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A Randomized Phase III Trial of Neoadjuvant Therapy in Patients With Palpable and Operable Breast Cancer Evaluating the Effect on Pathologic Complete Response (pCR) of Adding Capecitabine or Gemcitabine to Docetaxel When Administered Before AC With or Without Bevacizumab and Correlative Science Studies Attempting to Identify Predictors of High Likelihood for pCR With Each of the Regimens

Phase 3
18 Years
Open (Enrolling)
Breast Cancer

Thank you

Trial Information

A Randomized Phase III Trial of Neoadjuvant Therapy in Patients With Palpable and Operable Breast Cancer Evaluating the Effect on Pathologic Complete Response (pCR) of Adding Capecitabine or Gemcitabine to Docetaxel When Administered Before AC With or Without Bevacizumab and Correlative Science Studies Attempting to Identify Predictors of High Likelihood for pCR With Each of the Regimens



- Compare the efficacy of docetaxel followed by doxorubicin hydrocloride and
cyclophosphamide (AC) vs docetaxel and capecitabine followed by AC vs docetaxel and
gemcitabine hydrochloride followed by AC, with or without bevacizumab, in terms of an
increase in the rate of pathologic complete response (pCR) in the breast, in women with
palpable or operable breast cancer.


- Compare docetaxel/capecitabine with AC vs docetaxel/gemcitabine hydrochloride with AC
vs docetaxel with AC, with or without bevacizumab, in terms of the rate of pCR in the
breast and all post-therapy lymph nodes evaluated histologically (pCR breast and

- Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based
regimens (docetaxel with AC, docetaxel and capecitabine with AC, and docetaxel and
gemcitabine hydrochloride with AC) will increase the rate of pCR of the breast and
nodes compared to the same docetaxel/anthracycline-based regimens without bevacizumab
in these patients.

- Determine whether the addition of capecitabine or gemcitabine hydrochloride to
docetaxel, with or without bevacizumab, will increase the rate of clinical overall
response (cOR) compared to docetaxel alone with or without bevacizumab in these

- Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based
regimens will increase the rate of cOR compared to the same
docetaxel/anthracycline-based regimens without bevacizumab in these patients.

- Determine whether the addition of capecitabine or gemcitabine hydrochloride to
docetaxel, with or without bevacizumab, will increase the rate of clinical complete
response (cCR) compared to docetaxel alone with or without bevacizumab in these

- Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based
regimens (docetaxel with AC, docetaxel/capecitabine with AC, and docetaxel/gemcitabine
hydrochloride with AC) will increase the rate of cCR compared to the same
docetaxel/anthracycline-based regimens without bevacizumab in these patients.

- Identify gene expression profiles that can predict pCR in patients treated with the
different sequential docetaxel/anthracycline-based regimens with or without

- Identify gene expression profiles that can predict cOR in patients treated with
docetaxel alone, docetaxel/capecitabine, or docetaxel/gemcitabine hydrochloride with or
without bevacizumab.

- Determine the accuracy of an in vitro chemoresponse assay (ChemoFx®) as a predictor of
pCR in patients treated with the different sequential docetaxel/anthracycline-based
regimens without bevacizumab.

- Determine the accuracy of ChemoFx® as a predictor of cOR in patients treated with
docetaxel alone, docetaxel/capecitabine, or docetaxel/gemcitabine hydrochloride without
bevacizumab in these patients.

- Determine the impact of preoperative bevacizumab and sequential chemotherapy regimens
and postoperative bevacizumab therapy on cardiac function in these patients.

- Determine the impact of bevacizumab on surgical complications in these patients.

- Determine the toxicity of the preoperative regimens and the toxicity of postoperative
bevacizumab in these patients.

- Compare the docetaxel/anthracycline-based regimens with vs without bevacizumab, in
terms of an increase in disease-free survival, of these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to tumor
size (2-4 cm vs > 4 cm), nodal status (negative vs positive), hormone receptor status
(estrogen receptor [ER]-positive and/or progesterone-receptor [PgR]-positive vs ER- and
PgR-negative), and age (< 50 years vs ≥ 50 years). Patients are randomized to 1 of 6
treatment arms.

Core needle biopsies are performed at baseline. Tumor tissue samples are also collected
during definitive surgery. Samples are examined for gene expression and polymorphism by
reverse transcriptase-polymerase chain reaction analysis and chemoresponse assay (ChemoFx®).

After completion of study therapy, patients are followed periodically for 10 years.

PROJECTED ACCRUAL: A total of 1,200 patients will be accrued for this study.

Inclusion Criteria:

- The patient must have consented to participate and must have signed and dated an
appropriate Institutional Review Board (IRB)-approved consent form that conforms to
federal and institutional guidelines for the study treatment and submission of
pre-entry core biopsy material for correlative studies.

- Patients must be female.

- Patients must be 18 years of age or older.

- Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of
0 or 1.

- The diagnosis of invasive adenocarcinoma of the breast must have been made by core
needle biopsy.

- The primary breast tumor must be palpable and measure greater than or equal to 2.0 cm
on physical exam.

- All patients must have their left ventricular ejection fraction (LVEF) assessed by
multigated acquisition (MUGA) scan or echocardiogram within 3 months prior to study
entry. The LVEF must be greater than or equal to the lower limit of normal (LLN) for
the cardiac imaging facility performing the study. Note: If the cardiac imaging
facility cannot provide a LLN, use 50% as the LLN value.

- Note: Since the pre-entry LVEF serves as the baseline for comparing subsequent LVEF
assessments to determine if bevacizumab therapy can be continued, it is critical that
this baseline study be an accurate assessment of the patient's LVEF. If the baseline
LVEF is greater than 75%, the investigator should have the study reviewed for
accuracy prior to study entry. Following study entry, the LVEF determination may be
reviewed up until the time of the post-chemotherapy (preoperative) evaluation.
Please note that if a more accurate value is obtained from the review of the baseline
MUGA or echocardiogram, the correct value must be submitted to the NSABP before the
post-chemotherapy (preoperative) MUGA or echocardiogram is performed or it cannot be
used for managing postoperative bevacizumab.

- All patients must have an EKG within 3 months prior to study entry.

- At the time of randomization:

- Absolute neutrophil count (ANC) must be greater than or equal to 1200/mm3.

- Platelet count must be greater than or equal to 100,000/mm3.

- Hemoglobin must be greater than or equal to 10 g/dL.

- There must be evidence of adequate hepatic function by these criteria:

- Total bilirubin must be less than or equal to the ULN for the lab unless the
patient has a grade 1 bilirubin elevation (greater than ULN to 1.5 x ULN)
resulting from Gilbert's disease or similar syndrome due to slow conjugation of
bilirubin; and

- Alkaline phosphatase must be less than or equal 2.5 x ULN for the lab; and

- Aspartate Aminotransferase (AST) must be less than or equal to 1.5 x ULN for the

- Alkaline phosphatase and AST may not both be greater than the ULN. For example,
if the alkaline phosphatase is greater than the ULN but less than or equal 2.5 x
ULN, then the AST must be less than or equal the ULN. If the AST is greater
than the ULN but less than or equal 1.5 x ULN, then the alkaline phosphatase
must be less than or equal ULN.

- Patients with either skeletal pain or alkaline phosphatase that is greater than ULN
but less than or equal 2.5 x ULN are eligible for inclusion in the study if bone
scans do not demonstrate metastatic disease. Suspicious findings on bone scan must
be confirmed as benign by x-ray, MRI, or biopsy.

- Patients with AST or alkaline phosphatase greater than ULN are eligible for inclusion
in the study if liver imaging does not demonstrate metastatic disease and adequate
bone marrow and liver function results as described above are met.

- The following criteria for evidence of adequate renal function must be met:

- Serum creatinine less than or equal ULN for the lab.

- Calculated creatinine clearance must be greater than 50 mL/min.

- Urine protein/urine creatinine (UPC) ratio must be less than 1.0.

- Patient must be able to swallow oral medications.

Exclusion criteria:

- Tumor determined to be strongly human epidermal growth factor receptor 2
(HER2)-positive by immunohistochemistry (3+) or by fluorescent in situ hybridization
(positive for gene amplification).

- Excisional or incisional biopsy for this primary breast tumor.

- Surgical axillary staging procedure prior to study entry. Exceptions: 1) Fine
Needle Aspiration (FNA) or core biopsy of an axillary node is permitted for any
patient, and 2) although not recommended, a pre-neoadjuvant therapy sentinel lymph
node biopsy for patients with clinically negative axillary nodes is permitted.

- Tumors clinically staged as T4.

- Ipsilateral cN2b or cN3 disease. (Patients with cN1 or cN2a disease are eligible.)

- Definitive clinical or radiologic evidence of metastatic disease.

- Synchronous bilateral breast cancer (invasive or DCIS).

- Treatment including radiation therapy, chemotherapy, biotherapy, and/or hormonal
therapy for the currently diagnosed breast cancer prior to study entry.

- Any sex hormonal therapy, e.g., birth control pills, ovarian hormonal replacement
therapy, etc. (These patients are eligible if this therapy is discontinued prior to

- Therapy with any hormonal agent such as raloxifene, tamoxifen, or other selective
estrogen receptor modulator (SERM), either for osteoporosis or breast cancer
prevention. (Patients are eligible only if these medications are discontinued prior
to randomization.)

- Prior history of breast cancer, including DCIS. (Patients with a history of lobular
carcinoma in situ [LCIS] are eligible.)

- Prior therapy with anthracyclines, taxanes, capecitabine, 5-FU, gemcitabine, or
bevacizumab for any malignancy.

- Other malignancies unless the patient is considered to be disease-free for 5 or more
years prior to randomization and is deemed by her physician to be at low risk for
recurrence. Patients with the following cancers are eligible if diagnosed and
treated within the past 5 years: carcinoma in situ of the cervix, carcinoma in situ
of the colon, melanoma in situ, and basal cell and squamous cell carcinoma of the

- Cardiac disease that would preclude the use of anthracyclines. This includes:

- angina pectoris that requires the use of anti-anginal medication;

- history of documented congestive heart failure;

- serious cardiac arrhythmia requiring medication;

- severe conduction abnormality;

- valvular disease with documented cardiac function compromise; and

- uncontrolled hypertension defined as BP greater than 150/90 on antihypertensive
therapy. (Patients with hypertension that is well controlled on medication are

- History of myocardial infarction documented by elevated cardiac enzymes or persistent
regional wall abnormalities on assessment of LV function.

- History of transient ischemic attack (TIA) or cerebrovascular accident (CVA).

- History of other arterial thrombotic event within 12 months before study entry.

- Symptomatic peripheral vascular disease.

- Any significant non-traumatic bleeding within 6 months before study entry.

- Serious or non-healing wound, skin ulcers, or incompletely healed bone fracture.

- Gastroduodenal ulcer(s) determined by endoscopy to be active.

- Invasive procedures defined as follows:

- Major surgical procedure, open biopsy, or significant traumatic injury within 28
days prior to planned start of study therapy. (Note: Placement of a vascular
access device is not considered a major surgical procedure.)

- Anticipation of need for major surgical procedures (other than the required
breast surgery) during the course of the study.

- Known bleeding diathesis or coagulopathy. (Patients on warfarin with an in-range
international normalized ration [INR] [usually between 2 and 3] are eligible.)

- Sensory/motor neuropathy greater than or equal grade 2, as defined by the NCI's
Common Terminology Criteria for Adverse Events Version 3.0 (CTCAE v3.0).

- Other non-malignant systemic disease (cardiovascular, renal, hepatic, etc.) that
would preclude treatment with any of the treatment regimens or would prevent required

- Conditions that would prohibit administration of corticosteroids.

- History of severe hypersensitivity reaction to drugs formulated with polysorbate 80.

- Administration of any investigational agents within 30 days before study entry.

- Pregnancy or lactation at the time of proposed randomization.

Type of Study:


Study Design:

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

Outcome Measure:

Pathologic complete response (pCR) of the primary tumor in the breast

Outcome Description:

No histologic evidence of invasive tumor cells in the breast specimen removed at surgery

Outcome Time Frame:

Time of surgery, on average 6 or 13 months

Safety Issue:


Principal Investigator

Norman Wolmark, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

NSABP Foundation, Inc.


United States: Food and Drug Administration

Study ID:




Start Date:

November 2006

Completion Date:

March 2016

Related Keywords:

  • Breast Cancer
  • stage I breast cancer
  • stage II breast cancer
  • stage IIIA breast cancer
  • Breast Neoplasms



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Randolph Hospital Asheboro, North Carolina  27203
Moses Cone Regional Cancer Center at Wesley Long Community Hospital Greensboro, North Carolina  27401
Annie Penn Cancer Center Reidsville, North Carolina  27320
Altru Cancer Center at Altru Hospital Grand Forks, North Dakota  58201
Cancer Treatment Center Wooster, Ohio  44691
Allegheny Cancer Center at Allegheny General Hospital Pittsburgh, Pennsylvania  15212
Western Pennsylvania Cancer Institute at Western Pennsylvania Hospital Pittsburgh, Pennsylvania  15224-1791
Kaiser Permanente - Denver Denver, Colorado  80205
Kaiser Permanente - Lafayette Lafayette, Colorado  80026
Eastern Connecticut Hematology and Oncology Associates Norwich, Connecticut  06360
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
Herbert D. Kerman Regional Oncology Center - Daytona Beach Daytona Beach, Florida  32114
Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital Fort Lauderdale, Florida  33308
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler Savannah, Georgia  31405
Kaiser Permanente - Moanalua Medical Center and Clinic Honolulu, Hawaii  96819
Elkhart Clinic, LLC Elkhart, Indiana  46514-2098
Michiana Hematology-Oncology, PC - South Bend Mishawaka, Indiana  46545-1470
Reid Hospital & Health Care Services Richmond, Indiana  47374
McFarland Clinic, PC Ames, Iowa  50010
Cancer Center of Kansas, PA - Chanute Chanute, Kansas  66720
Cancer Center of Kansas, PA - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas - Fort Scott Fort Scott, Kansas  66701
Cancer Center of Kansas-Independence Independence, Kansas  67301
Cancer Center of Kansas, PA - Kingman Kingman, Kansas  67068
Lawrence Memorial Hospital Lawrence, Kansas  66044
Cancer Center of Kansas, PA - Newton Newton, Kansas  67114
Menorah Medical Center Overland Park, Kansas  66209
Saint Luke's Hospital - South Overland Park, Kansas  66213
Cancer Center of Kansas, PA - Parsons Parsons, Kansas  67357
Cancer Center of Kansas, PA - Pratt Pratt, Kansas  67124
Cancer Center of Kansas, PA - Salina Salina, Kansas  67401
Shawnee Mission Medical Center Shawnee Mission, Kansas  66204
Cancer Center of Kansas, PA - Wellington Wellington, Kansas  67152
Cancer Center of Kansas, PA - Wichita Wichita, Kansas  67214
Associates in Womens Health, PA - North Review Wichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas, PA - Winfield Winfield, Kansas  67156
Ochsner Health Center - Bluebonnet Baton Rouge, Louisiana  70809
Greater Baltimore Medical Center Cancer Center Baltimore, Maryland  21204
Foote Memorial Hospital Jackson, Michigan  49201
Haematology-Oncology Associates of Ohio and Michigan, PC Lambertville, Michigan  48144
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
Truman Medical Center - Hospital Hill Kansas City, Missouri  64108
St. Joseph Medical Center Kansas City, Missouri  64114
Heartland Hematology Oncology Associates, Incorporated Kansas City, Missouri  64118
North Kansas City Hospital Kansas City, Missouri  64116
Saint Luke's Cancer Institute at Saint Luke's Hospital Kansas City, Missouri  64111
Research Medical Center Kansas City, Missouri  64132
Saint Luke's East - Lee's Summit Lee's Summit, Missouri  64086
Liberty Hospital Liberty, Missouri  64068
Heartland Regional Medical Center Saint Joseph, Missouri  64506
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
Kalispell Medical Oncology at KRMC Kalispell, Montana  59901
Alegant Health Cancer Center at Bergan Mercy Medical Center Omaha, Nebraska  68124
Summa Center for Cancer Care at Akron City Hospital Akron, Ohio  44309-2090
Barberton Citizens Hospital Barberton, Ohio  44203
North Coast Cancer Care - Clyde Clyde, Ohio  43410
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center Columbus, Ohio  43210-1240
Hematology Oncology Center Elyria, Ohio  44035
Community Cancer Center Elyria, Ohio  44035
Wayne Hospital Greenville, Ohio  45331
Fisher-Titus Medical Center Norwalk, Ohio  44857
Flower Hospital Cancer Center Sylvania, Ohio  43560
St. Anne Mercy Hospital Toledo, Ohio  43623
Clinton Memorial Hospital Wilmington, Ohio  45177
Cleo Craig Cancer Research Clinic Lawton, Oklahoma  73505
St. Luke's Cancer Network at St. Luke's Hospital Bethlehem, Pennsylvania  18015
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
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
Providence Centralia Hospital Centralia, Washington  98531-9027
Franciscan Cancer Center at St. Joseph Medical Center Tacoma, Washington  98405-3004
Community Comprehensive Cancer Center at Camden-Clark Memorial Hospital Parkersburg, West Virginia  26102
Marshfield Clinic - Chippewa Center Chippewa Falls, Wisconsin  54729
Marshfield Clinic Cancer Care at Regional Cancer Center Eau Claire, Wisconsin  54701
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center Green Bay, Wisconsin  54311
Saint Joseph's Hospital Marshfield, Wisconsin  54449
Marshfield Clinic - Lakeland Center Minocqua, Wisconsin  54548
Ministry Medical Group at Saint Mary's Hospital Rhinelander, Wisconsin  54501
Marshfield Clinic at Saint Michael's Hospital Stevens Point, Wisconsin  54481
Marshfield Clinic - Wausau Center Wausau, Wisconsin  54401
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494
Cancer Resource Center at King's Daughters Medical Center Ashland, Kentucky  41101
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
Saint Louis University Cancer Center Saint Louis, Missouri  63110
Auburn Regional Center for Cancer Care Auburn, Washington  98002
John H. Stroger, Jr. Hospital of Cook County Chicago, Illinois  60612-9985
Community Hospital Munster, Indiana  46321
Aurora Sinai Medical Center Milwaukee, Wisconsin  53201-0342
St. Joseph Hospital Regional Cancer Center - Orange Orange, California  92868-3849
Phoebe Cancer Center at Phoebe Putney Memorial Hospital Albany, Georgia  31702
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
MetroWest Medical Center - Framingham Union Hospital Framingham, Massachusetts  01702
Good Samaritan Cancer Center at Good Samaritan Hospital Kearney, Nebraska  68848-1990
Tucker Center for Cancer Care at Orange Regional Medical Center Middletown, New York  10940-4199
Rutherford Hospital Rutherfordton, North Carolina  28139
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
St. Francis Hospital Evanston, Illinois  60202
Frederick Memorial Hospital Regional Cancer Therapy Center Frederick, Maryland  21701
Lapeer Regional Hospital Lapeer, Michigan  48446
St. John's Regional Medical Center Joplin, Missouri  64804
MBCCOP - Meharry Medical College - Nashville Nashville, Tennessee  37208-3599
Great Falls, Montana  59405
Guardian Oncology and Center for Wellness Missoula, Montana  59804
Roper St. Francis Cancer Center at Roper Hospital Charleston, South Carolina  29401
Louisville Oncology at Norton Cancer Institute - Louisville Louisville, Kentucky  40202
Scripps Cancer Center - San Diego San Diego, California  92121
Doctors Medical Center - San Pablo Campus San Pablo, California  94806
Galesburg Clinic, PC Galesburg, Illinois  61401
St. Vincent Healthcare Cancer Care Services Billings, Montana  59101
University of Tennessee Cancer Institute - Memphis Memphis, Tennessee  38104
Desert Regional Medical Center Comprehensive Cancer Center Palm Springs, California  92262
Parvin Radiation Oncology Kansas City, Missouri  64116
Midwest Hematology Oncology Group, Incorporated Saint Louis, Missouri  63109
East Bay Radiation Oncology Center Castro Valley, California  94546
Contra Costa Regional Medical Center Martinez, California  94553-3156
El Camino Hospital Cancer Center Mountain View, California  94040
Larry G Strieff MD Medical Corporation Oakland, California  94609
Tom K Lee, Incorporated Oakland, California  94609
Bay Area Breast Surgeons, Incorporated Oakland, California  94609
Valley Medical Oncology Consultants - Pleasanton Pleasanton, California  94588
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
Illinois CancerCare - Bloomington Bloomington%, Illinois  61701
Illinois CancerCare - Canton Canton, Illinois  61520
Illinois CancerCare - Carthage Carthage, Illinois  62321
Alexian Brothers Radiation Oncology Elk Grove Village, Illinois  60007
Illinois CancerCare - Eureka Eureka, Illinois  61530
Illinois CancerCare - Galesburg Galesburg, Illinois  61401
Illinois CancerCare - Havana Havana, Illinois  62644
Illinois CancerCare - Kewanee Clinic Kewanee, Illinois  61443
Illinois CancerCare - Macomb Macomb, Illinois  61455
OSF Holy Family Medical Center Monmouth, Illinois  61462
Illinois CancerCare - Monmouth Monmouth, Illinois  61462
Illinois CancerCare - Community Cancer Center Normal, Illinois  61761
Illinois CancerCare - Pekin Pekin, Illinois  61603
Illinois CancerCare - Peru Peru, Illinois  61354
Illinois CancerCare - Princeton Princeton, Illinois  61356
Illinois CancerCare - Spring Valley Spring Valley, Illinois  61362
York Hospital's Oncology Treatment Center York, Maine  03909
Hattiesburg Clinic, PA at Forrest General Hattiesburg, Mississippi  39401
Cancer Center of Paoli Memorial Hospital Paoli, Pennsylvania  19301-1792
CCOP - Main Line Health Wynnewood, Pennsylvania  19096
AnMed Cancer Center Anderson, South Carolina  29621
Cancer Care Center, Incorporated Salem, Ohio  44460
Center for Cancer Care at Goshen General Hospital Goshen, Indiana  46526
Valley Medical Oncology Consultants - Castro Valley Castro Valley, California  94546
Valley Medical Oncology Fremont, California  94538
Cancer Care Associates Fresno, California  93720
Memorial Hospital Cancer Center - Colorado Springs Colorado Springs, Colorado  80909
Mount Sinai Hospital Medical Center Chicago, Illinois  60608
Alamance Cancer Center at Alamance Regional Medical Center Burlington, North Carolina  27216
Marion L. Shepard Cancer Center at Beaufort County Hospital Washington, North Carolina  27889
Nashville Oncology Associates, PC Nashville, Tennessee  37203
Associates in Oncology and Hematology - Medical Center Drive Rockville, Maryland  20878
St. Agnes Hospital Cancer Center Baltimore, Maryland  21229
Aurora Women's Pavilion of West Allis Memorial Hospital West Allis, Wisconsin  53227
Vince Lombardi Cancer Clinic - Oshkosh Oshkosh, Wisconsin  54904
Kootenai Cancer Center - Coeur d'Alene Coeur d'Alene, Idaho  83814
Illinois CancerCare - Cottage Galesburg, Illinois  61401
Saint Francis Hospital Cancer Center Poughkeepsie, New York  12601
Cherry Tree Cancer Center Hanover, Pennsylvania  17331