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A Randomized Trial of Adjuvant Chemotherapy With Standard Regimens, Cyclophosphamide, Methotrexate and Fluorouracil - (CMF) or Doxorubicin and Cyclophosphamide - (AC), Versus Capecitabine in Women 65 Years and Older With Node Positive or Node-Negative Breast Cancer


Phase 3
65 Years
N/A
Not Enrolling
Female
Breast Cancer

Thank you

Trial Information

A Randomized Trial of Adjuvant Chemotherapy With Standard Regimens, Cyclophosphamide, Methotrexate and Fluorouracil - (CMF) or Doxorubicin and Cyclophosphamide - (AC), Versus Capecitabine in Women 65 Years and Older With Node Positive or Node-Negative Breast Cancer


OBJECTIVES:

- Compare the effectiveness of adjuvant chemotherapy comprising standard
cyclophosphamide, methotrexate, and fluorouracil (CMF) or doxorubicin and
cyclophosphamide (AC) vs oral capecitabine, in terms of disease-free and overall
survival, in elderly women with operable adenocarcinoma of the breast.

- Compare the quality of life and physical functioning of patients treated with these
regimens.

- Compare the toxicity of these regimens in these patients.

- Evaluate the adherence of older patients to an oral chemotherapy regimen.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to age
(65 to 69 vs 70 to 80 vs over 80), performance status (0-1 vs 2), and HER2 status (positive
vs negative vs unknown). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients with insufficient left ventricular ejection fraction (LVEF) are
assigned to group A. Patients with normal LVEF are assigned to group A or B based on
physician/patient choice.

- Group A (CMF): Patients receive oral cyclophosphamide (CTX) daily on days 1-14 and
methotrexate IV and fluorouracil IV on days 1 and 8. Treatment repeats every 4
weeks for 6 courses in the absence of disease progression or unacceptable
toxicity.

- Group B (AC): Patients receive doxorubicin IV and CTX IV on day 1. Treatment
repeats every 3 weeks for 4 courses in the absence of disease progression or
unacceptable toxicity.

- Arm II: Patients receive oral capecitabine twice daily on days 1-14. Treatment repeats
every 3 weeks for 6 courses in the absence of disease progression or unacceptable
toxicity.

Beginning within 12 weeks after treatment in arm I or II, patients with estrogen or
progesterone receptor-positive disease receive oral tamoxifen or an aromatase inhibitor
daily for 5 years.

Beginning 4-6 weeks after treatment in arm I or II, eligible patients who previously
underwent breast conservation surgery undergo radiotherapy.

Quality of life is assessed at baseline; at 6 weeks (group B), 9 weeks (arm II), or 12 weeks
(group A); and then at 1, 12, 18, and 24 months after study.

Drug adherence is assessed at 9 weeks during study (arm II).

Patients are followed at 1 month, every 6 months for 2 years, and then annually for 15
years.

PROJECTED ACCRUAL: A total of 600-1,800 patients (300-900 per treatment arm) will be accrued
for this study within 2-6 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically proven operable adenocarcinoma of the breast*

- Stage I-IIIC disease

- T1-4 (tumor size ≥ 1 cm), N0, M0 OR

- T1-4, N1-3, M0 NOTE: *Bilateral, synchronous breast cancer allowed provided
1 primary tumor meets the staging criteria

- Must have undergone 1 of the following within the past 12 weeks:

- Modified radical mastectomy

- No evidence of gross or microscopic invasive tumor at the surgical
resection margins

- Close margins (tumor less than 1 mm from margin) allowed

- Lumpectomy (clear margins preferred)

- Ductal carcinoma in situ or lobular carcinoma in situ at the surgical
resection margin allowed

- No invasive tumor at the final resection margin

- Any number of previously excised nodes allowed

- Axillary node dissection not required

- HER2/neu positive, negative, or unknown

- Patients with HER2 positive tumors by immunohistochemistry 3+ staining or that
demonstrate gene amplification by fluorescence in situ hybridization are
eligible to receive trastuzumab (Herceptin) on study

- Hormone receptor status:

- Not specified

PATIENT CHARACTERISTICS:

Age:

- 65 and over

Sex:

- Female

Menopausal status:

- Postmenopausal

Performance status:

- 0-2

Life expectancy:

- More than 5 years

Hematopoietic:

- Granulocyte count at least 1,500/mm^3

- Platelet count at least 100,000/mm^3

Hepatic:

- Bilirubin no greater than upper limit of normal

Renal:

- Creatinine clearance at least 30 mL/min

Cardiovascular:

- No uncontrolled cardiac disease that would preclude study entry

- Left ventricular ejection fraction at least lower limit of normal (arm I, group B
only)

Other:

- HIV negative

- No other concurrent active malignancy except nonmelanoma skin cancer

- Disease considered not currently active if completely treated with less than a
30% risk of relapse

- No psychiatric illness that would preclude informed consent

- No other medical condition (e.g., uncontrolled infection) that would preclude study
entry

- No hypersensitivity to fluorouracil

- No known dihydropyrimidine dehydrogenase deficiency

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- Not specified

Chemotherapy:

- No prior chemotherapy for breast cancer

- No other concurrent chemotherapy

Endocrine therapy:

- Up to 4 weeks of prior tamoxifen for current breast cancer allowed

- Prior tamoxifen or raloxifene for chemoprevention (e.g., breast cancer prevention
study) or other indications (including prior breast cancer) allowed but must be
discontinued before study entry

- No concurrent hormonal therapy except steroids for adrenal failure, hormones for
non-disease related conditions (e.g., insulin for diabetes), or intermittent
dexamethasone as an antiemetic

Radiotherapy:

- Not specified

Surgery:

- See Disease Characteristics

Other:

- No concurrent dexrazoxane

- No concurrent bisphosphonates except for treatment of osteoporosis

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Relapse-free Survival Rates at 2.4 Years

Outcome Description:

Percentage of participants who were alive and relapse-free at time of analysis were counted as "Alive without relapse" at 2.4 years. Participants who had a first local recurrence, first distant metastasis or death from any cause were counted as "relapse, first occurrence". These rates were estimated using the Kaplan Meier method

Outcome Time Frame:

randomization until date of first event, or date last known to be event free if no event was reported (up to 5 years)

Safety Issue:

No

Principal Investigator

Hyman B. Muss, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Fletcher Allen Health Care - University Health Center Campus

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000068891

NCT ID:

NCT00024102

Start Date:

September 2001

Completion Date:

November 2012

Related Keywords:

  • Breast Cancer
  • stage I breast cancer
  • stage II breast cancer
  • stage IIIA breast cancer
  • stage IIIB breast cancer
  • stage IIIC breast cancer
  • Breast Neoplasms

Name

Location

Akron City HospitalAkron, Ohio  44304
Roswell Park Cancer InstituteBuffalo, New York  14263
Memorial Sloan-Kettering Cancer CenterNew York, New York  10021
Mayo Clinic ScottsdaleScottsdale, Arizona  85259
Mayo Clinic - JacksonvilleJacksonville, Florida  32224
Mayo Clinic Cancer CenterRochester, Minnesota  55905
Walter Reed Army Medical CenterWashington, District of Columbia  20307-5000
University of Chicago Cancer Research CenterChicago, Illinois  60637
Duke Comprehensive Cancer CenterDurham, North Carolina  27710
CCOP - Upstate CarolinaSpartanburg, South Carolina  29303
CCOP - Atlanta RegionalAtlanta, Georgia  30342-1701
CCOP - Missouri Valley Cancer ConsortiumOmaha, Nebraska  68131
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 - Metro-MinnesotaSaint Louis Park, Minnesota  55416
Rush-Copley Cancer Care CenterAurora, Illinois  60507
Evanston Northwestern Healthcare - Evanston HospitalEvanston, Illinois  60201-1781
Joliet Oncology-Hematology Associates, Limited - WestJoliet, Illinois  60435
Carle Cancer Center at Carle Foundation HospitalUrbana, Illinois  61801
Saint Anthony Memorial Health CentersMichigan City, Indiana  46360
Cedar Rapids Oncology AssociatesCedar Rapids, Iowa  52403
Tufts-NEMC Cancer CenterBoston, Massachusetts  02111
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Fairview Ridges HospitalBurnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy HospitalCoon Rapids, Minnesota  55433
CCOP - DuluthDuluth, Minnesota  55805
Fairview Southdale HospitalEdina, Minnesota  55435
Mercy and Unity Cancer Center at Unity HospitalFridley, Minnesota  55432
Hutchinson Area Health CareHutchinson, Minnesota  55350
Meeker County Memorial HospitalLichfield, Minnesota  55355
HealthEast Cancer Care at St. John's HospitalMaplewood, Minnesota  55109
Hennepin County Medical Center - MinneapolisMinneapolis, Minnesota  55415
Regions Hospital Cancer Care CenterSt. Paul, Minnesota  55101
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
Minnesota Oncology Hematology, PA - WoodburyWoodbury, Minnesota  55125
CCOP - MeritCare HospitalFargo, North Dakota  58122
Case Comprehensive Cancer CenterCleveland, Ohio  44106-5065
St. Rita's Medical CenterLima, Ohio  45801
Geisinger Medical CenterDanville, Pennsylvania  17822-0001
Penn State Cancer Institute at Milton S. Hershey Medical CenterHershey, Pennsylvania  17033-0850
Geisinger Medical Group - Scenery ParkState College, Pennsylvania  16801
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical CenterWilkes-Barre, Pennsylvania  18711
Medical X-Ray Center, PCSioux Falls, South Dakota  57105
Avera Cancer InstituteSioux Falls, South Dakota  57105
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical CenterLa Crosse, Wisconsin  54601
Dean Medical Center - MadisonMadison, Wisconsin  53717
University of Alabama at Birmingham Comprehensive Cancer CenterBirmingham, Alabama  35294-3300
CCOP - Bay Area Tumor InstituteOakland, California  94609-3305
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Cape Cod HospitalHyannis, Massachusetts  02601
CCOP - Montana Cancer ConsortiumBillings, Montana  59101
Veterans Affairs Medical Center - DaytonDayton, Ohio  45428
Reading Hospital and Medical CenterReading, Pennsylvania  19612-6052
CCOP - MainLine HealthWynnewood, Pennsylvania  19096
University of Wisconsin Comprehensive Cancer CenterMadison, Wisconsin  53792
University of Miami Sylvester Comprehensive Cancer CenterMiami, Florida  33136
CCOP - Northern Indiana CR ConsortiumSouth Bend, Indiana  46601
CCOP - Grand RapidsGrand Rapids, Michigan  49503
Ellis Fischel Cancer Center at University of Missouri - ColumbiaColumbia, Missouri  65203
Siteman Cancer Center at Barnes-Jewish HospitalSaint Louis, Missouri  63110
Charles M. Barrett Cancer Center at University HospitalCincinnati, Ohio  45267-0526
MetroHealth's Cancer Care Center at MetroHealth Medical CenterCleveland, Ohio  44106
Kimmel Cancer Center at Thomas Jefferson University - PhiladelphiaPhiladelphia, Pennsylvania  19107
Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimore, Maryland  21231-2410
Cancer Research Center of HawaiiHonolulu, Hawaii  96813
USC/Norris Comprehensive Cancer Center and HospitalLos Angeles, California  90033-0804
MBCCOP - LSU Health Sciences CenterNew Orleans, Louisiana  70112
Brooke Army Medical CenterFort Sam Houston, Texas  78234-6200
CCOP - NorthwestTacoma, Washington  98405-0986
Kent County Memorial HospitalWarwick, Rhode Island  02886
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer InstituteBoston, Massachusetts  02115
Fletcher Allen Health Care - University Health Center CampusBurlington, Vermont  05401
Mobile Infirmary Medical CenterMobile, Alabama  36640-0460
St. Vincent Mercy Medical CenterToledo, Ohio  43608
Great Falls ClinicGreat Falls, Montana  59405
Arizona Cancer Center at University of Arizona Health Sciences CenterTucson, Arizona  85724
Cancer Research Center at Boston Medical CenterBoston, Massachusetts  02118
Josephine Ford Cancer Center at Henry Ford HospitalDetroit, Michigan  48202
Swedish Cancer Institute at Swedish Medical Center - First Hill CampusSeattle, Washington  98104
Thompson Cancer Survival CenterKnoxville, Tennessee  37916
Maine Center for Cancer Medicine and Blood Disorders - ScarboroughScarborough, Maine  04074
Overlook HospitalSummit, New Jersey  07902-0220
Hulston Cancer Center at Cox Medical Center SouthSpringfield, Missouri  65807
St. John's Regional Health CenterSpringfield, Missouri  65804
Carol G. Simon Cancer Center at Morristown Memorial HospitalMorristown, New Jersey  07962
Winthrop University HospitalMineola, New York  11501
Oklahoma University Medical CenterOklahoma City, Oklahoma  73104
Sioux Valley Hospital and University of South Dakota Medical CenterSioux Falls, South Dakota  57117-5134
Trinity Cancer Care CenterMinot, North Dakota  58701
CCOP - Toledo Community HospitalToledo, Ohio  43623-3456
St. Luke's Hospital Cancer CenterBethlehem, Pennsylvania  18015
Wilford Hall Medical CenterLackland Air Force Base, Texas  78236-5300
Stony Brook University Cancer CenterStony Brook, New York  11794-8174
SUNY Upstate Medical University HospitalSyracuse, New York  13210
Mission Hospitals - Memorial CampusAsheville, North Carolina  28801
Medical University of Ohio Cancer CenterToledo, Ohio  43614
Toledo HospitalToledo, Ohio  43606
Hollings Cancer Center at Medical University of South CarolinaCharleston, South Carolina  29425
Providence Cancer Center at Sacred Heart Medical CenterSpokane, Washington  99220-2555
Aultman Hospital Cancer Center at Aultman Health FoundationCanton, Ohio  44710-1799
James P. Wilmot Cancer Center at University of Rochester Medical CenterRochester, New York  14642
McCreery Cancer Center at Ottumwa RegionalOttumwa, Iowa  52501
CCOP - Hematology-Oncology Associates of Central New YorkEast Syracuse, New York  13057
Lewistown HospitalLewistown, Pennsylvania  17044
Mount Nittany Medical CenterState College, Pennsylvania  16803
Sibley Memorial HospitalWashington, District of Columbia  20016
Hematology Oncology Associates of the Quad CitiesBettendorf, Iowa  52722
Northern Michigan HospitalPetoskey, Michigan  49770
William Beaumont Hospital - Royal Oak CampusRoyal Oak, Michigan  48073
Wayne Memorial Hospital, IncorporatedGoldsboro, North Carolina  27534
University Cancer Center at University of Washington Medical CenterSeattle, Washington  98195
Group Health Central HospitalSeattle, Washington  98104
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Greenebaum Cancer Center at University of Maryland Medical CenterBaltimore, Maryland  21201
UNMC Eppley Cancer Center at the University of Nebraska Medical CenterOmaha, Nebraska  68198-7680
New Hampshire Oncology-Hematology, PA - HooksettHooksett, New Hampshire  03106
Lakeland Cancer Care Center at Lakeland Hospital - St. JosephSaint Joseph, Michigan  49085
Zimmer Cancer Center at New Hanover Regional Medical CenterWilmington, North Carolina  28402-9025
University of Illinois Cancer CenterChicago, Illinois  60612-7243
Swedish-American Regional Cancer CenterRockford, Illinois  61104-2315
CCOP - Nevada Cancer Research FoundationLas Vegas, Nevada  89109-2306
Madigan Army Medical Center - TacomaTacoma, Washington  98431
East Tennessee State University Cancer Center at Johnson City Medical CenterJohnson City, Tennessee  37604
Huntsman Cancer Institute at University of UtahSalt Lake City, Utah  84112
Robert H. Lurie Comprehensive Cancer Center at Northwestern UniversityChicago, Illinois  60611
Decatur Memorial Hospital Cancer Care InstituteDecatur, Illinois  62526
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital MarltonMarlton, New Jersey  08053
Fox Chase Virtua Health Cancer Program at Virtua West JerseyVoorhees, New Jersey  08043
Lakeland Regional Cancer Center at Lakeland Regional Medical CenterLakeland, Florida  33805
Veterans Affairs Medical Center - Chicago Westside HospitalChicago, Illinois  60612
Hematology Oncology Associates - SkokieSkokie, Illinois  60076
University Medical Center of Southern NevadaLas Vegas, Nevada  89102
Jennersville Regional HospitalWest Grove, Pennsylvania  19390-9499
Saint Rose HospitalHayward, California  94545
Moores UCSD Cancer CenterLa Jolla, California  92093-0658
Highland General Hospital at St. George's University School of MedicineOakland, California  94602
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
Valley Care Medical CenterPleasanton, California  94588
Salinas Valley Memorial HospitalSalinas, California  93901
Kaiser Permanente Medical Office -Vandever Medical OfficeSan Diego, California  92120
Memorial HospitalColorado Springs, Colorado  80909
Michael & Dianne Bienes Comprehensive Cancer Center at Holy Cross HospitalFort Lauderdale, Florida  33308
Ella Milbank Foshay Cancer Center at Jupiter Medical CenterJupiter, Florida  33458
Gwinnett Medical CenterLawrenceville, Georgia  30045
St. Joseph Medical CenterBloomington, Illinois  61701
Graham HospitalCanton, Illinois  61520
Memorial HospitalCarthage, Illinois  62321
Swedish Covenant HospitalChicago, Illinois  60625
Mercy Hospital and Medical CenterChicago, Illinois  60616
Hematology and Oncology AssociatesChicago, Illinois  60611
Eureka Community HospitalEureka, Illinois  61530
Galesburg Cottage HospitalGalesburg, Illinois  61401
Galesburg ClinicGalesburg, Illinois  61401
Mason District HospitalHavana, Illinois  62644
Hopedale Medical ComplexHopedale, Illinois  61747
Midwest Center for Hematology/OncologyJoliet, Illinois  60432
North Shore Oncology and Hematology Associates, Limited - LibertyvilleLibertyville, Illinois  60048
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
Oncology Hematology Associates of Central Illinois, PC - PeoriaPeoria, Illinois  61615
OSF St. Francis Medical CenterPeoria, Illinois  61637
Proctor HospitalPeoria, Illinois  61614
Illinois Valley Community HospitalPeru, Illinois  61354
Perry Memorial HospitalPrinceton, Illinois  61356
Hematology/Oncology of the North Shore at Gross Point Medical CenterSkokie, Illinois  60076
St. Margaret's HospitalSpring Valley, Illinois  61362
St. Francis Hospital and Health Centers - Beech Grove CampusBeech Grove, Indiana  46107
Fort Wayne Medical Oncology and HematologyFort Wayne, Indiana  46815
St. Luke's HospitalCedar Rapids, Iowa  52402
Mercy Regional Cancer Center at Mercy Medical CenterCedar Rapids, Iowa  52403
Genesis Regional Cancer Center at Genesis Medical CenterDavenport, Iowa  52803
Stormont-Vail Cancer CenterTopeka, Kansas  66604
St. Francis Comprehensive Cancer CenterTopeka, Kansas  66606
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
Community Cancer Center of MonroeMonroe, Michigan  48162
Mercy Memorial Hospital SystemMonroe, Michigan  48162
Providence Cancer Institute at Providence Hospital - Southfield CampusSouthfield, Michigan  48075
MeritCare Clinic - BemidjiBemidji, Minnesota  56601
Virginia Piper Cancer Institute at Abbott-Northwestern HospitalMinneapolis, Minnesota  55407
Chippewa County - Montevideo HospitalMontevideo, Minnesota  56265
Hubert H. Humphrey Cancer Center at North Memorial Medical CenterRobbinsdale, Minnesota  55422-2900
CentraCare Clinic - River CampusSt. Cloud, Minnesota  56303
Park Nicollet Health ServicesSt. Louis Park, Minnesota  55416
Saint Francis Cancer Treatment Center at Saint Francis Memorial Health CenterGrand Island, Nebraska  68803
Immanuel Medical CenterOmaha, Nebraska  68122
Creighton University Medical CenterOmaha, Nebraska  68131-2197
Booker Cancer Center at Riverview Medical CenterRed Bank, New Jersey  07701
Adirondack Cancer Care - Glens FallsGlens Falls, New York  12801
Charles R. Wood Cancer Center at Glens Falls HospitalGlens Falls, New York  12801
Highland Hospital of RochesterRochester, New York  14620
Cancer Care Center at Medcenter One HospitalBismarck, North Dakota  58501
MeritCare Medical GroupFargo, North Dakota  58122
Wood County Oncology CenterBowling Green, Ohio  43402
Samaritan North Cancer Care CenterDayton, Ohio  45415
Grandview HospitalDayton, Ohio  45405
David L. Rike Cancer Center at Miami Valley HospitalDayton, Ohio  45409
Good Samaritan HospitalDayton, Ohio  45406
Fremont Memorial HospitalFremont, Ohio  43420
Charles F. Kettering Memorial HospitalKettering, Ohio  45429
Lima Memorial HospitalLima, Ohio  45804
St. Luke's HospitalMaumee, Ohio  43537
Northwest Ohio Oncology CenterMaumee, Ohio  43537
Middletown Regional HospitalMiddletown, Ohio  45044
Toledo Clinic - OregonOregon, Ohio  43616
St. Charles Mercy HospitalOregon, Ohio  43616
North Coast Cancer Care, IncorporatedSandusky, Ohio  44870
Firelands Regional Medical CenterSandusky, Ohio  44870
Toledo Clinic, Incorporated - Main ClinicToledo, Ohio  43623
UVMC Cancer Care Center at Upper Valley Medical CenterTroy, Ohio  45373-1300
Fulton County Health CenterWauseon, Ohio  43567
Ruth G. McMillan Cancer Center at Greene Memorial HospitalXenia, Ohio  45385
LaFortune Cancer Center at St. John Medical CenterTulsa, Oklahoma  74104
Bryn Mawr HospitalBryn Mawr, Pennsylvania  19010
Hematology and Oncology AssociatesScranton, Pennsylvania  18510
Lankenau Cancer Center at Lankenau HospitalWynnewood, Pennsylvania  19096
Oncology Services of AberdeenAberdeen, South Dakota  57401
Mountainview MedicalBerlin, Vermont  05602
Providence Cancer Center at Holy Family HospitalSpokane, Washington  99207
North Star Lodge Cancer Center at Yakima Valley Memorial HospitalYakima, Washington  98902
Holy Family Memorial Medical Center Cancer Care CenterManitowoc, Wisconsin  54221-1450
St. Francis HospitalFederal Way, Washington  98003
St. Clare HospitalLakewood, Washington  98499-0998
Capital Medical CenterOlympia, Washington  98502
Providence St. Peter Hospital Regional Cancer CenterOlympia, Washington  98506
Good Samaritan Cancer CenterPuyallup, Washington  98371
St. Joseph Medical Center at Franciscan Health SystemTacoma, Washington  98405-3004
Faulkner HospitalJamaica Plain, Massachusetts  02130
Leavey Cancer Center at Northridge Hospital Medical CenterNorthridge, California  91325
Central Maine Medical CenterLewiston, Maine  04240
Bethke Cancer Center at Emerson HospitalConcord, Massachusetts  01742
Cancer Care Center at St. Luke's HospitalDuluth, Minnesota  55805
Saint Francis Cancer CenterShakopee, Minnesota  55379
St. Joseph's HospitalSt Paul, Minnesota  55102
Regional Cancer Center at Singing River HospitalPascagoula, Mississippi  39581
Missouri Baptist Cancer CenterSt. Louis, Missouri  63131
Randolph HospitalAsheboro, North Carolina  27203
Moses Cone Regional Cancer Center at Wesley Long Community HospitalGreensboro, North Carolina  27401
Annie Penn Cancer CenterReidsville, North Carolina  27320
Altru Cancer Center at Altru HospitalGrand Forks, North Dakota  58201
Western Pennsylvania Cancer Institute at Western Pennsylvania HospitalPittsburgh, Pennsylvania  15224-1791
St. Joseph Medical CenterReading, Pennsylvania  19604
Eastern Connecticut Hematology and Oncology AssociatesNorwich, Connecticut  06360
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/CandlerSavannah, Georgia  31405
Cancer Care and Hematology Specialists of Chicagoland - NilesNiles, Illinois  60714
McFarland Clinic, PCAmes, Iowa  50010
Haematology-Oncology Associates of Ohio and Michigan, PCLambertville, Michigan  48144
Willmar Cancer Center at Rice Memorial HospitalWillmar, Minnesota  56201
Alegant Health Cancer Center at Bergan Mercy Medical CenterOmaha, Nebraska  68124
Flower Hospital Cancer CenterSylvania, Ohio  43560
Cleo Craig Cancer Research ClinicLawton, Oklahoma  73505
Cancer Care Associates - Mercy CampusOklahoma City, Oklahoma  73120
St. Joseph Cancer CenterBellingham, Washington  98225
Vince Lombardi Cancer Center at Aurora Lakeland Medical Center - ElkhornElkhorn, Wisconsin  53121
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical CenterGreen Bay, Wisconsin  54311
Medical Consultants, LimitedMilwaukee, Wisconsin  53215
University of Minnesota Medical Center & Children's Hospital - FairviewMinneapolis, Minnesota  55455
FirstHealth Moore Regional Community Hospital Comprehensive Cancer CenterPinehurst, North Carolina  28374
Mid Dakota Clinic, PCBismarck, North Dakota  58501
St. Francis Medical CenterHonolulu, Hawaii  96817
Regional Cancer Center at Memorial Medical CenterSpringfield, Illinois  62781-0001
Auburn Regional Center for Cancer CareAuburn, Washington  98002
Community HospitalMunster, Indiana  46321
Memorial Hospital of Rhode IslandPawtucket, Rhode Island  02860
Aurora Sinai Medical CenterMilwaukee, Wisconsin  53201-0342
Queen's Cancer Institute at Queen's Medical CenterHonolulu, Hawaii  96813
Hematology Oncology Associates of Eastern IdahoIdaho Falls, Idaho  83404
Regional Cancer Institute at Bloomington HospitalBloomington, Indiana  47403
Caritas Norwood HospitalNorwood, Massachusetts  02062
Immanuel St. Joseph's ClinicMankato, Minnesota  56002
Good Samaritan Cancer Center at Good Samaritan HospitalKearney, Nebraska  68848-1990
Elliot Regional Cancer Center at Elliot HospitalManchester, New Hampshire  03103
Rutherford HospitalRutherfordton, North Carolina  28139
AnMed Health Cancer CenterAnderson, South Carolina  29621
Gibbs Regional Cancer Center at Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Martha Jefferson Hospital Cancer Care CenterCharlottesville, Virginia  22901
Glendale Memorial Hospital Comprehensive Cancer CenterGlendale, California  91204
St. Francis HospitalEvanston, Illinois  60202
Frederick Memorial Hospital Regional Cancer Therapy CenterFrederick, Maryland  21701
MBCCOP - Meharry Medical College - NashvilleNashville, Tennessee  37208-3599
Palm Beach Cancer Institute - West Palm BeachWest Palm Beach, Florida  33401
Cedar Valley Medical Specialists, PC - West Ridgeway AvenueWaterloo, Iowa  50702
Sletten Regional Cancer Institute at Benefis HealthcareGreat Falls, Montana  59405
Lakes Region General HospitalLaconia, New Hampshire  03246
University of Wisconcin Cancer Center at Aspirus Wausau HospitalWausau, Wisconsin  54401
Halifax Medical Center - Daytona BeachDaytona Beach, Florida  32115
Woodwinds Health CampusWoodbury, Minnesota  55125
Marshall University Medical CenterHuntington, West Virginia  25701
Center for Cancer Care at OSF Saint Anthony Medical CenterRockford, Illinois  61108
Doctors Medical Center - San Pablo CampusSan Pablo, California  94806
Kapiolani Medical Center at Pali MomiAiea, Hawaii  96701
Kapiolani Medical Center for Women and ChildrenHonolulu, Hawaii  96826
Straub Clinic and Hospital, IncorporatedHonolulu, Hawaii  96813
OnCare Hawaii, Incorporated - KuakiniHonolulu, Hawaii  96817
OnCare Hawaii, Incorporated - LusitanaHonolulu, Hawaii  96813
Pacific Cancer Institute - MauiWailuku, Hawaii  96793
Cancer Center of Paoli Memorial HospitalPaoli, Pennsylvania  19301-1792
Dale and Frances Hughes Cancer Center at Pocono Medical CenterEast Stroudsburg, Pennsylvania  18301
Associates in Hematology-Oncology, PC at Crozer Regional Cancer CenterUpland, Pennsylvania  19013
Provena St. Mary's Wasser Regional Cancer Center - KankakeeKankakee, Illinois  60901
Lawrence Memorial Hospital of MedfordMedford, Massachusetts  02155
Saint James Hospital and Health Centers Comprehensive Cancer Institute - Olympia FieldsOlympia Fields, Illinois  60461
Minnesota Oncology Hematology, PA at Maplewood Cancer CenterMaplewood, Minnesota  55109
Kent General Hospital at Bayhealth Medical CenterDover, Delaware  19901
Ocean Medical Center at Meridian HealthBrick, New Jersey  08724
J. Phillip Citta Regional Cancer Center at Community Medical CenterToms River, New Jersey  08755
St. Joseph's Mercy Cancer CenterHot Springs, Arkansas  71913
Augusta Oncology Associates - Walton WayAugusta, Georgia  30901
Heartland Oncology & HematologyCouncil Bluffs, Iowa  51503
Christus Schumpert Cancer Treatment CenterShreveport, Louisiana  71101
Mercy Hospital of PortlandPortland, Maine  04101
MaineGeneral Medical Center - Waterville CampusWaterville, Maine  04901
Saints Memorial Cancer Center at Saints Memorial Medical CenterLowell, Massachusetts  01852
South Shore HospitalSouth Weymouth, Massachusetts  02190
Albert Lea Cancer Center at Albert Lea Medical CenterAlbert Lea, Minnesota  56007
Carson-Tahoe Cancer Services at Carson Tahoe Regional HealthcareCarson City, Nevada  89703
Parkland Oncology-Hematology Clinic at Parkland Medical CenterDerry, New Hampshire  03038
Bronx-Lebanon Hospital Center & BronxCare Adult Medical PracticeBronx, New York  10456
CaroMont Cancer Center at Gaston Memorial HospitalGastonia, North Carolina  28053
Meadville Medical CenterMeadville, Pennsylvania  16335
Nashville Oncology Associates, P.C.Nashville, Tennessee  37203