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A Multicenter Phase III Randomized Trial of Adjuvant Therapy for Patients With HER2-Positive Node-Positive or High Risk Node-Negative Breast Cancer Comparing Chemotherapy Plus Trastuzumab With Chemotherapy Plus Trastuzumab Plus Bevacizumab


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

Thank you

Trial Information

A Multicenter Phase III Randomized Trial of Adjuvant Therapy for Patients With HER2-Positive Node-Positive or High Risk Node-Negative Breast Cancer Comparing Chemotherapy Plus Trastuzumab With Chemotherapy Plus Trastuzumab Plus Bevacizumab


This Phase III, randomized, open-label trial will determine whether the regimens of
chemotherapy plus trastuzumab plus bevacizumab improve invasive disease-free survival (IDFS)
relative to the regimens of chemotherapy plus trastuzumab. Secondary aims include
determining whether the addition of bevacizumab to chemotherapy plus trastuzumab will
improve disease-free survival (DFS), overall survival (OS), recurrence-free interval (RFI),
and distant recurrence-free interval (DRFI). The benefit of adding bevacizumab for IDFS,
DFS, OS, RFI, and DRFI will also be evaluated for each of the two chemotherapy regimens.
The cardiac and non-cardiac toxicities of each of the regimens will also be evaluated.

Following local determination that the tumor is HER2-positive for gene amplification by in
situ hybridization or is IHC 2+ or 3+, a tumor sample must be submitted for HER2 testing by
a designated central laboratory. If central testing confirms that the tumor is
HER2-positive (either positive by FISH or IHC 3+) and all other eligibility criteria have
been met, the patient will be randomized to a regimen of chemotherapy and trastuzumab with
or without bevacizumab.

Patients in the trial will be enrolled in one of two chemotherapy regimen cohorts. One
cohort will receive 6 cycles of docetaxel/carboplatin plus trastuzumab (TCH) with or without
bevacizumab; the other cohort will receive 3 cycles of docetaxel plus trastuzumab given with
or without bevacizumab followed by 3 cycles of 5-Fluorouracil, Epirubicin, Cyclophosphamide
(TH-FEC). With both regimens, patients will continue trastuzumab with or without
bevacizumab following chemotherapy to complete 1 year of targeted therapy. Following
completion of chemotherapy, patients will also receive adjuvant radiotherapy and endocrine
therapy as clinically indicated.

The trial will be conducted by investigators affiliated with the Cancer International
Research Group (CIRG) and the National Surgical Adjuvant Breast and Bowel Project (NSABP).
CIRG and NSABP investigators will only enroll patients in the TCH regimen cohort.
Additional investigators, referred to in the protocol as Independent Investigators, will
enroll patients in both the TCH regimen or the TH-FEC regimen cohort depending on
institutional preference for the one regimen that will be used by that institution for the
duration of the trial.

Patients will be given the option of allowing their tumor samples to be used for the BETH
translational research and correlative science studies. Also, patients will be asked to
consent to the submission of blood and serum samples at scheduled time points during the
study.

LVEF assessments will be performed before study entry and then at scheduled time points
during therapy and at 18, 36, and 60 months following randomization.

The planned sample size for the trial is 3,000 patients randomized in the faster accruing
cohort and a minimum of 3,500 patients overall.


Inclusion Criteria:



- Life expectancy of at least 10 years, excluding their diagnosis of breast cancer.

- Women who have had breast reconstruction utilizing tissue expanders must be in
agreement with delaying surgery to replace the tissue expanders with permanent
implants until 3 months following the last dose of bevacizumab

- Women of reproductive potential must agree to use an effective non-hormonal method of
contraception (for example condoms, some intrauterine devices, diaphragms,
vasectomized partner, or abstinence) during therapy and for at least 6 months after
the last dose of bevacizumab and/or trastuzumab.

- Submission of tumor samples from the breast surgery for central HER2 testing is
required for all patients prior to enrollment in the BETH Trial

- Signed and dated IRB/EC-approved consent

- ECOG performance status of 0 or 1

- The tumor must be unilateral invasive adenocarcinoma of the breast on histologic
examination.

- The breast cancer must be HER2-positive based on test results as follows: Local
testing (if available) should demonstrate that the tumor is IHC 2+ or 3+ or is
considered to be HER2-positive for gene amplification by FISH, CISH, or other in situ
hybridization (ISH) method. If local ISH test results are considered equivocal, the
tumor can be submitted for central HER2 testing. (If local testing is not possible,
the tumor can be submitted for central HER2 testing.) Central testing (a requirement
for ALL patients) must demonstrate that the tumor is HER2-positive which is defined
as FISH-positive and/or IHC 3+.

- All of the following staging criteria (according to the 6th edition of the AJCC
Cancer Staging Manual) must be met: By pathologic evaluation, primary tumor must be
pT1-3; By pathologic evaluation, ipsilateral nodes must be pN0, pN1 (pN1mi, pN1a,
pN1b, pN1c), pN2a, pN3a, or pN3b. If pN0, at least one of the following criteria must
be met: Pathologic tumor size > 2.0 cm; ER negative and PgR negative; Histologic
and/or nuclear grade 2 (intermediate) or 3 (high); or Age < 35 years

- Patients must have undergone either a total mastectomy or breast conserving surgery
(lumpectomy).

- For patients who undergo lumpectomy, the margins of the resected specimen must be
histologically free of invasive tumor and ductal carcinoma in situ (DCIS) as
determined by the local pathologist. If pathologic examination demonstrates tumor at
the line of resection, additional operative procedures may be performed to obtain
clear margins. If tumor is still present at the resected margin after
re-excision(s), the patient must undergo total mastectomy to be eligible. (Patients
with margins positive for lobular carcinoma in situ [LCIS] are eligible without
additional resection.)

- For patients who undergo mastectomy, margins must be free of gross residual tumor.
Patients with microscopic positive margins are eligible.

- Patients must have completed one of the following procedures for evaluation of
pathologic nodal status: Sentinel lymphadenectomy followed by removal of additional
non-sentinel lymph nodes if the sentinel node (SN) is positive; Sentinel
lymphadenectomy alone if pathologic nodal staging based on sentinel lymphadenectomy
is pN0, pN1mi or pN1b; or Axillary lymphadenectomy without SN isolation procedure.

- The interval between the last surgery for breast cancer (treatment or staging) and
randomization must be at least 28 days but no more than 84 days.

- Patients must have ER analysis performed on the primary tumor prior to randomization.
If ER analysis is negative, then PgR analysis must also be performed.

- The most recent postoperative blood counts, performed within 6 weeks prior to
randomization, must meet the following criteria: ANC must be greater than or equal to
1200/mm3; Platelet count must be greater than or equal to 100,000/mm3; and Hemoglobin
must be greater than or equal to 10 g/dL.

- The following criteria for evidence of adequate hepatic function must be met based on
the results of the most recent postoperative tests performed within 6 weeks prior to
randomization: total bilirubin must be less than or equal to upper limit of normal
(ULN) for the lab unless the patient has a bilirubin elevation > ULN to 1.5 x ULN due
to Gilbert's disease or similar syndrome involving slow conjugation of bilirubin; and
alkaline phosphatase must be less than or equal to 2.5 x ULN for the lab; and AST
must be less than or equal to 1.5 x ULN for the lab. Alkaline phosphatase and AST may
not both be > the ULN.

- Patients with AST or alkaline phosphatase > ULN are eligible for inclusion in the
study if liver imaging (CT, MRI, PET scan, or PET-CT scan performed within 3 months
prior to randomization) does not demonstrate metastatic disease and the requirements
for evidence of adequate hepatic function are met.

- Patients with alkaline phosphatase that is > ULN but less than or equal to 2.5 x ULN
are eligible for inclusion in the study if a bone scan,PET scan, or PET-CT scan
(performed within 3 months prior to randomization) does not demonstrate metastatic
disease.

- The following criteria for renal function must be met based on the results of the
most recent postoperative tests performed within 6 weeks prior to randomization:
Serum creatinine must be less than or equal to ULN for the lab. Measured or
calculated creatinine clearance must be > 60 mL/min.

- A urine sample must be tested for protein by determination of the urine
protein/creatinine (UPC) ratio or by urine dipstick. UPC ratio must be less than
1.0. Urine dipstick must indicate 0-1+ protein. If dipstick reading is greater than
or equal to 2+, determine the UPC ratio, which must be less than 1.0, or collect a
24-hour urine specimen, which must demonstrate < 1.0 g of protein per 24 hours.

- LVEF assessment must be performed within 3 months prior to randomization. The LVEF
must be greater than or equal to 55% regardless of the cardiac imaging facility's
lower limit of normal (LLN).

- The ECG (performed within 3 months prior to randomization) must not have demonstrated
any of the following conditions: ventricular arrhythmias except for benign premature
ventricular contractions; supraventricular and nodal arrhythmias requiring a
pacemaker or not controlled with medication; and conduction abnormality requiring a
pacemaker.

Exclusion Criteria:

- Inflammatory breast cancer.

- Definitive clinical or radiologic evidence of metastatic disease. (Chest imaging
[mandatory for all patients] and other imaging [if required] must have been performed
within 3 months prior to randomization.)

- Synchronous or previous contralateral invasive breast cancer (Patients with
synchronous or previous contralateral DCIS or LCIS are eligible).

- History of ipsilateral invasive breast cancer regardless of treatment or ipsilateral
DCIS treated with excision and RT. (Patients with history of ipsilateral LCIS are
eligible.)

- History of non-breast malignancies within the 5 years prior to study entry, except
for the following: carcinoma in situ of the cervix, carcinoma in situ of the colon,
melanoma in situ, and basal cell and squamous cell carcinomas of the skin.

- Previous therapy with anthracyclines, taxanes, carboplatin, trastuzumab, or
bevacizumab for any malignancy.

- RT, chemotherapy, and/or targeted therapy, administered for the currently diagnosed
breast cancer prior to randomization.

- Continued therapy with any hormonal agent such as raloxifene or tamoxifen (or other
SERM) or an aromatase inhibitor. (Patients are eligible if these medications are
discontinued prior to randomization.)

- Any sex hormonal therapy, e.g., birth control pills, ovarian hormone replacement
therapy, etc. Patients are eligible if these medications are discontinued prior to
randomization.

- Cardiac disease (history of and/or active disease) that would preclude the use of the
drugs included in the treatment regimens. This includes but is not confined to:
Active cardiac disease - angina pectoris that requires the use of anti-anginal
medication; ventricular arrhythmias except for benign premature ventricular
contractions; supraventricular and nodal arrhythmias requiring a pacemaker or not
controlled with medication; conduction abnormality requiring a pacemaker; valvular
disease with documented compromise in cardiac function; and symptomatic pericarditis.
History of cardiac disease - myocardial infarction documented by elevated cardiac
enzymes or persistent regional wall abnormalities on assessment of LV function;
history of documented CHF; and documented cardiomyopathy.

- Uncontrolled hypertension defined as systolic blood pressure (BP) > 150 mmHg or
diastolic BP > 90 mmHg, with or without anti-hypertensive medication. (BP must be
assessed within 28 days prior to randomization.) Patients with initial BP elevations
are eligible if initiation or adjustment of BP medication lowers pressure to meet
entry criteria.

- History of hypertensive crisis or hypertensive encephalopathy.

- History of TIA or CVA.

- History of any arterial thrombotic event within 12 months before randomization.

- Symptomatic peripheral vascular disease.

- Intrinsic lung disease resulting in dyspnea.

- Unstable diabetes mellitus.

- Active infection or chronic infection requiring chronic suppressive antibiotics.

- Any significant bleeding within 6 months before randomization, exclusive of
menorrhagia in premenopausal women.

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

- Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to planned start of study therapy.

- Anticipation of need for major surgical procedures during study therapy and for at
least 3 months following completion of bevacizumab.

- Gastroduodenal ulcer(s) documented by endoscopy to be active within 6 months before
randomization.

- History of GI perforation, abdominal fistulae, or intra-abdominal abscess.

- Known bleeding diathesis or coagulopathy.

- Requirement for therapeutic doses of coumadin or equivalent.

- Sensory/motor neuropathy greater than or equal to grade 2, as defined by the NCI
CTCAE v3.0.

- Conditions that would prohibit administration of corticosteroids.

- Chronic daily treatment with corticosteroids (dose of > 10 mg/day methylprednisolone
equivalent) (excluding inhaled steroids).

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

- Pregnancy or lactation at the time of study entry. (Note: Pregnancy testing must be
performed within 14 days prior to randomization according to institutional standards
for women of child-bearing potential.)

- Other non-malignant systemic disease that would preclude the patient from receiving
study treatment or would prevent required follow-up.

- Psychiatric or addictive disorders or other conditions that, in the opinion of the
investigator, would preclude the patient from meeting the study requirements.

- Use of any investigational product within 4 weeks prior to enrollment in the study.

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Invasive Disease-free Survival (IDFS)

Outcome Time Frame:

up to 10 years

Safety Issue:

No

Principal Investigator

Norman Wolmark, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

NSABP Foundation, Inc.

Authority:

United States: Food and Drug Administration

Study ID:

NSABP B-44-I

NCT ID:

NCT00625898

Start Date:

April 2008

Completion Date:

December 2021

Related Keywords:

  • Breast Cancer
  • HER2 positive breast cancer
  • invasive breast cancer
  • bevacizumab
  • NSABP
  • Roche
  • CIRG
  • trastuzumab
  • cyclophosphamide
  • docetaxel
  • carboplatin
  • 5-fluorouracil
  • epirubicin
  • Breast Neoplasms

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Akron City HospitalAkron, Ohio  44304
Baylor College of MedicineHouston, Texas  77030
Suburban HospitalBethesda, Maryland  20814
University of IowaIowa City, Iowa  52242
Stanford University Medical CenterStanford, California  94305-5408
University of Colorado Cancer CenterDenver, Colorado  80262
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Morristown Memorial HospitalMorristown, New Jersey  07962-1956
Henry Ford HospitalDetroit, Michigan  48202
Bridgeport HospitalBridgeport, Connecticut  06610
Marquette General HospitalMarquette, Michigan  49855
Newark Beth Israel Medical CenterNewark, New Jersey  07112
Beth Israel Medical CenterNew York, New York  10003
Akron General Medical CenterAkron, Ohio  44302
Lehigh Valley HospitalAllentown, Pennsylvania  18103
York HospitalYork, Pennsylvania  17315
LDS HospitalSalt Lake City, Utah  84143
Rush University Medical CenterChicago, Illinois  60612-3824
Hartford HospitalHartford, Connecticut  06102-5037
Eastern Maine Medical CenterBangor, Maine  04401
Franklin Square Hospital CenterBaltimore, Maryland  21237
Peninsula Regional Medical CenterSalisbury, Maryland  21801
Monmouth Medical CenterLong Branch, New Jersey  07740-6395
Cancer Institute of New JerseyNew Brunswick, New Jersey  08901
Florida Hospital Cancer InstituteOrlando, Florida  32804
Mountain States Tumor InstituteBoise, Idaho  83712
Thompson Cancer Survival CenterKnoxville, Tennessee  37916
Overlook HospitalSummit, New Jersey  07902-0220
St. John's Regional Health CenterSpringfield, Missouri  65804
Cancer Institute of New Jersey at HamiltonHamilton, New Jersey  08690
University of Medicine and Dentistry of New JerseyNewark, New Jersey  07103-2425
Mount Nittany Medical CenterState College, Pennsylvania  16803
Sibley Memorial HospitalWashington, District of Columbia  20016
North Colorado Medical CenterGreeley, Colorado  80631
McKee Medical CenterLoveland, Colorado  80539
Hackley HospitalMuskegon, Michigan  49443
Munson Medical CenterTraverse City, Michigan  49684
Georgia Cancer SpecialistsDecatur, Georgia  30033
South Bend ClinicSouth Bend, Indiana  46617
Florida Cancer SpecialistsFort Myers, Florida  33901
University Medical Center of Southern NevadaLas Vegas, Nevada  89102
Bay Regional Medical CenterBay City, Michigan  48708
Park Nicollet Health ServicesSt. Louis Park, Minnesota  55416
Northwest Ohio Oncology CenterMaumee, Ohio  43537
Providence St. Vincent Medical CenterPortland, Oregon  97225
Hematology and Oncology AssociatesScranton, Pennsylvania  18510
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
Park Nicollet ClinicSt. Louis Park, Minnesota  55416
Penrose Cancer CenterColorado Springs, Colorado  80933
Bixby Medical CenterAdrian, Michigan  49221
Battle Creek Health SystemBattle Creek, Michigan  49017
Saint Luke's HospitalChesterfield, Missouri  63017
Crossroads Cancer CenterEffingham, Illinois  62401
Lawrence Memorial HospitalLawrence, Kansas  66044
Lakeside Cancer Specialists, PLLCSaint Joseph, Michigan  49085
Adventist Medical CenterPortland, Oregon  97216
Comprehensive Blood and Cancer CenterBakersfield, California  93309
Washington Cancer InstituteWashington, District of Columbia  20010
Cancer Care CenterNew Albany, Indiana  47150
Pacific Shores Medical GroupLong Beach, California  90813
Palm Beach Cancer InstituteWest Palm Beach, Florida  33401
Baton Rouge General Medical CenterBaton Rouge, Louisiana  70821-2511
Genesys Regional Medical CenterGrand Blanc, Michigan  48439-8066
Ben Taub General HospitalHouston, Texas  77030
Greater Baltimore Medical CenterBaltimore, Maryland  21204
Sutter Roseville Medical CenterRoseville, California  95661
Lapeer Regional HospitalLapeer, Michigan  48446
Riddle Memorial HospitalMedia, Pennsylvania  19063
Metro Health HospitalGrand Rapids, Michigan  49506
Integrated Community Oncology NetworkJacksonville Beach, Florida  32250
University of PittsburghPittsburgh, Pennsylvania  15261
University of Alabama at BirminghamBirmingham, Alabama  35294-3300
Berkshire Hematology Oncology, P.C.Pittsfield, Massachusetts  01201
Associates in Oncology/HematologyRockville, Maryland  20850
Medical Oncology and Hematology, P.C.Hamden, Connecticut  06518
Emory UniversityAtlanta, Georgia  30322
Straub Clinic and HospitalHonolulu, Hawaii  96813
Lakeland Regional Cancer CenterLakeland, Florida  33805
Augusta Oncology AssociatesAugusta, Georgia  30901
Toledo ClinicOregon, Ohio  43616
Providence Portland Medical CenterPortland, Oregon  97213-3635
Albert Einstein Healthcare NetworkPhiladelphia, Pennsylvania  19141
Northeast Georgia Cancer Care, LLCAthens, Georgia  30607
Interlakes Oncology & Hematology, P.C.Rochester, New York  14623
University of Kentucky Medical CenterLexington, Kentucky  40536-0093
North Texas Regional Cancer CenterPlano, Texas  75075
Oncology Care AssociatesBethesda, Maryland  20817
Wilshire Oncology Medical GroupGlendora, California  91741
Santa Barbara Hematology Oncology Medical GroupLompoc, California  93438
Cancer Care Associates Medical Group, Inc.Torrance, California  90505
UCLA/Santa Clarita Valley Cancer CenterValencia, California  91355
Robert R. Carroll, MD, PAGainesville, Florida  32605
The Center for Cancer and Blood DisordersFort Worth, Texas  76104
Decatur Memorial HospitalDecatur, Illinois  62526
Mercy Medical CenterBaltimore, Maryland  21202
Hematology Oncology Centers of the Northern RockiesBillings, Montana  59101
The West ClinicMemphis, Tennessee  38120
Kimmel Cancer Center at JeffersonPhiladelphia, Pennsylvania  19107
Cancer Care of Southern IndianaBloomington, Indiana  47402
Holy Cross HospitalSilver Spring, Maryland  20910
Amsterdam Community Cancer ProgramAmsterdam, New York  12010
Ephrata Cancer Center at Ephrata Community HospitalEphrata, Pennsylvania  17522
Providence Saint Joseph Medical CenterBurbank, California  91505-4866
Sharp Rees-StealyLa Mesa, California  91942
Suburban Hematology-Oncology AssociatesLawrenceville, Georgia  30045
St. Luke's-Roosevelt Hospital CenterNew York, New York  
Northern Indiana Cancer Research ConsortiumSouth Bend, Indiana  
Nevada Cancer InstituteLas Vegas, Nevada  89135
Clearview Cancer InstituteHuntsville, Alabama  35805
Shaw Regional Cancer CenterEdwards, Colorado  81632
Rocky Mountain Cancer Center - MidtownDenver, Colorado  80218
Cancer Care of Western North CarolinaAsheville, North Carolina  28801
Kaiser Permanente-OaklandOakland, California  94611
Kaiser Permanente-RosevilleRoseville, California  95661
Kaiser Permanente-San FranciscoSan Francisco, California  94115
Kaiser Permanente-South San FranciscoSouth San Francisco, California  94080
Kaiser Permanente-VallejoVallejo, California  94589
Kaiser Permanente-Walnut CreekWalnut Creek, California  94596
Phoebe Putney Memorial HospitalAlbany, Georgia  31703
University of HawaiiHonolulu, Hawaii  96813
Edward HospitalNaperville, Illinois  60566
Michigan State University - Breslin Cancer CenterEast Lansing, Michigan  48824-1313
Grand Rapids Clinical Oncology ProgramGrand Rapids, Michigan  49503
Sparta Cancer Treatment CenterSparta, New Jersey  07871
Bayview Oncology AssociatesOregon, Ohio  43616
Flower Memorial HospitalSylvania, Ohio  43560
Scranton Hematology OncologyScranton, Pennsylvania  18510
Mercy HospitalScranton, Pennsylvania  18501
Aurora BayCare Medical CenterGreen Bay, Wisconsin  54311-6519
Medical Oncology & Hematology, P.C.Meriden, Connecticut  06451
Freeman Cancer InstituteJoplin, Missouri  64804
Northern Arizona Hematology & Oncology AssociatesSedona, Arizona  86336
Carolina BioOncology InstituteHuntersville, North Carolina  28078
Minnesota Oncology HematologyMinneapolis, Minnesota  55404
Hillman Cancer CenterPittsburg, Pennsylvania  15232
Antelope Valley Cancer CenterLancaster, California  93534
Northwestern Carolina Oncology & Hematology, PAHickory, North Carolina  28602
Marshfield Clinic Weston CenterWeston, Wisconsin  54476
Central Coast Medical Oncology CorporationSanta Maria, California  93454
Oncology AllianceMilwaukee, Wisconsin  53215
Spectrum Health HospitalsGrand Rapids, Michigan  49503
Howard Regional Health SystemKokomo, Indiana  46904
Medical Specialists of FairfieldFairfield, Connecticut  
Providence Medical GroupTerre Haute, Indiana  47802
Aultman HospitalCanton, Ohio  44710
Cancer Care & Hematology Specialists of ChicagolandNiles, Illinois  60714
Elkhart ClinicElkhart, Indiana  46515
Kootenai Cancer CenterPost Falls, Idaho  83854
Renown Regional Medical CenterReno, Nevada  89502
Intermountain Medical CenterMurray, Utah  84157
Utah Valley Regional Medical CenterProvo, Utah  84603
Summit Medical GroupSummit, New Jersey  07901
Geisinger ClinicDanville, Pennsylvania  17822
Eastern Connecticut Hematology & Oncology AssociatesNorwich, Connecticut  06360
Henry Ford Medical Center-FairlaneDearborn, Michigan  48126
Henry Ford Medical Center-West BloomfieldWest Bloomfield, Michigan  48322
Kaiser Permanente-West Los AngelesLos Angeles, California  90034
Mount Clemens Regional Medical CenterMount Clemens, Michigan  48043
Central Georgia Cancer CareMacon, Georgia  31201
Clearview Cancer Institute- HuntsvilleHuntsville, Alabama  35801
Kaiser Permanente-San DiegoSan Diego, California  92120
University Hospital and Medical Center - SUNYStonybrook, New York  11794
Case Western Reserve/University Hospitals-Ireland Cancer Cntr.Cleveland, Ohio  44106
CCOP, Columbia River OncologyPortland, Oregon  97225
Allegheny General Hospital/Allegheny-Singer Research InstitutePittsburgh, Pennsylvania  15212
MBCCOP, Virginia Commonwealth UniversityRichmond, Virginia  23298
CCOP, Marshfield ClinicMarshfield, Wisconsin  54449
Scripps Cancer Center-San DiegoLa Jolla, California  92037
Sutter Medical CenterSacramento, California  95816
CCOP-Colorado Cancer Research Prog. Inc.(Administrative Only)Denver, Colorado  80224
Kaiser Permanente-FranklinDenver, Colorado  80205
Kaiser Permanente Rock CreekLafayette, Colorado  80026
Edward Cancer Center PlainfieldPlainfield, Illinois  60585
CCOP, William Beaumont HospitalRoyal Oak, Michigan  48073
University of Missouri-Ellis FischelColumbia, Missouri  65203
CCOP, Kansas City (Administrative Only)Kansas City, Missouri  64131
New York Oncology Hematology PC-AlbanyAlbany, New York  12206
Thompson Cancer Survival Center-Dowell SpringsKnoxville, Tennessee  37909
West Virginia University Hospitals Inc.Morgantown, West Virginia  26506-9162
Cancer Care and Hematology Specialists of ChicagolandNiles, Illinois  60714
Drs. Forte, Schleider, Attas and Condemi, PAEnglewood, New Jersey  07631
St. Jude Heritage HealthcareFullerton, California  92835
Moses Cone Regional Cancer CenterGreensboro, North Carolina  27403
North County Oncology Medical Clinic, Inc.Oceanside, California  92056
Rockwood Cancer Treatment CenterSpokane, Washington  99204
Clearview Cancer Institute-DecaturDecatur, Alabama  35601
Northern Arizona Hematology & Onclogy AssociatesFlagstaff, Arizona  86001
Central Hematology/Oncology Medical Group, Inc.Alhambra, California  91801
Kaiser Permanente-Baldwin ParkBaldwin Park, California  91706
Kaiser Permanente-BellflowerBellflower, California  90706
Scripps Clinic EncinitasEncinitas, California  92024
Hematology-EncinitasEncinitas, California  92024
Kaiser Permanente-FontanaFontana, California  92335
Breastlink Medical Group, IncHawthorne, California  90250
Kaiser Permanente-IrvineIrvine, California  92618
Hematology-La JollaLa Jolla, California  92037
Sabina R. Wallach, MD., AMCLa Jolla, California  92037
Kaiser Permanente-SunsetLos Angeles, California  90027
Kaiser Permanente-Orange CountyPanorama City, California  92807
Kaiser Permanente-Panorama CityPanorama City, California  91042
Kaiser Permanente-RiversideRiverside, California  92505
Kaiser Permanente-SacramentoRoseville, California  95825
Sutter Medical GroupSacramento, California  95816
Peter T. Reissman, MD, IncSan Diego, California  92103
Scripps Clinic-Rancho BernardoSan Diego, California  92128
William Stanton, MD, IncSan Diego, California  92103
Kaiser Permanente-HaywardSan Francisco, California  94545
Sansum ClinicSanta Barbara, California  93105
Kaiser Permanente-Santa ClaraSanta Clara, California  95051
San Diego Pacific Oncology & Hematology-VistaVista, California  92803
Kaiser Permanente-Woodland HillsWoodland Hills, California  91367
Cypress Hematology/OncologyDenver, Colorado  80210
Oncology Associates P.C.-AvonAvon, Connecticut  06001
Medical Specialists of SWIMBridgeport, Connecticut  06606
Oncology Associates of Bridgeport-FairfieldFairfield, Connecticut  06824
Connecticut Multi Specialty Group-HartfordHartford, Connecticut  06106
Oncology Associates P.C.-HartfordHartford, Connecticut  06106
Black Rock Medical GroupTrumbull, Connecticut  06611
Oncology Associates of Bridgeport-TrumbullTrumbull, Connecticut  06611
Connecticut Multi Specialty Group-WethersfieldWethersfield, Connecticut  06109
Oncology Associates P.C.-WillimanticWillimantic, Connecticut  06226
CCOP, Christiana Care Health Services Inc.Newark, Delaware  19718
Washington Oncology-Hematology Center, PC-WashingtonWashington, District of Columbia  20037
Lynn Cancer InstituteBoca Raton, Florida  33428
Florida Cancer Specialists-Bonita SpringsBonita Springs, Florida  34135
Florida Cancer Specialists-BradentonBradenton, Florida  34209
Florida Cancer Specialists, BrandonBrandon, Florida  33511
Florida Cancer Specialists-Cape Coral Del PradoCape Coral, Florida  33990
Florida Cancer Specialists-Cape Coral ParkwayCape Coral, Florida  33914
Florida Cancer Specialists-EnglewoodEnglewood, Florida  34223
Florida Cancer Specialists-Fort Myers BroadwayFt. Myers, Florida  33901
Florida Cancer Specialists-Fort Myers SummerlinFt. Myers, Florida  33908
Florida Cancer Specialists-Naples GoodletteNaples, Florida  34102
Florida Cancer Specialists-NAPA RidgeNaples, Florida  34119
Florida Cancer Specialists, CornerstonePalm Harbor, Florida  34684
Florida Cancer Specialists-Port CharlottePort Charlotte, Florida  33980
Florida Cancer Specialist-CattlemanSarasota, Florida  34232
Florida Cancer Specialists-DowntownSarasota, Florida  34236
Florida Cancer Specialists-Park PlaceSt. Petersburg, Florida  33756
Florida Cancer Specialists-VeniceVenice, Florida  34292
Florida Cancer Specialists-Venice IslandVenice, Florida  34285
Grady HealthsystemAtlanta, Georgia  30303
Northwest Georgia Oncology Centers PCAustell, Georgia  30106
Suburban Hematology Oncology Associates PCSnellville, Georgia  30078
Oncare Hawaii, Inc-KMPHonolulu, Hawaii  96817
Oncare Hawaii, Inc-POB2Honolulu, Hawaii  96813
MBCCOP, John H. Stroger, JR., Hospital of Cook County-ChicagoChicago, Illinois  60612
Cancer Care Specialists-Central IllinoisDecatur, Illinois  62526
Yorkville Family PracticeYorkville, Illinois  60560
Corydon Hospital Medical PlazaCorydon, Indiana  47112
Michiana Hematology-Oncology, P.C. (Elkhart)Elkhart, Indiana  46514
Waverly Hematology OncologyGary, Indiana  27518
Clark Medical BuildingJeffersonville, Indiana  47130
Michiana Hematology-Oncology, P.C. (LaPorte)LaPorte, Indiana  46350
Oncology, P.C. PlymouthPlymouth, Indiana  46563
Michiana Hematology-Oncology PCPlymouth, Indiana  46563
Michiana Hematology-Oncology, P.C. (Main Office)South Bend, Indiana  46601
Michiana Hematology-Oncology, P.C. Cedar St.South Bend, Indiana  46617
Hematology and Medical Oncology Consultants-BettendorfBettendorf, Iowa  52722
Hematology and Medical Oncology Consultants-DavenportDavenport, Iowa  52804
NortonHealthcare PavillionLouisville, Kentucky  40202
Norton Medical Plaza IILouisville, Kentucky  40207
Norton Medical Plaza WestLouisville, Kentucky  40217
Old Brownsboro CrossingLouisville, Kentucky  40241
Harry & Jeannette Weinberg Cancer InstituteBaltimore, Maryland  21237
Hematology-Oncology AssociatesBaltimore, Maryland  21237
Carolyn Hendricks, MDBethesda, Maryland  20817
Washington Oncology-Hematology Center, PC-Chevy ChaseChevy Chase, Maryland  20815
The Office of Frederik SmithChevy Chase, Maryland  20815
Peninsula Regional Oncology & HematologySalisbury, Maryland  20817
Berkshire Hematology Oncology, P.C.-North AdamsNorth Adams, Massachusetts  01247
CCOP, St. Joseph Mercy HospitalAnn Arbor, Michigan  48106
Dr. Cook and Abramson - Bay CityBay City, Michigan  48706
St. Joseph Mercy Woodland Health CenterBrighton, Michigan  48114
Josephone Ford Cancer CenterBrownstown, Michigan  48183
UP Hematology/Oncology Assoc.-Doctor's Park Family PhysiciansEscanaba, Michigan  49829
Sing and AroraFlint, Michigan  48532
Genesys HurleyFlint, Michigan  48503
CCOP Hurley Medical CenterFlint, Michigan  48503
St. Mary's Health ServicesGrand Rapids, Michigan  49503
CCOP, St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  19229
Portage Internal Medical AssociatesHancock, Michigan  49935
UP Hematology/Oncology AssociatesIron Mountain, Michigan  49801
UP Hematology/Oncology Associates-Gogebic RangeIronwood, Michigan  49938
Hematology/Oncology Associates of OH and MI, PCLambertville, Michigan  48144
CCOP, Sparrow Health SystemLansing, Michigan  48909
Hematology Oncology-LapeerLapeer, Michigan  48446
Keewanaw Memorial HospitalLaurium, Michigan  49913
St. Mary Mercy Hospital - LivoniaLivonia, Michigan  48154
Upper Peninsula Hematology/Oncology AssociatesMarquette, Michigan  49855
Community Cancer Care Specialists-Mt. ClemensMt. Clemens, Michigan  48043
Michiana Hematology-Oncology PCNiles, Michigan  49120
CCOP, St. Mary's Medical CenterSaginaw, Michigan  48601
Chippewa Medical AssociatesSault Saint Marie, Michigan  49783
Osteopathic Medical Oncology HematologyShelby Township, Michigan  48315
Michiana Hematology-Oncology, PC LakelandSt. Joseph, Michigan  49085
CCOP, St. John Macomb HospitalWarren, Michigan  48093
Minnesota Oncology Hematology-BurnsvilleBurnsville, Minnesota  55337
Hubert H. Humphrey Cancer Center - Coon RapidsCoon Rapids, Minnesota  55433
Minnesota Oncology Hematology-EdinaEdina, Minnesota  55435
Fairview Southdale Medical Oncology ClinicEdina, Minnesota  55455
Hubert H. Humphrey Cancer Center - FridleyFridley, Minnesota  55432
Minnesota Oncology Hematology PA - MaplewoodMaplewood, Minnesota  55109
Minnesota Oncology Hematology-MinneapolisMinneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center-RobbinsdaleRobbinsdale, Minnesota  55422
Minnesota Hematology Oncology-St. PaulSt. Paul, Minnesota  55102
Minnesota Oncology Hematology-WaconiaWaconia, Minnesota  55387
University of Tennessee Cancer InstituteSouthaven, Mississippi  38671
St. John's Regional Health Center-JoplinJoplin, Missouri  64804
Cox Health SystemsSpringfield, Missouri  65807
Comprehensive Cancer Centers of Nevada (Siena)Henderson, Nevada  89052
Cancer ConsultantsLas Vegas, Nevada  89106
Cancer and Blood Specialists- Shadow LaneLas Vegas, Nevada  89106
Alpine Hematology-OncologyReno, Nevada  89503
NY Oncology Hematology PC at Albany Medical CenterAlbany, New York  12208
Hematology Oncology Assaociates of CNY, CCOPEast Syracuse, New York  12010
NY Oncology Hematology PC-Hudson Carvell Cancer Tx Prog.Hudson, New York  12534
NY Oncology Hematology PC- Latham- Capital District Oncology HematologyLatham, New York  12110
Riverview Cancer Care Medical AssociationRexford, New York  12148
Hematology Oncology Associates of CNY, CCOPRome, New York  13440
University Hospital and Medical Center-SUNYStony Brook, New York  11794
Hematology Oncology Assoc. of CNY, CCOP (Comm. General Hospital Satellite Office)Syracuse, New York  13215
Troy Cancer Treatment ProgramTroy, New York  12180
Cancer Center of NC at AshevilleAsheville, North Carolina  28803
CCOP, Mission Hospitals, Inc.Asheville, North Carolina  28801
Carolinas Hematology-Oncology Associates - Tyron StCharlotte, North Carolina  28203
CCOP Presbyterian HospitalCharlotte, North Carolina  28204
Carolinas Medical Center - Blumenthal Cancer CenterCharlotte, North Carolina  28204
Carolinas Hematology Oncology Associates - Harris Blvd.Charlotte, North Carolina  28262
Carolinas Hematology-Oncology - John J. DelaneyCharlotte, North Carolina  28277
Mecklenburg Medical Group - Cameron Valley PkwyCharlotte, North Carolina  28211
Mecklenburg Medical Group - Morehead Medical DrCharlotte, North Carolina  28204
CCOP, Wayne Memorial HospitalGoldsboro, North Carolina  27534
Alliance Cancer CenterAlliance, Ohio  44601
Tri County Hematology/OncologyCanton, Ohio  44781
Kenwood OfficeCincinnati, Ohio  45236
North Treatment Center - Blue Ash Medical CenterCincinnati, Ohio  45242
Oncology/Hematology Care Clinical Trials LLC, Cincinnati, OH Blue Ash Med. Cntr. (Administrative Only)Cincinnati, Ohio  45242
Oncology/Hematology Care Clinical Trials LLCCincinnati, Ohio  45236
Dayton Physicians-LLC-Hematology & Medical Oncology DivisionDayton, Ohio  45415
HealthplexFairfield, Ohio  45014
Dayton Physicians, LLC - GreenvilleGreenville, Ohio  45331
Hamilton OfficeHamilton, Ohio  45013
Dayton Clinical Oncology Program-KetteringKettering, Ohio  45429
Marian A. Llenado Lee, MD, Inc.Kettering, Ohio  45429
UHHS - Chagrin HighlandsOrange Village, Ohio  44122
UHHS Green Road-Ireland Cancer CenterSouth Euclid, Ohio  44121
UHHS Westlake-Ireland Cancer CenterWestlake, Ohio  44145
Northwest Cancer Specialists-Adventist OfficePortland, Oregon  97216
Northwest Cancer Specialists-PortlandPortland, Oregon  97213
Providence Oncology and Hematology Care ClinicPortland, Oregon  97225
Hematology Oncology Associates of NE PADonora, Pennsylvania  18142
UPMC Cancer Centers Arnold Palmer Pavilion-MountainviewGreensburg, Pennsylvania  15601
UPMC Cancer Centers Arnold Palmer-OakbrookGreensburg, Pennsylvania  15601
UPMC Cancer Centers-IndianaIndiana, Pennsylvania  15701
UPMC Cancer Centers-John P. Murtha Cancer CenterJohnstown, Pennsylvania  15901
UPMC Cancer Centers - McKeesport HospitalMcKeesport, Pennsylvania  15132
UPMC Cancer Centers Arnold Palmer-Mt. PleasantMt. Pleasant, Pennsylvania  15666
Cancer Center at Center OnePhiladelphia, Pennsylvania  19115
UPMC Cancer Centers - UPMC PassavantPIttsburgh, Pennsylvania  15237
UPMC Cancer Centers - UPMC St. MargaretPittsburgh, Pennsylvania  15215
NSABP Foundation, IncPittsburgh, Pennsylvania  15212
UPMC Cancer Centers-UniontownUniontown, Pennsylvania  15401
UPMC Cancer Centers - WexfordWexford, Pennsylvania  15090
Thompson Oncology Group-WestKnoxville, Tennessee  37932
Thompson Oncology Group-BlountKnoxville, Tennessee  37804
Texas Oncology- Sammons CCDallas, Texas  75246
Covenant Health System dba Joe Arrington Cancer Research & Treatment CenterLubbock, Texas  79410
McKay-Dee HospitalOgden, Utah  84403
Dixie Medical CenterSt. George, Utah  84780
VCU Massey Cancer Center at Stony PointRichmond, Virginia  23235
Overlake Internal MedicineBellevue, Washington  98004
Rockwood Cancer Treatment Center - Sinto AveSpokane, Washington  99204
Northwest Cancer Specialists-136th AveVancouver, Washington  98684
Northwest Cancer Specialists-134th St.Vancouver, Washington  98686
Southwest Washington HospitalVancouver, Washington  98664
Oncology Alliance-BurlingtonBurlington, Wisconsin  53105
Oncology Alliance-FranklinFranklin, Wisconsin  53132
Oncology Alliance-Kenosha NorthKenosha, Wisconsin  53144
Oncology Alliance-Kenosha SouthKenosha, Wisconsin  53143
Oncology Alliance-Menomonee FallsMenomonee Falls, Wisconsin  53051
Oncology Alliance-MequonMequon, Wisconsin  53092
Oncology Alliance-SouthMilwaukee, Wisconsin  53215
Oncology Alliance-RacineRacine, Wisconsin  53406
Oncology Alliance-WaukeskaWaukesha, Wisconsin  53188