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Phase III Trial of Continuous Schedule AC + G vs. Q 2 Week Schedule AC, Followed by Paclitaxel Given Either Every 2 Weeks or Weekly for 12 Weeks as Post-Operative Adjuvant Therapy in Node-Positive or High-Risk Node-Negative Breast Cancer

Phase 3
18 Years
Open (Enrolling)
Breast Cancer

Thank you

Trial Information

Phase III Trial of Continuous Schedule AC + G vs. Q 2 Week Schedule AC, Followed by Paclitaxel Given Either Every 2 Weeks or Weekly for 12 Weeks as Post-Operative Adjuvant Therapy in Node-Positive or High-Risk Node-Negative Breast Cancer


- Compare the disease-free survival of patients with node-positive or high-risk
node-negative breast cancer treated with 2 different schedules of adjuvant doxorubicin,
cyclophosphamide, and paclitaxel.

- Compare the overall survival of patients treated with these regimens.

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

- Correlate outcome with putative prognostic markers in patients treated with these

OUTLINE: This is a randomized, multicenter study. Patients are randomized to 1 of 2
treatment arms (arms V and VI) (arms I-IV closed 11/10/10).

- Arm I: (closed 11/10/10) Patients receive doxorubicin IV and cyclophosphamide IV on day
1 and pegfilgrastim subcutaneously (SC) on day 2 or filgrastim (G-CSF) SC on days 3-10.
Treatment repeats every 14 days for 6 courses.

Beginning 2 weeks after completion of doxorubicin and cyclophosphamide, patients receive
paclitaxel IV over 3 hours on day 1 and pegfilgrastim SC on day 2. Treatment repeats every
14 days for 6 courses.

- Arm II: (closed 11/10/10) Patients receive doxorubicin IV on day 1, oral
cyclophosphamide on days 1-7, and G-CSF SC on days 2-7. Treatment repeats every 7 days
for 15 courses.

Beginning 2 weeks after completion of cyclophosphamide, patients receive paclitaxel and
pegfilgrastim as in arm I.

- Arm III: (closed 11/10/10) Patients receive doxorubicin, cyclophosphamide, and
pegfilgrastim or G-CSF as in arm I.

Beginning 2 weeks after completion of doxorubicin and cyclophosphamide, patients receive
paclitaxel IV over 1 hour on day 1. Treatment repeats every 7 days for 12 courses.

- Arm IV: (closed 11/10/10) Patients receive doxorubicin, cyclophosphamide, and G-CSF as
in arm II.

Beginning 2 weeks after completion of cyclophosphamide, patients receive paclitaxel as in
arm III.

- Arm V: Patients receive doxorubicin IV and cyclophosphamide IV on day 1 and
pegfilgrastim SC on day 2. Treatment repeats every 14 days for 4 courses. Patients
receive doxorubicin IV and cyclophosphamide IV on day 1 and pegfilgrastim SC on day 2.
Treatment repeats every 14 days for 6 courses.

Beginning 2 weeks after completion of doxorubicin and cyclophosphamide, patients receive
paclitaxel IV over 3 hours on day 1 and pegfilgrastim SC on day 2. Treatment repeats every
14 days for 6 courses.

- Arm VI: Patients receive doxorubicin, cyclophosphamide, and pegfilgrastim as in arm V.

Beginning 2 weeks after completion of doxorubicin and cyclophosphamide, patients receive
paclitaxel IV over 1 hour on day 1. Treatment repeats every 7 days for 12 courses.

In all arms, treatment continues in the absence of disease progression or unacceptable

In all arms patients with HER2/neu-positive tumors also receive trastuzumab (Herceptin®)
weekly or every 3 weeks beginning concurrently with paclitaxel OR 3 months after the last
dose of paclitaxel and continuing for up to 52 weeks.

In all arms, patients with estrogen-receptor or progesterone-receptor positive tumors
receive hormonal therapy beginning within 28 days of the completion of adjuvant chemotherapy
or radiotherapy (if given).

After finishing study treatment patients are followed up every 6 months for 5 years and then
once a year for up to 15 years.

PROJECTED ACCRUAL: A total of 3,250 patients will be accrued for this study.

Inclusion Criteria


- Histologically confirmed stage I-III invasive breast cancer

- Operable disease

- Stage I, II, IIIA, and IIIC (T1-3, N3a only)

- No T4 tumors

- High-risk disease, defined by 1 of the following:

- Tumor ≥ 2 cm in greatest diameter (includes both invasive and intraductal

- Patients with nodal status of N0+ (i.e., no cluster of tumor cells in any
node greater than 0.2 mm) are considered to be node negative and must have
a primary tumor ≥ 2 cm in size or have a tumor ≥ 1 cm with high risk

- Patients who are node negative on the basis of a sentinel node procedure
and fewer than 6 axillary nodes are removed are eligible OR at least 6
axillary or intramammary nodes must be negative

- Tumor ≥ 1 cm in diameter and meeting 1 of the following criteria:

- ER-negative and PgR-negative

- ER-positive or PgR-positive with a Genomic Health Recurrence Score of ≥ 26

- One or more axillary or intramammary nodes are involved by metastatic breast

- If one or more nodes is involved, a minimum of 6 axillary or intramammary
nodes must have been examined histologically

- Patients with N0(I+) disease will be considered node negative

- HER2/neu-positive tumors (3+ by immunohistochemical staining or amplified by
fluorescence in-situ hybridization) allowed

- Bilateral synchronous breast cancer diagnosed within 1 month of each other allowed
provided the higher TNM stage primary tumor meets the eligibility criteria

- Prior modified radical mastectomy OR local excision of all tumors with axillary lymph
node dissection or sentinel node resection required

- No more than 84 days since prior surgery for the primary tumor and/or axilla

- Final resection margins for the primary tumor must be histologically negative
for invasive cancer and ductal carcinoma in situ

- Resection margins positive for lobular carcinoma in situ are allowed

- Hormone receptor status:

- Estrogen receptor status known

- Progesterone receptor status known



- 18 and over


- Male or female

Menopausal status

- Not specified

Performance status

- Zubrod 0-2

Life expectancy

- Not specified


- Absolute neutrophil count at least 1,200/mm^3

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


- Bilirubin no greater than upper limit of normal (ULN)

- Alkaline phosphatase no greater than 2 times ULN

- SGOT or SGPT no greater than 2 times ULN


- Creatinine no greater than ULN


- No congestive heart failure

- No active angina pectoris

- LVEF greater than or equal to the lower limit of normal* by MUGA or echocardiogram
NOTE: Patients age 60 and over OR with a history of hypertension


- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No other malignancy within the past 5 years except adequately treated basal cell or
squamous cell skin cancer, in situ cervical carcinoma, or lobular carcinoma in situ
of the breast

- Prior invasive breast cancer or ductal carcinoma in situ allowed if disease-free
for 5 years

- HIV negative


Biologic therapy

- Not specified


- No prior cytotoxic chemotherapy for this breast cancer

- No prior chemotherapy with an anthracycline, anthracenedione, or taxane

Endocrine therapy

- Not specified


- No prior radiotherapy for this malignancy

- At least 2 weeks since prior radiotherapy for ductal carcinoma in situ


- See Disease Characteristics

Type of Study:


Study Design:

Allocation: Randomized, Intervention Model: Factorial Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Disease-free survival by medical history, physical exam, and mammograms every 6 months (annually for mammograms) for 5 years and then annually for 15 years or until death

Outcome Time Frame:

every 6 months (annually for mammograms) for 5 years and then annually for 15 years or until death

Safety Issue:


Principal Investigator

George Thomas Budd, MD

Investigator Role:

Study Chair

Investigator Affiliation:

The Cleveland Clinic


United States: Federal Government

Study ID:




Start Date:

November 2003

Completion Date:

February 2017

Related Keywords:

  • Breast Cancer
  • stage II breast cancer
  • stage IA breast cancer
  • stage IB breast cancer
  • stage IIIC breast cancer
  • male breast cancer
  • HER2-positive breast cancer
  • estrogen receptor-negative breast cancer
  • estrogen receptor-positive breast cancer
  • progesterone receptor-negative breast cancer
  • progesterone receptor-positive breast cancer
  • Breast Neoplasms



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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 - Fort ScottFort Scott, Kansas  66701
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 - LiberalLiberal, Kansas  67905
Cancer Center of Kansas, PA - NewtonNewton, Kansas  67114
Menorah Medical CenterOverland Park, Kansas  66209
Saint Luke's Hospital - SouthOverland Park, Kansas  66213
Cancer Center of Kansas, PA - ParsonsParsons, Kansas  67357
Cancer Center of Kansas, PA - PrattPratt, Kansas  67124
Cancer Center of Kansas, PA - SalinaSalina, Kansas  67401
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
Foote Memorial HospitalJackson, Michigan  49201
St. Mary Mercy HospitalLivonia, Michigan  48154
Mercy Memorial Hospital - MonroeMonroe, Michigan  48162
Michiana Hematology Oncology PC - NilesNiles, Michigan  49120
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
Willmar Cancer Center at Rice Memorial HospitalWillmar, Minnesota  56201
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
Saint Luke's East - Lee's SummitLee's Summit, Missouri  64086
Liberty HospitalLiberty, Missouri  64068
Heartland Regional Medical CenterSaint Joseph, Missouri  64506
Saint Joseph Oncology, IncorporatedSaint Joseph, Missouri  64507
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
Northern Montana HospitalHavre, Montana  59501
Kalispell Medical Oncology at KRMCKalispell, Montana  59901
Alegant Health Cancer Center at Bergan Mercy Medical CenterOmaha, Nebraska  68124
Summa Center for Cancer Care at Akron City HospitalAkron, Ohio  44309-2090
Barberton Citizens HospitalBarberton, Ohio  44203
Mary Rutan HospitalBellefontaine, Ohio  43311
Grant Medical Center Cancer CareColumbus, Ohio  43215
Hematology Oncology CenterElyria, Ohio  44035
Community Cancer CenterElyria, Ohio  44035
Wayne HospitalGreenville, Ohio  45331
Knox Community HospitalMount Vernon, Ohio  43050
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
Cleo Craig Cancer Research ClinicLawton, Oklahoma  73505
Cancer Care Associates - Mercy CampusOklahoma City, Oklahoma  73120
Legacy Good Samaritan Hospital & Comprehensive Cancer CenterPortland, Oregon  97210
Penn State Hershey Cancer Institute at Milton S. Hershey Medical CenterHershey, Pennsylvania  17033-0850
Guthrie Cancer Center at Guthrie Clinic SayreSayre, Pennsylvania  18840
Hematology and Oncology Associates of Northeastern PennsylvaniaScranton, Pennsylvania  18510
Susquehanna Cancer Center at Divine Providence HospitalWilliamsport, Pennsylvania  17701
Sandra L. Maxwell Cancer CenterCedar City, Utah  84720
Jon and Karen Huntsman Cancer Center at Intermountain Medical CenterMurray, Utah  84157
Val and Ann Browning Cancer Center at McKay-Dee Hospital CenterOgden, Utah  84403
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
Community Comprehensive Cancer Center at Camden-Clark Memorial HospitalParkersburg, West Virginia  26102
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
Vince Lombardi Cancer Clinic - SheboyganSheboygan, Wisconsin  53081
Aurora Medical CenterSummit, Wisconsin  53066
Vince Lombardi Cancer Clinic - Two RiversTwo Rivers, Wisconsin  54241
Oncology Alliance, SC - Milwaukee - WestWauwatosa, Wisconsin  53226
Mid Dakota Clinic, PCBismarck, North Dakota  58501
Regional Cancer Center at Memorial Medical CenterSpringfield, Illinois  62781-0001
St. Joseph Hospital Regional Cancer Center - OrangeOrange, California  92868-3849
Queen's Cancer Institute at Queen's Medical CenterHonolulu, Hawaii  96813
Dizzy Gillespie Cancer Institute at Englewood Hospital and Medical CenterEnglewood, New Jersey  07631
Bethesda North HospitalCincinnati, Ohio  45242
Kinston Medical SpecialistsKinston, North Carolina  28501
Greenville Hospital Cancer CenterGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Grove CommonsGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Faris RoadGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Greer Medical OncologyGreer, South Carolina  29650
Cancer Centers of the Carolinas - SenecaSeneca, South Carolina  29672
Cancer Centers of the Carolinas - SpartanburgSpartanburg, South Carolina  29307
MedCentral - Mansfield HospitalMansfield, Ohio  44903
Resurrection Medical CenterChicago, Illinois  60631
Sherman HospitalElgin, Illinois  60120-2198
St. Francis HospitalEvanston, Illinois  60202
Lapeer Regional HospitalLapeer, Michigan  48446
St. John's Regional Medical CenterJoplin, Missouri  64804
Freeman Cancer Institute at Freeman Health SystemJoplin, Missouri  64803-2644
McLeod Regional Medical CenterFlorence, South Carolina  29501
MBCCOP - Meharry Medical College - NashvilleNashville, Tennessee  37208-3599
Providence Cancer CenterAnchorage, Alaska  99508
Lacks Cancer Center at Saint Mary's Health CareGrand Rapids, Michigan  49503
Metro Health HospitalGrand Rapids, Michigan  49506
PinnacleHealth Regional Cancer Center at Polyclinic HospitalHarrisburg, Pennsylvania  17105
University of Wisconcin Cancer Center at Aspirus Wausau HospitalWausau, Wisconsin  54401
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
South Carolina Oncology Associates, PAColumbia, South Carolina  29210
Doctors Medical Center - San Pablo CampusSan Pablo, California  94806
Galesburg Clinic, PCGalesburg, Illinois  61401
St. Vincent Healthcare Cancer Care ServicesBillings, Montana  59101
University of Tennessee Cancer Institute - MemphisMemphis, Tennessee  38104
Good Samaritan Hospital Cancer Treatment CenterCincinnati, Ohio  45220
Desert Regional Medical Center Comprehensive Cancer CenterPalm Springs, California  92262
Parvin Radiation OncologyKansas City, Missouri  64116
Midwest Hematology Oncology Group, IncorporatedSaint Louis, Missouri  63109
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
El Camino Hospital Cancer CenterMountain View, California  94040
Larry G Strieff MD Medical CorporationOakland, California  94609
Tom K Lee, IncorporatedOakland, California  94609
Bay Area Breast Surgeons, IncorporatedOakland, California  94609
Valley Medical Oncology Consultants - PleasantonPleasanton, California  94588
Kapiolani Medical Center at Pali MomiAiea, Hawaii  96701
Kapiolani Medical Center for Women and ChildrenHonolulu, Hawaii  96826
Straub Clinic and Hospital, IncorporatedHonolulu, Hawaii  96813
Hawaii Medical Center - EastHonolulu, Hawaii  96817
OnCare Hawaii, Incorporated - KuakiniHonolulu, Hawaii  96817
OnCare Hawaii, Incorporated - LusitanaHonolulu, Hawaii  96813
Maui Memorial Medical CenterWailuku, Hawaii  96793
Pacific Cancer Institute - MauiWailuku, Hawaii  96793
Illinois CancerCare - BloomingtonBloomington%, Illinois  61701
Illinois CancerCare - CantonCanton, Illinois  61520
Illinois CancerCare - CarthageCarthage, Illinois  62321
Elmhurst Memorial HospitalElmhurst, Illinois  60126
Illinois CancerCare - EurekaEureka, Illinois  61530
Illinois CancerCare - GalesburgGalesburg, Illinois  61401
Illinois CancerCare - HavanaHavana, Illinois  62644
Illinois CancerCare - Kewanee ClinicKewanee, Illinois  61443
Illinois CancerCare - MacombMacomb, Illinois  61455
OSF Holy Family Medical CenterMonmouth, Illinois  61462
Illinois CancerCare - MonmouthMonmouth, Illinois  61462
Illinois CancerCare - Community Cancer CenterNormal, Illinois  61761
Illinois CancerCare - PekinPekin, Illinois  61603
Illinois CancerCare - PeruPeru, Illinois  61354
Illinois CancerCare - PrincetonPrinceton, Illinois  61356
Illinois CancerCare - Spring ValleySpring Valley, Illinois  61362
Caritas St. Elizabeth's Medical CenterBrighton, Massachusetts  02135-2997
Mercy General Health PartnersMuskegon, Michigan  49443
New Hampshire Oncology - Hematology, PA at Payson Center for Cancer CareConcord, New Hampshire  03301
New Hampshire Oncology - Hematology, PA - HooksettHooksett, New Hampshire  03106
Bay Area HospitalCoos Bay, Oregon  97420
Franciscan Skemp Healthcare - La Crosse CampusLa Crosse, Wisconsin  54601
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
Medcenter One Hospital Cancer Care CenterBismarck, North Dakota  58501
St. Alexius Medical Center Cancer CenterBismarck, North Dakota  58502
Hematology-Oncology Associates of Fredericksburg, IncorporatedFredericksburg, Virginia  22401
University of Colorado Cancer Center at UC Health Sciences CenterAurora, Colorado  80045
Christus Schumpert Cancer Treatment CenterShreveport, Louisiana  71101
Hematology Oncology Associates, PCAlbuquerque, New Mexico  87106
Regional Medical CenterAnniston, Alabama  36202
Valley Medical Oncology Consultants - Castro ValleyCastro Valley, California  94546
Valley Medical OncologyFremont, California  94538
Memorial Hospital Cancer Center - Colorado SpringsColorado Springs, Colorado  80909
Provena St. Mary's Regional Cancer Center - KankakeeKankakee, Illinois  60901
Heartland Oncology and HematologyCouncil Bluffs, Iowa  51503
Ochsner Health Center - CovingtonCovington, Louisiana  70433
Addison Gilbert HospitalGloucester, Massachusetts  01930
New Orleans Cancer Institute at Memorial Medical CenterNew Orleans, Louisiana  70115
Cancer Centers of the Carolinas - EasleyEasley, South Carolina  29640
Self Regional Cancer Center at Self Regional Medical CenterGreenwood, South Carolina  29646
Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
Lakeview HospitalStillwater, Minnesota  55082
Princeton Community HospitalPrinceton, West Virginia  24740
Mount Carmel Regional Cancer CenterPittsburg, Kansas  66762
Union State Bank Cancer Center at Nyack HospitalNyack, New York  10960-1998
Northwest Cancer Specialists at Vancouver Cancer CenterVancouver, Washington  98684
CCOP - Kansas CityPrairie Village, Kansas  66208
St. Agnes Hospital Cancer CenterBaltimore, Maryland  21229
Vince Lombardi Cancer Clinic - OshkoshOshkosh, Wisconsin  54904
Shaw Regional Cancer CenterEdwards, Colorado  81632
Kootenai Cancer Center - Coeur d'AleneCoeur d'Alene, Idaho  83814
Langlade Memorial HospitalAntigo, Wisconsin  54409
San Luis Valley Regional Medical CenterAlamosa, Colorado  81101
Valley View Hospital Cancer CenterGlenwood Springs, Colorado  81601
Florida Hospital Memorial Medical CenterDaytona Beach, Florida  32117
Piedmont Fayette HospitalFayetteville, Georgia  30214
Castle Medical CenterKailua, Hawaii  96734
Kauai Medical ClinicLihue, Hawaii  96766
Central Dupage Cancer CenterWarrenville, Illinois  60555
Hays Medical CenterHays, Kansas  67601
Hutchinson Hospital CorporationHutchinson, Kansas  67502
Regional Cancer Center at Western Maryland Health System - Sacred Heart CampusCumberland, Maryland  21502
Clemens Regional Medical CenterMount Clemens, Michigan  48043
Southeast Cancer CenterCape Girardeau, Missouri  63703
Goldschmidt Cancer CenterJefferson City, Missouri  65109
Comprehensive Cancer Care, PCSaint Louis, Missouri  63141
Lakeside HospitalOmaha, Nebraska  68130
Presbyterian Cancer Treatment Center at Presbyterian Kaseman HospitalAlbuquerque, New Mexico  87110
University of New Mexico Cancer Center - SouthLas Cruces, New Mexico  88011
Cleveland Clinic Beachwood Family Health and Surgery CenterBeachwood, Ohio  44122
Cleveland Clinic Foundation - StrongsvilleStrongsville, Ohio  44136
Cancer Care Associates - NormanNorman, Oklahoma  73071
Cancer Care Associates at Troy and Dollie Smith Cancer CenterOklahoma City, Oklahoma  73120
Clackamas Radiation Oncology CenterClackamas, Oregon  97015
Providence Newberg Medical CenterNewberg, Oregon  97132
Willamette Falls HospitalOregon City, Oregon  97045
Butler Memorial HospitalButler, Pennsylvania  16001
Texas Tech University Health Sciences Center School of Medicine - El PasoEl Paso, Texas  79905
Island Hospital Cancer Care Center at Island HospitalAnacortes, Washington  98221
Highline Medical Center Cancer CenterBurien, Washington  98166
Riverview UW Cancer Center at Riverview HospitalWisconsin Rapids, Wisconsin  54494