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A Randomized Phase III Trial to Test the Strategy of Changing Therapy Versus Maintaining Therapy for Metastatic Breast Cancer Patients Who Have Elevated Circulating Tumor Cell Levels at First Follow-Up Assessment


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

Thank you

Trial Information

A Randomized Phase III Trial to Test the Strategy of Changing Therapy Versus Maintaining Therapy for Metastatic Breast Cancer Patients Who Have Elevated Circulating Tumor Cell Levels at First Follow-Up Assessment


OBJECTIVES:

Primary

- Determine whether women with metastatic breast cancer and elevated circulating tumor
cells (CTCs) (≥ 5 per 7.5 mL of whole blood) after 3 weeks of first-line chemotherapy
derive increased overall survival from changing to an alternative chemotherapy regimen
at the next course rather than waiting for clinical evidence of progressive disease
before changing to an alternative chemotherapy regimen.

- Determine whether these patients derive increased progression-free survival (PFS) from
changing to an alternative chemotherapy regimen at the next course rather than waiting
for clinical evidence of progressive disease before changing to an alternative
chemotherapy regimen.

- Confirm previous findings that patients with < 5 CTCs per 7.5 mL of whole blood on
initial screening have longer median OS and PFS than patients with ≥ 5 CTCs per 7.5 mL
of whole blood.

- Determine the prognostic value of sequentially collected CTC values in these patients.

- Compare toxicity between patients with and without elevated CTCs after 3 weeks of
first-line chemotherapy AND between the two randomized treatment arms.

Secondary

- Compare the prognostic and predictive value of CTC number vs breast cancer tumor
markers, including CA 15-3 and carcinoembryonic antigen.

- Create a serum specimen bank for future biologic investigation.

OUTLINE: This is a partially blinded, partially randomized, multicenter study. Patients are
assigned to 1 of 3 groups based on circulating tumor cells (CTCs) after 1 course of
chemotherapy.

All patients undergo blood collection before their first dose of first-line chemotherapy* to
determine baseline CTC count. Patients with < 5 CTCs at baseline are assigned to group I.
Patients with ≥ 5 CTCs at baseline undergo a second blood draw on day 22 (after completion
of 1 course of chemotherapy). Patients with < 5 CTCs after completing 1 course of
chemotherapy are assigned to group 2. Patients with ≥ 5 CTCs after completion of 1 course of
chemotherapy are assigned to group 3.

NOTE: *Chemotherapy may be initiated while waiting for the baseline CTC result.

- Group 1 (low risk of early progression): Patients continue to receive regular treatment
without change at the discretion of the physician. Patients are eligible for other
first-line chemotherapy trials. No further blood is collected.

- Group 2 (moderate risk of early progression): Patients continue to receive their
current chemotherapy regimen without change.

- Group 3 (high risk of early progression): Patients are stratified according to HER-2
status (positive vs negative) and disease type (bone-only vs measurable disease).
Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients continue with their current chemotherapy regimen without change.

- Arm II: Patients switch to a different chemotherapy regimen. Selection of a new
chemotherapy regimen is made by the patient's doctor.

Patients receiving hormonal therapy or biologic therapy and chemotherapy continue to receive
the hormonal or biologic therapy unchanged regardless of CTC level.

In groups 2 and 3, blood is collected periodically during chemotherapy and then at the
completion of chemotherapy. Samples are examined for CTCs via the CellSearch™ blood test.
Blood is also tested for CA 15-3 and carcinoembryonic antigen (CEA).

After completion of study therapy, patients are followed for up to 5 years.

PROJECTED ACCRUAL: A total of 500 patients will be accrued for this study.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed breast cancer

- Clinical evidence of metastatic disease (stage IV disease)

- Newly metastatic disease OR progressive metastatic disease while on hormonal
therapy

- Meets 1 of the following criteria:

- Measurable disease

- Bone-only disease* NOTE: *Patients with nonmeasurable disease that does not
include bone are not eligible

- HER-2 status determined by immunohistochemistry (IHC) or fluorescent in situ
hybridization (FISH) assay

- HER-2 positivity is defined as IHC 3+ or FISH+

- If IHC is indeterminate (2+), FISH must be performed to classify disease

- Planning to undergo first-line chemotherapy for metastatic disease

- Patients with brain metastases must have stable disease for > 90 days after
completion of prior radiotherapy to the brain

- No leptomeningeal disease

- Hormone receptor status not specified

PATIENT CHARACTERISTICS:

- Female

- Menopausal status not specified

- Zubrod performance status 0-2

- Not pregnant or nursing

- Negative pregnancy test

- No other malignancy within the past 5 years except adequately treated basal cell or
squamous cell skin cancer or stage I or II cancer currently in complete remission

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Prior hormonal therapy, bisphosphonate therapy, trastuzumab (Herceptin®), and/or
bevacizumab for metastatic disease allowed

- Any number of exogenous hormonal therapies for metastatic disease and/or as
adjuvant therapy allowed

- At least 1 year since prior adjuvant chemotherapy

- At least 2 weeks since prior minor surgery and recovered

- At least 4 weeks since prior major surgery and recovered

- No prior chemotherapy for metastatic disease

- Concurrent hormonal therapy and/or bisphosphonate therapy allowed

- Concurrent trastuzumab and/or bevacizumab allowed

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Overall survival

Outcome Time Frame:

Every 3 months until progression then every 6 months for 5 years or until death

Safety Issue:

No

Principal Investigator

Jeffrey B. Smerage, MD, PhD

Investigator Role:

Study Chair

Investigator Affiliation:

University of Michigan Cancer Center

Authority:

United States: Federal Government

Study ID:

CDR0000504319

NCT ID:

NCT00382018

Start Date:

October 2006

Completion Date:

May 2017

Related Keywords:

  • Breast Cancer
  • recurrent breast cancer
  • stage IV breast cancer
  • Breast Neoplasms

Name

Location

Roswell Park Cancer InstituteBuffalo, New York  14263
Fred Hutchinson Cancer Research CenterSeattle, Washington  98109
University of Michigan Comprehensive Cancer CenterAnn Arbor, Michigan  48109-0752
Barbara Ann Karmanos Cancer InstituteDetroit, Michigan  48201
Cleveland Clinic Cancer CenterCleveland, Ohio  44195
Tripler Army Medical CenterHonolulu, Hawaii  96859-5000
Hurley Medical CenterFlint, Michigan  48503
University of Texas Health Science Center at San AntonioSan Antonio, Texas  78284-7811
CCOP - Carle Cancer CenterUrbana, Illinois  61801
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical CenterGrand Junction, Colorado  81502
Rush-Copley Cancer Care CenterAurora, Illinois  60507
Saint Anthony Memorial Health CentersMichigan City, Indiana  46360
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
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
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
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
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
St. Rita's Medical CenterLima, Ohio  45801
Natalie Warren Bryant Cancer Center at St. Francis HospitalTulsa, Oklahoma  74136
Memorial Hospital of South BendSouth Bend, Indiana  46601
CCOP - Cancer Research for the OzarksSpringfield, Missouri  65807
CCOP - Montana Cancer ConsortiumBillings, Montana  59101
Newark Beth Israel Medical CenterNewark, New Jersey  07112
CCOP - GreenvilleGreenville, South Carolina  29615
LDS HospitalSalt Lake City, Utah  84143
CCOP - Northern Indiana CR ConsortiumSouth Bend, Indiana  46601
Saint Joseph Regional Medical CenterSouth Bend, Indiana  46617
CCOP - Grand RapidsGrand Rapids, Michigan  49503
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical CenterLebanon, New Hampshire  03756-0002
CCOP - Columbia River Oncology ProgramPortland, Oregon  97225
CCOP - Scott and White HospitalTemple, Texas  76508
MultiCare Regional Cancer Center at Tacoma General HospitalTacoma, Washington  98405
Cancer Research Center of HawaiiHonolulu, Hawaii  96813
Cleveland Clinic Taussig Cancer CenterCleveland, Ohio  44195
USC/Norris Comprehensive Cancer Center and HospitalLos Angeles, California  90033-0804
Veterans Affairs Medical Center - DenverDenver, Colorado  80220
Veterans Affairs Medical Center - San Antonio (Murphy)San Antonio, Texas  78284
CCOP - NorthwestTacoma, Washington  98405-0986
Utah Valley Regional Medical Center - ProvoProvo, Utah  84604
St. Joseph's Hospital and Medical CenterPaterson, New Jersey  07503
Louis A. Weiss Memorial HospitalChicago, Illinois  60640
St. Vincent Mercy Medical CenterToledo, Ohio  43608
Josephine Ford Cancer Center at Henry Ford HospitalDetroit, Michigan  48202
Swedish Cancer Institute at Swedish Medical Center - First Hill CampusSeattle, Washington  98104
Hulston Cancer Center at Cox Medical Center SouthSpringfield, Missouri  65807
St. John's Regional Health CenterSpringfield, Missouri  65804
UMDNJ University HospitalNewark, New Jersey  07103
CCOP - Toledo Community HospitalToledo, Ohio  43623-3456
Loma Linda University Cancer Institute at Loma Linda University Medical CenterLoma Linda, California  92354
Yale Cancer CenterNew Haven, Connecticut  06520-8028
Florida Hospital Cancer Institute at Florida Hospital OrlandoOrlando, Florida  32803-1273
St. Vincent Indianapolis HospitalIndianapolis, Indiana  46260
Alvin and Lois Lapidus Cancer Institute at Sinai HospitalBaltimore, Maryland  21215
Breslin Cancer Center at Ingham Regional Medical CenterLansing, Michigan  48910
Albert Einstein Cancer Center at Albert Einstein College of MedicineBronx, New York  10461
Medical University of Ohio Cancer CenterToledo, Ohio  43614
Toledo HospitalToledo, Ohio  43606
St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54307-3508
Saint Peter's University HospitalNew Brunswick, New Jersey  08901-1780
Green Bay Oncology, Limited - EscanabaEscanaba, Michigan  49431
Dickinson County Healthcare SystemIron Mountain, Michigan  49801
CCOP - Hematology-Oncology Associates of Central New YorkEast Syracuse, New York  13057
St. Mary's Hospital Medical Center - Green BayGreen Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54301-3526
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
Parma Community General HospitalParma, Ohio  44129
Alaska Regional Hospital Cancer CenterAnchorage, Alaska  99508
Battle Creek Health System Cancer Care CenterBattle Creek, Michigan  49017
William Beaumont Hospital - Royal Oak CampusRoyal Oak, Michigan  48073
Munson Medical CenterTraverse City, Michigan  49684
Hematology-Oncology Centers of the Northern Rockies - BillingsBillings, Montana  59101
Big Sky OncologyGreat Falls, Montana  59405
St. Peter's HospitalHelena, Montana  59601
Kalispell Regional Medical CenterKalispell, Montana  59901
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
Wayne Memorial Hospital, IncorporatedGoldsboro, North Carolina  27534
American Fork HospitalAmerican Fork, Utah  84003
Logan Regional HospitalLogan, Utah  84321
Utah Cancer Specialists at UCS Cancer CenterSalt Lake City, Utah  84106
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
Harborview Medical CenterSeattle, Washington  98104
Group Health Central HospitalSeattle, Washington  98104
North Puget Oncology at United General HospitalSedro-Wooley, Washington  98284
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Swedish-American Regional Cancer CenterRockford, Illinois  61104-2315
Butterworth Hospital at Spectrum HealthGrand Rapids, Michigan  49503-2560
University of Mississippi Cancer ClinicJackson, Mississippi  39216-4505
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
M. D. Anderson Cancer Center at University of TexasHouston, Texas  77030-4009
Gundersen Lutheran Center for Cancer and BloodLa Crosse, Wisconsin  54601
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical CenterHartford, Connecticut  06105
Elkhart General HospitalElkhart, Indiana  46515
Howard Community HospitalKokomo, Indiana  46904
Lakeland Regional Cancer Care Center - St. JosephSt. Joseph, Michigan  49085
Cleveland Clinic Cancer Center at Fairview HospitalCleveland, Ohio  44111
Hillcrest Cancer Center at Hillcrest HospitalMayfield Heights, Ohio  44124
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
UPMC Cancer CentersPittsburgh, Pennsylvania  15232
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
Ingalls Cancer Care Center at Ingalls Memorial HospitalHarvey, Illinois  60426
Center for Cancer Therapy at LaPorte Hospital and Health ServicesLa Porte, Indiana  46350
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
Bay Regional Medical CenterBay City, Michigan  48708
Mecosta County Medical CenterBig Rapids, Michigan  49307
Community Cancer Center of MonroeMonroe, Michigan  48162
Providence Cancer Institute at Providence Hospital - Southfield CampusSouthfield, Michigan  48075
Alexandria, Minnesota  56308
Coborn Cancer CenterSaint Cloud, Minnesota  56303
CentraCare Clinic - River CampusSt. Cloud, Minnesota  56303
Bismarck Cancer CenterBismarck, North Dakota  58501
Wood County Oncology CenterBowling Green, Ohio  43402
Lima Memorial HospitalLima, Ohio  45804
Northwest Ohio Oncology CenterMaumee, Ohio  43537
Toledo Clinic - OregonOregon, Ohio  43616
St. Charles Mercy HospitalOregon, Ohio  43616
North Coast Cancer Care, IncorporatedSandusky, Ohio  44870
Mercy Hospital of TiffinTiffin, Ohio  44883
Toledo Clinic, Incorporated - Main ClinicToledo, Ohio  43623
Fulton County Health CenterWauseon, Ohio  43567
Cleveland Clinic - WoosterWooster, Ohio  44691
Providence Milwaukie HospitalMilwaukie, Oregon  97222
Providence Cancer Center at Providence Portland Medical CenterPortland, Oregon  97213-2967
Providence St. Vincent Medical CenterPortland, Oregon  97225
Cancer Therapy and Research CenterSan Antonio, Texas  78229
University Hospital - San AntonioSan Antonio, Texas  78229
Dixie Regional Medical Center - East CampusSaint George, Utah  84770
Danville Regional Medical CenterDanville, Virginia  24541
Minor and James Medical, PLLCSeattle, Washington  98104
Southwest Washington Medical Center Cancer CenterVancouver, Washington  98668
Holy Family Memorial Medical Center Cancer Care CenterManitowoc, Wisconsin  54221-1450
Welch Cancer Center at Sheridan Memorial HospitalSheridan, Wyoming  82801
Montrose Memorial Hospital Cancer CenterMontrose, Colorado  81401
St. Francis HospitalFederal Way, Washington  98003
St. Clare HospitalLakewood, Washington  98499-0998
Providence St. Peter Hospital Regional Cancer CenterOlympia, Washington  98506
Good Samaritan Cancer CenterPuyallup, Washington  98371
Allenmore HospitalTacoma, Washington  98411-0414
Palo Alto Medical FoundationPalo Alto, California  94301
Pearlman Comprehensive Cancer Center at South Georgia Medical CenterValdosta, Georgia  31603
Cancer Center at Ball Memorial HospitalMuncie, Indiana  47303
Regional Cancer Center at Singing River HospitalPascagoula, Mississippi  39581
Missouri Baptist Cancer CenterSt. Louis, Missouri  63131
Altru Cancer Center at Altru HospitalGrand Forks, North Dakota  58201
Stanford Cancer CenterStanford, California  94305-5824
Michiana Hematology-Oncology, PC - ElkhartElkhart, Indiana  46514
Elkhart Clinic, LLCElkhart, Indiana  46514-2098
Michiana Hematology Oncology PC - La PorteLa Porte, Indiana  46350
Michiana Hematology-Oncology, PC - South BendMishawaka, Indiana  46545-1470
Michiana Hematology Oncology PC - PlymouthPlymouth, Indiana  46563
McFarland Clinic, PCAmes, Iowa  50010
Covenant Cancer Treatment CenterWaterloo, Iowa  50702
Tammy Walker Cancer Center at Salina Regional Health CenterSalina, Kansas  67401
Cotton-O'Neil Cancer CenterTopeka, Kansas  66606
Foote Memorial HospitalJackson, Michigan  49201
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
Willmar Cancer Center at Rice Memorial HospitalWillmar, Minnesota  56201
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
Hematology Oncology CenterElyria, Ohio  44035
Community Cancer CenterElyria, Ohio  44035
Fisher-Titus Medical CenterNorwalk, Ohio  44857
Flower Hospital Cancer CenterSylvania, Ohio  43560
St. Anne Mercy HospitalToledo, Ohio  43623
McGlinn Family Regional Cancer Center at Reading Hospital and Medical CenterReading, Pennsylvania  19612-6052
Guthrie Cancer Center at Guthrie Clinic SayreSayre, Pennsylvania  18840
Hematology and Oncology Associates of Northeastern PennsylvaniaScranton, Pennsylvania  18510
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
Oncology Alliance, SC - Milwaukee - WestWauwatosa, Wisconsin  53226
Mid Dakota Clinic, PCBismarck, North Dakota  58501
Queen's Cancer Institute at Queen's Medical CenterHonolulu, Hawaii  96813
Good Samaritan Cancer Center at Good Samaritan HospitalKearney, Nebraska  68848-1990
Pardee Memorial HospitalHendersonville, North Carolina  28791
Three Rivers Community HospitalGrants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical CenterMedford, Oregon  97504
Duke Cancer InstituteDurham, North Carolina  27710
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
Glendale Memorial Hospital Comprehensive Cancer CenterGlendale, California  91204
Resurrection Medical CenterChicago, Illinois  60631
West Tennessee Cancer Center at Jackson-Madison County General HospitalJackson, Tennessee  38301
Providence Cancer CenterAnchorage, Alaska  99508
Lacks Cancer Center at Saint Mary's Health CareGrand Rapids, Michigan  49503
St. Charles Medical Center - BendBend, Oregon  97701
Roper St. Francis Cancer Center at Roper HospitalCharleston, South Carolina  29401
Cancer Center at Phoenixville HospitalPhoenixville, Pennsylvania  19460
St. Vincent Healthcare Cancer Care ServicesBillings, Montana  59101
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
Elmhurst Memorial HospitalElmhurst, Illinois  60126
Mercy General Health PartnersMuskegon, Michigan  49443
Faxton Regional Cancer CenterUtica, New York  13502
Bay Area HospitalCoos Bay, Oregon  97420
Medcenter One Hospital Cancer Care CenterBismarck, North Dakota  58501
St. Alexius Medical Center Cancer CenterBismarck, North Dakota  58502
University of Colorado Cancer Center at UC Health Sciences CenterAurora, Colorado  80045
Providence Cancer Center at PMCCMedford, Oregon  97504
Lovelace Medical Center - DowntownAlbuquerque, New Mexico  87102
Hematology Oncology Associates, PCAlbuquerque, New Mexico  87106
Regional Medical CenterAnniston, Alabama  36202
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
Virginia Cancer Institute - West EndRichmond, Virginia  23230
Cancer Centers of the Carolinas - EasleyEasley, South Carolina  29640
Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
Lakeview HospitalStillwater, Minnesota  55082
Camino Medical Group - Treatment CenterMountain View, California  94040
Ephrata Cancer Center at Ephrata Community HospitalEphrata, Pennsylvania  17522
California Cancer Care, Incorporated - GreenbraeGreenbrae, California  94904
Community Regional Cancer Care at Community Hospital NorthIndianapolis, Indiana  46256
Shaw Regional Cancer CenterEdwards, Colorado  81632
San Luis Valley Regional Medical CenterAlamosa, Colorado  81101
Valley View Hospital Cancer CenterGlenwood Springs, Colorado  81601
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
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
Clackamas Radiation Oncology CenterClackamas, Oregon  97015
Providence Newberg Medical CenterNewberg, Oregon  97132
Willamette Falls HospitalOregon City, Oregon  97045
Island Hospital Cancer Care Center at Island HospitalAnacortes, Washington  98221
Highline Medical Center Cancer CenterBurien, Washington  98166
St. Nicholas HospitalSheboygan, Wisconsin  53081
Mercy HospitalPortland, Maine  04101
NEA Medical Center - Stadium BoulevardJonesboro, Arkansas  72401
Central Care Cancer Center at Carrie J. Babb Cancer CenterBolivar, Missouri  65613
Saint Vincent Hospital at Worcester Medical CenterWorcester, Massachusetts  01608
Spectrum Health Reed City HospitalReed City, Michigan  49677
Dickstein Cancer Treatment Center at White Plains Hospital CenterWhite Plains, New York  10601