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Phase III Study Comparing Sequential Chemotherapy (AG-ITP) To Cisplatin And Gemcitabine As Adjuvant Treatment After Cystectomy For Transitional Cell Carcinoma Of The Bladder


Phase 3
18 Years
N/A
Not Enrolling
Both
Bladder Cancer

Thank you

Trial Information

Phase III Study Comparing Sequential Chemotherapy (AG-ITP) To Cisplatin And Gemcitabine As Adjuvant Treatment After Cystectomy For Transitional Cell Carcinoma Of The Bladder


OBJECTIVES:

Primary

- Compare the survival of patients with completely resected locally advanced transitional
cell carcinoma of the bladder treated with adjuvant doxorubicin and gemcitabine
followed by paclitaxel and cisplatin vs adjuvant cisplatin and gemcitabine.

Secondary

- Compare the toxicity profiles of these regimens in these patients.

OUTLINE: This is a randomized study. Patients are stratified according to primary tumor
status (5), and number
of dissected nodes (0-10 or unknown vs > 10). Patients are randomized to one of two
treatment arms.

- Arm I: Patients receive adjuvant gemcitabine IV over 30 minutes on days 1, 8, and 15
and cisplatin IV over 30-60 minutes on day 1. Treatment repeats every 4 weeks for up to
4 courses in the absence of disease progression or unacceptable toxicity.

- Arm II: Patients receive adjuvant doxorubicin IV over 45 minutes followed by
gemcitabine IV over 2 hours on day 1. Patients also receive filgrastim (G-CSF)
subcutaneously (SC) daily on days 3-10. Treatment repeats every 14 days for up to 4
courses in the absence of disease progression or unacceptable toxicity. Beginning 14
days after the completion of doxorubicin and gemcitabine, patients receive paclitaxel
IV over 3 hours and cisplatin IV over 20-30 minutes on day 1. Patients also receive
G-CSF SC daily on days 3-10 or 4-11. Treatment repeats every 14 days for up to 4
courses in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 18 months, every 6 months for 18 months, and then
annually thereafter.

PROJECTED ACCRUAL: A total of 800 patients will be accrued for this study within 6 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed transitional cell carcinoma of the bladder

- Any T, N+, M0 OR

- T3a-4a, N0, M0

- At least 6 weeks but no more than 3 months since prior complete resection of bladder

- Cystoprostatectomy plus pelvic lymph node dissection in males

- Cystectomy/total abdominal hysterectomy/bilateral salpingo-oophorectomy plus
pelvic lymph node dissection in females

- Negative surgical margins

- Carcinoma in situ allowed

- No partial cystectomy or transurethral bladder tumor resection as definitive
loco-regional therapy

- Prostate cancer detected in resected specimen allowed if post-operative PSA is no
more than 0.05 mg/dL

- No metastatic or recurrent disease by post-operative chest x-ray and CT scan of
abdomen and pelvis

PATIENT CHARACTERISTICS:

Age:

- 18 and over

Performance status:

- ECOG 0-1

Life expectancy:

- Not specified

Hematopoietic:

- Absolute neutrophil count ≥ 1,500/mm^3

- Platelet count ≥ 150,000/mm^3

Hepatic:

- Bilirubin ≤ 1.5 times upper limit of normal (ULN)

- Alkaline phosphatase ≤ 2 times ULN

- AST ≤ 2 times ULN

Renal:

- Creatinine ≤ 1.5 mg/dL OR

- Creatinine clearance ≥ 60 mL/min

Cardiovascular:

- Normal cardiac function by history, physical exam, or chest radiograph

- Left ventricular ejection fraction at least 50% by radionuclide ventriculogram or
echocardiogram, for prior cardiac disease

- No New York Heart Association class III or IV heart disease

- No serious cardiac arrhythmias including first-, second-, and third-degree heart
block

Other:

- Negative pregnancy test

- No uncontrolled infection

- No other active cancer within the past 5 years except non-melanoma skin cancer or
curatively treated carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- Not specified

Chemotherapy:

- No prior systemic chemotherapy

Endocrine therapy:

- Not specified

Radiotherapy:

- No prior radiotherapy to bladder

Surgery:

- See Disease Characteristics

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Overall survival

Outcome Time Frame:

4 years

Safety Issue:

No

Principal Investigator

Dean F. Bajorin, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Memorial Sloan-Kettering Cancer Center

Authority:

United States: Federal Government

Study ID:

CDR0000068554

NCT ID:

NCT00014534

Start Date:

March 2004

Completion Date:

April 2009

Related Keywords:

  • Bladder Cancer
  • stage III bladder cancer
  • stage IV bladder cancer
  • transitional cell carcinoma of the bladder
  • Urinary Bladder Neoplasms
  • Carcinoma, Transitional Cell

Name

Location

Roswell Park Cancer InstituteBuffalo, New York  14263
Mayo Clinic - JacksonvilleJacksonville, Florida  32224
Mayo Clinic Cancer CenterRochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical CenterMaywood, Illinois  60153-5500
Walter Reed Army Medical CenterWashington, District of Columbia  20307-5000
Emory University Hospital - AtlantaAtlanta, Georgia  30322
University of Chicago Cancer Research CenterChicago, Illinois  60637
Indiana University Cancer CenterIndianapolis, Indiana  46202-5265
Duke Comprehensive Cancer CenterDurham, North Carolina  27710
CCOP - Upstate CarolinaSpartanburg, South Carolina  29303
CCOP - WichitaWichita, Kansas  67214-3882
Rhode Island HospitalProvidence, Rhode Island  02903
CCOP - Kansas CityKansas City, Missouri  64131
CCOP - Southern Nevada Cancer Research FoundationLas Vegas, Nevada  89106
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - Mount Sinai Medical CenterMiami Beach, Florida  33140
CCOP - Illinois Oncology Research AssociationPeoria, Illinois  61602
CCOP - Carle Cancer CenterUrbana, Illinois  61801
CCOP - Iowa Oncology Research AssociationDes Moines, Iowa  50309-1016
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
Veterans Affairs Medical Center - East OrangeEast Orange, New Jersey  07018-1095
CCOP - Northern New JerseyHackensack, New Jersey  07601
Aurora Presbyterian HospitalAurora, Colorado  80012
Boulder Community HospitalBoulder, Colorado  80301-9019
Penrose Cancer Center at Penrose HospitalColorado Springs, Colorado  80933
Porter Adventist HospitalDenver, Colorado  80210
Presbyterian - St. Luke's Medical CenterDenver, Colorado  80218
St. Joseph HospitalDenver, Colorado  80218
Rose Medical CenterDenver, Colorado  80220
Swedish Medical CenterEnglewood, Colorado  80110
Sky Ridge Medical CenterLone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United HospitalLongmont, Colorado  80502
North Suburban Medical CenterThornton, Colorado  80229
Rush-Copley Cancer Care CenterAurora, Illinois  60507
Carle Cancer Center at Carle Foundation HospitalUrbana, Illinois  61801
Saint Anthony Memorial Health CentersMichigan City, Indiana  46360
Cedar Rapids Oncology AssociatesCedar Rapids, Iowa  52403
Mercy Medical Center - Sioux CitySioux City, Iowa  51104
St. Luke's Regional Medical CenterSioux City, Iowa  51104
CCOP - Michigan Cancer Research ConsortiumAnn Arbor, Michigan  48106
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
Fairview Ridges HospitalBurnsville, Minnesota  55337
Fairview Southdale HospitalEdina, Minnesota  55435
Hutchinson Area Health CareHutchinson, Minnesota  55350
Meeker County Memorial HospitalLichfield, Minnesota  55355
Hennepin County Medical Center - MinneapolisMinneapolis, Minnesota  55415
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
Geisinger Medical CenterDanville, Pennsylvania  17822-0001
Penn State Cancer Institute at Milton S. Hershey Medical CenterHershey, Pennsylvania  17033-0850
Abramson Cancer Center of the University of PennsylvaniaPhiladelphia, Pennsylvania  19104-4283
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical CenterLa Crosse, Wisconsin  54601
Marshfield Clinic - Marshfield CenterMarshfield, Wisconsin  54449
Medical College of Wisconsin Cancer CenterMilwaukee, Wisconsin  53226
Comprehensive Cancer Center at Wake Forest UniversityWinston-Salem, North Carolina  27157-1082
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Memorial Hospital of South BendSouth Bend, Indiana  46601
CCOP - Montana Cancer ConsortiumBillings, Montana  59101
CCOP - ColumbusColumbus, Ohio  43206
Veterans Affairs Medical Center - DaytonDayton, Ohio  45428
CCOP - DaytonKettering, Ohio  45429
CCOP - GreenvilleGreenville, South Carolina  29615
University of Wisconsin Comprehensive Cancer CenterMadison, Wisconsin  53792
CCOP - Northern Indiana CR ConsortiumSouth Bend, Indiana  46601
Holden Comprehensive Cancer Center at University of IowaIowa City, Iowa  52242-1002
Cancer Institute of New Jersey at the Cooper University HospitalCamden, New Jersey  08103-1489
Long Island Cancer Center at Stony Brook University HospitalStony Brook, New York  11790-7775
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State UniversityColumbus, Ohio  43210-1240
CCOP - Columbia River Oncology ProgramPortland, Oregon  97225
Kimmel Cancer Center at Thomas Jefferson University - PhiladelphiaPhiladelphia, Pennsylvania  19107
Vanderbilt-Ingram Cancer Center at Vanderbilt Medical CenterNashville, Tennessee  37232-2516
Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimore, Maryland  21231-2410
Cleveland Clinic Taussig Cancer CenterCleveland, Ohio  44195
Veterans Affairs Medical Center - San FranciscoSan Francisco, California  94121
CCOP - Syracuse Hematology-Oncology Associates of Central New York, P.C.Syracuse, New York  13217
Veterans Affairs Medical Center - MinneapolisMinneapolis, Minnesota  55417
Veterans Affairs Medical Center - SyracuseSyracuse, New York  13210
Rebecca and John Moores UCSD Cancer CenterLa Jolla, California  92093-0658
Veterans Affairs Medical Center - San DiegoSan Diego, California  92161
UCSF Comprehensive Cancer CenterSan Francisco, California  94115
Louis A. Weiss Memorial HospitalChicago, Illinois  60640
St. Mary's Medical CenterHuntington, West Virginia  25701
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
CCOP - Colorado Cancer Research Program, IncorporatedDenver, Colorado  80224
Hillman Cancer Center at University of Pittsburgh Cancer InstitutePittsburgh, Pennsylvania  15236
Great Falls ClinicGreat Falls, Montana  59405
Arkansas Cancer Research Center at University of Arkansas for Medical SciencesLittle Rock, Arkansas  72205
Maine Center for Cancer Medicine and Blood Disorders - ScarboroughScarborough, Maine  04074
Hulston Cancer Center at Cox Medical Center SouthSpringfield, Missouri  65807
St. John's Regional Health CenterSpringfield, Missouri  65804
Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve UniversityCleveland, Ohio  44106
Oklahoma University Medical CenterOklahoma City, Oklahoma  73104
Sioux Valley Hospital and University of South Dakota Medical CenterSioux Falls, South Dakota  57117-5134
Cancer Institute of New Jersey at HamiltonHamilton, New Jersey  08690
Curtis & Elizabeth Anderson Cancer Institute at Memorial Health University Medical CenterSavannah, Georgia  31403-3089
Via Christi Cancer Center at Via Christi Regional Medical CenterWichita, Kansas  67214
Greenville Hospital System Cancer CenterGreenville, South Carolina  29605
Providence Cancer Center at Sacred Heart Medical CenterSpokane, Washington  99220-2555
West Virginia University - Robert C. Byrd Health Sciences Center - Charleston DivisionCharleston, West Virginia  25302
Mary Babb Randolph Cancer Center at West Virginia University HospitalsMorgantown, West Virginia  26506
James P. Wilmot Cancer Center at University of Rochester Medical CenterRochester, New York  14642
Lewistown HospitalLewistown, Pennsylvania  17044
Mount Nittany Medical CenterState College, Pennsylvania  16803
Batte Cancer Center at Northeast Medical CenterConcord, North Carolina  28025
Siouxland Hematology-Oncology AssociatesSioux City, Iowa  51101
Siouxland Regional Cancer CenterSioux City, Iowa  51101-1733
Cancer Center of Kansas - ChanuteChanute, Kansas  66720
Cancer Center of Kansas - Dodge CityDodge City, Kansas  67801
Cancer Center of Kansas, P.A. - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas - KingmanKingman, Kansas  67068
Southwest Medical CenterLiberal, Kansas  67901
Cancer Center of Kansas - NewtonNewton, Kansas  67114
Cancer Center of Kansas, P.A. - ParsonsParsons, Kansas  67357
Pratt Cancer Center of KansasPratt, Kansas  67124
Cancer Center of Kansas - SalinaSalina, Kansas  67042
Cancer Center of Kansas - WellingtonWellington, Kansas  67152
Cancer Center of Kansas, P.A.Wichita, Kansas  67208
Associates in Womens HealthWichita, Kansas  67203
Cancer Center of Kansas, P.A. - WichitaWichita, Kansas  67214
Cancer Center of Kansas - WinfieldWinfield, Kansas  67156
William Beaumont Hospital - Royal Oak CampusRoyal Oak, Michigan  48073
Northern Rockies Radiation Oncology CenterBillings, Montana  59101
St. Vincent HealthcareBillings, Montana  59101
Deaconess Billings Clinic - DowntownBillings, Montana  59101
Deaconess Billings Clinic Cancer CenterBillings, Montana  59107
Bozeman Deaconess HospitalBozeman, Montana  59715
St. James Community HospitalButte, Montana  59701
Sletten Regional Cancer InstituteGreat Falls, Montana  59405
St. Peter's HospitalHelena, Montana  59601
Kalispell Regional Medical CenterKalispell, Montana  59901
Eastern Montana Cancer CenterMiles City, Montana  59301
Montana Cancer Center at St. Patrick Hospital and Health Sciences CenterMissoula, Montana  59802
Community Medical CenterMissoula, Montana  59801
Fox Chase Virtua Health Cancer Program - MarltonMarlton, New Jersey  08053
Wayne Memorial Hospital, IncorporatedGoldsboro, North Carolina  27534
Adena Regional Medical CenterChillicothe, Ohio  54601
Doctors Hospital at Ohio HealthColumbus, Ohio  43228
Riverside Methodist Hospital Cancer CareColumbus, Ohio  43214
Grant Riverside Cancer ServicesColumbus, Ohio  43215
Mount Carmel West HospitalColumbus, Ohio  43222
Grady Memorial HospitalDelaware, Ohio  43015
Fairfield Medical CenterLancaster, Ohio  43130
Strecker Cancer Center at Marietta Memorial HospitalMarietta, Ohio  45750
Licking Memorial Cancer Care Program at Licking Memorial HospitalNewark, Ohio  43055
Community Hospital of Springfield and Clark CountySpringfield, Ohio  45505
Mercy Medical Center Oncology UnitSpringfield, Ohio  45504
Mount Carmel Cancer Services at Mount Carmel St. Ann's HospitalWesterville, Ohio  43081
Genesis - Good Samaritan HospitalZanesville, Ohio  43701
Avera McKennan Hospital and University Health CenterSioux Falls, South Dakota  57105
Medical X-Ray CenterSioux Falls, South Dakota  57105
Welch Cancer CenterSheridan, Wyoming  82801
Lombardi Cancer Center at Georgetown University Medical CenterWashington, District of Columbia  20007
Memorial Cancer Institute at Memorial Regional HospitalHollywood, Florida  33021
Lenoir Memorial Cancer CenterKinston, North Carolina  28503-1678
Miriam Hospital at LifespanProvidence, Rhode Island  02906
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical SchoolNew Brunswick, New Jersey  08903
MBCCOP-Medical College of Georgia Cancer CenterAugusta, Georgia  30912-4000
Medcenter One Health SystemBismarck, North Dakota  58501
Oncology/Hematology Associates of Central Illinois, P.C.Peoria, Illinois  61602
Elkhart General HospitalElkhart, Indiana  46515
Fox Chase Virtua Health Cancer Program at Virtua West JerseyVoorhees, New Jersey  08043
Front Range Cancer SpecialistsFort Collins, Colorado  80528
University Medical Center of Southern NevadaLas Vegas, Nevada  89102
Joan Karnell Cancer Center at Pennsylvania HospitalPhiladelphia, Pennsylvania  19107
Kaiser Permanente Medical Office -Vandever Medical OfficeSan Diego, California  92120
Poudre Valley HospitalFort Collins, Colorado  80524
St. Mary-Corwin Regional Medical CenterPueblo, Colorado  81004
Beebe Medical CenterLewes, Delaware  19958
St. Francis HospitalWilmington, Delaware  19805
Michael & Dianne Bienes Comprehensive Cancer Center at Holy Cross HospitalFort Lauderdale, Florida  33308
Ella Milbank Foshay Cancer Center at Jupiter Medical CenterJupiter, Florida  33458
St. Joseph Medical CenterBloomington, Illinois  61701
Graham HospitalCanton, Illinois  61520
Memorial HospitalCarthage, Illinois  62321
Galesburg Cottage HospitalGalesburg, Illinois  61401
Galesburg ClinicGalesburg, Illinois  61401
InterCommunity Cancer Center of Western IllinoisGalesburg, Illinois  61401
Mason District HospitalHavana, Illinois  62644
Hopedale Medical ComplexHopedale, Illinois  61747
Kewanee HospitalKewanee, Illinois  61443
McDonough District HospitalMacomb, Illinois  61455
BroMenn Regional Medical CenterNormal, Illinois  61761
Community Cancer CenterNormal, Illinois  61761
Community Hospital of OttawaOttawa, Illinois  61350
Cancer Treatment Center at Pekin HospitalPekin, Illinois  61554
OSF St. Francis Medical CenterPeoria, Illinois  61637
Proctor HospitalPeoria, Illinois  61614
Illinois Valley Community HospitalPeru, Illinois  61354
Perry Memorial HospitalPrinceton, Illinois  61356
St. Margaret's HospitalSpring Valley, Illinois  61362
Valley Cancer CenterSpring Valley, Illinois  61362
Center for Cancer Therapy at LaPorte Hospital and Health ServicesLa Porte, Indiana  46350
St. Luke's HospitalCedar Rapids, Iowa  52402
Genesis Medical Center - West CampusDavenport, Iowa  52804
Genesis Regional Cancer Center at Genesis Medical CenterDavenport, Iowa  52803
John Stoddard Cancer Center at Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
Mercy Capitol HospitalDes Moines, Iowa  50307
Medical Oncology and Hematology Associates at John Stoddard Cancer CenterDes Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer CenterDes Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des MoinesWest Des Moines, Iowa  50266
Union Hospital Cancer Center at Union HospitalElkton MD, Maryland  21921
Virginia Piper Cancer Institute at Abbott-Northwestern HospitalMinneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Medical CenterRobbinsdale, Minnesota  55422-2900
Charles R. Wood Cancer Center at Glens Falls HospitalGlens Falls, New York  12801
Community General Hospital of Greater SyracuseSyracuse, New York  13215
Wilson Medical CenterWilson, North Carolina  27893-3428
Bismarck Cancer CenterBismarck, North Dakota  58501
St. Alexius Medical CenterBismarck, North Dakota  58502
Samaritan North Cancer Care CenterDayton, Ohio  45415
Grandview HospitalDayton, Ohio  45405
Good Samaritan HospitalDayton, Ohio  45406
Charles F. Kettering Memorial HospitalKettering, Ohio  45429
Middletown Regional HospitalMiddletown, Ohio  45044
UVMC Cancer Care Center at Upper Valley Medical CenterTroy, Ohio  45373-1300
Cleveland Clinic - WoosterWooster, Ohio  44691
Ruth G. McMillan Cancer Center at Greene Memorial HospitalXenia, Ohio  45385
Legacy Mount Hood Medical CenterGresham, Oregon  97030
Providence Milwaukie HospitalMilwaukie, Oregon  97222
Providence Cancer Center at Providence Portland Medical CenterPortland, Oregon  97213-2967
Providence St. Vincent Medical CenterPortland, Oregon  97225
Legacy Meridian Park HospitalTualatin, Oregon  97062
Bon Secours St. Francis Health SystemGreenville, South Carolina  29601
Danville Regional Medical CenterDanville, Virginia  24541
Providence Cancer Center at Holy Family HospitalSpokane, Washington  99207
Eureka HospitalEureka, Illinois  61530
Joliet Oncology Hematology Associates, Limited - WestJoliet, Illinois  60435
Oncology Hematology Associates of Central Illinois - OttawaOttawa, Illinois  61350
Mercy HospitalCoon Rapids, Minnesota  55433
Mercy and Unity Cancer Center at Mercy and Unity HospitalsFridley, Minnesota  55432-2799
Park Nicollet ClinicSt. Louis Park, Minnesota  55416
Community Oncology Group - IndependenceIndependence, Ohio  44131
Rose Ramer Cancer Clinic at Anderson Area Medical CenterAnderson, South Carolina  29621
McFarland Clinic, P.C.Ames, Iowa  50010
St. John's HospitalMaplewood, Minnesota  55109
Mid Dakota Clinic, P.C.Bismarck, North Dakota  58501
Pottstown Memorial Regional Cancer CenterPottstown, Pennsylvania  19464
Geisinger Medical GroupState College, Pennsylvania  16801
Geisinger Wyoming Valley Medical CenterWilkes-Barre, Pennsylvania  18711
Fox Valley Hematology and OncologyAppleton, Wisconsin  54911
CCOP - Mayo Clinic Scottsdale Oncology ProgramScottsdale, Arizona  85259
St. Francis Hospital and Health CentersBeech Grove, Indiana  46107
Saint Joseph Regional Medical Center - Plymouth CampusPlymouth, Indiana  46544
Mercy Cancer Center at Mercy Medical CenterCedar Rapids, Iowa  52403
Wendt Regional Cancer Center at Finley HospitalDubuque, Iowa  52001
Central Maine Medical CenterLewiston, Maine  04240
Cancer Care Center at Regions HospitalSaint Paul, Minnesota  55101
Saint Francis Cancer CenterShakopee, Minnesota  55379
St. Joseph's HospitalSt Paul, Minnesota  55102
Woodwinds HospitalWoodbury, Minnesota  55125
Missouri Cancer AssociatesColumbia, Missouri  65201
Randolph HospitalAsheboro, North Carolina  27203
John Smith, Jr./Dalton McMichael Cancer Center at Morehead Memorial HospitalEden, North Carolina  27288
Moses Cone Regional Cancer Center at Wesley Long Community HospitalGreensboro, North Carolina  27401
Annie Penn Cancer CenterReidsville, North Carolina  27320
Akron City Hospital at Summa Health SystemAkron, Ohio  44304
Miami Valley HospitalDayton, Ohio  45409
Comprehensive Cancer Center at Legacy Good Samaritan Hospital & Medical CenterPortland, Oregon  97210
Institute of Oncology at Vilnius UniversityPortland, Oregon  97227
Cancer Center at Southwest Washington Medical CenterVancouver, Washington  98668
William N. Wishard Memorial HospitalIndianapolis, Indiana  46202
Regional Cancer Center at Memorial Medical CenterSpringfield, Illinois  62781-0001
Watson ClinicLakeland, Florida  33805
Phoebe Cancer Center at Phoebe Putney Memorial HospitalAlbany, Georgia  31702
Rutherford HospitalRutherfordton, North Carolina  28139
Gibbs Regional Cancer Center at Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Riddle Memorial HospitalMedia, Pennsylvania  19063
Roper St. Francis Healthcare - Roper HospitalCharleston, South Carolina  29401
Central Pennsylvania Hematology and Medical Oncology Associates, PCLemoyne, Pennsylvania  17043
Lipson Cancer and Blood Center at Rochester General HospitalRochester, New York  14621
Arroyo Grande Community HospitalArroyo Grande, California  93420
Lynn Regional Cancer Center of Boca Raton Community HospitalBoca Raton, Florida  33486
Hematology and Oncology of Northeast GeorgiaAthens, Georgia  30607
John B. Amos Community Cancer CenterColumbus, Georgia  31902
Provena St. Mary's Wasser Regional Cancer Center - KankakeeKankakee, Illinois  60901
Lawrence Memorial Hospital of MedfordMedford, Massachusetts  02155
St. Anthony's Cancer CenterSt. Louis, Missouri  63128
St. Elizabeth Boardman Cancer CenterBoardman, Ohio  44512
St. Joseph Health Care CenterWarren, Ohio  44484
St. Elizabeth Cancer Center at St. Elizabeth Health Center - YoungstownYoungstown, Ohio  44510
Cancer Treatment Center at Merle West Medical CenterKlamath Falls, Oregon  97601
UW Health OncologyMadison, Wisconsin  53715
University of Wisconsin Cancer Center at Aspirus Wausau HospitalWausau, Wisconsin  54401