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The BeST Trial: A Randomized Phase II Study of VEGF, RAF Kinase, and mTOR Combination Targeted Therapy (CTT) With Bevacizumab, Sorafenib and Temsirolimus in Advanced Renal Cell Carcinoma


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Clear Cell Renal Cell Carcinoma, Recurrent Renal Cell Cancer, Stage IV Renal Cell Cancer

Thank you

Trial Information

The BeST Trial: A Randomized Phase II Study of VEGF, RAF Kinase, and mTOR Combination Targeted Therapy (CTT) With Bevacizumab, Sorafenib and Temsirolimus in Advanced Renal Cell Carcinoma


PRIMARY OBJECTIVES:

I. To assess progression-free survival on each arm of combination targeted therapy (CTT)
compared to that of bevacizumab alone.

SECONDARY OBJECTIVES:

I. To assess the significance of changes in tumor size over early time points as a predictor
of PFS.

II. To quantify the number and percent of patients who have stable disease at 6 months of
therapy (failure to progress) in each treatment arm of CTT in patients with metastatic RCC.

III. To evaluate the safety of each treatment arm of combination targeted therapy (CTT) in
patients with metastatic RCC.

IV. To assess overall survival in each arm of the study. V. To assess the objective response
rate in each treatment arm of CTT in patients with metastatic RCC.

VI. To assess pathology, angiogenesis histology and to assess activation status of MAP
kinase and VEGFR2 pathways and relate to clinical outcome.

TERTIARY OBJECTIVES:

I. To analyze the pharmacokinetic and pharmacogenetic properties of sorafenib including
angiogenesis, monooxygenases polymorphisms and MDR.

II. To relate changes in tumor perfusion and vascular permeability on serial dynamic
contrast-enhanced MRI to clinical outcome and radiologic regression detected by other
standard methods.

III. To assess the potential of DCE MRI imaging as a biomarker for response to therapy
and/or as a prognostic indicator of disease progression.

IV. To assess site readiness and ability in acquiring DCE-MRI data. V. To determine the
relationship between tumor and blood biomarkers and clinical outcomes of patients treated
with the combination of targeted agents.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prior
cytokine or vaccine therapy (no vs yes) and Motzer risk category (low vs intermediate vs
high). Patients are randomized to 1 of 4 treatment arms.

ARM A: Patients receive bevacizumab intravenously (IV) over 30-90 minutes on days 1 and 15.

ARM B: Patients receive temsirolimus IV over 30 minutes on days 1, 8, 15, and 22 and
bevacizumab as in arm A.

ARM C: Patients receive bevacizumab as in arm A and sorafenib tosylate orally (PO) twice
daily on days 1-28.

ARM D: Patients receive temsirolimus as in arm B and sorafenib tosylate as in arm C.

In all arms treatment repeats every 28 days in the absence of disease progression or
unacceptable toxicity.

After completion of study treatment, patients are followed periodically for 5 years.


Inclusion Criteria:



- Histologically confirmed clear cell renal cell carcinoma

- Primary or metastatic lesion

- Less than 25% of any other histology (papillary, chromophobe, or oncocytic)

- Sufficient pathology material available for diagnostic review

- Core-needle biopsy allowed

- No fine-needle aspirations as only source for diagnosis

- Measurable metastatic disease

- Lesions that can be accurately measured in ≥ 1 dimension(longest diameter to be
recorded) as > 20 mm (2.0 cm) with conventional techniques or as ≥ 10 mm (1.0
cm) with spiral CT scan

- Not curable by standard radiotherapy or surgery

- Prior nephrectomy required, with the following exceptions:

- Primary tumor ≤ 5 cm

- Extensive liver metastases (> 30% of liver parenchymal) or multiple (> 5) bone
metastases

- Unresectable primary tumor due to invasion into adjacent organs or encasing the
aorta or vena cava

- No history or clinical evidence of CNS disease, including primary brain tumor or
brain metastases

- ECOG performance status 0-1

- Life expectancy > 3 months

- WBC ≥ 3,000/mm³

- Absolute granulocyte count ≥ 1,200/mm³

- Platelet count ≥ 100,000/mm³

- Hemoglobin ≥ 9.0 g/dL (transfusions allowed)

- Creatinine ≤ 1.5 times upper limit of normal (ULN) OR creatinine clearance ≥ 55
mL/min

- Bilirubin ≤ 1.5 times ULN

- AST/ALT ≤ 2.5 times ULN (5.0 times ULN in the presence of liver metastases)

- INR ≤ 1.5 and aPTT normal

- Fasting cholesterol < 350 mg/dL

- Fasting triglycerides < 400 mg/dL

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for 6 months after
completion of study treatment

- No seizures not controlled with standard medical therapy

- No stroke within the past 12 months

- No other malignancies within the past 5 years except basal cell skin cancer, squamous
cell skin cancer, carcinoma in situ of the cervix, or ductal or lobular carcinoma in
situ of the breast

- No history of allergic reactions attributed to Chinese hamster ovary cell products,
other recombinant human antibodies, or compounds of similar chemical or biologic
composition to sorafenib tosylate, temsirolimus, or bevacizumab

- No history of bleeding diathesis or coagulopathy

- No condition that impairs ability to swallow pills

- No significant traumatic injury within the past 28 days

- No clinically significant cardiovascular disease, including any of the following:

- Uncontrolled hypertension

- Blood pressure must be ≤ 150/100 mm Hg on a stable antihypertensive regimen

- Myocardial infarction or unstable angina within the past 6 months

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

- Serious cardiac arrhythmia requiring medication

- Unstable angina pectoris

- Peripheral vascular disease ≥ grade 2

- No serious, nonhealing wound, ulcer, or bone fracture

- No significant proteinuria

- If urine protein: creatinine ratio > 0.5, 24-hour urine protein must be < 1,000
mg

- No uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection requiring parental antibiotics on day 0 or psychiatric illness or social
situations that would preclude compliance with study requirements

- No concurrent prophylactic hematopoietic colony-stimulating factors

- No prior cytotoxic chemotherapy

- No prior antiangiogenic therapy including, but not limited to, sunitinib malate,
ZD6474, or VEGF Trap

- No prior bevacizumab, mTOR inhibitors (including, but not limited to, temsirolimus),
or sorafenib tosylate

- Prior thalidomide or interferon alfa allowed as adjuvant therapy or for metastatic
disease

- More than 4 weeks since prior immunotherapy and recovered

- No more than 1 prior vaccine or cytokine-based immunotherapy regimen for
metastatic disease

- More than 2 weeks since prior radiotherapy and recovered

- More than 4 weeks since prior major surgery or open biopsy

- No concurrent major surgery

- No concurrent or recent full-dose anticoagulants or thrombolytic agents (unless
required to maintain patency of pre-existing or permanent indwelling IV catheters)

- No concurrent cytochrome P450 enzyme-inducing drugs including any of the following:

- Phenytoin

- Carbamazepine

- Phenobarbital

- Rifampin

- No concurrent combination antiretroviral therapy for HIV-positive patients

- No other concurrent anticancer therapies or investigational agents

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Progression-free survival (PFS) as defined by Response Evaluation Criteria in Solid Tumors (RECIST)

Outcome Description:

Each combination therapy will also be evaluated in comparison to a historical control rate of 9 months using a one-sample exponential test with one-sided Type I error of 10%.

Outcome Time Frame:

Time from randomization to clinical evidence of disease progression or death without progression, assessed up to 2 years

Safety Issue:

No

Principal Investigator

Keith Flaherty

Investigator Role:

Principal Investigator

Investigator Affiliation:

Eastern Cooperative Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00533

NCT ID:

NCT00378703

Start Date:

September 2007

Completion Date:

Related Keywords:

  • Clear Cell Renal Cell Carcinoma
  • Recurrent Renal Cell Cancer
  • Stage IV Renal Cell Cancer
  • Carcinoma
  • Carcinoma, Renal Cell

Name

Location

Baylor College of MedicineHouston, Texas  77030
Mayo ClinicRochester, Minnesota  55905
University of Mississippi Medical CenterJackson, Mississippi  39216-4505
Washington University School of MedicineSaint Louis, Missouri  63110
University of Washington Medical CenterSeattle, Washington  98195-6043
Hurley Medical CenterFlint, Michigan  48503
Pennsylvania HospitalPhiladelphia, Pennsylvania  19107
Sinai Hospital of BaltimoreBaltimore, Maryland  21225
Beth Israel Deaconess Medical CenterBoston, Massachusetts  02215
Boulder Community HospitalBoulder, Colorado  80301-9019
Porter Adventist HospitalDenver, Colorado  80210
Rose Medical CenterDenver, Colorado  80220
Swedish Medical CenterEnglewood, Colorado  80110
Sky Ridge Medical CenterLone Tree, Colorado  80124
North Suburban Medical CenterThornton, Colorado  80229
Fairview Ridges HospitalBurnsville, Minnesota  55337
Hutchinson Area Health CareHutchinson, Minnesota  55350
Meeker County Memorial HospitalLichfield, Minnesota  55355
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
Geisinger Medical CenterDanville, Pennsylvania  17822-0001
CentraCare ClinicSaint Cloud, Minnesota  56303
Rapid City Regional HospitalRapid City, South Dakota  57709
Marshfield ClinicMarshfield, Wisconsin  54449
Glendale Memorial Hospital and Health CenterGlendale, California  91204
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Memorial Hospital of South BendSouth Bend, Indiana  46601
Mary Bird Perkins Cancer CenterBaton Rouge, Louisiana  70809
Akron General Medical CenterAkron, Ohio  44302
Lehigh Valley HospitalAllentown, Pennsylvania  18103
Virginia Piper Cancer InstituteMinneapolis, Minnesota  55407
North Shore University HospitalManhasset, New York  11030
University of Arkansas for Medical SciencesLittle Rock, Arkansas  72205
Hartford HospitalHartford, Connecticut  06102-5037
Eastern Maine Medical CenterBangor, Maine  04401
University of Nebraska Medical CenterOmaha, Nebraska  68198-3330
Via Christi Regional Medical CenterWichita, Kansas  67214
Ochsner Clinic FoundationNew Orleans, Louisiana  70121
University of Oklahoma Health Sciences CenterOklahoma City, Oklahoma  73104
Iowa Methodist Medical CenterDes Moines, Iowa  50309
Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
Medical Center of Central GeorgiaMacon, Georgia  31201
Group Health CooperativeSeattle, Washington  98112
University of Wisconsin Hospital and ClinicsMadison, Wisconsin  53792-0001
Great Falls ClinicGreat Falls, Montana  59405
Thompson Cancer Survival CenterKnoxville, Tennessee  37916
Long Island Jewish Medical CenterNew Hyde Park, New York  11040
Montefiore Medical CenterBronx, New York  10467-2490
North Colorado Medical CenterGreeley, Colorado  80631
McKee Medical CenterLoveland, Colorado  80539
Cancer Center of Kansas - ChanuteChanute, Kansas  66720
Cancer Center of Kansas - Dodge CityDodge City, Kansas  67801
Cancer Center of Kansas - NewtonNewton, Kansas  67114
Cancer Center of Kansas - SalinaSalina, Kansas  67042
Cancer Center of Kansas - WellingtonWellington, Kansas  67152
Associates in Womens HealthWichita, Kansas  67203
Cancer Center of Kansas - WinfieldWinfield, Kansas  67156
Munson Medical CenterTraverse City, Michigan  49684
Northern Rockies Radiation Oncology CenterBillings, Montana  59101
Bozeman Deaconess HospitalBozeman, Montana  59715
Kalispell Medical OncologyKalispell, Montana  59901
Kalispell Regional Medical CenterKalispell, Montana  59901
Adena Regional Medical CenterChillicothe, Ohio  54601
Grady Memorial HospitalDelaware, Ohio  43015
Fairfield Medical CenterLancaster, Ohio  43130
Medical X-Ray CenterSioux Falls, South Dakota  57105
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Welch Cancer CenterSheridan, Wyoming  82801
Elkhart General HospitalElkhart, Indiana  46515
South Bend ClinicSouth Bend, Indiana  46617
Front Range Cancer SpecialistsFort Collins, Colorado  80528
University Medical Center of Southern NevadaLas Vegas, Nevada  89102
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
Sutter Solano Medical CenterVallejo, California  94589
Poudre Valley HospitalFort Collins, Colorado  80524
Beebe Medical CenterLewes, Delaware  19958
Memorial HospitalCarthage, Illinois  62321
Hematology and Oncology AssociatesChicago, Illinois  60611
Galesburg Cottage HospitalGalesburg, Illinois  61401
Galesburg ClinicGalesburg, Illinois  61401
Mason District HospitalHavana, Illinois  62644
Kewanee HospitalKewanee, Illinois  61443
McDonough District HospitalMacomb, Illinois  61455
BroMenn Regional Medical CenterNormal, Illinois  61761
Proctor HospitalPeoria, Illinois  61614
Perry Memorial HospitalPrinceton, Illinois  61356
Genesis Medical Center - West CampusDavenport, Iowa  52804
Mecosta County Medical CenterBig Rapids, Michigan  49307
Community Cancer Center of MonroeMonroe, Michigan  48162
Saint Francis Medical CenterCape Girardeau, Missouri  63701
Great Plains Regional Medical CenterNorth Platte, Nebraska  69101-6598
Bismarck Cancer CenterBismarck, North Dakota  58501
Grandview HospitalDayton, Ohio  45405
Fremont Memorial HospitalFremont, Ohio  43420
Lima Memorial HospitalLima, Ohio  45804
Firelands Regional Medical CenterSandusky, Ohio  44870
Mercy Hospital of TiffinTiffin, Ohio  44883
Fulton County Health CenterWauseon, Ohio  43567
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
Eureka HospitalEureka, Illinois  61530
Mercy HospitalCoon Rapids, Minnesota  55433
Graham Hospital AssociationCanton, Illinois  61520
Holy Family Medical CenterDes Plaines, Illinois  60016
Hematology Oncology Associates of Illinois-Highland ParkHighland Park, Illinois  60035
Saint Joseph Medical CenterJoliet, Illinois  60435
Trinity Medical CenterMoline, Illinois  61265-1291
Pekin HospitalPekin, Illinois  61554
Medical Oncology and Hematology AssociatesDes Moines, Iowa  50309
Ottumwa Regional Health CenterOttumwa, Iowa  52501
Bixby Medical CenterAdrian, Michigan  49221
Saint Joseph Mercy HospitalAnn Arbor, Michigan  48106
Fairview-Southdale HospitalEdina, Minnesota  55435
Abbott-Northwestern HospitalMinneapolis, Minnesota  55407
Regions HospitalSaint Paul, Minnesota  55101
Saint Francis Regional Medical CenterShakopee, Minnesota  55379
Rice Memorial HospitalWillmar, Minnesota  56201
Mary Imogene Bassett HospitalCooperstown, New York  13326
Saint Luke's HospitalMaumee, Ohio  43537
Lancaster General HospitalLancaster, Pennsylvania  17604-3555
Geisinger Medical GroupState College, Pennsylvania  16801
Fox Valley Hematology and OncologyAppleton, Wisconsin  54911
Highland General HospitalOakland, California  94602
Northeast Georgia Medical CenterGainesville, Georgia  30501
Swedish American HospitalRockford, Illinois  61104
Center for Cancer Care and ResearchSt. Louis, Missouri  63141
Miami Valley HospitalDayton, Ohio  45409
Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Hospital District Sixth of Harper CountyAnthony, Kansas  67003
Cancer Center of Kansas - Fort ScottFort Scott, Kansas  66701
Cancer Center of Kansas-IndependenceIndependence, Kansas  67301
Lawrence Memorial HospitalLawrence, Kansas  66044
Menorah Medical CenterOverland Park, Kansas  66209
Shawnee Mission Medical CenterShawnee Mission, Kansas  66204
North Kansas City HospitalKansas City, Missouri  64116
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
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
Northern Montana HospitalHavre, Montana  59501
Mary Rutan HospitalBellefontaine, Ohio  43311
Wayne HospitalGreenville, Ohio  45331
Knox Community HospitalMount Vernon, Ohio  43050
Fisher-Titus Medical CenterNorwalk, Ohio  44857
Clinton Memorial HospitalWilmington, Ohio  45177
Wenatchee Valley Medical CenterWenatchee, Washington  98801-2028
Marshfield Clinic Cancer Care at Regional Cancer CenterEau Claire, Wisconsin  54701
UW Cancer Center Johnson CreekJohnson Creek, Wisconsin  53038
Saint Joseph's HospitalMarshfield, Wisconsin  54449
Marshfield Clinic - Weston CenterWeston, Wisconsin  54476
Diagnostic and Treatment CenterWeston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids CenterWisconsin Rapids, Wisconsin  54494
Rocky Mountain OncologyCasper, Wyoming  82609
Longmont United HospitalLongmont, Colorado  80501
Memorial Hospital of Rhode IslandPawtucket, Rhode Island  02860
Baton Rouge General Medical CenterBaton Rouge, Louisiana  70821-2511
Ben Taub General HospitalHouston, Texas  77030
Methodist HospitalHouston, Texas  77030
Greene Memorial HospitalXenia, Ohio  45385
Greater Baltimore Medical CenterBaltimore, Maryland  21204
Rutherford HospitalRutherfordton, North Carolina  28139
Union Hospital of Cecil CountyElkton MD, Maryland  21921
Presbyterian HospitalCharlotte, North Carolina  28233-3549
Mayo Clinic in ArizonaScottsdale, Arizona  85259-5404
Mayo Clinic in FloridaJacksonville, Florida  32224
Sherman HospitalElgin, Illinois  60120-2198
Memorial Medical CenterSpringfield, Illinois  62781
Saint Francis Medical CenterGrand Island, Nebraska  68802
Southeastern Medical Oncology CenterGoldsboro, North Carolina  27534
Metro Health HospitalGrand Rapids, Michigan  49506
Guardian Oncology and Center for WellnessMissoula, Montana  59804
University of PittsburghPittsburgh, Pennsylvania  15261
Woodwinds Health CampusWoodbury, Minnesota  55125
University of Alabama at BirminghamBirmingham, Alabama  35294-3300
Vanderbilt UniversityNashville, Tennessee  37232-6305
Independence Regional Health CenterIndependence, Missouri  64050
Northwestern UniversityChicago, Illinois  60611
East Bay Radiation Oncology CenterCastro Valley, California  94546
Contra Costa Regional Medical CenterMartinez, California  94553-3156
Larry G Strieff MD Medical CorporationOakland, California  94609
Tahoe Forest Cancer CenterTruckee, California  96161
Bay Area HospitalCoos Bay, Oregon  97420
Hennepin County Medical CenterMinneapolis, Minnesota  
Saint Louis University HospitalSt. Louis, Missouri  63110-0250
University of RochesterRochester, New York  14642
Glens Falls HospitalGlens Falls, New York  12801
El Camino HospitalMountain View, California  94040
University of California at San DiegoLa Jolla, California  92093
University of Arizona Health Sciences CenterTucson, Arizona  85724
Riverside Methodist HospitalColumbus, Ohio  43214
Licking Memorial HospitalNewark, Ohio  43055-2899
Mid Dakota ClinicBismarck, North Dakota  58501
Columbus CCOPColumbus, Ohio  43206
Indiana University Medical CenterIndianapolis, Indiana  46202
Presbyterian - Saint Lukes Medical Center - Health OneDenver, Colorado  80218
Wichita CCOPWichita, Kansas  67214-3882
Montana Cancer Consortium CCOPBillings, Montana  59101
Flower HospitalSylvania, Ohio  43560-2197
Metro-Minnesota CCOPSt. Louis Park, Minnesota  
UC Davis Comprehensive Cancer CenterSacramento, California  95817
Providence HospitalSouthfield, Michigan  48075
Thomas Jefferson University HospitalPhiladelphia, Pennsylvania  19131
Decatur Memorial HospitalDecatur, Illinois  62526
Louisiana State University Health Science CenterNew Orleans, Louisiana  70112
Virginia Commonwealth UniversityRichmond, Virginia  
Kaiser PermanentePortland, Oregon  97227
Montana Cancer SpecialistsMissoula, Montana  59807-7877
Providence Saint Joseph Medical CenterBurbank, California  91505-4866
University of Chicago Comprehensive Cancer CenterChicago, Illinois  60637-1470
University of Southern CaliforniaLos Angeles, California  90033
Northern Indiana Cancer Research ConsortiumSouth Bend, Indiana  
Rockwood ClinicSpokane, Washington  99220
Valley View Hospital Cancer CenterGlenwood Springs, Colorado  81601
Froedtert and the Medical College of WisconsinMilwaukee, Wisconsin  53226
Wake Forest University Health SciencesWinston-Salem, North Carolina  27157
OSF Saint Francis Medical CenterPeoria, Illinois  61637
Saint Edward Mercy Medical CenterFt. Smith, Arkansas  72903
Valley Medical Oncology Consultants-Castro ValleyCastro Valley, California  94546
Eden Hospital Medical CenterCastro Valley, California  94546
Valley Medical Oncology Consultants-FremontFremont, California  94538
Fremont - Rideout Cancer CenterMarysville, California  95901
Bay Area Breast Surgeons IncOakland, California  94609
Bay Area Tumor Institution CCOPOakland, California  94609
Tom K Lee IncOakland, California  94609
Valley Medical Oncology ConsultantsPleasanton, California  94588
Valley Care Health System - PleasantonPleasanton, California  94588
Doctors Medical Center- JC Robinson Regional Cancer CenterSan Pablo, California  94806
The Medical Center of AuroraAurora, Colorado  80012
Penrose-Saint Francis HealthcareColorado Springs, Colorado  80907
Memorial Hospital Colorado SpringsColorado Springs, Colorado  80909
Saint Anthony Central HospitalDenver, Colorado  80204
Exempla Saint Joseph HospitalDenver, Colorado  80218
Colorado Cancer Research Program CCOPDenver, Colorado  80224-2522
Saint Mary's Hospital and Regional Medical CenterGrand Junction, Colorado  81502
Saint Mary Corwin Medical CenterPueblo, Colorado  81004
M D Anderson Cancer Center- OrlandoOrlando, Florida  32806
John B Amos Cancer CenterColumbus, Georgia  31904
Saint Anthony's HealthAlton, Illinois  62002
Rush - Copley Medical CenterAurora, Illinois  60504
Resurrection HealthcareChicago, Illinois  60631
Hopedale Medical Complex - HospitalHopedale, Illinois  61747
Joliet Oncology-Hematology Associates LimitedJoliet, Illinois  60435
Midwest Center for Hematology OncologyJoliet, Illinois  60432
North Shore Hematology OncologyLibertyville, Illinois  60048
Stoffel, Thomas J MD (UIA Investigator)Moline, Illinois  61265
Garneau, Stewart C MD (UIA Investigator)Moline, Illinois  61265
Sharis, Christine M MD (UIA Investigator)Moline, Illinois  61265
Porubcin, Michael MD (UIA Investigator)Moline, Illinois  61265
Good Samaritan Regional Medical CenterMt. Vernon, Illinois  62864
Hematology Oncology Consultants LimitedNaperville, Illinois  60540
Community Cancer Center FoundationNormal, Illinois  61761
Illinois CancerCare-Ottawa ClinicOttawa, Illinois  61350
Ottawa Regional Hospital and Healthcare CenterOttawa, Illinois  61350
Pekin Cancer Treatment CenterPekin, Illinois  61554
Illinois Oncology Research Association CCOPPeoria, Illinois  61615
Illinois CancerCare-PeoriaPeoria, Illinois  61615
Illinois Valley HospitalPeru, Illinois  61354
Hematology Oncology Associates of Illinois - SkokieSkokie, Illinois  60076
Saint Margaret's HospitalSpring Valley, Illinois  61362
Carle Clinic-Urbana MainUrbana, Illinois  61801
Saint Francis Hospital and Health CentersBeech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Inc - State BoulevardFort Wayne, Indiana  46845
Richard L. Roudebush Veterans Affairs Medical CenterIndianapolis, Indiana  46202
Wishard HospitalIndianapolis, Indiana  46202
Saint Anthony Memorial Health CenterMichigan City, Indiana  46360
Reid Hospital and Health Care ServicesRichmond, Indiana  47374
McFarland ClinicAmes, Iowa  50010
Hematology Oncology Associates-Quad CitiesBettendorf, Iowa  52722
Constantinou, Costas L MD (UIA Investigator)Bettendorf, Iowa  52722
Cedar Rapids Oncology AssociationCedar Rapids, Iowa  52403
Mercy HospitalCedar Rapids, Iowa  52403
Genesis Medical Center - East CampusDavenport, Iowa  52803
Iowa Oncology Research Association CCOPDes Moines, Iowa  50309
Mercy CapitolDes Moines, Iowa  50307
Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Medical Oncology and Hematology Associates-Des MoinesDes Moines, Iowa  50309
Mercy Medical Center-Sioux CitySioux City, Iowa  51104
Saint Luke's Regional Medical CenterSioux City, Iowa  51104
Cancer Center of Kansas - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas-KingmanKingman, Kansas  67068
Radiation Oncology Practice Corporation SouthwestOverland Park, Kansas  66210
Cancer Center of Kansas - ParsonsParsons, Kansas  67357
Cancer Center of Kansas - PrattPratt, Kansas  67124
Stormont-Vail Regional Health CenterTopeka, Kansas  66604
Saint Francis Hospital and Medical Center - TopekaTopeka, Kansas  66606
Cancer Center of Kansas-Wichita Medical Arts TowerWichita, Kansas  67208
Cancer Center of Kansas - Main OfficeWichita, Kansas  67214
Ochsner Clinic Foundation-Baton RougeBaton Rouge, Louisiana  70809
Medical Center of LouisianaNew Orleans, Louisiana  70112
Ochsner Clinic CCOPNew Orleans, Louisiana  70121
Hickman Cancer CenterAdrian, Michigan  49221
Michigan Cancer Research Consortium Community Clinical Oncology ProgramAnn Arbor, Michigan  48106
Oakwood HospitalDearborn, Michigan  48123
Saint John Hospital and Medical CenterDetroit, Michigan  48236
Green Bay Oncology - EscanabaEscanaba, Michigan  49431
Grand Rapids Clinical Oncology ProgramGrand Rapids, Michigan  49503
Saint Mary's Health CareGrand Rapids, Michigan  49503
Spectrum Health at Butterworth CampusGrand Rapids, Michigan  49503
Green Bay Oncology - Iron MountainIron Mountain, Michigan  49801
Allegiance HealthJackson, Michigan  49201
Sparrow HospitalLansing, Michigan  48912
Saint Mary Mercy HospitalLivonia, Michigan  48154
Mercy Memorial HospitalMonroe, Michigan  48162
Mercy Health Partners-Mercy CampusMuskegon, Michigan  49443
Mercy Health Partners-Hackley CampusMuskegon, Michigan  49442
Saint Joseph Mercy OaklandPontiac, Michigan  48341-2985
Saint Joseph Mercy Port HuronPort Huron, Michigan  48060
Saint Mary's of MichiganSaginaw, Michigan  48601
Lakeland HospitalSt. Joseph, Michigan  49085
Saint John Macomb-Oakland HospitalWarren, Michigan  48093
Medini, Eitan MD (UIA Investigator)Alexandria, Minnesota  56308
Miller-Dwan HospitalDuluth, Minnesota  55805
Etzell, Paul S MD (UIA Investigator)Fergus Falls, Minnesota  56537
Swenson, Wade II, MD (UIA Investigator)Fergus Falls, Minnesota  56537
Unity HospitalFridley, Minnesota  55432
Saint John's Hospital - HealtheastMaplewood, Minnesota  55109
Minnesota Oncology Hematology PA-MaplewoodMaplewood, Minnesota  55109
North Memorial Medical Health CenterRobbinsdale, Minnesota  55422
Saint Cloud HospitalSaint Cloud, Minnesota  56303
Park Nicollet Clinic - Saint Louis ParkSaint Louis Park, Minnesota  55416
Saint Joseph's Hospital - HealtheastSaint Paul, Minnesota  55102
Minnesota Oncology and Hematology PA-WoodburyWoodbury, Minnesota  55125
Southeast Missouri HospitalCape Girardeau, Missouri  63701
Radiation Oncology Practice Corporation - NorthKansas City, Missouri  64154
Saint Luke's Cancer InstituteKansas City, Missouri  64111
Radiation Oncology Practice Corporation SouthKansas City, Missouri  64114
Saint Luke's Hospital of Kansas CityKansas City, Missouri  64111
Saint Joseph Health CenterKansas City, Missouri  64114
Liberty Radiation Oncology ClinicKansas City, Missouri  64116
Truman Medical CenterKansas City, Missouri  64108
Saint Louis-Cape Girardeau CCOPSaint Louis, Missouri  63141
Missouri Baptist Medical CenterSaint Louis, Missouri  63131
Saint John's Mercy Medical CenterSaint Louis, Missouri  63141
Saint John's HospitalSpringfield, Missouri  65804
Hematology-Oncology Centers of the Northern Rockies PCBillings, Montana  59101
Saint Vincent HealthcareBillings, Montana  59101
Billings ClinicBillings, Montana  59107-7000
Saint James Community Hospital and Cancer Treatment CenterButte, Montana  59701
Berdeaux, Donald MD (UIA Investigator)Great Falls, Montana  59405
Saint Peter's Community HospitalHelena, Montana  59601
Glacier Oncology PLLCKalispell, Montana  59901
Community Medical HospitalMissoula, Montana  59801
Saint Patrick Hospital - Community HospitalMissoula, Montana  59802
Nevada Cancer Research Foundation CCOPLas Vegas, Nevada  89106
Portsmouth Regional HospitalPortsmouth, New Hampshire  03802
Cooper Hospital University Medical CenterCamden, New Jersey  08103
Veterans Adminstration New Jersey Health Care SystemEast Orange, New Jersey  07018-1095
South Jersey HealthcareVineland, New Jersey  08360
The North Division of Montefiore Medical CenterBronx, New York  10466
Orange Regional Medical CenterMiddletown, New York  10940
Columbia University Medical CenterNew York, New York  10032
Mission Hospitals IncAsheville, North Carolina  28801
Margaret R Pardee Memorial HospitalHendersonville, North Carolina  28791
Kinston Medical Specialists PAKinston, North Carolina  28501
Saint Alexius Medical CenterBismarck, North Dakota  58501
Doctors HospitalColumbus, Ohio  43228
Grant Medical CenterColumbus, Ohio  43215
Mount Carmel Health Center WestColumbus, Ohio  43222
Good Samaritan Hospital - DaytonDayton, Ohio  45406
Dayton CCOPDayton, Ohio  45429
Samaritan North Health CenterDayton, Ohio  45415
Veteran Affairs Medical CenterDayton, Ohio  45428
Hematology Oncology Center IncorporatedElyria, Ohio  44035
Blanchard Valley HospitalFindlay, Ohio  45840
Atrium Medical Center-Middletown Regional HospitalFranklin, Ohio  45005-1066
Kettering Medical CenterKettering, Ohio  45429
Marietta Memorial HospitalMarietta, Ohio  45750
Toledo Radiation Oncology at Northwest Ohio Onocolgy CenterMaumee, Ohio  43537
Saint Charles HospitalOregon, Ohio  43616
North Coast Cancer CareSandusky, Ohio  44870
Toledo Community Hospital Oncology Program CCOPToledo, Ohio  43617
Mercy Cancer Center at Saint Anne Mercy HospitalToledo, Ohio  43623
University of ToledoToledo, Ohio  43614
Saint Vincent Mercy Medical CenterToledo, Ohio  43608
Upper Valley Medical CenterTroy, Ohio  45373
Saint Ann's HospitalWesterville, Ohio  43081
Genesis HealthCare SystemZanesville, Ohio  43701
Natalie W Bryant Cancer CenterTulsa, Oklahoma  74136
Saint Luke's HospitalBethlehem, Pennsylvania  18015
Central PA Hematology-Medical Oncology Associates PCLemoyne, Pennsylvania  17043
Riddle HospitalMedia, Pennsylvania  19063
Hematology and Oncology Associates of North East PennsylvaniaScranton, Pennsylvania  18508
Scranton Hematology OncologyScranton, Pennsylvania  18510
Mercy HospitalScranton, Pennsylvania  18501
Geisinger Wyoming ValleyWilkes-Barre, Pennsylvania  18711
AnMed Health HospitalAnderson, South Carolina  29621
Upstate Carolina CCOPSpartanburg, South Carolina  29303
Sanford Cancer Center-Oncology ClinicSioux Falls, South Dakota  57104
The Don and Sybil Harrington Cancer CenterAmarillo, Texas  79106
Veterans Administration Medical CenterHouston, Texas  77030
Saint Luke's Episcopal HospitalHouston, Texas  77030
Fredericksburg Oncology IncFredericksburg, Virginia  22401
Harrison Bremerton Hematology and OncologyBremerton, Washington  98310
Columbia Basin Hematology and Oncology PLLCKennewick, Washington  99336
Minor and James Medical PLLCSeattle, Washington  98104
The PolyclinicSeattle, Washington  98122
Swedish Medical Center-First HillSeattle, Washington  98122-4307
Sacred Heart HospitalEau Claire, Wisconsin  54701
Saint Vincent HospitalGreen Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's HospitalGreen Bay, Wisconsin  54303
Saint Mary's HospitalGreen Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent HospitalGreen Bay, Wisconsin  54301-3526
Dean Hematology and Oncology ClinicMadison, Wisconsin  53717
UW Health Oncology - 1 South ParkMadison, Wisconsin  53715
Bay Area Medical CenterMarinette, Wisconsin  54143
Marshfield Clinic-Minocqua CenterMinocqua, Wisconsin  54548
Green Bay Oncology - Oconto FallsOconto Falls, Wisconsin  54154
Marshfield Clinic at James Beck Cancer CenterRhinelander, Wisconsin  54501
Marshfield Clinic-Rice Lake CenterRice Lake, Wisconsin  54868
Saint Michael's HospitalStevens Point, Wisconsin  54481
Green Bay Oncology - Sturgeon BaySturgeon Bay, Wisconsin  54235
Marshfield Clinic-Wausau CenterWausau, Wisconsin  54401
University of IllinoisChicago, Illinois  60612
Elkhart ClinicElkhart, Indiana  46515
Marin General HospitalGreenbrae, California  94904
University of Colorado Cancer Center - Anschutz Cancer PavilionAurora, Colorado  80045
The Shaw Regional Cancer CenterEdwards, Colorado  81632
Montrose Memorial HospitalMontrose, Colorado  81401
Kootenai Cancer CenterPost Falls, Idaho  83854
Illinois CancerCare-BloomingtonBloomington%, Illinois  61701
Illinois CancerCare-CantonCanton, Illinois  61520
Illinois CancerCare-CarthageCarthage, Illinois  62321
Jesse Brown Veterans Affairs Medical CenterChicago, Illinois  60612
Illinois CancerCare-EurekaEureka, Illinois  61530
Illinois CancerCare-CottageGalesburg, Illinois  61401
Illinois CancerCare-HavanaHavana, Illinois  62644
Illinois CancerCare-Kewanee ClinicKewanee, Illinois  61443
Illinois CancerCare-MacombMacomb, Illinois  61455
Illinois CancerCare-MonmouthMonmouth, Illinois  61462
DuPage Medical Group-OgdenNaperville, Illinois  60563
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
Michiana Hematology Oncology PC-ElkhartElkhart, Indiana  46514
Michiana Hematology Oncology PC-PlymouthPlymouth, Indiana  46563
Michiana Hematology Oncology PC-South BendSouth Bend, Indiana  46601
Michiana Hematology Oncology-PC WestvilleWestville, Indiana  46391
Saint Mary's Regional Medical CenterLewiston, Maine  04240
Michiana Hematology Oncology PC-NilesNiles, Michigan  49120
North Coast Cancer Care-ClydeClyde, Ohio  43410
Community Health Partners Regional Medical CenterElyria, Ohio  44035
Vanderbilt-Ingram Cancer Center Cool SpringsFranklin, Tennessee  37067
The Center for Biomedical ResearchKnoxville, Tennessee  37909
East Tennessee Baptist Hospital-Mercy Health PartnersKnoxville, Tennessee  37920
University of Tennessee - KnoxvilleKnoxville, Tennessee  37920
Skagit Valley HospitalMt. Vernon, Washington  98273
Evergreen Hematology and Oncology PSSpokane, Washington  99218
West Virginia University CharlestonCharleston, West Virginia  25304
Marshfield Clinic-Chippewa CenterChippewa Falls, Wisconsin  54729
Holy Family Memorial HospitalManitowoc, Wisconsin  54221
Riverview HospitalWisconsin Rapids, Wisconsin  54494
State University of New York Downstate Medical CenterBrooklyn, New York  11203
FirstHealth of the Carolinas-Moore Regional HosiptalPinehurst, North Carolina  28374
Hematology Oncology Associates-BerwynBerwyn, Illinois  60402
Spector, David MD (UIA Investigator)Moline, Illinois  61265
Saint Luke's South HospitalOverland Park, Kansas  66213
Doctors Carrol, Sheth, RaghavanLouisville, Kentucky  40215
Heartland Hematology and Oncology Associates IncorporatedKansas City, Missouri  64118
Saint Joseph Oncology IncSaint Joseph, Missouri  64507
Kings County HospitalBrooklyn, New York  11203
University of Tennessee - MemphisMemphis, Tennessee  38163
Memorial Hospital Of MartinsvilleMartinsville, Virginia  24115
Gundersen LutheranLa Crosse, Wisconsin  54601
University Hospital of BrooklynBrooklyn, New York  11203
The Center for Cancer and Blood Disorders-BurlesonBurleson, Texas  76115
The Center for Cancer and Blood Disorders-CleburneCleburne, Texas  76033
The Center for Cancer and Blood Disorders-Fort WorthFort Worth, Texas  76104
The Center for Cancer and Blood Disorders-Mineral WellsMineral Wells, Texas  76067
The Center for Cancer and Blood Disorders-WeatherfordWeatherford, Texas  76086
Siouxland Hematology Oncology AssociatesSioux City, Iowa  51101
Carle Foundation - Carle Cancer CenterUrbana, Illinois  61801
Michiana Hematology Oncology PC-MishawakaMishawaka, Indiana  46545-1470
Oncology Associates at Mercy Medical CenterCedar Rapids, Iowa  52403
Marie Yeager Cancer CenterSaint Joseph, Michigan  49085
Hematology Oncology Associates of Central New York PCEast Syracuse, New York  13057
The Toledo Hospital/Toledo Children's HospitalToledo, Ohio  43606
Sanford USD Medical Center - Sioux FallsSioux Falls, South Dakota  57117-5134
North Shore-LIJ Health System CCOPManhasset, New York  11030
Genesys Regional Medical Center-West Flint CampusFlint, Michigan  48532
Essentia Health Duluth Clinic CCOPDuluth, Minnesota  55805
Essentia Health Saint Mary's Medical CenterDuluth, Minnesota  55805
Sanford Bismarck Medical CenterBismarck, North Dakota  58501
Toledo Clinic Cancer Centers-OregonOregon, Ohio  43616
Geisinger Medical Center-Cancer Center HazeltonHazleton, Pennsylvania  18201
Veterans Administration-San Diego Medical CenterSan Diego, California  92161
Community Howard Regional HealthKokomo, Indiana  46904
Indiana University Health La Porte HospitalLa Porte, Indiana  46350
Saint Joseph Regional Medical Center-MishawakaMishawaka, Indiana  46545-1470
PeaceHealth Saint Joseph Medical CenterBellingham, Washington  98225
Christiana Care Health System-Christiana HospitalNewark, Delaware  19718
Illinois Cancer Specialists-NilesNiles, Illinois  60714
Bronson Battle CreekBattle Creek, Michigan  49017
Springfield Regional Medical CenterSpringfield, Ohio  45505
NEA Baptist Memorial HospitalJonesboro, Arkansas  72401
Marin Cancer Care IncGreenbrae, California  94904
Saint Louis Cancer and Breast Institute-South CitySaint Louis, Missouri  63109
Toledo Clinic Cancer Centers-Bowling GreenBowling Green, Ohio  43402
Toledo Clinic Cancer Centers-MaumeeMaumee, Ohio  43537-1839
Toledo Clinic Cancer Centers-ToledoToledo, Ohio  43623
Harrison Poulsbo Hematology and OncologyPoulsbo, Washington  98370