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A Randomized Phase III Double-Blind Placebo-Controlled Trial of First-Line Chemotherapy and Trastuzumab With or Without Bevacizumab for Patients With HER-2/NEU Over-Expressing Metastatic Breast Cancer


Phase 3
18 Years
N/A
Open (Enrolling)
Both
HER2-positive Breast Cancer, Male Breast Cancer, Recurrent Breast Cancer, Stage IV Breast Cancer

Thank you

Trial Information

A Randomized Phase III Double-Blind Placebo-Controlled Trial of First-Line Chemotherapy and Trastuzumab With or Without Bevacizumab for Patients With HER-2/NEU Over-Expressing Metastatic Breast Cancer


PRIMARY OBJECTIVE:

I. Evaluate efficacy of the addition of bevacizumab in patients eligible for first-line
trastuzumab with chemotherapy for HER-2/NEU overexpressing metastatic breast cancer, by
assessing the progression-free survival (PFS) after initiation of combination therapy.

SECONDARY OBJECTIVES:

I. Evaluate response rates (RR) in patients with measurable disease (RECIST), when
applicable.

II. Evaluate overall survival (OS). III. Evaluate time to progression (TTP). IV. Evaluate
the percent of patients who are progression-free (PPF) at 6 months.

V. Compare the toxicity of chemotherapy/trastuzumab to that of chemotherapy/ trastuzumab in
combination with bevacizumab.

VI. Compare breast cancer symptoms and treatment related symptoms between patients receiving
chemotherapy and trastuzumab with or without bevacizumab.

VII. Evaluate whether PFS correlates with VEGF levels in breast tumor tissue. VIII. Analysis
of Circulating Tumor Cells and Circulating Endothelial Cells (CEC).

IX. Serially enumerate CTC and CEC in patients on study and determine whether: The number of
CTC and CEC decrease in responding patients; the extent of CTC and CEC decrease is greater
in the experimental arm, Arm B versus the control arm, Arm A; enumeration of CTC and CEC in
responding patients correlate with progression free survival (PFS).

X. Perform an exploratory analysis of phosphorylation status of akt-2 in circulating tumor
cells.

XI. Perform an exploratory analysis of RT-PCR of CTC mRNA to determine whether change in
expression of selected down stream targets of bevacizumab therapy can serve as
pharmacodynamic or surrogate markers of bevacizumab targeting and modulation.

OUTLINE: This is a multicenter study. Patients are stratified according to prior treatment
with adjuvant trastuzumab (Herceptin) (yes vs no), prior treatment with neoadjuvant or
adjuvant taxane (yes vs no), disease-free interval (> 24 months vs =< 24 months), and
planned treatment with carboplatin (yes vs no). Patients are randomized to 1 of 2 treatment
arms.

ARM A:

INDUCTION THERAPY: Patients receive trastuzumab intravenously (IV) over 30-90 minutes on
days 1, 8, 15, and 22 and paclitaxel IV over 60 minutes with or without carboplatin IV over
60 minutes on days 1, 8, and 15. Patients also receive placebo IV over 30-90 minutes on day
1 and 15. Treatment repeats every 4 weeks for 6 courses in the absence of disease
progression or unacceptable toxicity.

MAINTENANCE THERAPY: Beginning 1 week after the last dose of induction trastuzumab, patients
receive trastuzumab IV over 30-90 minutes and placebo IV over 30-90 minutes on day 1.
Treatment repeats every 3 weeks in the absence of disease progression or unacceptable
toxicity.

ARM B:

INDUCTION THERAPY: Patients receive trastuzumab and paclitaxel with or without carboplatin
as in arm A. Patients also receive bevacizumab IV over 30-90 minutes on days 1 and 15.
Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or
unacceptable toxicity.

MAINTENANCE THERAPY: Beginning 1 week after the last dose of induction trastuzumab, patients
receive trastuzumab IV over 30-90 minutes and bevacizumab IV over 30-90 minutes on day 1.
Treatment repeats every 3 weeks in the absence of disease progression or unacceptable
toxicity.

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


Inclusion Criteria:



- ECOG performance status of 0 or 1

- Histologically confirmed breast cancer that overexpresses HER-2/NEU

- HER-2/NEU overexpression is defined as 3+ HER-2 positivity as measured by
immunohistochemistry OR HER-2 gene amplification as measured by FISH

- Evidence of metastatic disease and/or chest wall recurrence

- Evaluable (measurable or non-measurable) disease is allowed if confirmed within 4
weeks prior to study randomization

- No history or radiologic evidence of CNS disease

- Platelet count >= 100,000/mm^3

- Total bilirubin =< 1.5 mg/dL

- AST =< 2 times upper limit of normal (ULN) (=< 5 times normal in patients with known
liver involvement)

- Serum creatinine =< 1.5 mg/dL

- Urine protein:creatinine ratio =< 0.5 OR 24-hour urine protein < 1,000 mg

- INR =< 1.5 times ULN

- PTT =< 1.5 times ULN

- LVEF above the lower limit of normal by MUGA scan or ECHO

- No grade 2-4 neuropathy

- No unstable angina pectoris

- No serious cardiac arrhythmia requiring medication

- No clinically significant peripheral vascular disease

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No current non-healing wound or fracture

- No hypersensitivity to Chinese hamster ovary cell products or other recombinant human
antibodies, paclitaxel, or drugs using the vehicle Cremophor

- No serious medical or psychiatric illness that would preclude study participation

- No other active malignancy within the past 5 years except carcinoma in situ of the
cervix or nonmelanoma skin cancer

- Adjuvant or neoadjuvant taxane therapy for breast cancer is allowed provided last
dose was given >= 12 months prior to diagnosis of recurrence

- No prior chemotherapy, trastuzumab, or bevacizumab for metastatic breast cancer

- No prior cumulative dose of doxorubicin hydrochloride > 360 mg/m2 or epirubicin
hydrochloride > 640 mg/m2 (in the neoadjuvant or adjuvant setting)

- More than 4 weeks since prior major surgical procedure (except for non-operative
biopsy)

- More than 7 days since prior placement of a vascular access device

- Concurrent full-dose anticoagulants (e.g., warfarin) with PT/INR > 1.5 allowed
provided the following criteria are met:

- In-range INR (usually between 2 and 3) on a stable dose of oral anticoagulant or on a
stable dose of low molecular weight heparin

- No active bleeding or pathological condition that carries a high risk of bleeding
(e.g., tumor involving major vessels or known varices)

- No concurrent local radiotherapy for pain control or life-threatening situations

- No concurrent drugs known to inhibit platelet function, including the following:

- dipyridamole,

- ticlopidine,

- clopidogrel,

- cilostazol

- Adjuvant trastuzumab (Herceptin) therapy for breast cancer is allowed provided last
dose was given >= 12 months prior to diagnosis of recurrence

- Adjuvant or neoadjuvant therapy with lapatinib ditosylate is allowed provided last
dose was given >= 4 weeks prior to diagnosis of recurrence

- Absolute neutrophil count >= 1,000/mm^3

- No clinically significant cardiovascular disease

- No cerebrovascular accident within the past 6 months

- No myocardial infarction or unstable angina within the past 6 months

- No New York Heart Association class II-IV congestive heart failure

- No uncontrolled hypertension

- Endocrine treatment in the adjuvant or metastatic setting is allowed, provided last
dose given >= 2 weeks prior to randomization

- More than 3 weeks since prior radiotherapy

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Outcome Measure:

Progression-free survival

Outcome Description:

This primary comparison will be performed using a one-sided log rank test stratified using an overall type I error of 2.5%.

Outcome Time Frame:

From randomization to progression per RECIST, new second breast cancer primaries or to death from any cause without documentation of progression, whichever occurs first, assessed up to 10 years

Safety Issue:

No

Principal Investigator

Ingrid Mayer

Investigator Role:

Principal Investigator

Investigator Affiliation:

Eastern Cooperative Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00504

NCT ID:

NCT00520975

Start Date:

November 2007

Completion Date:

Related Keywords:

  • HER2-positive Breast Cancer
  • Male Breast Cancer
  • Recurrent Breast Cancer
  • Stage IV Breast Cancer
  • Breast Neoplasms
  • Breast Neoplasms, Male

Name

Location

Albert Einstein College of MedicineBronx, New York  10461
Roswell Park Cancer InstituteBuffalo, New York  14263
Mayo ClinicRochester, Minnesota  55905
Washington University School of MedicineSaint Louis, Missouri  63110
University of Washington Medical CenterSeattle, Washington  98195-6043
Hurley Medical CenterFlint, Michigan  48503
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
Morristown Memorial HospitalMorristown, New Jersey  07962-1956
Ingalls Memorial HospitalHarvey, Illinois  60426
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Memorial Hospital of South BendSouth Bend, Indiana  46601
Mary Bird Perkins Cancer CenterBaton Rouge, Louisiana  70809
Grand View HospitalSellersville, Pennsylvania  18960
Virginia Piper Cancer InstituteMinneapolis, Minnesota  55407
Eastern Maine Medical CenterBangor, Maine  04401
Camden-Clark Memorial HospitalParkersburg, West Virginia  26102
Via Christi Regional Medical CenterWichita, Kansas  67214
Scott and White Memorial HospitalTemple, Texas  76508
Iowa Methodist Medical CenterDes Moines, Iowa  50309
Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
Cape Fear Valley Health SystemFayetteville, North Carolina  28302-2000
Group Health CooperativeSeattle, Washington  98112
University of Wisconsin Hospital and ClinicsMadison, Wisconsin  53792-0001
Great Falls ClinicGreat Falls, Montana  59405
Overlook HospitalSummit, New Jersey  07902-0220
Fred Hutchinson Cancer Research Center/University of Washington Cancer ConsortiumSeattle, Washington  98109
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
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
Harborview Medical CenterSeattle, Washington  98104
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Welch Cancer CenterSheridan, Wyoming  82801
Elkhart General HospitalElkhart, Indiana  46515
South Bend ClinicSouth Bend, Indiana  46617
Saint Rose HospitalHayward, California  94545
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
Memorial HospitalCarthage, Illinois  62321
Hematology and Oncology AssociatesChicago, Illinois  60611
Galesburg Cottage HospitalGalesburg, Illinois  61401
Galesburg ClinicGalesburg, Illinois  61401
Mason District HospitalHavana, Illinois  62644
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
Community Cancer Center of MonroeMonroe, Michigan  48162
Bismarck Cancer CenterBismarck, North Dakota  58501
Grandview HospitalDayton, Ohio  45405
Lima Memorial HospitalLima, Ohio  45804
Mercy Medical CenterSpringfield, Ohio  45504
Mercy Hospital of TiffinTiffin, Ohio  44883
Fulton County Health CenterWauseon, Ohio  43567
Providence Milwaukie HospitalMilwaukie, Oregon  97222
Danville Regional Medical CenterDanville, Virginia  24541
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
Pekin HospitalPekin, Illinois  61554
Medical Oncology and Hematology AssociatesDes Moines, Iowa  50309
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
Saint Luke's HospitalMaumee, Ohio  43537
Lancaster General HospitalLancaster, Pennsylvania  17604-3555
Highland General HospitalOakland, California  94602
Pomona Valley Hospital Medical CenterPomona, California  91767
Center for Cancer Care and ResearchSt. Louis, Missouri  63141
Miami Valley HospitalDayton, Ohio  45409
Eastern Connecticut Hematology and Oncology AssociatesNorwich, Connecticut  06360
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
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
Northern Montana HospitalHavre, Montana  59501
Mary Rutan HospitalBellefontaine, Ohio  43311
Wayne HospitalGreenville, Ohio  45331
Clinton Memorial HospitalWilmington, Ohio  45177
Adventist Medical CenterPortland, Oregon  97216
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
Diagnostic and Treatment CenterWeston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids CenterWisconsin Rapids, Wisconsin  54494
Longmont United HospitalLongmont, Colorado  80501
Baton Rouge General Medical CenterBaton Rouge, Louisiana  70821-2511
Zale Lipshy University HospitalDallas, Texas  75235-7786
Greene Memorial HospitalXenia, Ohio  45385
Greater Baltimore Medical CenterBaltimore, Maryland  21204
Memorial Medical CenterSpringfield, Illinois  62781
Doylestown HospitalDoylestown, Pennsylvania  18901
Guardian Oncology and Center for WellnessMissoula, Montana  59804
Queen's Medical CenterHonolulu, Hawaii  96813
Woodwinds Health CampusWoodbury, Minnesota  55125
Vanderbilt UniversityNashville, Tennessee  37232-6305
Northwestern UniversityChicago, Illinois  60611
Cancer Care AssociatesTulsa, Oklahoma  74136
East Bay Radiation Oncology CenterCastro Valley, California  94546
Contra Costa Regional Medical CenterMartinez, California  94553-3156
Larry G Strieff MD Medical CorporationOakland, California  94609
Hennepin County Medical CenterMinneapolis, Minnesota  
University of RochesterRochester, New York  14642
El Camino HospitalMountain View, California  94040
Case Western Reserve UniversityCleveland, Ohio  44106
Emory UniversityAtlanta, Georgia  30322
Wayne State UniversityDetroit, Michigan  48202
Riverside Methodist HospitalColumbus, Ohio  43214
Licking Memorial HospitalNewark, Ohio  43055-2899
Providence Portland Medical CenterPortland, Oregon  97213-3635
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
University of Texas Southwestern Medical CenterDallas, Texas  
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
Decatur Memorial HospitalDecatur, Illinois  62526
Louisiana State University Health Science CenterNew Orleans, Louisiana  70112
Montana Cancer SpecialistsMissoula, Montana  59807-7877
Memorial Health University Medical CenterSavannah, Georgia  31404
Northern Indiana Cancer Research ConsortiumSouth Bend, Indiana  
Hawaii Medical Center EastHonolulu, Hawaii  96817
OSF Saint Francis Medical CenterPeoria, Illinois  61637
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
Community Hospital of Monterey PeninsulaMonterey, California  93940
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
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
Saint Joseph's-Candler Health SystemSavannah, Georgia  31405
University of HawaiiHonolulu, Hawaii  96813
Rush - Copley Medical CenterAurora, Illinois  60504
John H Stroger Jr Hospital of Cook CountyChicago, Illinois  60612-3785
Evanston CCOP-NorthShore University HealthSystemEvanston, Illinois  60201
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
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
Wishard HospitalIndianapolis, Indiana  46202
Saint Vincent Hospital and Health ServicesIndianapolis, Indiana  46260
Saint Anthony Memorial Health CenterMichigan City, Indiana  46360
Reid Hospital and Health Care ServicesRichmond, Indiana  47374
McFarland ClinicAmes, Iowa  50010
Constantinou, Costas L MD (UIA Investigator)Bettendorf, Iowa  52722
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
Covenant Medical CenterWaterloo, Iowa  50702
Cancer Center of Kansas - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas-KingmanKingman, Kansas  67068
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
Medical Center of LouisianaNew Orleans, Louisiana  70112
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
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
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
Miller-Dwan HospitalDuluth, Minnesota  55805
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
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
Saint John's Regional Medical CenterJoplin, Missouri  64804
Missouri Baptist Medical CenterSaint Louis, Missouri  63131
Ozark Health Ventures LLC dba Cancer Research for The Ozarks SpringfieldSpringfield, Missouri  65802
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
Benefis Healthcare- Sletten Cancer InstituteGreat Falls, Montana  59405
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
Good Samaritan HospitalKearney, Nebraska  68847
Portsmouth Regional HospitalPortsmouth, New Hampshire  03802
South Jersey HealthcareVineland, New Jersey  08360
Orange Regional Medical CenterMiddletown, New York  10940
Interlakes Foundation Inc-RochesterRochester, New York  14623
State University of New York Upstate Medical UniversitySyracuse, New York  13210
Mission Hospitals IncAsheville, North Carolina  28801
Gaston Memorial HospitalGastonia, North Carolina  28054
Wayne Memorial HospitalGoldsboro, North Carolina  27534
Margaret R Pardee Memorial HospitalHendersonville, North Carolina  28791
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
Providence Saint Vincent Medical CenterPortland, Oregon  97225
Columbia River Oncology ProgramPortland, Oregon  97225
Pottstown Memorial Medical CenterPottstown, Pennsylvania  19464
Saint Joseph Medical CenterReading, Pennsylvania  19605
Hematology and Oncology Associates of Rhode Island IncCranston, Rhode Island  02920
Kent County HospitalWarwick, Rhode Island  02886
Conklin Regional Cancer CenterAberdeen, South Dakota  57401
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
West Virginia UniversityMorgantown, West Virginia  26506
Langlade Hospital and Cancer CenterAntigo, Wisconsin  54409
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
Bay Area Medical CenterMarinette, Wisconsin  54143
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
University of IllinoisChicago, Illinois  60612
York HospitalYork, Maine  03909
Portneuf Medical CenterPocatello, Idaho  83201
Illinois CancerCare-BloomingtonBloomington%, Illinois  61701
Illinois CancerCare-CantonCanton, Illinois  61520
Illinois CancerCare-CarthageCarthage, Illinois  62321
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
The Memorial Hospital at EastonEaston, Maryland  21601
Memorial Hospital at Easton - Shore Regional Cancer CenterEaston, Maryland  21601
North Coast Cancer Care-ClydeClyde, Ohio  43410
Erlanger Medical CenterChattanooga, Tennessee  37403
Saint Paul HospitalDallas, Texas  75235
West Virginia University CharlestonCharleston, West Virginia  25304
Riverview HospitalWisconsin Rapids, Wisconsin  54494
University of Miami Miller School of Medicine-Sylvester Cancer CenterMiami, Florida  33136
Grady Health SystemAtlanta, Georgia  30303
Capital Regional Medical CenterJefferson City, Missouri  65101
Hematology Oncology Associates-BerwynBerwyn, Illinois  60402
Hinsdale Hematology Oncology Associates IncorporatedHinsdale, Illinois  60521
Spector, David MD (UIA Investigator)Moline, Illinois  61265
University of Tennessee - MemphisMemphis, Tennessee  38163
Siouxland Hematology Oncology AssociatesSioux City, Iowa  51101
IU Health ArnettLafayette, Indiana  
Carle Foundation - Carle Cancer CenterUrbana, Illinois  61801
Emory University Hospital MidtownAtlanta, Georgia  30308
Eastern Cooperative Oncology GroupBoston, Massachusetts  02215
The Toledo Hospital/Toledo Children's HospitalToledo, Ohio  43606
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
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
Illinois Cancer Specialists-NilesNiles, Illinois  60714
Springfield Regional Medical CenterSpringfield, Ohio  45505
NEA Baptist Memorial HospitalJonesboro, Arkansas  72401
Edward Hospital/Cancer CenterNaperville, Illinois  60540
Toledo Clinic Cancer Centers-Bowling GreenBowling Green, Ohio  43402
Toledo Clinic Cancer Centers-MaumeeMaumee, Ohio  43537-1839
Toledo Clinic Cancer Centers-ToledoToledo, Ohio  43623
PeaceHealth Southwest Medical CenterVancouver, Washington  98664