancer Center
- Montefiore Medical Center-Einstein Campus
- Montefiore Medical Center-Weiler Hospital
- Montefiore Medical Center - Moses Campus
- New York-Presbyterian/Brooklyn Methodist Hospital
- Roswell Park Cancer Institute
- Arnot Ogden Medical Center/Falck Cancer Center
- Garnet Health Medical Center
- NYU Winthrop Hospital
- Mount Sinai Union Square
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
- Mount Sinai West
- Mount Sinai Hospital
- NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
- NYP/Weill Cornell Medical Center
- University of Rochester
- Staten Island University Hospital
- Stony Brook University Medical Center
- State University of New York Upstate Medical University
- Dickstein Cancer Treatment Center
- Atrium Health Stanly/LCI-Albemarle
- Randolph Hospital
- Mission Hospital
- Messino Cancer Centers
- Hope Women's Cancer Centers-Asheville
- Cone Health Cancer Center at Alamance Regional
- UNC Lineberger Comprehensive Cancer Center
- Carolinas Medical Center/Levine Cancer Institute
- Novant Health Presbyterian Medical Center
- Oncology Specialists of Charlotte
- Atrium Health Pineville/LCI-Pineville
- Southeastern Medical Oncology Center-Clinton
- Atrium Health Cabarrus/LCI-Concord
- Duke University Medical Center
- Southeastern Medical Oncology Center-Goldsboro
- Cone Health Cancer Center
- Margaret R Pardee Memorial Hospital
- Novant Health Cancer Institute - Huntersville
- Southern Oncology Specialists-Huntersville
- Southeastern Medical Oncology Center-Jacksonville
- Vidant Oncology-Kenansville
- Novant Health Cancer Institute - Kernersville
- Vidant Oncology-Kinston
- Novant Health Cancer Institute - Matthews
- Cone Heath Cancer Center at Mebane
- Novant Health Cancer Institute - Mooresville
- Novant Health Cancer Institute - Mount Airy
- FirstHealth of the Carolinas-Moore Regional Hospital
- Annie Penn Memorial Hospital
- Vidant Oncology-Richlands
- Novant Health Cancer Institute - Statesville
- Novant Health Cancer Institute - Thomasville
- Novant Health Cancer Institute - Wilkesboro
- Novant Health Forsyth Medical Center
- Novant Health Oncology Specialists
- Wake Forest University Health Sciences
- Sanford Bismarck Medical Center
- Essentia Health Cancer Center-South University Clinic
- Sanford Broadway Medical Center
- Sanford Roger Maris Cancer Center
- Summa Health System - Akron Campus
- Cleveland Clinic Cancer Center Beachwood
- UHHS-Chagrin Highlands Medical Center
- Indu and Raj Soin Medical Center
- Strecker Cancer Center-Belpre
- Cleveland Clinic Mercy Hospital
- Aultman Health Foundation
- Dayton Physicians LLC-Miami Valley South
- Geauga Hospital
- Adena Regional Medical Center
- The Christ Hospital
- Good Samaritan Hospital - Cincinnati
- Case Western Reserve University
- MetroHealth Medical Center
- Cleveland Clinic Cancer Center/Fairview Hospital
- Cleveland Clinic Foundation
- Ohio State University Comprehensive Cancer Center
- Mount Carmel East Hospital
- Columbus Oncology and Hematology Associates Inc
- Riverside Methodist Hospital
- Grant Medical Center
- The Mark H Zangmeister Center
- Mount Carmel Health Center West
- Doctors Hospital
- Delaware Health Center-Grady Cancer Center
- Grady Memorial Hospital
- Mercy Cancer Center-Elyria
- Dayton Physicians LLC-Atrium
- Cleveland Clinic Cancer Center Independence
- Kettering Medical Center
- Saint Rita's Medical Center
- OhioHealth Mansfield Hospital
- Cleveland Clinic Cancer Center Mansfield
- Marietta Memorial Hospital
- OhioHealth Marion General Hospital
- Hillcrest Hospital Cancer Center
- UH Seidman Cancer Center at Lake Health Mentor Campus
- UH Seidman Cancer Center at Southwest General Hospital
- Knox Community Hospital
- Licking Memorial Hospital
- University Hospitals Parma Medical Center
- Mercy Health Perrysburg Cancer Center
- Southern Ohio Medical Center
- North Coast Cancer Care
- UH Seidman Cancer Center at Firelands Regional Medical Center
- Springfield Regional Medical Center
- Trinity's Tony Teramana Cancer Center
- Cleveland Clinic Cancer Center Strongsville
- ProMedica Flower Hospital
- ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
- Mercy Health - Saint Anne Hospital
- Toledo Clinic Cancer Centers-Toledo
- University Hospitals Sharon Health Center
- South Pointe Hospital
- Saint Ann's Hospital
- UH Seidman Cancer Center at Saint John Medical Center
- UHHS-Westlake Medical Center
- Cleveland Clinic Wooster Family Health and Surgery Center
- Genesis Healthcare System Cancer Care Center
- Cancer Centers of Southwest Oklahoma Research
- University of Oklahoma Health Sciences Center
- Mercy Hospital Oklahoma City
- Integris Cancer Institute of Oklahoma
- Cancer Treatment Centers of America
- Oklahoma Cancer Specialists and Research Institute-Tulsa
- Saint Alphonsus Medical Center-Baker City
- Providence Cancer Institute Clackamas Clinic
- Good Samaritan Hospital
- Three Rivers Community Hospital
- Legacy Mount Hood Medical Center
- Rogue Valley Medical Center
- Providence Newberg Medical Center
- Saint Alphonsus Medical Center-Ontario
- Legacy Good Samaritan Hospital and Medical Center
- Providence Portland Medical Center
- Providence Saint Vincent Medical Center
- Kaiser Permanente Northwest
- Oregon Health and Science University
- Legacy Meridian Park Hospital
- Jefferson Abington Hospital
- Lehigh Valley Hospital-Cedar Crest
- Lehigh Valley Hospital - Muhlenberg
- Bryn Mawr Hospital
- Doylestown Hospital
- Saint Vincent Hospital
- UPMC Pinnacle Cancer Center/Community Osteopathic Campus
- Jefferson Hospital
- Riddle Memorial Hospital
- Forbes Hospital
- Paoli Memorial Hospital
- Thomas Jefferson University Hospital
- Fox Chase Cancer Center
- Jefferson Torresdale Hospital
- Eastern Regional Medical Center
- Allegheny General Hospital
- West Penn Hospital
- University of Pittsburgh Cancer Institute (UPCI)
- Chester County Hospital
- Reading Hospital
- Wexford Health and Wellness Pavilion
- UPMC Susquehanna
- Asplundh Cancer Pavilion
- Lankenau Medical Center
- UPMC Memorial
- AnMed Health Cancer Center
- Saint Joseph's/Candler - Bluffton Campus
- Prisma Health Cancer Institute - Spartanburg
- Medical University of South Carolina
- Prisma Health Cancer Institute - Laurens
- Prisma Health Cancer Institute - Easley
- McLeod Regional Medical Center
- Gibbs Cancer Center-Gaffney
- Tidelands Georgetown Memorial Hospital
- Saint Francis Hospital
- Prisma Health Cancer Institute - Butternut
- Prisma Health Cancer Institute - Faris
- Saint Francis Cancer Center
- Prisma Health Cancer Institute - Eastside
- Self Regional Healthcare
- Prisma Health Cancer Institute - Greer
- Gibbs Cancer Center-Pelham
- South Carolina Cancer Specialists PC
- Levine Cancer Institute-Rock Hill
- Prisma Health Cancer Institute - Seneca
- Spartanburg Medical Center
- MGC Hematology Oncology-Union
- Lexington Medical Center
- Avera Cancer Institute at Pierre
- Rapid City Regional Hospital
- Sanford Cancer Center Oncology Clinic
- Avera Cancer Institute
- Sanford USD Medical Center - Sioux Falls
- Baptist Memorial Hospital and Cancer Center-Collierville
- Vanderbilt-Ingram Cancer Center Cool Springs
- Ballad Health Cancer Care - Kingsport
- Thompson Cancer Survival Center
- Thompson Cancer Survival Center - West
- Thompson Oncology Group-Lenoir City
- Thompson Oncology Group-Maryville
- Baptist Memorial Hospital and Cancer Center-Memphis
- Vanderbilt Breast Center at One Hundred Oaks
- Vanderbilt University/Ingram Cancer Center
- Thompson Oncology Group-Oak Ridge
- The Don and Sybil Harrington Cancer Center
- Dell Seton Medical Center at The University of Texas
- Austin Cancer Centers-Central Austin
- Austin Cancer Centers-Saint David's
- Houston Methodist San Jacinto Hospital
- MD Anderson in The Woodlands
- Lyndon Baines Johnson General Hospital
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
- Ben Taub General Hospital
- Houston Methodist Hospital
- M D Anderson Cancer Center
- Methodist Willowbrook Hospital
- MD Anderson West Houston
- Houston Methodist West Hospital
- MD Anderson League City
- Houston Methodist Saint John Hospital
- MD Anderson in Sugar Land
- Houston Methodist Sugar Land Hospital
- Houston Methodist The Woodlands Hospital
- Farmington Health Center
- University of Utah Sugarhouse Health Center
- Huntsman Cancer Institute/University of Utah
- South Jordan Health Center
- Norris Cotton Cancer Center-North
- Wellmont Medical Associates-Bristol
- Inova Schar Cancer Institute
- Augusta Health Center for Cancer and Blood Disorders
- Peninsula Cancer Institute-Gloucester
- Centra Lynchburg Hematology-Oncology Clinic Inc
- Bon Secours Memorial Regional Medical Center
- Bon Secours Saint Francis Medical Center
- Peninsula Cancer Institute-Newport News
- Southwest VA Regional Cancer Center
- Bon Secours Saint Mary's Hospital
- Virginia Cancer Institute
- VCU Massey Cancer Center at Stony Point
- Virginia Commonwealth University/Massey Cancer Center
- VCU Community Memorial Health Center
- Peninsula Cancer Institute-Cancer Specialists of Tidewater
- Peninsula Cancer Institute-Williamsburg
- Shenandoah Oncology PC
- Providence Regional Cancer System-Aberdeen
- Overlake Medical Center
- PeaceHealth Saint Joseph Medical Center
- Harrison HealthPartners Hematology and Oncology-Bremerton
- Providence Regional Cancer System-Centralia
- Swedish Cancer Institute-Edmonds
- Kadlec Clinic Hematology and Oncology
- Seattle Cancer Care Alliance at EvergreenHealth
- Providence Regional Cancer System-Lacey
- PeaceHealth Saint John Medical Center
- Skagit Regional Health Cancer Care Center
- Skagit Valley Hospital
- Jefferson Healthcare
- Harrison HealthPartners Hematology and Oncology-Poulsbo
- Virginia Mason Medical Center
- FHCC South Lake Union
- Fred Hutchinson Cancer Research Center
- Swedish Medical Center-First Hill
- FHCC at Northwest Hospital
- University of Washington Medical Center - Montlake
- Spokane Valley Cancer Center-Mayfair
- PeaceHealth Southwest Medical Center
- Legacy Cancer Institute Medical Oncology and Day Treatment
- Legacy Salmon Creek Hospital
- North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
- Edwards Comprehensive Cancer Center
- Langlade Hospital and Cancer Center
- ThedaCare Regional Cancer Center
- Ascension Saint Elizabeth Hospital
- Duluth Clinic Ashland
- Ascension Southeast Wisconsin Hospital - Elmbrook Campus
- Aurora Cancer Care-Southern Lakes VLCC
- Ascension Calumet Hospital
- Aurora Health Center-Fond du Lac
- Ascension Saint Francis - Reiman Cancer Center
- Aurora Health Care Germantown Health Center
- Aurora Cancer Care-Grafton
- Saint Vincent Hospital Cancer Center Green Bay
- Saint Vincent Hospital Cancer Center at Saint Mary's
- Aurora BayCare Medical Center
- UW Cancer Center Johnson Creek
- Aurora Cancer Care-Kenosha South
- Gundersen Lutheran Medical Center
- University of Wisconsin Carbone Cancer Center
- Aurora Bay Area Medical Group-Marinette
- Saint Vincent Hospital Cancer Center at Marinette
- Aspirus Medford Hospital
- Ascension Columbia Saint Mary's Hospital Ozaukee
- Aurora Cancer Care-Milwaukee
- Ascension Columbia Saint Mary's Hospital - Milwaukee
- Aurora Saint Luke's Medical Center
- Aurora Sinai Medical Center
- ProHealth D N Greenwald Center
- Cancer Center of Western Wisconsin
- ProHealth Oconomowoc Memorial Hospital
- Saint Vincent Hospital Cancer Center at Oconto Falls
- Ascension Mercy Hospital
- Vince Lombardi Cancer Clinic - Oshkosh
- Ascension All Saints Hospital
- Aurora Cancer Care-Racine
- Vince Lombardi Cancer Clinic-Sheboygan
- Ascension Saint Michael's Hospital
- Saint Vincent Hospital Cancer Center at Sturgeon Bay
- Aurora Medical Center in Summit
- Vince Lombardi Cancer Clinic-Two Rivers
- ProHealth Waukesha Memorial Hospital
- UW Cancer Center at ProHealth Care
- ThedaCare Cancer Care - Waupaca
- Aspirus Regional Cancer Center
- Ascension Medical Group Southeast Wisconsin - Mayfair Road
- Aurora Cancer Care-Milwaukee West
- Aurora West Allis Medical Center
- Aspirus Cancer Care - Wisconsin Rapids
- Billings Clinic-Cody
- Tom Baker Cancer Centre
- Cross Cancer Institute
- BCCA-Fraser Valley Cancer Centre
- BCCA-Vancouver Cancer Centre
- The Moncton Hospital
- Atlantic Health Sciences Corporation-Saint John Regional Hospital
- Doctor H. Bliss Murphy Cancer Centre
- Juravinski Cancer Centre at Hamilton Health Sciences
- Grand River Regional Cancer Centre at Grand River Hospital
- London Regional Cancer Program
- Stronach Regional Health Centre at Southlake
- Algoma District Cancer Program Sault Area Hospital
- Humber River Hospital
- Odette Cancer Centre- Sunnybrook Health Sciences Centre
- Hopital de la Cite-de-la-Sante
- The Research Institute of the McGill University Health Centre (MUHC)
- Jewish General Hospital
- Hopital Du Sacre-Coeur de Montreal
- CHU de Quebec-Hopital du Saint-Sacrement (HSS)
- Allan Blair Cancer Centre
- Cancer Center-Metro Medical Center Bayamon
- Doctors Cancer Center
- San Juan Community Oncology Group
- San Juan City Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Arm I (observation)
Arm II (pembrolizumab)
Patients receive no treatment but are monitored at standard clinical intervals during first year after randomization. Patients are examined every 12 weeks for 1 year, every 6 months for 4 years, and then annually for 5 years. Patients may undergo radiation therapy within 12 weeks of last breast cancer operation or after treatment. Patients may also undergo collection of blood samples throughout the trial.
Patients receive pembrolizumab IV over 30 minutes on days 1 and 22. Cycles repeat every 42 days for 52 weeks in the absence of disease progression or unacceptable toxicity. Patients may undergo radiation therapy within 12 weeks of last breast cancer operation or after treatment. Patients may also undergo collection of blood samples throughout the trial.