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Endocrine Therapy With or Without Anti-VEGF Therapy: A Randomized, Phase III Trial of Endocrine Therapy Alone or Endocrine Therapy Plus Bevacizumab (NSC 704865; IND 7921) for Women With Hormone Receptor-Positive Advanced Breast Cancer


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Recurrent Breast Cancer, Stage IIIB Breast Cancer, Stage IV Breast Cancer

Thank you

Trial Information

Endocrine Therapy With or Without Anti-VEGF Therapy: A Randomized, Phase III Trial of Endocrine Therapy Alone or Endocrine Therapy Plus Bevacizumab (NSC 704865; IND 7921) for Women With Hormone Receptor-Positive Advanced Breast Cancer


PRIMARY OBJECTIVES:

I. To compare the progression-free survival of women with estrogen- and/or
progesterone-receptor-positive stage IIIB-IV breast cancer treated with letrozole with vs
without bevacizumab as first-line treatment.

SECONDARY OBJECTIVES:

I. To compare the proportion of patients receiving letrozole with or without bevacizumab who
remain progression-free at 6 and 12 months.

II. To compare the incidence of objective response (complete response [CR] + partial
response [PR]) in patients receiving letrozole with or without bevacizumab, as determined by
RECIST criteria, excluding patients with non-measurable disease.

III. To compare the incidence of clinical benefit (CR + PR + stable disease >= 6 months) in
patients receiving letrozole with or without bevacizumab.

IV. To compare the duration of objective response in patients receiving letrozole with or
without bevacizumab.

V. To compare the time to treatment failure, defined as the interval from randomization
until progression, toxicity, withdrawn consent, or going onto non protocol therapy, in
patients receiving letrozole with or without bevacizumab.

VI. To compare the overall survival of patients receiving letrozole with or without
bevacizumab, including the probability of survival until 36 months.

V. To compare toxicity levels of bevacizumab in both the letrozole-treated patients and in
the tamoxifen-treated* patients.

VI. To compare progression-free survival and overall survival of all patients receiving
endocrine therapy with and without bevacizumab (by combining both letrozole and tamoxifen*
patient subgroups). NOTE: *As of 5/15/2011, patients only receive letrozole.

OUTLINE: This is a multicenter study. Patients are stratified according to planned endocrine
therapy* (letrozole vs tamoxifen*), disease measurability (no vs yes), and disease-free
interval from initial diagnosis to first progression (≤ 24 months vs > 24 months). Patients
are randomized to 1 of 2 treatment arms.

NOTE: The placebo-controlled portion of the study was canceled on 5-15-10

ARM I: Patients receive oral endocrine therapy* (tamoxifen citrate or letrozole) once daily
on days 1-21 and bevacizumab IV on day 1. Treatment repeats every 21 days in the absence of
disease progression or unacceptable toxicity.

ARM II: Patients receive oral endocrine therapy* (tamoxifen citrate or letrozole) once daily
on days 1-21. Treatment repeats every 21 days in the absence of disease progression or
unacceptable toxicity.

After completion of study therapy, patients are followed up every 6 months for the first 2
years and then annually for up to 3 years.

NOTE: As of 5/15/2011, patients only receive letrozole.


Inclusion Criteria:



- Histologic confirmation of invasive cancer of the female breast in either the primary
or metastatic setting

- Stage IIIB disease not amenable to local therapy or stage IV disease

- Must have measurable or nonmeasurable disease by RECIST criteria, with radiologic
scans (CT scan of the chest/abdomen)

- Measurable disease is defined as lesions that can be accurately measured in at
least one dimension (longest diameter to be recorded) as ≥ 2.0 cm with
conventional techniques or as ≥ 1.0 cm with spiral CT scan

- Nonmeasurable disease is defined as all other lesions, including small lesions
(longest diameter < 2.0 cm with conventional techniques or < 1.0 cm with spiral
CT scan) and truly nonmeasurable lesions, including any of the following:

- Bone lesions

- Leptomeningeal disease

- Ascites

- Pleural/pericardial effusion

- Inflammatory breast disease

- Abdominal masses that are not confirmed and followed by imaging techniques

- Cystic lesions

- Baseline bone scans required for all patients for determination of metastatic bone
disease

- CT scan with bone windows required only for patients with bone metastases as the
only site of disease

- No known CNS metastases or leptomeningeal disease(screening with brain imaging is not
required for asymptomatic patients)

- Hormone receptor status: tumors (from either primary or metastatic sites) must
express estrogen receptor (ER)and/or progesterone receptor (PgR) in ≥ 1% of cells

- Menopausal status: pre- or postmenopausal, meeting 1 of the following criteria:

- Age ≥ 55 years and one year or more of amenorrhea

- Age < 55 years and one year or more of amenorrhea, with an estradiol assay <
20pg/ml

- Age < 55 with prior hysterectomy but intact ovaries, with an estradiol assay <
20 pg/ml

- Surgical menopause with bilateral oophorectomy

- Ovarian suppression on a luteinizing hormone-releasing hormone agonist
(goserelin acetate or leuprolide acetate)

- Premenopausal women must undergo ovarian suppression prior to beginning
protocol therapy

- Ovarian radiation is not permitted for induction of ovarian
suppression

- ECOG (Zubrod) performance status 0-1

- Life expectancy ≥ 12 weeks

- Granulocytes ≥ 1,000/μl

- Platelet count ≥ 100,000/μl

- Creatinine ≤ 2.0 mg/dL

- Bilirubin ≤ 1.5 times upper limit of normal (ULN) unless due to Gilbert's syndrome

- Transaminases (ALT, AST) ≤ 2.5 times ULN

- INR ≤ 1.6 unless on full dose warfarin

- Urinalysis ≤ 1+ protein

- Proteinuria ≥ 2 + at baseline must demonstrate < 1 g of protein/24 hr or
protein:creatinine ratio < 1 on 24-hoururine collection

- No "currently active" second malignancy other than nonmelanoma skin cancers

- Patients are not considered to have a "currently active" malignancy if they have
completed therapy and are considered by their physician to be at less than 30%
risk of relapse

- Taxane-related neurotoxicity must have resolved to sensory grade < 2

- No motor neuropathy of any grade

- No significant traumatic injury within 28 days prior to study registration

- No history of abdominal fistula, or intra-abdominal abscess within the past 6 months

- No history of GI perforation within the past 12 months

- No history of significant bleeding episodes (e.g., hemoptysis, upper or lower GI
bleeding) within the past 6 months

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

- Uncontrolled hypertension, defined as systolic blood pressure (BP) > 150 mm Hg
and/or diastolic BP > 90 mm Hg on antihypertensive medications

- Prior history of hypertensive crisis or hypertensive encephalopathy

- Myocardial infarction or unstable angina within past 6 months

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

- Symptomatic peripheral vascular disease

- Significant vascular disease (e.g., aortic aneurysm, aortic dissection)

- Significant arterial thrombotic events

- No history of stroke or transient ischemic attack within the past 6 months

- History of seizures must be well controlled with standard medication

- No known allergies to imidazole drugs, (e.g., clotrimazole, ketoconazole, miconazole,
econazole, sulconazole, ticonazole, or terconazole) or compounds structurally similar
to bevacizumab (for patients treated with aromatase inhibitors)

- No known allergies to selective estrogen receptor modulators (e.g., tamoxifen,
raloxifene, or toremifene) or compounds structurally similar to bevacizumab (for
patients treated with tamoxifen) NOTE: As of 5/15/2011, patients only receive
letrozole.

- No serious, non-healing wound, ulcer, or bone fracture

- Not pregnant or nursing

- Negative pregnancy test

- No prior endocrine therapy in the metastatic setting unless tamoxifen or an aromatase
inhibitor was initiated within 4 weeks prior to registration

- If prior endocrine therapy was initiated within the past 4 weeks, the patients
should remain on that chosen hormonal therapy (tamoxifen or aromatase inhibitor)
as the study therapy. NOTE: As of 5/15/2011, patients only receive letrozole.

- Patients who began therapy with tamoxifen (after 5/15/2011), anastrozole or
exemestane must switch to letrozole

- Prior endocrine therapy in the adjuvant setting allowed

- Prior treatment with ovarian suppression is allowed in either the adjuvant or
metastatic setting

- If medical ovarian suppression is being administered it can be initiated any
time prior to or at the start of protocol therapy, and continued throughout the
duration of the trial

- At least 28 days since surgical castration with bilateral oophorectomy

- At least 2 weeks since prior radiotherapy and all toxicities resolved

- At least 12 months since the completion of prior adjuvant or neoadjuvant chemotherapy
and all toxicities must have resolved

- No prior anti-VEGF or VEGFR tyrosine kinase inhibitor therapy

- May have received 1 prior chemotherapy regimen for metastatic disease

- More than 28 days since prior major surgical procedure or open biopsy and fully
recovered from any such procedure

- No core biopsy or other minor surgical procedure (except placement of a vascular
access device) within 7 days prior to study registration

- Prior palliative irradiation of a symptomatic lesion, or one that may produce
disability (e.g., unstable femur) prior to study initiation, provided other
measurable or non-measurable disease is present, is allowed

- Palliative radiotherapy may not be administered during protocol therapy

- Must not have anticipation of need for major surgical procedure during the course of
the study

- Concurrent full-dose anticoagulation therapy is allowed for the treatment of prior
conditions such as venous thromboses or atrial fibrillation, but not for the
treatment of prior arterial thrombotic events

- Patients on full-dose anticoagulants must be on a stable dose of warfarin and
have an in-range INR (usually between 2 and 3) or be on a stable dose flow
molecular weight heparin

- Concurrent antiplatelet agents, daily prophylactic aspirin, or anticoagulation for
atrial fibrillation allowed

- Concurrent treatment with bisphosphonates is allowed and recommended

- No concurrent hormones or other chemotherapeutic agents except for steroids given for
adrenal failure or chronic non-cancer related diseases, hormones administered for
non-disease-related conditions (e.g., insulin for diabetes), and intermittent use of
dexamethasone as an antiemetic in solid tumor protocols

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Progression-free survival

Outcome Time Frame:

From randomization until disease progression or death, assessed up to 3 years

Safety Issue:

No

Principal Investigator

Maura Dickler

Investigator Role:

Principal Investigator

Investigator Affiliation:

Cancer and Leukemia Group B

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00477

NCT ID:

NCT00601900

Start Date:

May 2008

Completion Date:

Related Keywords:

  • Recurrent Breast Cancer
  • Stage IIIB Breast Cancer
  • Stage IV Breast Cancer
  • Breast Neoplasms

Name

Location

Albert Einstein College of Medicine Bronx, New York  10461
Memorial Sloan Kettering Cancer Center New York, New York  10021
University of Iowa Hospitals and Clinics Iowa City, Iowa  52242
University of Mississippi Medical Center Jackson, Mississippi  39216-4505
Washington University School of Medicine Saint Louis, Missouri  63110
Abington Memorial Hospital Abington, Pennsylvania  19001
Hurley Medical Center Flint, Michigan  48503
Sinai Hospital of Baltimore Baltimore, Maryland  21225
Beth Israel Deaconess Medical Center Boston, Massachusetts  02215
Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
North Suburban Medical Center Thornton, Colorado  80229
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Avera Cancer Institute Sioux Falls, South Dakota  57105
CentraCare Clinic Saint Cloud, Minnesota  56303
Rapid City Regional Hospital Rapid City, South Dakota  57709
Morristown Memorial Hospital Morristown, New Jersey  07962-1956
Marshfield Clinic Marshfield, Wisconsin  54449
Sutter Health Western Division Cancer Research Group Greenbrae, California  94904
Ingalls Memorial Hospital Harvey, Illinois  60426
Methodist Medical Center of Illinois Peoria, Illinois  61636
Memorial Hospital of South Bend South Bend, Indiana  46601
Mary Bird Perkins Cancer Center Baton Rouge, Louisiana  70809
Cape Cod Hospital Hyannis, Massachusetts  02601
Marquette General Hospital Marquette, Michigan  49855
Newark Beth Israel Medical Center Newark, New Jersey  07112
Beth Israel Medical Center New York, New York  10003
Lehigh Valley Hospital Allentown, Pennsylvania  18103
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Grand View Hospital Sellersville, Pennsylvania  18960
Waukesha Memorial Hospital Waukesha, Wisconsin  53188
Dana-Farber Cancer Institute Boston, Massachusetts  02115
University of Kansas Medical Center Kansas City, Kansas  66160-7353
Hartford Hospital Hartford, Connecticut  06102-5037
Illinois Masonic Medical Center Chicago, Illinois  60657
Eastern Maine Medical Center Bangor, Maine  04401
Staten Island University Hospital Staten Island, New York  10305
University of Nebraska Medical Center Omaha, Nebraska  68198-3330
Ochsner Clinic Foundation New Orleans, Louisiana  70121
Carolinas Medical Center Charlotte, North Carolina  28232-2861
Iowa Methodist Medical Center Des Moines, Iowa  50309
Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Elmhurst Hospital Center Elmhurst, New York  11373
Weill Medical College of Cornell University New York, New York  10021
Medical Center of Central Georgia Macon, Georgia  31201
Bellin Memorial Hospital Green Bay, Wisconsin  54301
Great Falls Clinic Great Falls, Montana  59405
Overlook Hospital Summit, New Jersey  07902-0220
MetroHealth Medical Center Cleveland, Ohio  44109
Trinity Cancer Care Center Minot, North Dakota  58701
Montefiore Medical Center Bronx, New York  10467-2490
Chester County Hospital West Chester, Pennsylvania  19380
Sibley Memorial Hospital Washington, District of Columbia  20016
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Northern Rockies Radiation Oncology Center Billings, Montana  59101
Bozeman Deaconess Hospital Bozeman, Montana  59715
Big Sky Oncology Great Falls, Montana  59405
Kalispell Medical Oncology Kalispell, Montana  59901
Kalispell Regional Medical Center Kalispell, Montana  59901
Adena Regional Medical Center Chillicothe, Ohio  54601
Grady Memorial Hospital Delaware, Ohio  43015
Fairfield Medical Center Lancaster, Ohio  43130
Avera McKennan Hospital and University Health Center Sioux Falls, South Dakota  57105
Medical X-Ray Center Sioux Falls, South Dakota  57105
Welch Cancer Center Sheridan, Wyoming  82801
Brigham and Women's Hospital Boston, Massachusetts  02115
Mercy Health System Janesville, Wisconsin  53545
Elkhart General Hospital Elkhart, Indiana  46515
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center Columbus, Ohio  43210-1240
Front Range Cancer Specialists Fort Collins, Colorado  80528
Alta Bates Summit Medical Center - Summit Campus Oakland, California  94609
Sutter Solano Medical Center Vallejo, California  94589
Poudre Valley Hospital Fort Collins, Colorado  80524
Beebe Medical Center Lewes, Delaware  19958
Saint Joseph's Hospital of Atlanta Atlanta, Georgia  30342-1701
Piedmont Hospital Atlanta, Georgia  30309
Gwinnett Medical Center Lawrenceville, Georgia  30045
Southern Regional Medical Center Riverdale, Georgia  30274-2600
Memorial Hospital Carthage, Illinois  62321
Mercy Hospital and Medical Center Chicago, Illinois  60616
Galesburg Clinic Galesburg, Illinois  61401
Mason District Hospital Havana, Illinois  62644
McDonough District Hospital Macomb, Illinois  61455
BroMenn Regional Medical Center Normal, Illinois  61761
Proctor Hospital Peoria, Illinois  61614
Perry Memorial Hospital Princeton, Illinois  61356
Salina Regional Health Center Salina, Kansas  67401
Bay Regional Medical Center Bay City, Michigan  48708
Great Plains Regional Medical Center North Platte, Nebraska  69101-6598
Creighton University Medical Center Omaha, Nebraska  68131-2197
Bismarck Cancer Center Bismarck, North Dakota  58501
Providence Milwaukie Hospital Milwaukie, Oregon  97222
Doctor's Hospital of Laredo Laredo, Texas  78041
Danville Regional Medical Center Danville, Virginia  24541
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Eureka Hospital Eureka, Illinois  61530
Graham Hospital Association Canton, Illinois  61520
Holy Family Medical Center Des Plaines, Illinois  60016
Saint Joseph Medical Center Joliet, Illinois  60435
Trinity Medical Center Moline, Illinois  61265-1291
Medical Oncology and Hematology Associates Des Moines, Iowa  50309
Saint Joseph Mercy Hospital Ann Arbor, Michigan  48106
Rice Memorial Hospital Willmar, Minnesota  56201
Altru Cancer Center Grand Forks, North Dakota  58206
Highland General Hospital Oakland, California  94602
Pomona Valley Hospital Medical Center Pomona, California  91767
Northeast Georgia Medical Center Gainesville, Georgia  30501
Randolph Hospital Asheboro, North Carolina  27203
Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
Northern Montana Hospital Havre, Montana  59501
Mary Rutan Hospital Bellefontaine, Ohio  43311
Knox Community Hospital Mount Vernon, Ohio  43050
Adventist Medical Center Portland, Oregon  97216
Marshfield Clinic Cancer Care at Regional Cancer Center Eau Claire, Wisconsin  54701
Saint Joseph's Hospital Marshfield, Wisconsin  54449
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494
Rocky Mountain Oncology Casper, Wyoming  82609
Longmont United Hospital Longmont, Colorado  80501
Singing River Hospital Pascagoula, Mississippi  39581
Greater Baltimore Medical Center Baltimore, Maryland  21204
Lowell General Hospital Lowell, Massachusetts  01854
Rutherford Hospital Rutherfordton, North Carolina  28139
AnMed Health Cancer Center Anderson, South Carolina  29621
Harold Alfond Center for Cancer Care Augusta, Maine  04330
Union Hospital of Cecil County Elkton MD, Maryland  21921
Memorial Medical Center Springfield, Illinois  62781
Phelps County Regional Medical Center Rolla, Missouri  65401
Saint Francis Medical Center Grand Island, Nebraska  68802
Doylestown Hospital Doylestown, Pennsylvania  18901
McLeod Regional Medical Center Florence, South Carolina  29501
Guardian Oncology and Center for Wellness Missoula, Montana  59804
University of Pittsburgh Pittsburgh, Pennsylvania  15261
Newton-Wellesley Hospital Newton, Massachusetts  02462
Providence Hospital Mobile, Alabama  36608
University of North Carolina Chapel Hill, North Carolina  27599
East Bay Radiation Oncology Center Castro Valley, California  94546
Contra Costa Regional Medical Center Martinez, California  94553-3156
Larry G Strieff MD Medical Corporation Oakland, California  94609
Tahoe Forest Cancer Center Truckee, California  96161
Elmhurst Memorial Hospital Elmhurst, Illinois  60126
Queens Hospital Center Jamaica, New York  11432
Holy Cross Hospital Fort Lauderdale, Florida  33308
El Camino Hospital Mountain View, California  94040
Yale University New Haven, Connecticut  06520
Wayne State University Detroit, Michigan  48202
New Hampshire Oncology-Hematology PA Hooksett, New Hampshire  03106
Riverside Methodist Hospital Columbus, Ohio  43214
Licking Memorial Hospital Newark, Ohio  43055-2899
Providence Portland Medical Center Portland, Oregon  97213-3635
California Pacific Medical Center San Francisco, California  94115
Dartmouth Hitchcock Medical Center Lebanon, New Hampshire  03756
Mid Dakota Clinic Bismarck, North Dakota  58501
Columbus CCOP Columbus, Ohio  43206
Presbyterian - Saint Lukes Medical Center - Health One Denver, Colorado  80218
Montana Cancer Consortium CCOP Billings, Montana  59101
Alegent Health Immanuel Medical Center Omaha, Nebraska  68122
Alegent Health Bergan Mercy Medical Center Omaha, Nebraska  68124
Mount Sinai Hospital Medical Center Chicago, Illinois  60608
UC Davis Comprehensive Cancer Center Sacramento, California  95817
Providence Hospital Southfield, Michigan  48075
Decatur Memorial Hospital Decatur, Illinois  62526
Tulane University Health Sciences Center New Orleans, Louisiana  70112
Kaiser Permanente Portland, Oregon  97227
Frederick Memorial Hospital Frederick, Maryland  21701
CentraState Medical Center Freehold, New Jersey  07728
Holy Cross Hospital Silver Spring, Maryland  20910
Montana Cancer Specialists Missoula, Montana  59807-7877
Providence Saint Joseph Medical Center Burbank, California  91505-4866
University of Chicago Comprehensive Cancer Center Chicago, Illinois  60637-1470
University of Southern California Los Angeles, California  90033
DeKalb Medical Center Decatur, Georgia  30033
Northern Indiana Cancer Research Consortium South Bend, Indiana  
Rockwood Clinic Spokane, Washington  99220
Vince Lombardi Cancer Clinic - Oshkosh Oshkosh, Wisconsin  54904
Piedmont Fayette Hospital Fayetteville, Georgia  30214
Hays Medical Center Hays, Kansas  67601
Southeast Cancer Center Cape Girardeau, Missouri  63703
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
Providence Newberg Medical Center Newberg, Oregon  97132
Littleton Adventist Hospital Littleton, Colorado  80122
Froedtert and the Medical College of Wisconsin Milwaukee, Wisconsin  53226
Wake Forest University Health Sciences Winston-Salem, North Carolina  27157
OSF Saint Francis Medical Center Peoria, Illinois  61637
Northside Hospital Atlanta, Georgia  30342
Saint Helena Hospital Saint Helena, California  94574
Mills - Peninsula Hospitals Burlingame, California  94010
Valley Medical Oncology Consultants-Castro Valley Castro Valley, California  94546
Eden Hospital Medical Center Castro Valley, California  94546
Northbay Cancer Center Fairfield, California  94533
Valley Medical Oncology Consultants-Fremont Fremont, California  94538
California Cancer Center - North Fresno Fresno, California  93720
Fremont - Rideout Cancer Center Marysville, California  95901
Bay Area Breast Surgeons Inc Oakland, California  94609
Bay Area Tumor Institution CCOP Oakland, California  94609
Tom K Lee Inc Oakland, California  94609
Valley Medical Oncology Consultants Pleasanton, California  94588
Valley Care Health System - Pleasanton Pleasanton, California  94588
University of California San Francisco Medical Center-Mount Zion San Francisco, California  94115
Doctors Medical Center- JC Robinson Regional Cancer Center San Pablo, California  94806
The Medical Center of Aurora Aurora, Colorado  80012
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Saint Anthony Central Hospital Denver, Colorado  80204
Exempla Saint Joseph Hospital Denver, Colorado  80218
Colorado Cancer Research Program CCOP Denver, Colorado  80224-2522
Saint Mary's Hospital and Regional Medical Center Grand Junction, Colorado  81502
Saint Mary Corwin Medical Center Pueblo, Colorado  81004
Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
Middlesex Hospital Middletown, Connecticut  06457
The Hospital of Central Connecticut New Britain, Connecticut  06050
Stamford Hospital Stamford, Connecticut  06904
Atlanta Regional CCOP Atlanta, Georgia  30342
Well Star Cobb Hospital Austell, Georgia  30106
John B Amos Cancer Center Columbus, Georgia  31904
Wellstar Kennestone Hospital Marietta, Georgia  30060
Rush - Copley Medical Center Aurora, Illinois  60504
John H Stroger Jr Hospital of Cook County Chicago, Illinois  60612-3785
Resurrection Healthcare Chicago, Illinois  60631
Cancer Institute at Alexian Brothers Elk Grove Village, Illinois  60007
Joliet Oncology-Hematology Associates Limited Joliet, Illinois  60435
Provena Saint Mary's Hospital Kankakee, Illinois  60901
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
Hematology Oncology Consultants Limited Naperville, Illinois  60540
Community Cancer Center Foundation Normal, Illinois  61761
Illinois CancerCare-Ottawa Clinic Ottawa, Illinois  61350
Ottawa Regional Hospital and Healthcare Center Ottawa, Illinois  61350
Pekin Cancer Treatment Center Pekin, Illinois  61554
Illinois Oncology Research Association CCOP Peoria, Illinois  61615
Illinois CancerCare-Peoria Peoria, Illinois  61615
Illinois Valley Hospital Peru, Illinois  61354
Carle Clinic-Urbana Main Urbana, Illinois  61801
Fort Wayne Medical Oncology and Hematology Inc - State Boulevard Fort Wayne, Indiana  46845
Saint Vincent Hospital and Health Services Indianapolis, Indiana  46260
Saint Anthony Memorial Health Center Michigan City, Indiana  46360
McFarland Clinic Ames, Iowa  50010
Hematology Oncology Associates-Quad Cities Bettendorf, Iowa  52722
Constantinou, Costas L MD (UIA Investigator) Bettendorf, Iowa  52722
Medical Oncology and Hematology Associates-West Des Moines Clive, Iowa  50325
Iowa Oncology Research Association CCOP Des Moines, Iowa  50309
Mercy Capitol Des Moines, Iowa  50307
Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Medical Oncology and Hematology Associates-Des Moines Des Moines, Iowa  50309
Mercy Medical Center-Sioux City Sioux City, Iowa  51104
Saint Luke's Regional Medical Center Sioux City, Iowa  51104
Stormont-Vail Regional Health Center Topeka, Kansas  66604
Saint Francis Hospital and Medical Center - Topeka Topeka, Kansas  66606
Our Lady Bellefonte Hospital Ashland, Kentucky  41101
Ochsner Clinic Foundation-Baton Rouge Baton Rouge, Louisiana  70809
Ochsner Clinic CCOP New Orleans, Louisiana  70121
Holy Family Hospital Methuen, Massachusetts  01844
Michigan Cancer Research Consortium Community Clinical Oncology Program Ann Arbor, Michigan  48106
Oakwood Hospital Dearborn, Michigan  48123
Saint John Hospital and Medical Center Detroit, Michigan  48236
Michigan State University - Breslin Cancer Center East Lansing, Michigan  48824-1313
Green Bay Oncology - Escanaba Escanaba, Michigan  49431
McLaren Regional Medical Center Flint, Michigan  48532
Grand Rapids Clinical Oncology Program Grand Rapids, Michigan  49503
Green Bay Oncology - Iron Mountain Iron Mountain, Michigan  49801
Allegiance Health Jackson, Michigan  49201
Ingham Regional Medical Center Lansing, Michigan  48910
Sparrow Hospital Lansing, Michigan  48912
Saint Mary Mercy Hospital Livonia, Michigan  48154
Mid-Michigan Medical Center - Midland Midland, Michigan  48670
Mercy Health Partners-Hackley Campus Muskegon, Michigan  49442
Northern Michigan Regional Hospital Petoskey, Michigan  49770
Saint Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Saint Joseph Mercy Port Huron Port Huron, Michigan  48060
Saint Mary's of Michigan Saginaw, Michigan  48601
Lakeland Hospital St. Joseph, Michigan  49085
Saint John Macomb-Oakland Hospital Warren, Michigan  48093
Medini, Eitan MD (UIA Investigator) Alexandria, Minnesota  56308
Miller-Dwan Hospital Duluth, Minnesota  55805
Etzell, Paul S MD (UIA Investigator) Fergus Falls, Minnesota  56537
Swenson, Wade II, MD (UIA Investigator) Fergus Falls, Minnesota  56537
Immanuel-Saint Joseph Hospital-Mayo Health System Mankato, Minnesota  56002
Saint Cloud Hospital Saint Cloud, Minnesota  56303
Southeast Missouri Hospital Cape Girardeau, Missouri  63701
Freeman Health System Joplin, Missouri  64804
Truman Medical Center Kansas City, Missouri  64108
Missouri Baptist Medical Center Saint Louis, Missouri  63131
Ozark Health Ventures LLC dba Cancer Research for The Ozarks Springfield Springfield, Missouri  65802
Saint John's Hospital Springfield, Missouri  65804
Cox Medical Center Springfield, Missouri  65807
Hematology-Oncology Centers of the Northern Rockies PC Billings, Montana  59101
Saint Vincent Healthcare Billings, Montana  59101
Billings Clinic Billings, Montana  59107-7000
Saint James Community Hospital and Cancer Treatment Center Butte, Montana  59701
Benefis Healthcare- Sletten Cancer Institute Great Falls, Montana  59405
Berdeaux, Donald MD (UIA Investigator) Great Falls, Montana  59405
Saint Peter's Community Hospital Helena, Montana  59601
Glacier Oncology PLLC Kalispell, Montana  59901
Community Medical Hospital Missoula, Montana  59801
Saint Patrick Hospital - Community Hospital Missoula, Montana  59802
Lincoln Medical Education Foundation Cancer Resource Center Lincoln, Nebraska  68510
Missouri Valley Cancer Consortium CCOP Omaha, Nebraska  68106
New Hampshire Oncology Hematology Associates Hooksett, New Hampshire  03106
Cheshire Medical Center-Dartmouth-Hitchcock Keene Keene, New Hampshire  03431
LRGHealthcare-Lakes Region General Hospital Laconia, New Hampshire  03246
Cooper Hospital University Medical Center Camden, New Jersey  08103
South Jersey Healthcare Vineland, New Jersey  08360
Adirondack Cancer Center Glens Falls, New York  12801
Saint Luke's Roosevelt Hospital Center - Saint Luke's Division New York, New York  10025
Columbia University Medical Center New York, New York  10032
Faxton-Saint Luke's Healthcare Utica, New York  13502
Wayne Memorial Hospital Goldsboro, North Carolina  27534
Kinston Medical Specialists PA Kinston, North Carolina  28501
Saint Alexius Medical Center Bismarck, North Dakota  58501
Aultman Health Foundation Canton, Ohio  44710
Doctors Hospital Columbus, Ohio  43228
Grant Medical Center Columbus, Ohio  43215
Mount Carmel Health Center West Columbus, Ohio  43222
Saint Rita's Medical Center Lima, Ohio  45801
Marietta Memorial Hospital Marietta, Ohio  45750
Saint Ann's Hospital Westerville, Ohio  43081
Genesis HealthCare System Zanesville, Ohio  43701
Providence Saint Vincent Medical Center Portland, Oregon  97225
Columbia River Oncology Program Portland, Oregon  97225
Scranton Hematology Oncology Scranton, Pennsylvania  18510
Mercy Hospital Scranton, Pennsylvania  18501
Hematology and Oncology Associates of Rhode Island Inc Cranston, Rhode Island  02920
Kent County Hospital Warwick, Rhode Island  02886
AnMed Health Hospital Anderson, South Carolina  29621
Upstate Carolina CCOP Spartanburg, South Carolina  29303
Conklin Regional Cancer Center Aberdeen, South Dakota  57401
Sanford Cancer Center-Oncology Clinic Sioux Falls, South Dakota  57104
Wheeling Hospital Wheeling, West Virginia  26003
Saint Vincent Hospital Green Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's Hospital Green Bay, Wisconsin  54303
Saint Mary's Hospital Green Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent Hospital Green Bay, Wisconsin  54301-3526
Aurora BayCare Medical Center Green Bay, Wisconsin  54311-6519
Dean Hematology and Oncology Clinic Madison, Wisconsin  53717
Vince Lombardi Cancer Clinic-Marinette Marinette, Wisconsin  54143
Bay Area Medical Center Marinette, Wisconsin  54143
Marshfield Clinic-Minocqua Center Minocqua, Wisconsin  54548
Oconomowoc Memorial Hospital-ProHealth Care Inc Oconomowoc, Wisconsin  53066-3896
Green Bay Oncology - Oconto Falls Oconto Falls, Wisconsin  54154
Marshfield Clinic at James Beck Cancer Center Rhinelander, Wisconsin  54501
Marshfield Clinic-Rice Lake Center Rice Lake, Wisconsin  54868
Green Bay Oncology - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
University of California Medical Center At Irvine-Orange Campus Orange, California  92868
University of Maryland Greenebaum Cancer Center Baltimore, Maryland  21201
Olathe Cancer Center Olathe, Kansas  66061
Jupiter Medical Center Jupiter, Florida  33458
Gainesville Hematology Oncology Associates Gainesville, Florida  32605
Elkhart Clinic Elkhart, Indiana  46515
Marin General Hospital Greenbrae, California  94904
Mount Sinai Medical Center CCOP Miami Beach, Florida  33140
Northeast Georgia Cancer Care LLC Athens, Georgia  30607
Harbin Clinic Medical Oncology and Clinical Research Rome, Georgia  30165
Illinois CancerCare-Bloomington Bloomington%, Illinois  61701
Illinois CancerCare-Canton Canton, Illinois  61520
Illinois CancerCare-Carthage Carthage, Illinois  62321
Illinois CancerCare-Eureka Eureka, Illinois  61530
Illinois CancerCare-Havana Havana, Illinois  62644
Illinois CancerCare-Kewanee Clinic Kewanee, Illinois  61443
Illinois CancerCare-Macomb Macomb, Illinois  61455
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
Michiana Hematology Oncology PC-Elkhart Elkhart, Indiana  46514
Michiana Hematology Oncology PC-Plymouth Plymouth, Indiana  46563
Michiana Hematology Oncology PC-South Bend South Bend, Indiana  46601
Michiana Hematology Oncology-PC Westville Westville, Indiana  46391
Michiana Hematology Oncology PC-Niles Niles, Michigan  49120
Central Care Cancer Center-Carrie J Babb Cancer Center Bolivar, Missouri  65613
Skaggs Cancer Center Branson, Missouri  65616
University of Missouri - Ellis Fischel Columbia, Missouri  65203
Hackensack University Medical CCOP Hackensack, New Jersey  07601
Moses Cone Health System-Regional Cancer Center Greensboro, North Carolina  27403
Annie Penn Memorial Hospital Reidsville, North Carolina  27320
Erlanger Medical Center Chattanooga, Tennessee  37403
West Virginia University Charleston Charleston, West Virginia  25304
Marshfield Clinic-Chippewa Center Chippewa Falls, Wisconsin  54729
Holy Family Memorial Hospital Manitowoc, Wisconsin  54221
Aurora Advanced Healthcare Inc-Mequon Mequon, Wisconsin  53092
Medical Consultants Limited Milwaukee, Wisconsin  53215
Vince Lombardi Cancer Clinic-Sheboygan Sheboygan, Wisconsin  53081
Marshfield Clinic Cancer Care at Saint Michael's Hospital Stevens Point, Wisconsin  54481
Aurora Medical Center in Summit Summit, Wisconsin  53066
Vince Lombardi Cancer Clinic Two Rivers, Wisconsin  54241
Riverview Hospital Wisconsin Rapids, Wisconsin  54494
Kaiser Permanente - Largo Medical Center Largo, Maryland  20774
Kaiser Permanente - Towson Medical Center Lutherville, Maryland  21093
Kaiser Permanente - Fair Oaks Medical Center Fairfax, Virginia  22033
Spector, David MD (UIA Investigator) Moline, Illinois  61265
Doctors Carrol, Sheth, Raghavan Louisville, Kentucky  40215
Hematology and Oncology Clinic Baton Rouge, Louisiana  70809
Ochsner North Shore Medical Center Covington, Louisiana  70433
Veterans Administration Medical Center Baltimore, Maryland  21201
Capital Region Medical Center-Goldschmidt Cancer Center Jefferson City, Missouri  65109
Comprehensive Cancer Care PC Saint Louis, Missouri  63141
Saint Joseph Hospital Nashua, New Hampshire  03060
Arnot Ogden Medical Center Elmira, New York  14905
Southern Ohio Medical Center Portsmouth, Ohio  45662
Saint Charles Medical Center-Bend Bend, Oregon  97701
Saint Francis Hospital Greenville, South Carolina  29601
Gundersen Lutheran La Crosse, Wisconsin  54601
Saint Nicholas Hospital Madison, Wisconsin  53715
Sparks Regional Medical Center Fort Smith, Arkansas  72901
Los Angeles County-USC Medical Center Los Angeles, California  90033
San Francisco General Hospital San Francisco, California  94110
Eisenhower Army Medical Center Fort Gordon, Georgia  30509
Siouxland Hematology Oncology Associates Sioux City, Iowa  51101
The Schiffler Cancer Center of Wheeling Hospital Wheeling, West Virginia  26003
Dublin Hematology Oncology Care PC Dublin, Georgia  31021
IU Health Arnett Lafayette, Indiana  
Georgia Health Sciences University Augusta, Georgia  30912
Alta Bates Summit Medical Center-Herrick Campus Berkeley, California  94704
Boca Raton Regional Hospital Boca Raton, Florida  33486
Carle Foundation - Carle Cancer Center Urbana, Illinois  61801
Michiana Hematology Oncology PC-Mishawaka Mishawaka, Indiana  46545-1470
Marie Yeager Cancer Center Saint Joseph, Michigan  49085
Hematology Oncology Associates of Central New York PC East Syracuse, New York  13057
Roy and Patricia Disney Family Cancer Center Burbank, California  91505
Sanford USD Medical Center - Sioux Falls Sioux Falls, South Dakota  57117-5134
Providence Sacred Heart Medical Center and Children's Hospital Spokane, Washington  99204
Genesys Regional Medical Center-West Flint Campus Flint, Michigan  48532
Essentia Health Duluth Clinic CCOP Duluth, Minnesota  55805
Essentia Health Saint Mary's Medical Center Duluth, Minnesota  55805
Sanford Bismarck Medical Center Bismarck, North Dakota  58501
Community Howard Regional Health Kokomo, Indiana  46904
Indiana University Health La Porte Hospital La Porte, Indiana  46350
Saint Joseph Regional Medical Center-Mishawaka Mishawaka, Indiana  46545-1470
Via Christi Hospital-Pittsburg Pittsburg, Kansas  66762
Aurora Cancer Care-Burlington Burlington, Wisconsin  53105
Aurora Cancer Care-Franklin Franklin, Wisconsin  53132
Aurora Cancer Care-Glendale Glendale, Wisconsin  53212
Aurora Cancer Care-Kenosha South Kenosha, Wisconsin  53142
Aurora Cancer Care-Milwaukee South Milwaukee, Wisconsin  53215
Aurora Cancer Care-Racine Racine, Wisconsin  53406-5661
Aurora Cancer Care-Waukesha Waukesha, Wisconsin  53188
Aurora Cancer Care-Milwaukee West Wauwatosa, Wisconsin  53226
Christiana Care Health System-Christiana Hospital Newark, Delaware  19718
Springfield Regional Medical Center Springfield, Ohio  45505
Promise Regional Medical Center-Hutchinson Hutchinson, Kansas  65702
Guthrie Clinic-Robert Packer Hospital Sayre, Pennsylvania  18840
Providence Holy Family Hospital Spokane, Washington  99208
PeaceHealth Southwest Medical Center Vancouver, Washington  98664
Aurora Cancer Care-Southern Lakes Elkhorn, Wisconsin  53121
Maine Center for Cancer Medicine and Blood Disorders-Scarborough Scarborough, Maine  04074
Saint Vincent's Hospital and Medical Center of New York New York, New York  10011
Ochsner Baptist Medical Center New Orleans, Louisiana  70115
Providence Willamette Falls Medical Center Oregon City, Oregon  97045
East Bay Medical Oncology Hematology Medical Associates-Antioch Antioch, California  94531
Diablo Valley Oncology and Hematology Medical Group-Pleasant Hill Pleasant Hill, California  94523
East Bay Medical Oncology Hematology Medical Associates Inc-Pleasant Hill Pleasant Hill, California  94523
East Bay Medical Oncology Hematology Associates Inc San Leandro, California  94578
LC Ferguson Cancer Center Freeport, Illinois  61032
Dana-Farber/Brigham and Women's Cancer Center at Milford Regional Milford, Massachusetts  01757