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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
Open (Enrolling)
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



- 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.


- 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

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


- Histologically confirmed breast cancer

- Clinical evidence of metastatic disease (stage IV disease)

- Newly metastatic disease OR progressive metastatic disease while on hormonal

- 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


- 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


- 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:


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:


Principal Investigator

Jeffrey B. Smerage, MD, PhD

Investigator Role:

Study Chair

Investigator Affiliation:

University of Michigan Cancer Center


United States: Federal Government

Study ID:




Start Date:

October 2006

Completion Date:

May 2017

Related Keywords:

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



Roswell Park Cancer Institute Buffalo, New York  14263
Fred Hutchinson Cancer Research Center Seattle, Washington  98109
University of Michigan Comprehensive Cancer Center Ann Arbor, Michigan  48109-0752
Barbara Ann Karmanos Cancer Institute Detroit, Michigan  48201
Cleveland Clinic Cancer Center Cleveland, Ohio  44195
Tripler Army Medical Center Honolulu, Hawaii  96859-5000
Hurley Medical Center Flint, Michigan  48503
University of Texas Health Science Center at San Antonio San Antonio, Texas  78284-7811
CCOP - Carle Cancer Center Urbana, Illinois  61801
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center Grand Junction, Colorado  81502
Rush-Copley Cancer Care Center Aurora, Illinois  60507
Saint Anthony Memorial Health Centers Michigan City, Indiana  46360
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLP Sioux City, Iowa  51101
St. Luke's Regional Medical Center Sioux City, Iowa  51104
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
Genesys Hurley Cancer Institute Flint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Sparrow Regional Cancer Center Lansing, Michigan  48912-1811
St. John Macomb Hospital Warren, Michigan  48093
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
Fairview Southdale Hospital Edina, Minnesota  55435
Mercy and Unity Cancer Center at Unity Hospital Fridley, Minnesota  55432
Hutchinson Area Health Care Hutchinson, Minnesota  55350
Minnesota Oncology Hematology, PA - Maplewood Maplewood, Minnesota  55109
HealthEast Cancer Care at St. John's Hospital Maplewood, Minnesota  55109
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital Minneapolis, Minnesota  55407
St. Francis Cancer Center at St. Francis Medical Center Shakopee, Minnesota  55379
Park Nicollet Cancer Center St. Louis Park, Minnesota  55416
Regions Hospital Cancer Care Center St. Paul, Minnesota  55101
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Minnesota Oncology Hematology, PA - Woodbury Woodbury, Minnesota  55125
St. Rita's Medical Center Lima, Ohio  45801
Natalie Warren Bryant Cancer Center at St. Francis Hospital Tulsa, Oklahoma  74136
Memorial Hospital of South Bend South Bend, Indiana  46601
CCOP - Cancer Research for the Ozarks Springfield, Missouri  65807
CCOP - Montana Cancer Consortium Billings, Montana  59101
Newark Beth Israel Medical Center Newark, New Jersey  07112
CCOP - Greenville Greenville, South Carolina  29615
LDS Hospital Salt Lake City, Utah  84143
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
Saint Joseph Regional Medical Center South Bend, Indiana  46617
CCOP - Grand Rapids Grand Rapids, Michigan  49503
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
CCOP - Columbia River Oncology Program Portland, Oregon  97225
CCOP - Scott and White Hospital Temple, Texas  76508
MultiCare Regional Cancer Center at Tacoma General Hospital Tacoma, Washington  98405
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
USC/Norris Comprehensive Cancer Center and Hospital Los Angeles, California  90033-0804
Veterans Affairs Medical Center - Denver Denver, Colorado  80220
Veterans Affairs Medical Center - San Antonio (Murphy) San Antonio, Texas  78284
CCOP - Northwest Tacoma, Washington  98405-0986
Utah Valley Regional Medical Center - Provo Provo, Utah  84604
St. Joseph's Hospital and Medical Center Paterson, New Jersey  07503
Louis A. Weiss Memorial Hospital Chicago, Illinois  60640
St. Vincent Mercy Medical Center Toledo, Ohio  43608
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus Seattle, Washington  98104
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
UMDNJ University Hospital Newark, New Jersey  07103
CCOP - Toledo Community Hospital Toledo, Ohio  43623-3456
Loma Linda University Cancer Institute at Loma Linda University Medical Center Loma Linda, California  92354
Yale Cancer Center New Haven, Connecticut  06520-8028
Florida Hospital Cancer Institute at Florida Hospital Orlando Orlando, Florida  32803-1273
St. Vincent Indianapolis Hospital Indianapolis, Indiana  46260
Alvin and Lois Lapidus Cancer Institute at Sinai Hospital Baltimore, Maryland  21215
Breslin Cancer Center at Ingham Regional Medical Center Lansing, Michigan  48910
Albert Einstein Cancer Center at Albert Einstein College of Medicine Bronx, New York  10461
Medical University of Ohio Cancer Center Toledo, Ohio  43614
Toledo Hospital Toledo, Ohio  43606
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
Saint Peter's University Hospital New Brunswick, New Jersey  08901-1780
Green Bay Oncology, Limited - Escanaba Escanaba, Michigan  49431
Dickinson County Healthcare System Iron Mountain, Michigan  49801
CCOP - Hematology-Oncology Associates of Central New York East Syracuse, New York  13057
St. Mary's Hospital Medical Center - Green Bay Green Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54301-3526
Green Bay Oncology, Limited at St. Mary's Hospital Green Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical Center Marinette, Wisconsin  54143
Green Bay Oncology, Limited - Oconto Falls Oconto Falls, Wisconsin  54154
Green Bay Oncology, Limited - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
Parma Community General Hospital Parma, Ohio  44129
Alaska Regional Hospital Cancer Center Anchorage, Alaska  99508
Battle Creek Health System Cancer Care Center Battle Creek, Michigan  49017
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
Munson Medical Center Traverse City, Michigan  49684
Hematology-Oncology Centers of the Northern Rockies - Billings Billings, Montana  59101
Big Sky Oncology Great Falls, Montana  59405
St. Peter's Hospital Helena, Montana  59601
Kalispell Regional Medical Center Kalispell, Montana  59901
Glacier Oncology, PLLC Kalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Missoula, Montana  59802
Montana Cancer Specialists at Montana Cancer Center Missoula, Montana  59802
Wayne Memorial Hospital, Incorporated Goldsboro, North Carolina  27534
American Fork Hospital American Fork, Utah  84003
Logan Regional Hospital Logan, Utah  84321
Utah Cancer Specialists at UCS Cancer Center Salt Lake City, Utah  84106
Olympic Hematology and Oncology Bremerton, Washington  98310
Skagit Valley Hospital Cancer Care Center Mt. Vernon, Washington  98273
University Cancer Center at University of Washington Medical Center Seattle, Washington  98195
Harborview Medical Center Seattle, Washington  98104
Group Health Central Hospital Seattle, Washington  98104
North Puget Oncology at United General Hospital Sedro-Wooley, Washington  98284
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Swedish-American Regional Cancer Center Rockford, Illinois  61104-2315
Butterworth Hospital at Spectrum Health Grand Rapids, Michigan  49503-2560
University of Mississippi Cancer Clinic Jackson, Mississippi  39216-4505
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
M. D. Anderson Cancer Center at University of Texas Houston, Texas  77030-4009
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
Elkhart General Hospital Elkhart, Indiana  46515
Howard Community Hospital Kokomo, Indiana  46904
Lakeland Regional Cancer Care Center - St. Joseph St. Joseph, Michigan  49085
Cleveland Clinic Cancer Center at Fairview Hospital Cleveland, Ohio  44111
Hillcrest Cancer Center at Hillcrest Hospital Mayfield Heights, Ohio  44124
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
UPMC Cancer Centers Pittsburgh, Pennsylvania  15232
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center Boise, Idaho  83706
Ingalls Cancer Care Center at Ingalls Memorial Hospital Harvey, Illinois  60426
Center for Cancer Therapy at LaPorte Hospital and Health Services La Porte, Indiana  46350
Hickman Cancer Center at Bixby Medical Center Adrian, Michigan  49221
Bay Regional Medical Center Bay City, Michigan  48708
Mecosta County Medical Center Big Rapids, Michigan  49307
Community Cancer Center of Monroe Monroe, Michigan  48162
Providence Cancer Institute at Providence Hospital - Southfield Campus Southfield, Michigan  48075
Alexandria, Minnesota  56308
Coborn Cancer Center Saint Cloud, Minnesota  56303
CentraCare Clinic - River Campus St. Cloud, Minnesota  56303
Bismarck Cancer Center Bismarck, North Dakota  58501
Wood County Oncology Center Bowling Green, Ohio  43402
Lima Memorial Hospital Lima, Ohio  45804
Northwest Ohio Oncology Center Maumee, Ohio  43537
Toledo Clinic - Oregon Oregon, Ohio  43616
St. Charles Mercy Hospital Oregon, Ohio  43616
North Coast Cancer Care, Incorporated Sandusky, Ohio  44870
Mercy Hospital of Tiffin Tiffin, Ohio  44883
Toledo Clinic, Incorporated - Main Clinic Toledo, Ohio  43623
Fulton County Health Center Wauseon, Ohio  43567
Cleveland Clinic - Wooster Wooster, Ohio  44691
Providence Milwaukie Hospital Milwaukie, Oregon  97222
Providence Cancer Center at Providence Portland Medical Center Portland, Oregon  97213-2967
Providence St. Vincent Medical Center Portland, Oregon  97225
Cancer Therapy and Research Center San Antonio, Texas  78229
University Hospital - San Antonio San Antonio, Texas  78229
Dixie Regional Medical Center - East Campus Saint George, Utah  84770
Danville Regional Medical Center Danville, Virginia  24541
Minor and James Medical, PLLC Seattle, Washington  98104
Southwest Washington Medical Center Cancer Center Vancouver, Washington  98668
Holy Family Memorial Medical Center Cancer Care Center Manitowoc, Wisconsin  54221-1450
Welch Cancer Center at Sheridan Memorial Hospital Sheridan, Wyoming  82801
Montrose Memorial Hospital Cancer Center Montrose, Colorado  81401
St. Francis Hospital Federal Way, Washington  98003
St. Clare Hospital Lakewood, Washington  98499-0998
Providence St. Peter Hospital Regional Cancer Center Olympia, Washington  98506
Good Samaritan Cancer Center Puyallup, Washington  98371
Allenmore Hospital Tacoma, Washington  98411-0414
Palo Alto Medical Foundation Palo Alto, California  94301
Pearlman Comprehensive Cancer Center at South Georgia Medical Center Valdosta, Georgia  31603
Cancer Center at Ball Memorial Hospital Muncie, Indiana  47303
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Missouri Baptist Cancer Center St. Louis, Missouri  63131
Altru Cancer Center at Altru Hospital Grand Forks, North Dakota  58201
Stanford Cancer Center Stanford, California  94305-5824
Michiana Hematology-Oncology, PC - Elkhart Elkhart, Indiana  46514
Elkhart Clinic, LLC Elkhart, Indiana  46514-2098
Michiana Hematology Oncology PC - La Porte La Porte, Indiana  46350
Michiana Hematology-Oncology, PC - South Bend Mishawaka, Indiana  46545-1470
Michiana Hematology Oncology PC - Plymouth Plymouth, Indiana  46563
McFarland Clinic, PC Ames, Iowa  50010
Covenant Cancer Treatment Center Waterloo, Iowa  50702
Tammy Walker Cancer Center at Salina Regional Health Center Salina, Kansas  67401
Cotton-O'Neil Cancer Center Topeka, Kansas  66606
Foote Memorial Hospital Jackson, Michigan  49201
St. Mary Mercy Hospital Livonia, Michigan  48154
Mercy Memorial Hospital - Monroe Monroe, Michigan  48162
St. Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy Hospital Port Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - Saginaw Saginaw, Michigan  48601
Lakeside Cancer Specialists, PLLC Saint Joseph, Michigan  49085
Willmar Cancer Center at Rice Memorial Hospital Willmar, Minnesota  56201
Billings Clinic - Downtown Billings, Montana  59107-7000
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
St. James Healthcare Cancer Care Butte, Montana  59701
Great Falls Clinic - Main Facility Great Falls, Montana  59405
Sletten Cancer Institute at Benefis Healthcare Great Falls, Montana  59405
Northern Montana Hospital Havre, Montana  59501
Kalispell Medical Oncology at KRMC Kalispell, Montana  59901
Hematology Oncology Center Elyria, Ohio  44035
Community Cancer Center Elyria, Ohio  44035
Fisher-Titus Medical Center Norwalk, Ohio  44857
Flower Hospital Cancer Center Sylvania, Ohio  43560
St. Anne Mercy Hospital Toledo, Ohio  43623
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Guthrie Cancer Center at Guthrie Clinic Sayre Sayre, Pennsylvania  18840
Hematology and Oncology Associates of Northeastern Pennsylvania Scranton, Pennsylvania  18510
Sandra L. Maxwell Cancer Center Cedar City, Utah  84720
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center Murray, Utah  84157
Val and Ann Browning Cancer Center at McKay-Dee Hospital Center Ogden, Utah  84403
Fredericksburg Oncology, Incorporated Fredericksburg, Virginia  22401
St. Joseph Cancer Center Bellingham, Washington  98225
Providence Centralia Hospital Centralia, Washington  98531-9027
Columbia Basin Hematology Kennewick, Washington  99336
Harrison Poulsbo Hematology and Onocology Poulsbo, Washington  98370
Evergreen Hematology and Oncology, PS Spokane, Washington  99218
Franciscan Cancer Center at St. Joseph Medical Center Tacoma, Washington  98405-3004
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
Oncology Alliance, SC - Milwaukee - West Wauwatosa, Wisconsin  53226
Mid Dakota Clinic, PC Bismarck, North Dakota  58501
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Good Samaritan Cancer Center at Good Samaritan Hospital Kearney, Nebraska  68848-1990
Pardee Memorial Hospital Hendersonville, North Carolina  28791
Three Rivers Community Hospital Grants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical Center Medford, Oregon  97504
Duke Cancer Institute Durham, North Carolina  27710
Kinston Medical Specialists Kinston, North Carolina  28501
Greenville Hospital Cancer Center Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Grove Commons Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Faris Road Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Greer Medical Oncology Greer, South Carolina  29650
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Glendale Memorial Hospital Comprehensive Cancer Center Glendale, California  91204
Resurrection Medical Center Chicago, Illinois  60631
West Tennessee Cancer Center at Jackson-Madison County General Hospital Jackson, Tennessee  38301
Providence Cancer Center Anchorage, Alaska  99508
Lacks Cancer Center at Saint Mary's Health Care Grand Rapids, Michigan  49503
St. Charles Medical Center - Bend Bend, Oregon  97701
Roper St. Francis Cancer Center at Roper Hospital Charleston, South Carolina  29401
Cancer Center at Phoenixville Hospital Phoenixville, Pennsylvania  19460
St. Vincent Healthcare Cancer Care Services Billings, Montana  59101
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Kapiolani Medical Center for Women and Children Honolulu, Hawaii  96826
Straub Clinic and Hospital, Incorporated Honolulu, Hawaii  96813
Hawaii Medical Center - East Honolulu, Hawaii  96817
OnCare Hawaii, Incorporated - Kuakini Honolulu, Hawaii  96817
OnCare Hawaii, Incorporated - Lusitana Honolulu, Hawaii  96813
Maui Memorial Medical Center Wailuku, Hawaii  96793
Pacific Cancer Institute - Maui Wailuku, Hawaii  96793
Elmhurst Memorial Hospital Elmhurst, Illinois  60126
Mercy General Health Partners Muskegon, Michigan  49443
Faxton Regional Cancer Center Utica, New York  13502
Bay Area Hospital Coos Bay, Oregon  97420
Medcenter One Hospital Cancer Care Center Bismarck, North Dakota  58501
St. Alexius Medical Center Cancer Center Bismarck, North Dakota  58502
University of Colorado Cancer Center at UC Health Sciences Center Aurora, Colorado  80045
Providence Cancer Center at PMCC Medford, Oregon  97504
Lovelace Medical Center - Downtown Albuquerque, New Mexico  87102
Hematology Oncology Associates, PC Albuquerque, New Mexico  87106
Regional Medical Center Anniston, Alabama  36202
Southeastern Regional Medical Center Lumberton, North Carolina  28359
Granville Medical Center Oxford, North Carolina  27565
Duke Health Raleigh Hospital Raleigh, North Carolina  27609
Person Memorial Hospital Roxboro, North Carolina  27573
Virginia Cancer Institute - West End Richmond, Virginia  23230
Cancer Centers of the Carolinas - Easley Easley, South Carolina  29640
Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
Lakeview Hospital Stillwater, Minnesota  55082
Camino Medical Group - Treatment Center Mountain View, California  94040
Ephrata Cancer Center at Ephrata Community Hospital Ephrata, Pennsylvania  17522
California Cancer Care, Incorporated - Greenbrae Greenbrae, California  94904
Community Regional Cancer Care at Community Hospital North Indianapolis, Indiana  46256
Shaw Regional Cancer Center Edwards, Colorado  81632
San Luis Valley Regional Medical Center Alamosa, Colorado  81101
Valley View Hospital Cancer Center Glenwood Springs, Colorado  81601
Clemens Regional Medical Center Mount Clemens, Michigan  48043
Southeast Cancer Center Cape Girardeau, Missouri  63703
Goldschmidt Cancer Center Jefferson City, Missouri  65109
Comprehensive Cancer Care, PC Saint Louis, Missouri  63141
Presbyterian Cancer Treatment Center at Presbyterian Kaseman Hospital Albuquerque, New Mexico  87110
University of New Mexico Cancer Center - South Las Cruces, New Mexico  88011
Cleveland Clinic Beachwood Family Health and Surgery Center Beachwood, Ohio  44122
Cleveland Clinic Foundation - Strongsville Strongsville, Ohio  44136
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
Providence Newberg Medical Center Newberg, Oregon  97132
Willamette Falls Hospital Oregon City, Oregon  97045
Island Hospital Cancer Care Center at Island Hospital Anacortes, Washington  98221
Highline Medical Center Cancer Center Burien, Washington  98166
St. Nicholas Hospital Sheboygan, Wisconsin  53081
Mercy Hospital Portland, Maine  04101
NEA Medical Center - Stadium Boulevard Jonesboro, Arkansas  72401
Central Care Cancer Center at Carrie J. Babb Cancer Center Bolivar, Missouri  65613
Saint Vincent Hospital at Worcester Medical Center Worcester, Massachusetts  01608
Spectrum Health Reed City Hospital Reed City, Michigan  49677
Dickstein Cancer Treatment Center at White Plains Hospital Center White Plains, New York  10601