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Phase II Feasibility Trial Incorporating Bevacizumab Into Dose Dense Doxorubicin and Cyclophosphamide Followed by Paclitaxel in Patients With Lymph Node Positive Breast Cancer


Phase 2
18 Years
N/A
Not Enrolling
Both
Breast Cancer

Thank you

Trial Information

Phase II Feasibility Trial Incorporating Bevacizumab Into Dose Dense Doxorubicin and Cyclophosphamide Followed by Paclitaxel in Patients With Lymph Node Positive Breast Cancer


PRIMARY OBJECTIVES:

I. Determine the incidence of clinically apparent cardiac dysfunction in patients with
resected lymph node-positive breast cancer treated with adjuvant bevacizumab and dose dense
doxorubicin and cyclophosphamide followed by paclitaxel.

SECONDARY OBJECTIVES:

I. Determine the changes in left ventricular ejection fraction (LVEF) in patients treated
with this regimen.

II. Determine the non-cardiac toxicity of this regimen in these patients.

OUTLINE: This is a non-randomized, multicenter study. Patients are sequentially assigned to
1 of 2 treatment arms.

ARM A: Patients receive doxorubicin IV, cyclophosphamide IV over 20-30 minutes, and
bevacizumab IV over 30-90 minutes on day 1. Patients also receive filgrastim (G-CSF)
subcutaneously (SQ) on days 2-11 or pegfilgrastim SC on day 2. Treatment repeats every 14
days for 4 courses. Patients then receive paclitaxel IV over 3 hours and bevacizumab IV over
30-90 minutes on day 1. Patients also receive G-CSF or pegfilgrastim as above. Treatment
with paclitaxel, bevacizumab, and G-CSF or pegfilgrastim repeats every 14 days for 4
courses. Patients then receive bevacizumab alone every 14 days for up to 18 courses.

ARM B: Patients receive doxorubicin, cyclophosphamide, and G-CSF or pegfilgrastim as in
group I. Patients then receive paclitaxel, bevacizumab, and G-CSF or pegfilgrastim as in
group I. Patients then receive bevacizumab alone every 14 days for up to 22 courses.

Treatment in both groups continues in the absence of disease recurrence or unacceptable
toxicity.

Patients who require radiotherapy (post-lumpectomy) or who plan radiotherapy at the
discretion of the investigator (post-mastectomy) undergo radiotherapy beginning within 6
weeks after the completion of chemotherapy.

Premenopausal patients with estrogen receptor (ER) and / or progesterone receptor (PR)
positive disease receive oral tamoxifen once daily for 5 years beginning at the time of
radiotherapy or within 6 weeks after the completion of chemotherapy. Postmenopausal patients
with ER and / or PR positive disease receive an aromatase inhibitor (e.g., anastrozole,
letrozole, or exemestane) or tamoxifen followed by an aromatase inhibitor once daily for up
to 10 years.

After completion of study treatment, patients are followed every 3 months for 2 years and
then every 6 months for up to 3 years from study entry.


Inclusion Criteria:



- Histologically confirmed adenocarcinoma of the breast

- Node-positive disease in 1 or more axillary or internal mammary lymph node by
histology with hematoxylin and eosin staining

- Has undergone prior definitive breast surgery including total mastectomy and axillary
dissection (modified radical mastectomy), total mastectomy and sentinel node biopsy,
lumpectomy and axillary dissection or lumpectomy and sentinel node biopsy within the
past 29-84 days (arm A only)

- Surgical margins must be histologically free of invasive tumor and ductal
carcinoma in situ, but lobular carcinoma in situ allowed

- Synchronous bilateral breast cancer diagnosed within the past month allowed provided
the higher TNM (Tumor,Node,Metastasis) stage tumor meets study eligibility criteria

- Age>=18

- ECOG performance status of 0-2

- Adequate organ function as evidenced by following, obtained within 8 weeks prior to
registration:

- Absolute neutrophil count ≥ 1,000/mm^3

- Platelet count ≥ 100,000/mm^3

- Bilirubin ≤ 1.5 mg/dL

- Aspartate aminotransferase (AST) ≤ 2 times upper limit normal (ULN)

- Prothrombin time international normalized ratio (PT INR) ≤ 1.5 times normal

- Partial thromboplastin time (PTT) ≤ 1.5 times normal

- Creatinine ≤ 1.5 mg/dL

- Urine protein:creatinine ratio < 1.0

- Left ventricular ejection fraction (LVEF) normal by multi gated acquisition scan
(MUGA) or echocardiogram (ECHO)

- Fertile patients must use effective contraception during and for 3-4 months after
completion of study treatment

- Prior tamoxifen or raloxifene for chemoprevention allowed

- More than 4 weeks since prior major surgery

- Non-operative biopsy or placement of a vascular access device is not considered
major surgery

- Regular use of cyclo-oxygenase-2 inhibitors or low-dose aspirin allowed

Exclusion Criteria:

- With immunohistologic staining as the only evidence of nodal involvement

- Her2/neu-positive disease(i.e.,3+ by immunohistochemistry or positive by fluorescent
in situ hybridization)

- Clinical evidence of inflammatory disease or fixed axillary nodes (N2)

- History of myocardial infarction within the past year

- History of unstable angina within the past year

- History of arterial thrombotic events within the past year

- Uncontrolled or clinically significant arrhythmia

- New York Heart Association grade II-IV congestive heart failure

- Peripheral vascular disease ≥ grade II

- Uncontrolled hypertension, defined as systolic blood pressure (BP)>160 mm Hg or
diastolic BP>90 mm Hg

- History of deep venous thrombosis

- History of cerebrovascular disease, including transient ischemic attack or stroke

- Other clinically significant cardiovascular disease

- History of pulmonary embolism

- Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within
the past 6 months

- Non-healing wound or bone fracture

- Hypersensitivity to paclitaxel or drugs using Cremophor

- Hypersensitivity to Chinese hamster ovary cell products or other recombinant human
antibodies

- Pregnant

- Nursing during and for ≥ 3-4 months after completion of study treatment

- Prior cytotoxic chemotherapy for breast cancer

- Prior anthracycline, anthracenedione, or taxane for any condition

- Prior hormonal therapy for breast cancer

- Other concurrent tamoxifen or raloxifene

- Prior radiotherapy for breast cancer

- Concurrent radiotherapy to the internal mammary chain

- Concurrent therapeutic anticoagulants

- Concurrent prophylactic use of anticoagulants to maintain patency of vascular
assess device allowed

- Concurrent regular use of aspirin (i.e., daily for ≥ 10 days at doses of > 325
mg/day) or regular therapeutic doses of other nonsteroidal anti-inflammatory drugs
known to inhibit platelet function

- Other concurrent drugs known to inhibit platelet function, including any of the
following:

- Dipyridamole

- Ticlopidine

- Clopidogrel

- Cilostazol

- Concurrent cardioprotectant agents

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Congestive Heart Failure Rate

Outcome Description:

Clinical congestive heart failure includes patients with symptomatic decline in LVEF to at or below the lower limit of normal (LLN), or symptomatic diastolic dysfunction. 223 treated patients were included in the analysis.

Outcome Time Frame:

assessed on day 1 of cycles 5, 9, 17 and 25, and at end of treatment, then every 3 months for <2 years and every 6 months for 2-3 years from study entry

Safety Issue:

Yes

Principal Investigator

Kathy Miller, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Indiana University Melvin and Bren Simon Cancer Center

Authority:

United States: Federal Government

Study ID:

NCI-2012-02977

NCT ID:

NCT00119262

Start Date:

October 2005

Completion Date:

September 2009

Related Keywords:

  • Breast Cancer
  • stage II breast cancer
  • stage IIIA breast cancer
  • stage IIIB breast cancer
  • male breast cancer
  • lymph node positive breast cancer
  • Breast Neoplasms

Name

Location

George Washington University Medical CenterWashington, District of Columbia  20037
Mayo Clinic - JacksonvilleJacksonville, Florida  32224
Mayo Clinic Cancer CenterRochester, Minnesota  55905
Indiana University Cancer CenterIndianapolis, Indiana  46202-5265
CCOP - WichitaWichita, Kansas  67214-3882
Hurley Medical CenterFlint, Michigan  48503
CCOP - Missouri Valley Cancer ConsortiumOmaha, Nebraska  68131
CCOP - Carle Cancer CenterUrbana, Illinois  61801
CCOP - Iowa Oncology Research AssociationDes Moines, Iowa  50309-1016
Beth Israel Deaconess Medical CenterBoston, Massachusetts  02215
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
Aurora Presbyterian HospitalAurora, Colorado  80012
Boulder Community HospitalBoulder, Colorado  80301-9019
Penrose Cancer Center at Penrose HospitalColorado Springs, Colorado  80933
Porter Adventist HospitalDenver, Colorado  80210
Presbyterian - St. Luke's Medical CenterDenver, Colorado  80218
St. Joseph HospitalDenver, Colorado  80218
Rose Medical CenterDenver, Colorado  80220
Swedish Medical CenterEnglewood, Colorado  80110
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
North Suburban Medical CenterThornton, Colorado  80229
Rush-Copley Cancer Care CenterAurora, Illinois  60507
Evanston Northwestern Healthcare - Evanston HospitalEvanston, Illinois  60201-1781
Hinsdale Hematology Oncology AssociatesHinsdale, Illinois  60521
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
Mercy Medical Center - Sioux CitySioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLPSioux City, Iowa  51101
St. Luke's Regional Medical CenterSioux City, Iowa  51104
CCOP - Michigan Cancer Research ConsortiumAnn Arbor, Michigan  48106
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
Foote HospitalJackson, Michigan  49201
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
Sparrow Regional Cancer CenterLansing, Michigan  48912-1811
Seton Cancer Institute - SaginawSaginaw, Michigan  48601
St. John Macomb HospitalWarren, Michigan  48093
Fairview Ridges HospitalBurnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy HospitalCoon Rapids, Minnesota  55433
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
Mercy Cancer Center at Mercy Medical CenterCanton, Ohio  44708
Case Comprehensive Cancer CenterCleveland, Ohio  44106-5065
St. Rita's Medical CenterLima, Ohio  45801
Natalie Warren Bryant Cancer Center at St. Francis HospitalTulsa, Oklahoma  74136
Geisinger Medical CenterDanville, Pennsylvania  17822-0001
Penn State Cancer Institute at Milton S. Hershey Medical CenterHershey, Pennsylvania  17033-0850
Abramson Cancer Center of the University of PennsylvaniaPhiladelphia, Pennsylvania  19104-4283
Geisinger Medical Group - Scenery ParkState College, Pennsylvania  16801
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical CenterWilkes-Barre, Pennsylvania  18711
Vanderbilt-Ingram Cancer CenterNashville, Tennessee  37232-6838
Marshfield Clinic - Marshfield CenterMarshfield, Wisconsin  54449
University of Alabama at Birmingham Comprehensive Cancer CenterBirmingham, Alabama  35294-3300
Memorial Hospital of South BendSouth Bend, Indiana  46601
Reading Hospital and Medical CenterReading, Pennsylvania  19612-6052
Mercy Hospital Cancer Center - ScrantonScranton, Pennsylvania  18501
CCOP - MainLine HealthWynnewood, Pennsylvania  19096
University of Miami Sylvester Comprehensive Cancer CenterMiami, Florida  33136
Hinsdale, Illinois  60521
CCOP - Northern Indiana CR ConsortiumSouth Bend, Indiana  46601
Saint Joseph Regional Medical CenterSouth Bend, Indiana  46617
Siteman Cancer Center at Barnes-Jewish HospitalSaint Louis, Missouri  63110
Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimore, Maryland  21231-2410
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
St. Vincent Mercy Medical CenterToledo, Ohio  43608
CCOP - Colorado Cancer Research Program, IncorporatedDenver, Colorado  80224
Overlook HospitalSummit, New Jersey  07902-0220
Washington Cancer Institute at Washington Hospital CenterWashington, District of Columbia  20010
Carol G. Simon Cancer Center at Morristown Memorial HospitalMorristown, New Jersey  07962
Cancer Institute of New Jersey at HamiltonHamilton, New Jersey  08690
CCOP - Toledo Community HospitalToledo, Ohio  43623-3456
Florida Hospital Cancer Institute at Florida Hospital OrlandoOrlando, Florida  32803-1273
Via Christi Cancer Center at Via Christi Regional Medical CenterWichita, Kansas  67214
Albert Einstein Cancer Center at Albert Einstein College of MedicineBronx, New York  10461
NYU Cancer Institute at New York University Medical CenterNew York, New York  10016
Wake Forest University Comprehensive Cancer CenterWinston-Salem, North Carolina  27157-1096
Medical University of Ohio Cancer CenterToledo, Ohio  43614
Toledo HospitalToledo, Ohio  43606
St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54307-3508
Aultman Hospital Cancer Center at Aultman Health FoundationCanton, Ohio  44710-1799
Green Bay Oncology, Limited - EscanabaEscanaba, Michigan  49431
Hunterdon Regional Cancer Center at Hunterdon Medical CenterFlemington, New Jersey  08822
CCOP - Hematology-Oncology Associates of Central New YorkEast Syracuse, New York  13057
Lewistown HospitalLewistown, Pennsylvania  17044
Mount Nittany Medical CenterState College, Pennsylvania  16803
St. Mary's Hospital Medical Center - Green BayGreen Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Mary's HospitalGreen Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical CenterMarinette, Wisconsin  54143
Green Bay Oncology, Limited - Oconto FallsOconto Falls, Wisconsin  54154
Green Bay Oncology, Limited - Sturgeon BaySturgeon Bay, Wisconsin  54235
Hematology Oncology Associates of the Quad CitiesBettendorf, Iowa  52722
Baptist Cancer Institute - JacksonvilleJacksonville, Florida  32207
Siouxland Regional Cancer CenterSioux City, Iowa  51101-1733
Southwest Medical CenterLiberal, Kansas  67901
Wayne Memorial Hospital, IncorporatedGoldsboro, North Carolina  27534
New Hampshire Oncology-Hematology, PA - HooksettHooksett, New Hampshire  03106
Lakeland Cancer Care Center at Lakeland Hospital - St. JosephSaint Joseph, Michigan  49085
Lenoir Memorial Cancer CenterKinston, North Carolina  28503-1678
Lombardi Comprehensive Cancer Center at Georgetown University Medical CenterWashington, District of Columbia  20007
Swedish-American Regional Cancer CenterRockford, Illinois  61104-2315
St. Barnabas Medical Center Cancer CenterLivingston, New Jersey  07039
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical SchoolNew Brunswick, New Jersey  08903
Elkhart General HospitalElkhart, Indiana  46515
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
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
Front Range Cancer SpecialistsFort Collins, Colorado  80528
Joan Karnell Cancer Center at Pennsylvania HospitalPhiladelphia, Pennsylvania  19107
Memorial Medical Center Cancer ServicesModesto, California  95355
St. Mary-Corwin Regional Medical CenterPueblo, Colorado  81004
Ingalls Cancer Care Center at Ingalls Memorial HospitalHarvey, Illinois  60426
Trinity Medical Center - EastMoline, Illinois  61265
Fort Wayne Medical Oncology and HematologyFort Wayne, Indiana  46815
Howard Community Hospital at Howard Regional Health SystemKokomo, Indiana  46904
Center for Cancer Therapy at LaPorte Hospital and Health ServicesLa Porte, Indiana  46350
Bettendorf, Iowa  52722
John Stoddard Cancer Center at Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
Mercy Capitol HospitalDes Moines, Iowa  50307
Medical Oncology and Hematology Associates at John Stoddard Cancer CenterDes Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer CenterDes Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des MoinesWest Des Moines, Iowa  50266
Cancer Center of Kansas, PA - Dodge CityDodge City, Kansas  67801
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
St. Joseph Mercy Cancer Center at St. Joseph Mercy HospitalAnn Arbor, Michigan  48106-0995
Green Bay Oncology, Limited - Iron MountainIron Mountain, Michigan  49801
Community Cancer Center of MonroeMonroe, Michigan  48162
Mercy Memorial Hospital SystemMonroe, Michigan  48162
MeritCare Clinic - BemidjiBemidji, Minnesota  56601
Virginia Piper Cancer Institute at Abbott-Northwestern HospitalMinneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Medical CenterRobbinsdale, Minnesota  55422-2900
Park Nicollet Health ServicesSt. Louis Park, Minnesota  55416
Immanuel Medical CenterOmaha, Nebraska  68122
Creighton University Medical CenterOmaha, Nebraska  68131-2197
Mountainside Hospital Cancer CenterMontclair, New Jersey  07042
Booker Cancer Center at Riverview Medical CenterRed Bank, New Jersey  07701
Iredell Memorial HospitalStatesville, North Carolina  28677
MeritCare Medical GroupFargo, North Dakota  58122
Wood County Oncology CenterBowling Green, Ohio  43402
Blanchard Valley Medical AssociatesFindlay, Ohio  45840
Fremont Memorial HospitalFremont, Ohio  43420
Kenton Oncology, IncorporatedKenton, Ohio  43326
Lima Memorial HospitalLima, Ohio  45804
St. Luke's HospitalMaumee, Ohio  43537
Northwest Ohio Oncology CenterMaumee, Ohio  43537
Toledo Clinic - OregonOregon, Ohio  43616
St. Charles Mercy HospitalOregon, Ohio  43616
North Coast Cancer Care, IncorporatedSandusky, Ohio  44870
Firelands Regional Medical CenterSandusky, Ohio  44870
Mercy Hospital of TiffinTiffin, Ohio  44883
Toledo Clinic, Incorporated - Main ClinicToledo, Ohio  43623
Fulton County Health CenterWauseon, Ohio  43567
Bryn Mawr HospitalBryn Mawr, Pennsylvania  19010
St. Mary Regional Cancer CenterLanghorne, Pennsylvania  19047
Hematology and Oncology AssociatesScranton, Pennsylvania  18510
Lankenau Cancer Center at Lankenau HospitalWynnewood, Pennsylvania  19096
Baptist Regional Cancer Center at Baptist Hospital of East TennesseeKnoxville, Tennessee  37901
Green Bay Oncology, Limited at St. Vincent HospitalGreen Bay, Wisconsin  54301-3526
DeCesaris Cancer Institute at Anne Arundel Medical CenterAnnapolis, Maryland  21401
Morton Hospital & Medical CenterTaunton, Massachusetts  02780
Cancer Care Center at St. Luke's HospitalDuluth, Minnesota  55805
Saint Francis Cancer CenterShakopee, Minnesota  55379
St. Joseph's HospitalSt Paul, Minnesota  55102
Carl and Dorothy Bennett Cancer Center at Stamford HospitalStamford, Connecticut  06904
William N. Wishard Memorial HospitalIndianapolis, Indiana  46202
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, PA - KingmanKingman, Kansas  67068
Cancer Center of Kansas, PA - NewtonNewton, Kansas  67114
Cancer Center of Kansas, PA - ParsonsParsons, Kansas  67357
Cancer Center of Kansas, PA - PrattPratt, Kansas  67124
Cancer Center of Kansas, PA - SalinaSalina, Kansas  67401
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
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
Ministry Medical Group at Saint Mary's HospitalRhinelander, Wisconsin  54501
Methodist Cancer Center at Methodist Hospital - OmahaOmaha, Nebraska  68114
Stanford Comprehensive Cancer Center at Stanford University Medical CenterStanford, California  94305
Elliot Regional Cancer Center at Elliot HospitalManchester, New Hampshire  03103
Manchester Memorial HospitalManchester, Connecticut  06040-4188
Sherman HospitalElgin, Illinois  60120-2198
Oncology/Hematology Associates of Southwest Indiana at St. Mary's Cancer CenterEvansville, Indiana  47714
Woodwinds Health CampusWoodbury, Minnesota  55125
Cancer Center of Paoli Memorial HospitalPaoli, Pennsylvania  19301-1792
Minnesota Oncology Hematology, PA at Maplewood Cancer CenterMaplewood, Minnesota  55109
Community Hospital of the Monterey Peninsula Comprehensive Cancer CenterMonterey, California  93940
Arnett Cancer CareLafayette, Indiana  47904
Bendheim Cancer Center at Greenwich HospitalGreenwich, Connecticut  06830
Norwalk HospitalNorwalk, Connecticut  06856
York HospitalYork, Maine  03909
Cancer Center at Erlanger HealthChattanooga, Tennessee  37403