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Tipifarnib for the Treatment of Advanced Solid Tumors, Lymphoma, or Histiocytic Disorders With HRAS Gene Alterations, a Pediatric MATCH Treatment Trial

Study Purpose

This phase II pediatric MATCH trial studies how well tipifarnib works in treating patients with solid tumors that have recurred or spread to other places in the body (advanced), lymphoma, or histiocytic disorders, that have a genetic alteration in the gene HRAS. Tipifarnib may block the growth of cancer cells that have specific genetic changes in a gene called HRAS and may reduce tumor size.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 12 Months - 21 Years
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

  • - Patient must have enrolled onto APEC1621SC and must have been given a treatment assignment to MATCH to APEC1621M based on the presence of an actionable mutation as defined in APEC1621SC.
  • - Patients must be >=12 months and =< 21 years of age at the time of study enrollment.
  • - Patients must have a body surface area >= 0.29 m^2 at enrollment.
  • - Patients must have radiographically measurable disease at the time of study enrollment.
Patients with neuroblastoma who do not have measurable disease but have metaiodobenzylguanidine (MIBG) positive (+) evaluable disease are eligible. Measurable disease in patients with CNS involvement is defined as any lesion that is at minimum 10 mm in one dimension on standard magnetic resonance imaging (MRI) or computed tomography (CT)
  • - Note: The following do not qualify as measurable disease: - Malignant fluid collections (e.g., ascites, pleural effusions) - Bone marrow infiltration except that detected by MIBG scan for neuroblastoma.
  • - Lesions only detected by nuclear medicine studies (e.g., bone, gallium or positron emission tomography [PET] scans) except as noted for neuroblastoma.
  • - Elevated tumor markers in plasma or cerebral spinal fluid (CSF) - Previously radiated lesions that have not demonstrated clear progression post radiation.
  • - Leptomeningeal lesions that do not meet the measurement requirements for Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.
  • - Karnofsky >= 50 for patients > 16 years of age and Lansky >= 50 for patients =< 16 years of age.
Note: Neurologic deficits in patients with CNS tumors must have been relatively stable for at least 7 days prior to study enrollment. Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
  • - Patients must have fully recovered from the acute toxic effects of all prior anti-cancer therapy and must meet the following minimum duration from prior anti-cancer directed therapy prior to enrollment.
If after the required timeframe, the numerical eligibility criteria are met, e.g. blood count criteria, the patient is considered to have recovered adequately.
  • - Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive.
  • - >= 21 days after the last dose of cytotoxic or myelosuppressive chemotherapy (42 days if prior nitrosourea) - Anti-cancer agents not known to be myelosuppressive (e.g. not associated with reduced platelet or absolute neutrophil count [ANC] counts): >= 7 days after the last dose of agent.
  • - Antibodies: >= 21 days must have elapsed from infusion of last dose of antibody, and toxicity related to prior antibody therapy must be recovered to grade =< 1.
  • - Corticosteroids: If used to modify immune adverse events related to prior therapy, >= 14 days must have elapsed since last dose of corticosteroid.
  • - Hematopoietic growth factors: >= 14 days after the last dose of a long-acting growth factor (e.g. pegfilgrastim) or 7 days for short-acting growth factor.
For growth factors that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur. The duration of this interval must be discussed with the study chair and the study-assigned research coordinator.
  • - Interleukins, interferons and cytokines (other than hematopoietic growth factors): >= 21 days after the completion of interleukins, interferon or cytokines (other than hematopoietic growth factors) - Stem cell infusions (with or without total body irradiation [TBI]): - Allogeneic (non-autologous) bone marrow or stem cell transplant, or any stem cell infusion including donor lymphocyte infusion (DLI) or boost infusion: >= 84 days after infusion and no evidence of graft versus host disease (GVHD) - Autologous stem cell infusion including boost infusion: >= 42 days.
  • - Cellular therapy: >= 42 days after the completion of any type of cellular therapy (e.g. modified T cells, natural killer [NK] cells, dendritic cells, etc.) - Radiation therapy (XRT)/external beam irradiation including protons: >= 14 days after local XRT; >= 150 days after TBI, craniospinal XRT or if radiation to >= 50% of the pelvis; >= 42 days if other substantial bone marrow (BM) radiation.
  • - Note: Radiation may not be delivered to "measurable disease" tumor site(s) being used to follow response to subprotocol treatment.
  • - Radiopharmaceutical therapy (e.g., radiolabeled antibody, 131I-MIBG): >= 42 days after systemically administered radio-pharmaceutical therapy.
  • - Patients must not have received prior exposure to tipifarnib.
  • - For patients with solid tumors without known bone marrow involvement (within 7 days prior to enrollment): - Peripheral absolute neutrophil count (ANC) >= 1000/mm^3.
  • - For patients with solid tumors without known bone marrow involvement (within 7 days prior to enrollment): - Platelet count >= 100,000/mm^3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment) - Patients with known bone marrow metastatic disease will be eligible for study provided they meet the blood counts (may receive transfusions provided they are not known to be refractory to red cell or platelet transfusions).
These patients will not be evaluable for hematologic toxicity.
  • - Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2 (within 7 days prior to enrollment) or.
  • - A serum creatinine based on age/gender as follows (within 7 days prior to enrollment): - Age: Maximum serum creatinine (mg/dL) - 1 to < 2 years: male (0.6), female (0.6) - 2 to < 6 years: male (0.8), female (0.8) - 6 to < 10 years: male (1), female (1) - 10 to < 13 years: male (1.2), female (1.2) - 13 to < 16 years: male (1.5), female (1.4) - >= 16 years: male (1.7), female (1.4) - Bilirubin (sum of conjugated + unconjugated) =< 1.5 x upper limit of normal (ULN) for age (within 7 days prior to enrollment) - Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 135 U/L.
(For the purpose of this study, the ULN for SGPT is 45 U/L.) (within 7 days prior to enrollment)
  • - Serum albumin >= 2 g/dL (within 7 days prior to enrollment) - Patients with seizure disorder may be enrolled if on anticonvulsants and well controlled.
  • - Nervous system disorders (Common Terminology Criteria for Adverse Events [CTCAE] version [v] 5.0) resulting from prior therapy must be =< grade 2.
  • - Patients must be able to swallow intact tablets or crushed tablets mixed in water, orange juice, apple juice, tomato juice, ginger ale, applesauce, yogurt, protein shake, or a dietary supplement drink (such as Ensure).
Percutaneous endoscopic gastrostomy (PEG)-tube or nasogastric tube administration is permitted.
  • - All patients and/or their parents or legally authorized representatives must sign a written informed consent.
Assent, when appropriate, will be obtained according to institutional guidelines.

Exclusion Criteria:

  • - Pregnant or breast-feeding women will not be entered on this study due to risks of fetal and teratogenic adverse events as seen in animal/human studies.
Pregnancy tests must be obtained in girls who are post-menarchal. Males or females of reproductive potential may not participate unless they have agreed to use two effective contraceptive methods for the duration of study treatment. Both female subjects and male subjects with female partners of child-bearing potential must agree to use a highly effective method of contraception for 2 weeks prior to protocol therapy, during, and at least 4 weeks after last dose of tipifarnib. In addition, since tipifarnib could induce toxicity of male reproductive organs and cause impairment of fertility, sperm cryopreservation should be recommended for male subjects wishing to preserve their fertility following tipifarnib treatment.
  • - Patients receiving corticosteroids who have not been on a stable or decreasing dose of corticosteroid for at least 7 days prior to enrollment are not eligible.
If used to modify immune adverse events related to prior therapy, >= 14 days must have elapsed since last dose of corticosteroid.
  • - Patients who are currently receiving another investigational drug are not eligible.
  • - Patients who are currently receiving other anti-cancer agents are not eligible.
  • - Patients who are receiving cyclosporine, tacrolimus or other agents to prevent graft-versus-host disease post bone marrow transplant are not eligible for this trial.
  • - Patients who are currently receiving drugs that are strong inducers or inhibitors of CYP3A4/5 or UGT are not eligible.
Strong inducers or inhibitors of CYP3A4/5 or UGT should be avoided from 14 days prior to the 1st dose of tipifarnib to the end of the study. In addition, patients receiving agents that are sensitive or narrow therapeutic range substrates of CYP3A4/5 are not eligible. Note: CYP3A4/5 inducing anti-epileptic drugs and dexamethasone for CNS tumors or metastases, on a stable dose, are allowed.
  • - Patients with known hypersensitivity to tipifarnib or any components of the tablet are not eligible.
  • - Patients with hypersensitivity to imidazoles, such as clotrimazole, ketoconazole, miconazole and others in this drug class are not eligible.
  • - Patients who have an uncontrolled infection are not eligible.
  • - Patients who have received a prior solid organ transplantation are not eligible.
- Patients who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study are not eligible

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT04284774
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

Phase 2
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

National Cancer Institute (NCI)
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Christine A Pratilas
Principal Investigator Affiliation Children's Oncology Group
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

NIH
Overall Status Active, not recruiting
Countries Puerto Rico, United States
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Malignant Solid Neoplasm, Recurrent Adrenal Gland Pheochromocytoma, Recurrent Ectomesenchymoma, Recurrent Ependymoma, Recurrent Ewing Sarcoma, Recurrent Hepatoblastoma, Recurrent Kidney Wilms Tumor, Recurrent Langerhans Cell Histiocytosis, Recurrent Malignant Germ Cell Tumor, Recurrent Malignant Glioma, Recurrent Medulloblastoma, Recurrent Melanoma, Recurrent Neuroblastoma, Recurrent Non-Hodgkin Lymphoma, Recurrent Osteosarcoma, Recurrent Peripheral Primitive Neuroectodermal Tumor, Recurrent Rhabdoid Tumor, Recurrent Rhabdoid Tumor of the Kidney, Recurrent Rhabdomyosarcoma, Recurrent Soft Tissue Sarcoma, Recurrent Thyroid Gland Carcinoma, Recurrent WHO Grade 2 Glioma, Refractory Adrenal Gland Pheochromocytoma, Refractory Ependymoma, Refractory Ewing Sarcoma, Refractory Hepatoblastoma, Refractory Langerhans Cell Histiocytosis, Refractory Malignant Germ Cell Tumor, Refractory Malignant Glioma, Refractory Medulloblastoma, Refractory Melanoma, Refractory Neuroblastoma, Refractory Non-Hodgkin Lymphoma, Refractory Osteosarcoma, Refractory Peripheral Primitive Neuroectodermal Tumor, Refractory Rhabdoid Tumor, Refractory Rhabdoid Tumor of the Kidney, Refractory Rhabdomyosarcoma, Refractory Soft Tissue Sarcoma, Refractory Thyroid Gland Carcinoma, Refractory WHO Grade 2 Glioma
Additional Details

PRIMARY OBJECTIVE:

  • I. To determine the objective response rate (ORR; complete response + partial response) in pediatric patients treated with tipifarnib with advanced solid tumors (including central nervous system [CNS] tumors), lymphomas or histiocytic disorders that harbor activating genetic alterations in HRAS.
SECONDARY OBJECTIVES:
  • I. To estimate the progression free survival in pediatric patients treated with tipifarnib with advanced solid tumors (including CNS tumors), lymphomas or histiocytic disorders that harbor activating genetic alterations in HRAS.
  • II. To obtain information about the tolerability of tipifarnib in children and adolescents with relapsed or refractory cancer.
EXPLORATORY OBJECTIVES:
  • I. To evaluate other biomarkers as predictors of response to tipifarnib and specifically, whether tumors that harbor different missense mutations or variant allele frequency will demonstrate differential response to tipifarnib treatment.
  • II. To explore approaches to profiling changes in tumor genomics over time through evaluation of circulating tumor deoxyribonucleic acid (DNA).
OUTLINE: Patients receive tipifarnib orally (PO) or via nasogastric or gastric tube twice daily (BID) on days 1-7 and 15-21. Treatment repeats every 28 days for up to 26 cycles (2 years) in the absence of disease progression or unacceptable toxicity. Patients undergo tumor disease evaluation with positron emission tomography (PET) scan, computed tomography (CT) scan, magnetic resonance imaging (MRI), or meta-iodobenzylguanidine (MIBG) scintigraphy throughout the trial. Patients may undergo bone marrow aspiration or biopsy at baseline, or if there is suspicion of bone marrow metastasis, or when a complete or partial response is identified, or if there is disease progression in the marrow suspected. Patients may undergo blood specimen collections throughout the trial. After completion of study treatment, patients are followed up at 30 days, then periodically thereafter.

Arms & Interventions

Arms

Experimental: Treatment (tipifarnib)

Patients receive tipifarnib PO or via nasogastric or gastric tube BID on days 1-7 and 15-21. Treatment repeats every 28 days for up to 26 cycles (2 years) in the absence of disease progression or unacceptable toxicity. Patients undergo tumor disease evaluation with PET scan, CT scan, MRI, or MIBG scintigraphy throughout the trial. Patients may undergo bone marrow aspiration or biopsy at baseline, or if there is suspicion of bone marrow metastasis, or when a complete or partial response is identified, or if there is disease progression in the marrow suspected. Patients may undergo blood specimen collections throughout the trial.

Interventions

Procedure: - Biospecimen Collection

Undergo blood sample collection

Procedure: - Bone Marrow Aspiration and Biopsy

Undergo bone marrow aspiration or biopsy

Procedure: - Computed Tomography

Undergo a CT scan

Procedure: - Magnetic Resonance Imaging

Undergo MRI

Procedure: - Positron Emission Tomography

Undergo a PET scan

Procedure: - Radionuclide Imaging

Undergo a MIBG scintigraphy scan

Drug: - Tipifarnib

Given PO or via nasogastric or gastric tube

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

Children's Hospital of Alabama, Birmingham, Alabama

Status

Address

Children's Hospital of Alabama

Birmingham, Alabama, 35233

Providence Alaska Medical Center, Anchorage, Alaska

Status

Address

Providence Alaska Medical Center

Anchorage, Alaska, 99508

Banner Children's at Desert, Mesa, Arizona

Status

Address

Banner Children's at Desert

Mesa, Arizona, 85202

Phoenix Childrens Hospital, Phoenix, Arizona

Status

Address

Phoenix Childrens Hospital

Phoenix, Arizona, 85016

Tucson, Arizona

Status

Address

Banner University Medical Center - Tucson

Tucson, Arizona, 85719

Arkansas Children's Hospital, Little Rock, Arkansas

Status

Address

Arkansas Children's Hospital

Little Rock, Arkansas, 72202-3591

Kaiser Permanente Downey Medical Center, Downey, California

Status

Address

Kaiser Permanente Downey Medical Center

Downey, California, 90242

City of Hope Comprehensive Cancer Center, Duarte, California

Status

Address

City of Hope Comprehensive Cancer Center

Duarte, California, 91010

Loma Linda University Medical Center, Loma Linda, California

Status

Address

Loma Linda University Medical Center

Loma Linda, California, 92354

Long Beach, California

Status

Address

Miller Children's and Women's Hospital Long Beach

Long Beach, California, 90806

Children's Hospital Los Angeles, Los Angeles, California

Status

Address

Children's Hospital Los Angeles

Los Angeles, California, 90027

Cedars Sinai Medical Center, Los Angeles, California

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Address

Cedars Sinai Medical Center

Los Angeles, California, 90048

Mattel Children's Hospital UCLA, Los Angeles, California

Status

Address

Mattel Children's Hospital UCLA

Los Angeles, California, 90095

Valley Children's Hospital, Madera, California

Status

Address

Valley Children's Hospital

Madera, California, 93636

UCSF Benioff Children's Hospital Oakland, Oakland, California

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Address

UCSF Benioff Children's Hospital Oakland

Oakland, California, 94609

Kaiser Permanente-Oakland, Oakland, California

Status

Address

Kaiser Permanente-Oakland

Oakland, California, 94611

Children's Hospital of Orange County, Orange, California

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Address

Children's Hospital of Orange County

Orange, California, 92868

Palo Alto, California

Status

Address

Lucile Packard Children's Hospital Stanford University

Palo Alto, California, 94304

Sacramento, California

Status

Address

University of California Davis Comprehensive Cancer Center

Sacramento, California, 95817

Rady Children's Hospital - San Diego, San Diego, California

Status

Address

Rady Children's Hospital - San Diego

San Diego, California, 92123

Naval Medical Center -San Diego, San Diego, California

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Address

Naval Medical Center -San Diego

San Diego, California, 92134

UCSF Medical Center-Mission Bay, San Francisco, California

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Address

UCSF Medical Center-Mission Bay

San Francisco, California, 94158

Torrance, California

Status

Address

Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center

Torrance, California, 90502

Children's Hospital Colorado, Aurora, Colorado

Status

Address

Children's Hospital Colorado

Aurora, Colorado, 80045

Denver, Colorado

Status

Address

Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center

Denver, Colorado, 80218

Connecticut Children's Medical Center, Hartford, Connecticut

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Address

Connecticut Children's Medical Center

Hartford, Connecticut, 06106

Yale University, New Haven, Connecticut

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Address

Yale University

New Haven, Connecticut, 06520

Alfred I duPont Hospital for Children, Wilmington, Delaware

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Address

Alfred I duPont Hospital for Children

Wilmington, Delaware, 19803

MedStar Georgetown University Hospital, Washington, District of Columbia

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Address

MedStar Georgetown University Hospital

Washington, District of Columbia, 20007

Children's National Medical Center, Washington, District of Columbia

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Address

Children's National Medical Center

Washington, District of Columbia, 20010

Broward Health Medical Center, Fort Lauderdale, Florida

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Address

Broward Health Medical Center

Fort Lauderdale, Florida, 33316

Fort Myers, Florida

Status

Address

Golisano Children's Hospital of Southwest Florida

Fort Myers, Florida, 33908

Gainesville, Florida

Status

Address

University of Florida Health Science Center - Gainesville

Gainesville, Florida, 32610

Hollywood, Florida

Status

Address

Memorial Regional Hospital/Joe DiMaggio Children's Hospital

Hollywood, Florida, 33021

Nemours Children's Clinic-Jacksonville, Jacksonville, Florida

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Address

Nemours Children's Clinic-Jacksonville

Jacksonville, Florida, 32207

Miami, Florida

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Address

University of Miami Miller School of Medicine-Sylvester Cancer Center

Miami, Florida, 33136

Nicklaus Children's Hospital, Miami, Florida

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Address

Nicklaus Children's Hospital

Miami, Florida, 33155

Miami Cancer Institute, Miami, Florida

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Miami Cancer Institute

Miami, Florida, 33176

AdventHealth Orlando, Orlando, Florida

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Address

AdventHealth Orlando

Orlando, Florida, 32803

Arnold Palmer Hospital for Children, Orlando, Florida

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Address

Arnold Palmer Hospital for Children

Orlando, Florida, 32806

Nemours Children's Hospital, Orlando, Florida

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Address

Nemours Children's Hospital

Orlando, Florida, 32827

Sacred Heart Hospital, Pensacola, Florida

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Address

Sacred Heart Hospital

Pensacola, Florida, 32504

Johns Hopkins All Children's Hospital, Saint Petersburg, Florida

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Address

Johns Hopkins All Children's Hospital

Saint Petersburg, Florida, 33701

Tampa General Hospital, Tampa, Florida

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Address

Tampa General Hospital

Tampa, Florida, 33606

Tampa, Florida

Status

Address

Saint Joseph's Hospital/Children's Hospital-Tampa

Tampa, Florida, 33607

Saint Mary's Hospital, West Palm Beach, Florida

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Address

Saint Mary's Hospital

West Palm Beach, Florida, 33407

Atlanta, Georgia

Status

Address

Children's Healthcare of Atlanta - Egleston

Atlanta, Georgia, 30322

Savannah, Georgia

Status

Address

Memorial Health University Medical Center

Savannah, Georgia, 31404

Honolulu, Hawaii

Status

Address

Kapiolani Medical Center for Women and Children

Honolulu, Hawaii, 96826

Saint Luke's Cancer Institute - Boise, Boise, Idaho

Status

Address

Saint Luke's Cancer Institute - Boise

Boise, Idaho, 83712

Lurie Children's Hospital-Chicago, Chicago, Illinois

Status

Address

Lurie Children's Hospital-Chicago

Chicago, Illinois, 60611

University of Illinois, Chicago, Illinois

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Address

University of Illinois

Chicago, Illinois, 60612

Chicago, Illinois

Status

Address

University of Chicago Comprehensive Cancer Center

Chicago, Illinois, 60637

Loyola University Medical Center, Maywood, Illinois

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Address

Loyola University Medical Center

Maywood, Illinois, 60153

Saint Jude Midwest Affiliate, Peoria, Illinois

Status

Address

Saint Jude Midwest Affiliate

Peoria, Illinois, 61637

Springfield, Illinois

Status

Address

Southern Illinois University School of Medicine

Springfield, Illinois, 62702

Riley Hospital for Children, Indianapolis, Indiana

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Address

Riley Hospital for Children

Indianapolis, Indiana, 46202

Indianapolis, Indiana

Status

Address

Ascension Saint Vincent Indianapolis Hospital

Indianapolis, Indiana, 46260

Blank Children's Hospital, Des Moines, Iowa

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Address

Blank Children's Hospital

Des Moines, Iowa, 50309

Iowa City, Iowa

Status

Address

University of Iowa/Holden Comprehensive Cancer Center

Iowa City, Iowa, 52242

Lexington, Kentucky

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Address

University of Kentucky/Markey Cancer Center

Lexington, Kentucky, 40536

Norton Children's Hospital, Louisville, Kentucky

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Address

Norton Children's Hospital

Louisville, Kentucky, 40202

Children's Hospital New Orleans, New Orleans, Louisiana

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Address

Children's Hospital New Orleans

New Orleans, Louisiana, 70118

Ochsner Medical Center Jefferson, New Orleans, Louisiana

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Address

Ochsner Medical Center Jefferson

New Orleans, Louisiana, 70121

Eastern Maine Medical Center, Bangor, Maine

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Address

Eastern Maine Medical Center

Bangor, Maine, 04401

Maine Children's Cancer Program, Scarborough, Maine

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Address

Maine Children's Cancer Program

Scarborough, Maine, 04074

Baltimore, Maryland

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Address

University of Maryland/Greenebaum Cancer Center

Baltimore, Maryland, 21201

Sinai Hospital of Baltimore, Baltimore, Maryland

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Address

Sinai Hospital of Baltimore

Baltimore, Maryland, 21215

Baltimore, Maryland

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Address

Johns Hopkins University/Sidney Kimmel Cancer Center

Baltimore, Maryland, 21287

Bethesda, Maryland

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Address

National Institutes of Health Clinical Center

Bethesda, Maryland, 20892

Boston, Massachusetts

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Address

Massachusetts General Hospital Cancer Center

Boston, Massachusetts, 02114

Dana-Farber Cancer Institute, Boston, Massachusetts

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Address

Dana-Farber Cancer Institute

Boston, Massachusetts, 02215

Worcester, Massachusetts

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Address

UMass Memorial Medical Center - University Campus

Worcester, Massachusetts, 01655

C S Mott Children's Hospital, Ann Arbor, Michigan

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Address

C S Mott Children's Hospital

Ann Arbor, Michigan, 48109

Children's Hospital of Michigan, Detroit, Michigan

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Address

Children's Hospital of Michigan

Detroit, Michigan, 48201

Detroit, Michigan

Status

Address

Wayne State University/Karmanos Cancer Institute

Detroit, Michigan, 48201

East Lansing, Michigan

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Address

Michigan State University Clinical Center

East Lansing, Michigan, 48824

Grand Rapids, Michigan

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Address

Helen DeVos Children's Hospital at Spectrum Health

Grand Rapids, Michigan, 49503

Bronson Methodist Hospital, Kalamazoo, Michigan

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Address

Bronson Methodist Hospital

Kalamazoo, Michigan, 49007

Beaumont Children's Hospital-Royal Oak, Royal Oak, Michigan

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Address

Beaumont Children's Hospital-Royal Oak

Royal Oak, Michigan, 48073

Minneapolis, Minnesota

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Address

Children's Hospitals and Clinics of Minnesota - Minneapolis

Minneapolis, Minnesota, 55404

Minneapolis, Minnesota

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Address

University of Minnesota/Masonic Cancer Center

Minneapolis, Minnesota, 55455

Mayo Clinic in Rochester, Rochester, Minnesota

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Address

Mayo Clinic in Rochester

Rochester, Minnesota, 55905

University of Mississippi Medical Center, Jackson, Mississippi

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Address

University of Mississippi Medical Center

Jackson, Mississippi, 39216

Children's Mercy Hospitals and Clinics, Kansas City, Missouri

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Address

Children's Mercy Hospitals and Clinics

Kansas City, Missouri, 64108

Saint Louis, Missouri

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Address

Cardinal Glennon Children's Medical Center

Saint Louis, Missouri, 63104

Washington University School of Medicine, Saint Louis, Missouri

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Address

Washington University School of Medicine

Saint Louis, Missouri, 63110

Mercy Hospital Saint Louis, Saint Louis, Missouri

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Address

Mercy Hospital Saint Louis

Saint Louis, Missouri, 63141

Omaha, Nebraska

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Address

Children's Hospital and Medical Center of Omaha

Omaha, Nebraska, 68114

University of Nebraska Medical Center, Omaha, Nebraska

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Address

University of Nebraska Medical Center

Omaha, Nebraska, 68198

Las Vegas, Nevada

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Address

University Medical Center of Southern Nevada

Las Vegas, Nevada, 89102

Sunrise Hospital and Medical Center, Las Vegas, Nevada

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Address

Sunrise Hospital and Medical Center

Las Vegas, Nevada, 89109

Las Vegas, Nevada

Status

Address

Alliance for Childhood Diseases/Cure 4 the Kids Foundation

Las Vegas, Nevada, 89135

Summerlin Hospital Medical Center, Las Vegas, Nevada

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Address

Summerlin Hospital Medical Center

Las Vegas, Nevada, 89144

Renown Regional Medical Center, Reno, Nevada

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Address

Renown Regional Medical Center

Reno, Nevada, 89502

Lebanon, New Hampshire

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Address

Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center

Lebanon, New Hampshire, 03756

Hackensack University Medical Center, Hackensack, New Jersey

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Address

Hackensack University Medical Center

Hackensack, New Jersey, 07601

Morristown Medical Center, Morristown, New Jersey

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Address

Morristown Medical Center

Morristown, New Jersey, 07960

Saint Peter's University Hospital, New Brunswick, New Jersey

Status

Address

Saint Peter's University Hospital

New Brunswick, New Jersey, 08901

New Brunswick, New Jersey

Status

Address

Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital

New Brunswick, New Jersey, 08903

Albany Medical Center, Albany, New York

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Address

Albany Medical Center

Albany, New York, 12208

Montefiore Medical Center - Moses Campus, Bronx, New York

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Address

Montefiore Medical Center - Moses Campus

Bronx, New York, 10467

Roswell Park Cancer Institute, Buffalo, New York

Status

Address

Roswell Park Cancer Institute

Buffalo, New York, 14263

NYU Winthrop Hospital, Mineola, New York

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Address

NYU Winthrop Hospital

Mineola, New York, 11501

New Hyde Park, New York

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Address

The Steven and Alexandra Cohen Children's Medical Center of New York

New Hyde Park, New York, 11040

New York, New York

Status

Address

Laura and Isaac Perlmutter Cancer Center at NYU Langone

New York, New York, 10016

New York, New York

Status

Address

NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

New York, New York, 10032

Memorial Sloan Kettering Cancer Center, New York, New York

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Address

Memorial Sloan Kettering Cancer Center

New York, New York, 10065

NYP/Weill Cornell Medical Center, New York, New York

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Address

NYP/Weill Cornell Medical Center

New York, New York, 10065

University of Rochester, Rochester, New York

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Address

University of Rochester

Rochester, New York, 14642

Stony Brook University Medical Center, Stony Brook, New York

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Address

Stony Brook University Medical Center

Stony Brook, New York, 11794

Syracuse, New York

Status

Address

State University of New York Upstate Medical University

Syracuse, New York, 13210

New York Medical College, Valhalla, New York

Status

Address

New York Medical College

Valhalla, New York, 10595

Mission Hospital, Asheville, North Carolina

Status

Address

Mission Hospital

Asheville, North Carolina, 28801

Chapel Hill, North Carolina

Status

Address

UNC Lineberger Comprehensive Cancer Center

Chapel Hill, North Carolina, 27599

Charlotte, North Carolina

Status

Address

Carolinas Medical Center/Levine Cancer Institute

Charlotte, North Carolina, 28203

Charlotte, North Carolina

Status

Address

Novant Health Presbyterian Medical Center

Charlotte, North Carolina, 28204

Duke University Medical Center, Durham, North Carolina

Status

Address

Duke University Medical Center

Durham, North Carolina, 27710

East Carolina University, Greenville, North Carolina

Status

Address

East Carolina University

Greenville, North Carolina, 27834

Wake Forest University Health Sciences, Winston-Salem, North Carolina

Status

Address

Wake Forest University Health Sciences

Winston-Salem, North Carolina, 27157

Sanford Broadway Medical Center, Fargo, North Dakota

Status

Address

Sanford Broadway Medical Center

Fargo, North Dakota, 58122

Akron, Ohio

Status

Address

Children's Hospital Medical Center of Akron

Akron, Ohio, 44308

Cincinnati, Ohio

Status

Address

Cincinnati Children's Hospital Medical Center

Cincinnati, Ohio, 45229

Rainbow Babies and Childrens Hospital, Cleveland, Ohio

Status

Address

Rainbow Babies and Childrens Hospital

Cleveland, Ohio, 44106

Cleveland Clinic Foundation, Cleveland, Ohio

Status

Address

Cleveland Clinic Foundation

Cleveland, Ohio, 44195

Nationwide Children's Hospital, Columbus, Ohio

Status

Address

Nationwide Children's Hospital

Columbus, Ohio, 43205

Dayton Children's Hospital, Dayton, Ohio

Status

Address

Dayton Children's Hospital

Dayton, Ohio, 45404

Toledo, Ohio

Status

Address

ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital

Toledo, Ohio, 43606

Oklahoma City, Oklahoma

Status

Address

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma, 73104

Legacy Emanuel Children's Hospital, Portland, Oregon

Status

Address

Legacy Emanuel Children's Hospital

Portland, Oregon, 97227

Oregon Health and Science University, Portland, Oregon

Status

Address

Oregon Health and Science University

Portland, Oregon, 97239

Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania

Status

Address

Lehigh Valley Hospital-Cedar Crest

Allentown, Pennsylvania, 18103

Geisinger Medical Center, Danville, Pennsylvania

Status

Address

Geisinger Medical Center

Danville, Pennsylvania, 17822

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Status

Address

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, 19104

Philadelphia, Pennsylvania

Status

Address

Saint Christopher's Hospital for Children

Philadelphia, Pennsylvania, 19134

Pittsburgh, Pennsylvania

Status

Address

Children's Hospital of Pittsburgh of UPMC

Pittsburgh, Pennsylvania, 15224

Rhode Island Hospital, Providence, Rhode Island

Status

Address

Rhode Island Hospital

Providence, Rhode Island, 02903

Prisma Health Richland Hospital, Columbia, South Carolina

Status

Address

Prisma Health Richland Hospital

Columbia, South Carolina, 29203

BI-LO Charities Children's Cancer Center, Greenville, South Carolina

Status

Address

BI-LO Charities Children's Cancer Center

Greenville, South Carolina, 29605

Sanford USD Medical Center - Sioux Falls, Sioux Falls, South Dakota

Status

Address

Sanford USD Medical Center - Sioux Falls

Sioux Falls, South Dakota, 57117-5134

T C Thompson Children's Hospital, Chattanooga, Tennessee

Status

Address

T C Thompson Children's Hospital

Chattanooga, Tennessee, 37403

East Tennessee Childrens Hospital, Knoxville, Tennessee

Status

Address

East Tennessee Childrens Hospital

Knoxville, Tennessee, 37916

Saint Jude Children's Research Hospital, Memphis, Tennessee

Status

Address

Saint Jude Children's Research Hospital

Memphis, Tennessee, 38105

Nashville, Tennessee

Status

Address

The Children's Hospital at TriStar Centennial

Nashville, Tennessee, 37203

Nashville, Tennessee

Status

Address

Vanderbilt University/Ingram Cancer Center

Nashville, Tennessee, 37232

Austin, Texas

Status

Address

Dell Children's Medical Center of Central Texas

Austin, Texas, 78723

Driscoll Children's Hospital, Corpus Christi, Texas

Status

Address

Driscoll Children's Hospital

Corpus Christi, Texas, 78411

Medical City Dallas Hospital, Dallas, Texas

Status

Address

Medical City Dallas Hospital

Dallas, Texas, 75230

Dallas, Texas

Status

Address

UT Southwestern/Simmons Cancer Center-Dallas

Dallas, Texas, 75390

El Paso Children's Hospital, El Paso, Texas

Status

Address

El Paso Children's Hospital

El Paso, Texas, 79905

Cook Children's Medical Center, Fort Worth, Texas

Status

Address

Cook Children's Medical Center

Fort Worth, Texas, 76104

Houston, Texas

Status

Address

Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center

Houston, Texas, 77030

M D Anderson Cancer Center, Houston, Texas

Status

Address

M D Anderson Cancer Center

Houston, Texas, 77030

Covenant Children's Hospital, Lubbock, Texas

Status

Address

Covenant Children's Hospital

Lubbock, Texas, 79410

UMC Cancer Center / UMC Health System, Lubbock, Texas

Status

Address

UMC Cancer Center / UMC Health System

Lubbock, Texas, 79415

Children's Hospital of San Antonio, San Antonio, Texas

Status

Address

Children's Hospital of San Antonio

San Antonio, Texas, 78207

San Antonio, Texas

Status

Address

Methodist Children's Hospital of South Texas

San Antonio, Texas, 78229

Scott and White Memorial Hospital, Temple, Texas

Status

Address

Scott and White Memorial Hospital

Temple, Texas, 76508

Primary Children's Hospital, Salt Lake City, Utah

Status

Address

Primary Children's Hospital

Salt Lake City, Utah, 84113

Burlington, Vermont

Status

Address

University of Vermont and State Agricultural College

Burlington, Vermont, 05405

Inova Fairfax Hospital, Falls Church, Virginia

Status

Address

Inova Fairfax Hospital

Falls Church, Virginia, 22042

Norfolk, Virginia

Status

Address

Children's Hospital of The King's Daughters

Norfolk, Virginia, 23507

Naval Medical Center - Portsmouth, Portsmouth, Virginia

Status

Address

Naval Medical Center - Portsmouth

Portsmouth, Virginia, 23708-2197

Richmond, Virginia

Status

Address

Virginia Commonwealth University/Massey Cancer Center

Richmond, Virginia, 23298

Seattle Children's Hospital, Seattle, Washington

Status

Address

Seattle Children's Hospital

Seattle, Washington, 98105

Spokane, Washington

Status

Address

Providence Sacred Heart Medical Center and Children's Hospital

Spokane, Washington, 99204

Tacoma, Washington

Status

Address

Mary Bridge Children's Hospital and Health Center

Tacoma, Washington, 98405

Madigan Army Medical Center, Tacoma, Washington

Status

Address

Madigan Army Medical Center

Tacoma, Washington, 98431

West Virginia University Healthcare, Morgantown, West Virginia

Status

Address

West Virginia University Healthcare

Morgantown, West Virginia, 26506

Madison, Wisconsin

Status

Address

University of Wisconsin Carbone Cancer Center

Madison, Wisconsin, 53792

Marshfield Medical Center-Marshfield, Marshfield, Wisconsin

Status

Address

Marshfield Medical Center-Marshfield

Marshfield, Wisconsin, 54449

Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Status

Address

Children's Hospital of Wisconsin

Milwaukee, Wisconsin, 53226

International Sites

University Pediatric Hospital, San Juan, Puerto Rico

Status

Address

University Pediatric Hospital

San Juan, , 00926