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Cyclophosphamide And Doxorubicin (CA) (4 VS 6 Cycles) Versus Paclitaxel (4 VS 6 Cycles) As Adjuvant Therapy For Breast Cancer in Women With 0-3 Positive Axillary Lymph Nodes:A 2X2 Factorial Phase III Randomized Study


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Breast Cancer

Thank you

Trial Information

Cyclophosphamide And Doxorubicin (CA) (4 VS 6 Cycles) Versus Paclitaxel (4 VS 6 Cycles) As Adjuvant Therapy For Breast Cancer in Women With 0-3 Positive Axillary Lymph Nodes:A 2X2 Factorial Phase III Randomized Study


OBJECTIVES:

Primary

- Compare the disease-free survival of women with operable breast cancer and 0-3 positive
axillary lymph nodes treated with two different schedules (4 vs 6 courses) of adjuvant
cyclophosphamide and doxorubicin vs paclitaxel. (Arms II and IV closed to accrual as of
1/30/2008)

- Compare the disease-free survival of patients treated with these regimens.

Secondary

- Compare overall survival, local control, and time to distant metastasis in patients
treated with these regimens.

- Compare the toxic effects of these regimens in these patients.

- Compare the effect of these regimens on the induction of menopause in premenopausal
patients.

- Determine the discrepancy of myelosuppression in patients with MDR1 haplotypes on the
CA treatment arm.

- Compare the disease-free survival of patients with MDR1 haplotypes treated with these
regimens.

- Correlate CYP3A5, CYP2C8, and CYP2B6 polymorphisms with disease-free survival and
toxicity in patients treated with these regimens.

OUTLINE: This is a randomized study. Patients are stratified according to menopausal status
(premenopausal vs postmenopausal), estrogen receptor (ER)/progesterone receptor (PR) status
(ER and/or PR positive or unknown vs ER and PR negative), and HER2/neu status (negative vs
unknown vs positive [by immunohistochemistry 3+ staining or gene amplification by
fluorescence in situ hybridization]). Patients are randomized to 1 of 4 treatment arms (arms
II and IV closed to accrual as of 1/30/2008).

- Arm I: Patients receive doxorubicin IV and cyclophosphamide IV on day 1. Treatment
repeats every 14 days for 4 courses.

- Arm II (closed to accrual as of 1/30/2008): Patients receive doxorubicin and
cyclophosphamide as in arm I. Treatment repeats every 14 days for 6 courses.

- Arm III: Patients receive paclitaxel IV over 1 hour on day 1. Treatment repeats every
14 days for 4 courses.

- Arm IV (closed to accrual as of 1/30/2008): Patients receive paclitaxel as in arm III.
Treatment repeats every 14 days for 6 courses.

Treatment in all arms continues in the absence of disease progression or unacceptable
toxicity.

Lumpectomy patients must then undergo radiotherapy. Mastectomy patients undergo radiotherapy
at the discretion of the treating physician.

Patients are followed every 6 months for 2 years and then annually for 15 years.

PROJECTED ACCRUAL: A total of 4,646 patients will be accrued for this study within 29
months.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed invasive carcinoma of the breast with 0-3 positive axillary
lymph nodes

- Meets 1 of the following criteria for node-negative disease:

- Negative sentinel lymph node biopsy

- At least 6 negative axillary lymph nodes removed and determined to be
negative by axillary dissection

- Meets 1 of the following criteria for node-positive disease (1-3 positive
axillary lymph nodes):

- At least 1 positive lymph node by sentinel lymph node biopsy AND at least 6
axillary lymph nodes removed by axillary dissection; of all the nodes
removed from both the sentinel lymph node biopsy and the axillary
dissection, 1-3 must be positive

- At least 6 lymph nodes removed by axillary dissection; 1-3 nodes from the
axillary dissection must be positive

- "High-risk" disease that warrants chemotherapy (ultimately determined by the treating
physician)

- Modified radical mastectomy or lumpectomy within the past 84 days required

- Negative tumor margins for invasive cancer and ductal carcinoma in situ (DCIS)

- Lobular carcinoma in situ (LCIS) at the margin allowed

- Multicentric disease allowed provided margins and axillary nodes are negative after
resection

- Bilateral synchronous disease allowed

- Invasive cancer on one side and DCIS or LCIS on the contralateral side is allowed
provided all other eligibility criteria are met

- No locally advanced, inflammatory, or metastatic breast cancer

- No dermal lymphatics involvement, even if there are no clinical signs of inflammatory
cancer

- HER2/neu positive, negative, or unknown

- Hormone receptor status:

- Any estrogen and/or progesterone receptor status

PATIENT CHARACTERISTICS:

Age:

- 18 and over

Sex:

- Female

Menopausal status:

- Premenopausal or postmenopausal

Performance status:

- CTC 0-1

Life expectancy:

- Not specified

Hematopoietic:

- Absolute neutrophil count at least 1,000/mm^3

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

Hepatic:

- Bilirubin no greater than 1.5 times upper limit of normal

Renal:

- Creatinine no greater than 2.0 mg/dL

Cardiovascular:

- No active congestive heart failure

- No myocardial infarction within the past 6 months

Other:

- Not pregnant or nursing

- Fertile patients must use effective nonhormonal contraception during and for at least
2 months after study participation

- No other malignancy within the past 5 years except curatively treated basal cell or
squamous cell skin cancer or carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- No prior trastuzumab (Herceptin^®) for this malignancy

Chemotherapy:

- See Disease Characteristics

- No prior chemotherapy for this malignancy

- No other concurrent chemotherapy

Endocrine therapy:

- No prior hormonal therapy for this malignancy except tamoxifen given for up to 4
weeks

- Prior tamoxifen or other selective estrogen receptor modulators (SERMs) for
prevention or other indications (e.g., osteoporosis) allowed

- No concurrent exogenous hormonal therapy (including oral contraceptives,
postmenopausal hormone replacement therapy, or raloxifene) except:

- Steroids for adrenal failure

- Hormonal agents for nondisease-related conditions (e.g., insulin for diabetes or
synthroid for hypothyroidism)

- Intermittent dexamethasone as an antiemetic and premedication for paclitaxel

- No concurrent tamoxifen or other SERMs

Surgery:

- See Disease Characteristics

Other:

- No concurrent dexrazoxane

- No concurrent raloxifene

- Concurrent bisphosphonates for osteoporosis allowed

- Concurrent trastuzumab (Herceptin^®) allowed for patients with HER2-positive disease

- Concurrent enrollment on adjuvant bisphosphonate studies allowed

- Concurrent enrollment on adjuvant hormonal studies allowed provided hormonal therapy
does not commence until completion of study chemotherapy

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Outcome Measure:

Disease-free survival

Safety Issue:

No

Principal Investigator

Lawrence N. Shulman, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Dana-Farber Cancer Institute

Authority:

United States: Federal Government

Study ID:

CDR0000069444

NCT ID:

NCT00041119

Start Date:

May 2002

Completion Date:

Related Keywords:

  • Breast Cancer
  • stage IB breast cancer
  • stage II breast cancer
  • Breast Neoplasms

Name

Location

Roswell Park Cancer InstituteBuffalo, New York  14263
Memorial Sloan-Kettering Cancer CenterNew York, New York  10021
University of Michigan Comprehensive Cancer CenterAnn Arbor, Michigan  48109-0752
Mayo Clinic ScottsdaleScottsdale, Arizona  85259
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
Barbara Ann Karmanos Cancer InstituteDetroit, Michigan  48201
Duke Comprehensive Cancer CenterDurham, North Carolina  27710
CCOP - WichitaWichita, Kansas  67214-3882
Hurley Medical CenterFlint, Michigan  48503
CCOP - Kansas CityKansas City, Missouri  64131
CCOP - Missouri Valley Cancer ConsortiumOmaha, Nebraska  68131
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - Mount Sinai Medical CenterMiami Beach, Florida  33140
CCOP - Carle Cancer CenterUrbana, Illinois  61801
CCOP - Iowa Oncology Research AssociationDes Moines, Iowa  50309-1016
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
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
CCOP - Colorado Cancer Research ProgramDenver, Colorado  80224-2522
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
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical CenterGrand Junction, Colorado  81502
Sky Ridge Medical CenterLone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United HospitalLongmont, Colorado  80502
St. Mary - Corwin Regional Medical CenterPueblo, Colorado  81004
North Suburban Medical CenterThornton, Colorado  80229
Rush-Copley Cancer Care CenterAurora, Illinois  60507
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
CCOP - Michigan Cancer Research ConsortiumAnn Arbor, Michigan  48106
Saint Joseph Mercy Cancer CenterAnn Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical CenterDearborn, Michigan  48123-2500
Genesys Hurley Cancer InstituteFlint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  48236
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
Sparrow Regional Cancer CenterLansing, Michigan  48912-1811
St. John Macomb HospitalWarren, Michigan  48093
MeritCare BemidjiBemidji, Minnesota  56601
Fairview Ridges HospitalBurnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy HospitalCoon Rapids, Minnesota  55433
Duluth Clinic Cancer Center - DuluthDuluth, Minnesota  55805-1983
CCOP - DuluthDuluth, Minnesota  55805
Miller - Dwan Medical CenterDuluth, Minnesota  55805
Fairview Southdale HospitalEdina, Minnesota  55435
Mercy and Unity Cancer Center at Unity HospitalFridley, Minnesota  55432
Hutchinson Area Health CareHutchinson, Minnesota  55350
Minnesota Oncology Hematology, PA - MaplewoodMaplewood, Minnesota  55109
HealthEast Cancer Care at St. John's HospitalMaplewood, Minnesota  55109
Hennepin County Medical Center - MinneapolisMinneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern HospitalMinneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
St. Francis Cancer Center at St. Francis Medical CenterShakopee, Minnesota  55379
Park Nicollet Cancer CenterSt. Louis Park, Minnesota  55416
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
MeritCare BroadwayFargo, North Dakota  58122
CCOP - MeritCare HospitalFargo, North Dakota  58122
Aultman Cancer Center at Aultman HospitalCanton, Ohio  44710-1799
Mercy Cancer Center at Mercy Medical CenterCanton, Ohio  44708
Case Comprehensive Cancer CenterCleveland, Ohio  44106-5065
MetroHealth Cancer Care Center at MetroHealth Medical CenterCleveland, Ohio  44109
St. Rita's Medical CenterLima, Ohio  45801
Natalie Warren Bryant Cancer Center at St. Francis HospitalTulsa, Oklahoma  74136
Penn State Cancer Institute at Milton S. Hershey Medical CenterHershey, Pennsylvania  17033-0850
Sanford Cancer Center at Sanford USD Medical CenterSioux Falls, South Dakota  57117-5039
Medical X-Ray Center, PCSioux Falls, South Dakota  57105
Dean Medical Center - MadisonMadison, Wisconsin  53717
University of Wisconsin Paul P. Carbone Comprehensive Cancer CenterMadison, Wisconsin  53792-6164
Marshfield Clinic - Marshfield CenterMarshfield, Wisconsin  54449
Marshfield Clinic - Indianhead CenterRice Lake, Wisconsin  54868
CCOP - OchsnerNew Orleans, Louisiana  70121
Rapid City Regional HospitalRapid City, South Dakota  57709
CCOP - Bay Area Tumor InstituteOakland, California  94609-3305
Memorial Hospital of South BendSouth Bend, Indiana  46601
Cape Cod HospitalHyannis, Massachusetts  02601
CCOP - Cancer Research for the OzarksSpringfield, Missouri  65807
CCOP - Montana Cancer ConsortiumBillings, Montana  59101
CCOP - ColumbusColumbus, Ohio  43206
CCOP - DaytonKettering, Ohio  45429
Mercy Hospital Cancer Center - ScrantonScranton, Pennsylvania  18501
Grand View HospitalSellersville, Pennsylvania  18960
CCOP - GreenvilleGreenville, South Carolina  29615
Harrington Cancer CenterAmarillo, Texas  79106
CCOP - Northern Indiana CR ConsortiumSouth Bend, Indiana  46601
Saint Joseph Regional Medical CenterSouth Bend, Indiana  46617
Holden Comprehensive Cancer Center at University of IowaIowa City, Iowa  52242-1002
UMASS Memorial Cancer Center - University CampusWorcester, Massachusetts  01605-2982
Ellis Fischel Cancer Center at University of Missouri - ColumbiaColumbia, Missouri  65203
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical CenterLebanon, New Hampshire  03756-0002
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel HillChapel Hill, North Carolina  27599-7570
CCOP - Columbia River Oncology ProgramPortland, Oregon  97225
Kimmel Cancer Center at Thomas Jefferson University - PhiladelphiaPhiladelphia, Pennsylvania  19107
MultiCare Regional Cancer Center at Tacoma General HospitalTacoma, Washington  98405
Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimore, Maryland  21231-2410
Cleveland Clinic Taussig Cancer CenterCleveland, Ohio  44195
USC/Norris Comprehensive Cancer Center and HospitalLos Angeles, California  90033-0804
MBCCOP - LSU Health Sciences CenterNew Orleans, Louisiana  70112
CCOP - St. Louis-Cape GirardeauSaint Louis, Missouri  63141
CCOP - Virginia Mason Research CenterSeattle, Washington  98101
CCOP - NorthwestTacoma, Washington  98405-0986
Naval Medical Center - San DiegoSan Diego, California  92134-3202
Kent County Memorial HospitalWarwick, Rhode Island  02886
Peninsula Regional Medical CenterSalisbury, Maryland  21801
Rebecca and John Moores UCSD Cancer CenterLa Jolla, California  92093-0658
University of California Davis Cancer CenterSacramento, California  95817
Elmhurst Hospital CenterElmhurst, New York  11373
Queens Cancer Center of Queens HospitalJamaica, New York  11432
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
Medical Center of Central GeorgiaMacon, Georgia  31201
St. Vincent Mercy Medical CenterToledo, Ohio  43608
Palmetto Health South Carolina Cancer CenterColumbia, South Carolina  29203
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
UMDNJ University HospitalNewark, New Jersey  07103
CCOP - Toledo Community HospitalToledo, Ohio  43623-3456
Waukesha Memorial Hospital Regional Cancer CenterWaukesha, Wisconsin  53188
University of Florida Shands Cancer CenterGainesville, Florida  32610-0232
Florida Hospital Cancer Institute at Florida Hospital OrlandoOrlando, Florida  32803-1273
Via Christi Cancer Center at Via Christi Regional Medical CenterWichita, Kansas  67214
Ochsner Cancer Institute at Ochsner Clinic FoundationNew Orleans, Louisiana  70121
Albert Einstein Cancer Center at Albert Einstein College of MedicineBronx, New York  10461
Mount Sinai Medical CenterNew York, New York  10029
Stony Brook University Cancer CenterStony Brook, New York  11794-8174
SUNY Upstate Medical University HospitalSyracuse, New York  13210
Wake Forest University Comprehensive Cancer CenterWinston-Salem, North Carolina  27157-1096
Medical University of Ohio Cancer CenterToledo, Ohio  43614
Toledo HospitalToledo, Ohio  43606
Rhode Island Hospital Comprehensive Cancer CenterProvidence, Rhode Island  02903
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - DallasDallas, Texas  75390
Carilion Cancer Center of Western VirginiaRoanoke, Virginia  24029
Providence Cancer Center at Sacred Heart Medical CenterSpokane, Washington  99220-2555
Edwards Comprehensive Cancer Center at Cabell Huntington HospitalHuntington, West Virginia  25701
Lahey Clinic Medical Center - BurlingtonBurlington, Massachusetts  01805
James P. Wilmot Cancer Center at University of Rochester Medical CenterRochester, New York  14642
Our Lady of Mercy Medical Center Comprehensive Cancer CenterBronx, New York  10466
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
Somerset Medical CenterSomerville, New Jersey  08876
Batte Cancer Center at Northeast Medical CenterConcord, North Carolina  28025
North Colorado Medical CenterGreeley, Colorado  80631
McKee Medical CenterLoveland, Colorado  80539
Saint Anthony's Hospital at Saint Anthony's Health CenterAlton, Illinois  62002
Good Samaritan Regional Health CenterMt. Vernon, Illinois  62864
Southwest Medical CenterLiberal, Kansas  67901
Northern Michigan HospitalPetoskey, Michigan  49770
William Beaumont Hospital - Royal Oak CampusRoyal Oak, Michigan  48073
David C. Pratt Cancer Center at St. John's MercySt. Louis, Missouri  63141
Northern Rockies Radiation Oncology CenterBillings, Montana  59101
Hematology-Oncology Centers of the Northern Rockies - BillingsBillings, Montana  59101
St. Peter's HospitalHelena, Montana  59601
Glacier Oncology, PLLCKalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences CenterMissoula, Montana  59802
Montana Cancer Specialists at Montana Cancer CenterMissoula, Montana  59802
Community Medical CenterMissoula, Montana  59801
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
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
Olympic Hematology and OncologyBremerton, Washington  98310
Skagit Valley Hospital Cancer Care CenterMt. Vernon, Washington  98273
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
Memorial Cancer Institute at Memorial Regional HospitalHollywood, Florida  33021
Zimmer Cancer Center at New Hanover Regional Medical CenterWilmington, North Carolina  28402-9025
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical CenterSavannah, Georgia  31403-3089
Mountain States Tumor Institute at St. Luke's Regional Medical CenterBoise, Idaho  83712-6297
University of Illinois Cancer CenterChicago, Illinois  60612-7243
Advocate Lutheran General Cancer Care CenterPark Ridge, Illinois  60068-1174
Swedish-American Regional Cancer CenterRockford, Illinois  61104-2315
CancerCare of Maine at Eastern Maine Medical CenterBangor, Maine  04401
Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer InstituteBoston, Massachusetts  02115
Masonic Cancer Center at University of MinnesotaMinneapolis, Minnesota  55455
University of Mississippi Cancer ClinicJackson, Mississippi  39216-4505
Siteman Cancer Center at Barnes-Jewish Hospital - Saint LouisSt. Louis, Missouri  63110
CCOP - Nevada Cancer Research FoundationLas Vegas, Nevada  89109-2306
Herbert Irving Comprehensive Cancer Center at Columbia University Medical CenterNew York, New York  10032
Oklahoma University Cancer InstituteOklahoma City, Oklahoma  73104
Legacy Emanuel Hospital and Health Center and Children's HospitalPortland, Oregon  97227
Madigan Army Medical Center - TacomaTacoma, Washington  98431
Gundersen Lutheran Center for Cancer and BloodLa Crosse, Wisconsin  54601
Methodist Estabrook Cancer CenterOmaha, Nebraska  68114-4199
Robert H. Lurie Comprehensive Cancer Center at Northwestern UniversityChicago, Illinois  60611
Decatur Memorial Hospital Cancer Care InstituteDecatur, Illinois  62526
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical CenterHartford, Connecticut  06105
Helen and Harry Gray Cancer Center at Hartford HospitalHartford, Connecticut  06102-5037
Elkhart General HospitalElkhart, Indiana  46515
Howard Community HospitalKokomo, Indiana  46904
South Bend ClinicSouth Bend, Indiana  46617
Lakeland Regional Cancer Care Center - St. JosephSt. Joseph, Michigan  49085
Mount Carmel Health - West HospitalColumbus, Ohio  43222
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
Lakeland Regional Cancer Center at Lakeland Regional Medical CenterLakeland, Florida  33805
University Medical Center of Southern NevadaLas Vegas, Nevada  89102
Joan Karnell Cancer Center at Pennsylvania HospitalPhiladelphia, Pennsylvania  19107
UPMC Cancer CentersPittsburgh, Pennsylvania  15232
Peninsula Medical CenterBurlingame, California  94010
Sutter Health - Western Division Cancer Research GroupGreenbrae, California  94904
Marin Cancer Institute at Marin General HospitalGreenbrae, California  94904
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
Valley Care Medical CenterPleasanton, California  94588
California Pacific Medical Center - California CampusSan Francisco, California  94118
Ella Milbank Foshay Cancer Center at Jupiter Medical CenterJupiter, Florida  33458
Swedish Covenant HospitalChicago, Illinois  60625
Hematology and Oncology AssociatesChicago, Illinois  60611
Ingalls Cancer Care Center at Ingalls Memorial HospitalHarvey, Illinois  60426
Midwest Center for Hematology/OncologyJoliet, Illinois  60432
St. Francis Hospital and Health Centers - Beech Grove CampusBeech Grove, Indiana  46107
Fort Wayne Medical Oncology and HematologyFort Wayne, Indiana  46815
Center for Cancer Therapy at LaPorte Hospital and Health ServicesLa Porte, Indiana  46350
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
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
Cancer Center of Kansas, PA - Dodge CityDodge City, Kansas  67801
St. Francis Comprehensive Cancer CenterTopeka, Kansas  66606
Pennington Cancer Center at Baton Rouge GeneralBaton Rouge, Louisiana  70806
Mary Bird Perkins Cancer Center - Baton RougeBaton Rouge, Louisiana  70809
Medical Center of Louisiana - New OrleansNew Orleans, Louisiana  70112
Sturdy Memorial HospitalAttleboro, Massachusetts  02703
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
Community Cancer Center of MonroeMonroe, Michigan  48162
CentraCare Clinic - River CampusSt. Cloud, Minnesota  56303
Saint Francis Medical CenterCape Girardeau, Missouri  63701
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
Kingsbury Center for Cancer Care at Cheshire Medical CenterKeene, New Hampshire  03431
Cancer Institute of New Jersey at Cooper - VoorheesVoorhees, New Jersey  08043
Highland Hospital of RochesterRochester, New York  14620
Iredell Memorial HospitalStatesville, North Carolina  28677
Bismarck Cancer CenterBismarck, North Dakota  58501
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
Blanchard Valley Medical AssociatesFindlay, Ohio  45840
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
Mercy Medical CenterSpringfield, Ohio  45504
Mercy Hospital of TiffinTiffin, Ohio  44883
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
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
Kaiser Permanente Health Care - PortlandPortland, Oregon  97232
Providence Cancer Center at Providence Portland Medical CenterPortland, Oregon  97213-2967
Providence St. Vincent Medical CenterPortland, Oregon  97225
Legacy Meridian Park HospitalTualatin, Oregon  97062
Oncology Services of AberdeenAberdeen, South Dakota  57401
Virginia Oncology Associates - HamptonHampton, Virginia  23666
Minor and James Medical, PLLCSeattle, Washington  98104
Polyclinic First HillSeattle, Washington  98122
Providence Cancer Center at Holy Family HospitalSpokane, Washington  99207
Southwest Washington Medical Center Cancer CenterVancouver, Washington  98668
North Star Lodge Cancer Center at Yakima Valley Memorial HospitalYakima, Washington  98902
Holy Family Memorial Medical Center Cancer Care CenterManitowoc, Wisconsin  54221-1450
Welch Cancer Center at Sheridan Memorial HospitalSheridan, Wyoming  82801
Massachusetts General HospitalBoston, Massachusetts  02114-2617
Fairbanks Cancer Treatment Center at Fairbanks Memorial HospitalFairbanks, Alaska  99701
St. Anthony Central HospitalDenver, Colorado  80204-1335
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
St. Francis HospitalFederal Way, Washington  98003
Cascade Cancer Center at Evergreen Hospital Medical CenterKirkland, Washington  98034-3013
St. Clare HospitalLakewood, Washington  98499-0998
Providence St. Peter Hospital Regional Cancer CenterOlympia, Washington  98506
Good Samaritan Cancer CenterPuyallup, Washington  98371
Valley Medical CenterRenton, Washington  98055
Allenmore HospitalTacoma, Washington  98411-0414
Lancaster General HospitalLancaster, Pennsylvania  17604-3555
Hembree Mercy Cancer Center at St. Edward Mercy Medical CenterFt. Smith, Arkansas  72903
California Cancer Center - Woodward Park OfficeFresno, California  93720
Highland General HospitalOakland, California  94602
Northeast Georgia Medical CenterGainesville, Georgia  30501
Creticos Cancer Center at Advocate Illinois Masonic Medical CenterChicago, Illinois  60657
Regional Cancer Center at Singing River HospitalPascagoula, Mississippi  39581
Saint Luke's HospitalChesterfield, Missouri  63017
Missouri Baptist Cancer CenterSt. Louis, Missouri  63131
Cancer Resource Center - LincolnLincoln, Nebraska  68510
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
Allegheny Cancer Center at Allegheny General HospitalPittsburgh, Pennsylvania  15212
St. Joseph Medical CenterReading, Pennsylvania  19604
Midelfort Clinic - LutherEau Claire, Wisconsin  54702
UAB Comprehensive Cancer CenterBirmingham, Alabama  35294
Alta Bates Summit Comprehensive Cancer CenterBerkeley, California  94704
Eastern Connecticut Hematology and Oncology AssociatesNorwich, Connecticut  06360
Tunnell Cancer Center at Beebe Medical CenterLewes, Delaware  19958
Herbert D. Kerman Regional Oncology Center - Daytona BeachDaytona Beach, Florida  32114
Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross HospitalFort Lauderdale, Florida  33308
John B. Amos Cancer CenterColumbus, Georgia  31904
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/CandlerSavannah, Georgia  31405
Elkhart Clinic, LLCElkhart, Indiana  46514-2098
Michiana Hematology-Oncology, PC - South BendMishawaka, Indiana  46545-1470
Reid Hospital & Health Care ServicesRichmond, Indiana  47374
McFarland Clinic, PCAmes, Iowa  50010
Cancer Center of Kansas, PA - ChanuteChanute, Kansas  66720
Cancer Center of Kansas, PA - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas-IndependenceIndependence, Kansas  67301
Cancer Center of Kansas, PA - KingmanKingman, Kansas  67068
Lawrence Memorial HospitalLawrence, Kansas  66044
Cancer Center of Kansas, PA - NewtonNewton, Kansas  67114
Menorah Medical CenterOverland Park, Kansas  66209
Cancer Center of Kansas, PA - ParsonsParsons, Kansas  67357
Cancer Center of Kansas, PA - PrattPratt, Kansas  67124
Cancer Center of Kansas, PA - SalinaSalina, Kansas  67401
Shawnee Mission Medical CenterShawnee Mission, Kansas  66204
Cotton-O'Neil Cancer CenterTopeka, Kansas  66606
Cancer Center of Kansas, PA - WellingtonWellington, Kansas  67152
Cancer Center of Kansas, PA - WichitaWichita, Kansas  67214
Associates in Womens Health, PA - North ReviewWichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts TowerWichita, Kansas  67208
Cancer Center of Kansas, PA - WinfieldWinfield, Kansas  67156
Ochsner Health Center - BluebonnetBaton Rouge, Louisiana  70809
Union Hospital Cancer Program at Union HospitalElkton MD, Maryland  21921
Foote Memorial HospitalJackson, Michigan  49201
Haematology-Oncology Associates of Ohio and Michigan, PCLambertville, Michigan  48144
St. Mary Mercy HospitalLivonia, Michigan  48154
Mercy Memorial Hospital - MonroeMonroe, Michigan  48162
St. Joseph Mercy OaklandPontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy HospitalPort Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - SaginawSaginaw, Michigan  48601
Lakeside Cancer Specialists, PLLCSaint Joseph, Michigan  49085
St. Luke's Hospital Cancer Care CenterDuluth, Minnesota  55805
Fergus Falls Medical Group, PAFergus Falls, Minnesota  56537
Truman Medical Center - Hospital HillKansas City, Missouri  64108
St. Joseph Medical CenterKansas City, Missouri  64114
Heartland Hematology Oncology Associates, IncorporatedKansas City, Missouri  64118
North Kansas City HospitalKansas City, Missouri  64116
Saint Luke's Cancer Institute at Saint Luke's HospitalKansas City, Missouri  64111
Research Medical CenterKansas City, Missouri  64132
Heartland Regional Medical CenterSaint Joseph, Missouri  64506
Arch Medical Services, Incorporated at Center for Cancer Care and ResearchSaint Louis, Missouri  63141
Billings Clinic - DowntownBillings, Montana  59107-7000
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
St. James Healthcare Cancer CareButte, Montana  59701
Great Falls Clinic - Main FacilityGreat Falls, Montana  59405
Sletten Cancer Institute at Benefis HealthcareGreat Falls, Montana  59405
Kalispell Medical Oncology at KRMCKalispell, Montana  59901
Alegant Health Cancer Center at Bergan Mercy Medical CenterOmaha, Nebraska  68124
Leo W. Jenkins Cancer Center at ECU Medical SchoolGreenville, North Carolina  27834
Summa Center for Cancer Care at Akron City HospitalAkron, Ohio  44309-2090
Barberton Citizens HospitalBarberton, Ohio  44203
North Coast Cancer Care - ClydeClyde, Ohio  43410
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer CenterColumbus, Ohio  43210-1240
Grant Medical Center Cancer CareColumbus, Ohio  43215
Wayne HospitalGreenville, Ohio  45331
Fisher-Titus Medical CenterNorwalk, Ohio  44857
Flower Hospital Cancer CenterSylvania, Ohio  43560
St. Anne Mercy HospitalToledo, Ohio  43623
Mount Carmel St. Ann's Cancer CenterWesterville, Ohio  43081
Clinton Memorial HospitalWilmington, Ohio  45177
Cleo Craig Cancer Research ClinicLawton, Oklahoma  73505
Cancer Care Associates - Mercy CampusOklahoma City, Oklahoma  73120
Adventist Medical CenterPortland, Oregon  97216
Legacy Good Samaritan Hospital & Comprehensive Cancer CenterPortland, Oregon  97210
Hematology and Oncology Associates of Northeastern PennsylvaniaScranton, Pennsylvania  18510
Fredericksburg Oncology, IncorporatedFredericksburg, Virginia  22401
St. Joseph Cancer CenterBellingham, Washington  98225
Providence Centralia HospitalCentralia, Washington  98531-9027
Columbia Basin HematologyKennewick, Washington  99336
Harrison Poulsbo Hematology and OnocologyPoulsbo, Washington  98370
Evergreen Hematology and Oncology, PSSpokane, Washington  99218
Franciscan Cancer Center at St. Joseph Medical CenterTacoma, Washington  98405-3004
Wenatchee Valley Medical CenterWenatchee, Washington  98801-2028
Marshfield Clinic - Chippewa CenterChippewa Falls, Wisconsin  54729
Marshfield Clinic Cancer Care at Regional Cancer CenterEau Claire, Wisconsin  54701
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
UW Cancer Center Johnson CreekJohnson Creek, Wisconsin  53038
Vince Lombardi Cancer Clinic - MarinetteMarinette, Wisconsin  54143
Saint Joseph's HospitalMarshfield, Wisconsin  54449
Medical Consultants, LimitedMilwaukee, Wisconsin  53215
Marshfield Clinic - Lakeland CenterMinocqua, Wisconsin  54548
Ministry Medical Group at Saint Mary's HospitalRhinelander, Wisconsin  54501
Vince Lombardi Cancer Clinic - SheboyganSheboygan, Wisconsin  53081
Saint Michael's Hospital Cancer CenterStevens Point, Wisconsin  54481
Aurora Medical CenterSummit, Wisconsin  53066
Vince Lombardi Cancer Clinic - Two RiversTwo Rivers, Wisconsin  54241
Marshfield Clinic - Wausau CenterWausau, Wisconsin  54401
Marshfield Clinic - Wisconsin Rapids CenterWisconsin Rapids, Wisconsin  54494
Cancer Resource Center at King's Daughters Medical CenterAshland, Kentucky  41101
Mid Dakota Clinic, PCBismarck, North Dakota  58501
Regional Cancer Center at Memorial Medical CenterSpringfield, Illinois  62781-0001
Auburn Regional Center for Cancer CareAuburn, Washington  98002
Memorial Hospital of Rhode IslandPawtucket, Rhode Island  02860
Aurora Sinai Medical CenterMilwaukee, Wisconsin  53201-0342
Washington Township HospitalFremont, California  94538
Lowell General HospitalLowell, Massachusetts  01854
Caritas Norwood HospitalNorwood, Massachusetts  02062
Good Samaritan Cancer Center at Good Samaritan HospitalKearney, Nebraska  68848-1990
Elliot Regional Cancer Center at Elliot HospitalManchester, New Hampshire  03103
Pardee Memorial HospitalHendersonville, North Carolina  28791
Three Rivers Community HospitalGrants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical CenterMedford, Oregon  97504
Martha Jefferson Hospital Cancer Care CenterCharlottesville, Virginia  22901
Regional Cancer Center at Oconomowoc Memorial HospitalOconomowoc, Wisconsin  53066
Harold Alfond Center for Cancer CareAugusta, Maine  04330
Dana-Farber/Brigham and Women's Cancer CenterBoston, Massachusetts  02115
Kinston Medical SpecialistsKinston, North Carolina  28501
Miriam HospitalProvidence, Rhode Island  02906
St. Francis HospitalEvanston, Illinois  60202
Frederick Memorial Hospital Regional Cancer Therapy CenterFrederick, Maryland  21701
St. John's Regional Medical CenterJoplin, Missouri  64804
McLeod Regional Medical CenterFlorence, South Carolina  29501
MBCCOP - Meharry Medical College - NashvilleNashville, Tennessee  37208-3599
Palm Beach Cancer Institute - West Palm BeachWest Palm Beach, Florida  33401
Great Falls, Montana  59405
Lakes Region General HospitalLaconia, New Hampshire  03246
Roper St. Francis Cancer Center at Roper HospitalCharleston, South Carolina  29401
Rockwood Clinic Cancer Treatment CenterSpokane, Washington  99204-2967
Franklin & Edith Scarpa Regional Cancer Center at South Jersey HealthcareVineland, New Jersey  08360
Lipson Cancer and Blood Center at Rochester General HospitalRochester, New York  14621
Center for Cancer Care at OSF Saint Anthony Medical CenterRockford, Illinois  61108
Doctors Medical Center - San Pablo CampusSan Pablo, California  94806
St. Vincent Healthcare Cancer Care ServicesBillings, Montana  59101
Center for Cancer Care and Research at Watson Clinic, LLPLakeland, Florida  33805
Berkshire Hematology Oncology, PCPittsfield, Massachusetts  01201
Parvin Radiation OncologyKansas City, Missouri  64116
Midwest Hematology Oncology Group, IncorporatedSaint Louis, Missouri  63109
Lynchburg Hematology-Oncology ClinicLynchburg, Virginia  24501
Providence Cancer Center at Providence HospitalMobile, Alabama  36608
East Bay Radiation Oncology CenterCastro Valley, California  94546
Contra Costa Regional Medical CenterMartinez, California  94553-3156
Tibotec Therapeutics - Division of Ortho Biotech Products, LPMarysville, California  95901
Memorial Medical CenterModesto, California  95355
Tom K Lee, IncorporatedOakland, California  94609
Bay Area Breast Surgeons, IncorporatedOakland, California  94609
Valley Medical Oncology Consultants - PleasantonPleasanton, California  94588
Tahoe Forest Cancer CenterTruckee, California  96161
Alexian Brothers Radiation OncologyElk Grove Village, Illinois  60007
Trinity Cancer Center at Trinity Medical Center - 7th Street CampusMoline, Illinois  61265
Iowa Blood and Cancer CareCedar Rapids, Iowa  52402
Caritas St. Elizabeth's Medical CenterBrighton, Massachusetts  02135-2997
Hattiesburg Clinic, PA at Forrest GeneralHattiesburg, Mississippi  39401
New Hampshire Oncology - Hematology, PA at Payson Center for Cancer CareConcord, New Hampshire  03301
Center for Cancer Care at Exeter HospitalExeter, New Hampshire  03833
New Hampshire Oncology - Hematology, PA - HooksettHooksett, New Hampshire  03106
Faxton Regional Cancer CenterUtica, New York  13502
Trinity CancerCare CenterMinot, North Dakota  58701
United States Air Force Medical Center - Wright-PattersonWright-Patterson AFB, Ohio  45433-5529
Franciscan Skemp Healthcare - La Crosse CampusLa Crosse, Wisconsin  54601
Saint James Hospital and Health Centers Comprehensive Cancer Institute - Olympia FieldsOlympia Fields, Illinois  60461
Medcenter One Hospital Cancer Care CenterBismarck, North Dakota  58501
St. Alexius Medical Center Cancer CenterBismarck, North Dakota  58502
Providence Cancer Center at PMCCMedford, Oregon  97504
Callahan Cancer Center at Great Plains Regional Medical CenterNorth Platte, Nebraska  69103
Regional Medical CenterAnniston, Alabama  36202
Valley Medical Oncology Consultants - Castro ValleyCastro Valley, California  94546
Valley Medical OncologyFremont, California  94538
Cancer Care AssociatesFresno, California  93720
Mercy Regional Cancer Center at Mercy Medical CenterRedding, California  96049
Memorial Hospital Cancer Center - Colorado SpringsColorado Springs, Colorado  80909
Integrated Community Oncology Network - Orange ParkOrange Park, Florida  32073
Mount Sinai Hospital Medical CenterChicago, Illinois  60608
Provena St. Mary's Regional Cancer Center - KankakeeKankakee, Illinois  60901
Heartland Oncology and HematologyCouncil Bluffs, Iowa  51503
Ochsner Health Center - CovingtonCovington, Louisiana  70433
Hudner Oncology Center at Saint Anne's Hospital - Fall RiverFall River, Massachusetts  02721
Addison Gilbert HospitalGloucester, Massachusetts  01930
NSMC Cancer Center - PeabodyPeabody, Massachusetts  01960
Noble HospitalWestfield, Massachusetts  01085
Immanuel St. Joseph'sMankato, Minnesota  56002
Hematology & Oncology ClinicHattiesburg, Mississippi  39402
Skaggs Cancer Center at Skaggs Regional Medical CenterBranson, Missouri  65616
Dana-Farber Cancer Institute at LondonderryLondonderry, New Hampshire  03053
Fitzpatrick Cancer Center at Champlain Valley Physicians Hospital Medical CenterPlattsburgh, New York  12901
Alamance Cancer Center at Alamance Regional Medical CenterBurlington, North Carolina  27216
Cape Fear Valley Medical Center Cancer CenterFayetteville, North Carolina  28302-2000
Maria Parham Medical CenterHenderson, North Carolina  27536
Southeastern Regional Medical CenterLumberton, North Carolina  28359
Granville Medical CenterOxford, North Carolina  27565
Duke Health Raleigh HospitalRaleigh, North Carolina  27609
Person Memorial HospitalRoxboro, North Carolina  27573
Marion L. Shepard Cancer Center at Beaufort County HospitalWashington, North Carolina  27889
Nashville Oncology Associates, PCNashville, Tennessee  37203
Virginia Cancer Institute - West EndRichmond, Virginia  23230
Luther Midlelfort HospitalEau Claire, Wisconsin  54702
Mercy Regional Cancer CenterJanesville, Wisconsin  53547
Columbia Saint Mary's Hospital - OzaukeeMequon, Wisconsin  53097
Columbia-Saint Mary's Cancer Care CenterMilwaukee, Wisconsin  53211