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Randomized Phase II 2 x 2 Factorial Trial of the Addition of Carboplatin +/- Bevacizumab to Neoadjuvant Weekly Paclitaxel Followed by Dose-Dense AC in Hormone Receptor-Poor/HER2-Negative Resectable Breast Cancer


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Estrogen Receptor-negative Breast Cancer, HER2-negative Breast Cancer, Male Breast Cancer, Progesterone Receptor-negative Breast Cancer, Stage II Breast Cancer, Stage IIIA Breast Cancer, Triple-negative Breast Cancer

Thank you

Trial Information

Randomized Phase II 2 x 2 Factorial Trial of the Addition of Carboplatin +/- Bevacizumab to Neoadjuvant Weekly Paclitaxel Followed by Dose-Dense AC in Hormone Receptor-Poor/HER2-Negative Resectable Breast Cancer


PRIMARY OBJECTIVES:

I. To determine whether adding bevacizumab to neoadjuvant weekly paclitaxel (+/-
carboplatin) and subsequent dose-dense doxorubicin and cyclophosphamide (ddAC) significantly
raises the rate of pathologic complete response (pCR) in the breast in patients with
HR-poor/HER2 (-), resectable breast cancer.

II. To determine whether adding carboplatin every 3 weeks to neoadjuvant weekly paclitaxel
followed by ddAC (+/- bevacizumab) significantly raises the rate of pCR in the breast in
patients with HR-poor/HER2(-), resectable breast cancer.

III. To determine whether adding bevacizumab every 2 weeks to neoadjuvant weekly paclitaxel
(+/- carboplatin) and subsequent ddAC significantly raises the rate of pCR in the breast in
patients with basal-like breast cancers, as defined by gene expression array.

IV. To determine whether adding carboplatin every 3 weeks to neoadjuvant weekly paclitaxel
followed by ddAC (+/- bevacizumab) significantly raises the rate of pCR in the breast in
patients with basal-like breast cancers, as defined by gene expression array.

SECONDARY OBJECTIVES:

I. To determine the pCR rates in the breast and axilla, using AJCC TNM criteria (Version 6),
to neoadjuvant weekly paclitaxel, with or without carboplatin, followed by ddAC, with or
without bevacizumab, given concurrently with the weekly paclitaxel and ddAC, in (a) patients
with HR-poor/HER2(-), resectable breast cancer and (b) the subset of patients with
basal-like breast cancers, as defined by gene expression array.

II. To assess whether there is an interaction between the addition of carboplatin and
bevacizumab to neoadjuvant chemotherapy (NAC) with weekly paclitaxel followed by ddAC as
regards the path pCR rates in (a) patients with HR-poor/HER2(-), resectable breast cancer
and (b) the subset of patients with basal-like breast cancers, as defined by gene expression
array.

III. To assess the toxicity of the control regimen (weekly paclitaxel followed by ddAC) and
any incremental toxicities associated with the addition of carboplatin and/or bevacizumab in
this patient population, including the incidence of febrile neutropenia, grade > 3
thrombocytopenia, grade > 2 neurotoxicity, grade > 3 hypertension, and clinically
significant bleeding or thrombotic (including cardiovascular and cerebrovascular) events.

IV. To determine the recurrence-free survival (RFS) measured from definitive surgery to
first event, and time to first failure (TFF) measured from study entry to first event (see
Sec 16.2).

V. To determine overall survival (OS), defined as time from registration to death from any
cause.

VI. To assess the impact of NAC with weekly paclitaxel followed by ddAC, with or without
carboplatin and/or bevacizumab, on axillary lymph node involvement at surgery, particularly
in patients with clinically or histologically positive axillary lymph nodes prior to
initiation of NAC.

VII. To assess the impact of the addition of bevacizumab to NAC on the incidence and
severity of post-op complications, especially excessive bleeding, delayed wound healing, and
thrombotic complications.

VIII. To evaluate residual cancer burden (RCB) as a predictor of RFS, TFF and OS.

IX. To determine the correlation between clinical, radiographic, and pathologic response.

X. Given the prevalence of the triple-negative phenotype in young African-American women,
the study team, the CALGB Committee on Advocacy, Research Communications and Ethics (CARE)
and the CARE Disparities Subcommittee will collaborate to develop a plan intended to enhance
accrual of this patient subgroup.

TERTIARY OBJECTIVES:

I. To assess whether the impact of the addition of carboplatin and/or bevacizumab to NAC
with weekly paclitaxel followed by ddAC on achievement of pathologic CRs in patients with
HR-poor/HER2(-), resectable breast cancer is influenced by molecular subtype, as defined by
gene expression array.

II. To obtain blood, fresh frozen and fixed tumor tissue to test specific hypotheses for
which biomarker data exist and to evaluate biomarkers in tissue, blood, and serum that may
influence response to and toxicity of weekly paclitaxel, ddAC, carboplatin, and/or
bevacizumab.

III. To obtain blood samples to test specific hypotheses for which biomarker data exist and
to evaluate biomarkers in blood that may influence response to and toxicity of weekly
paclitaxel, ddAC, carboplatin and/or bevacizumab.

IV. To determine the surgical practice patterns for breast conservation and sentinel
lymphadenectomy in patients undergoing neoadjuvant chemotherapy.

V. To examine the practice patterns and use of sentinel lymphadenectomy (pre-chemotherapy or
post-chemotherapy) in patients with T2 or T3 breast cancer.

VI. To examine the proportion of patients who presented with T2 or T3 cancers who undergo
mastectomy despite cytoreduction adequate for breast conservation.

VII. To determine the radiotherapy practice patterns for post-mastectomy and regional nodal
irradiation in patients undergoing neoadjuvant chemotherapy.

OUTLINE: This is a multicenter study. Patients are stratified according to clinical stage of
disease (II vs III). Patients are randomized to 1 of 4 treatment arms.

ARM I: Patients receive paclitaxel IV over 60 minutes once weekly in weeks 1-12. Patients
then receive dose-dense doxorubicin hydrochloride IV over 3-10 minutes and cyclophosphamide
IV over 5-60 minutes (ddAC) once in weeks 13, 15, 17, and 19.

ARM II: Patients receive paclitaxel and ddAC as in arm I. Patients also receive bevacizumab
IV over 30-90 minutes once in weeks 1, 3, 5, 7, 9, 11, 13, 15, and 17.

ARM III: Patients receive paclitaxel and ddAC as in arm I. Patients also receive carboplatin
IV over 30 minutes once in weeks 1, 4, 7, and 10.

ARM IV: Patients receive paclitaxel and ddAC as in arm I, bevacizumab as in arm II, and
carboplatin as in arm III. Patients in all arms undergo definitive surgery (i.e., modified
radical mastectomy or breast-conserving surgery with appropriate management of the axilla)
between 4-8 weeks after completion of neoadjuvant therapy. Patients undergo core tissue
biopsies at baseline for correlative biomarker studies.

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


Inclusion Criteria:



- Histologically confirmed invasive breast cancer by core needle or incisional biopsy
(excisional biopsy is not allowed)

- Clinical stage II-III disease

- No inflammatory breast cancer

- Resectable disease

- Intent to undergo surgery after completion of neoadjuvant therapy

- Hormone receptor status poor, defined as estrogen receptor-negative and progesterone
receptor-negative tumor OR staining present in ≤ 10% of invasive cancer cells by IHC

- HER2-negative disease, defined as IHC0-1+ OR FISH ratio (HER2 gene copy/chromosome
17) of < 2.0

- Measurable disease, defined as clinically orradiographically measurable target lesion
in the breast that is ≥ 1 cm

- No axillary disease only (i.e., no identifiable tumor in the breast that is ≥ 1
cm onphysical exam or radiographic study)

- Multicentric or bilateral disease allowed provided the target lesion meets the above
eligibility criteria

- Concurrent registration on CALGB-150709 required

- Menopausal status not specified

- Zubrod performance status 0-1

- Granulocytes ≥ 1,000/μL

- Platelets ≥ 100,000/μL

- Total bilirubin ≤ 1.5 times upper limit of normal(ULN)

- ALT ≤ 2.5 times ULN

- Creatinine clearance> 30 mL/min

- Urine protein ≤ 1+ by urinalysis OR urine protein:creatinine ratio < 1 OR 24-hour
urine protein < 1 g

- PT/INR ≤ 1.5 times ULN (INR ≤ 3 times ULN if patient is on stable, therapeutic doses
of warfarin and has no active bleeding or pathologic condition that is associated
with a high risk of bleeding)

- LVEF > lower limit of normal by MUGA scan or echocardiogram

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective, non-hormonal contraception during the entire
period of study treatment

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

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

- No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within
the past 6 months

- No baseline neuropathy ≥ grade 2

- No congestive heart failure

- No myocardial infarction, unstable angina pectoris, arterial thrombotic event,
stroke, or transient ischemia attack within the past 12 months

- No uncontrolled hypertension (systolic blood pressure [BP] > 160 mm Hg or diastolic
BP > 90 mm Hg), uncontrolled or symptomatic arrhythmia, or peripheral vascular
disease ≥ grade 2

- More than 28 days since prior and no concurrent major surgical procedure; the
following are NOT considered to be major surgical procedures:

- Obtaining the required research needle biopsies

- Placement of a radiopaque clip to localize a tumor or tumors for subsequent
surgical resection

- Placement of a port for central venous access

- Fine needle aspiration of a prominent or suspicious axillary lymph node

- Needle biopsy of a clinically or radiographically detected lesion to rule out
metastatic disease

- Pretreatment sentinel lymph node sampling

- No prior chemotherapy, hormonal therapy, or radiotherapy with therapeutic intent for
this cancer

- No other concurrent chemotherapy

- No concurrent hormonal therapy, except steroids for adrenal failure or hormones for
non-disease-related conditions (e.g., insulin for diabetes, dexamethasone as
pre-treatment for paclitaxel, or dexamethasone as an antiemetic)

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Pathologic complete response (pCR), defined as the absence of residual invasive carcinoma in the breast

Outcome Description:

Will use two separate chi-square tests, one for each factor, to assess the difference in proportion of pCR in the breast between the control and experimental groups. Will use exact binomial methods to construct 95% confidence intervals around the pCR incidence by factor.

Outcome Time Frame:

At the time of definitive surgical removal

Safety Issue:

No

Principal Investigator

William Sikov

Investigator Role:

Principal Investigator

Investigator Affiliation:

Cancer and Leukemia Group B

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-01172

NCT ID:

NCT00861705

Start Date:

May 2009

Completion Date:

Related Keywords:

  • Estrogen Receptor-negative Breast Cancer
  • HER2-negative Breast Cancer
  • Male Breast Cancer
  • Progesterone Receptor-negative Breast Cancer
  • Stage II Breast Cancer
  • Stage IIIA Breast Cancer
  • Triple-negative Breast Cancer
  • Breast Neoplasms
  • Breast Neoplasms, Male

Name

Location

Memorial Sloan Kettering Cancer CenterNew York, New York  10021
Roswell Park Cancer InstituteBuffalo, New York  14263
University of Iowa Hospitals and ClinicsIowa City, Iowa  52242
University of Mississippi Medical CenterJackson, Mississippi  39216-4505
Washington University School of MedicineSaint Louis, Missouri  63110
University of Washington Medical CenterSeattle, Washington  98195-6043
Rhode Island HospitalProvidence, Rhode Island  02903
Beth Israel Deaconess Medical CenterBoston, Massachusetts  02215
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
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
Fairview Ridges HospitalBurnsville, Minnesota  55337
Hutchinson Area Health CareHutchinson, Minnesota  55350
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
Avera Cancer InstituteSioux Falls, South Dakota  57105
Massachusetts General Hospital Cancer CenterBoston, Massachusetts  02114
Sutter Health Western Division Cancer Research GroupGreenbrae, California  94904
Memorial Hospital of South BendSouth Bend, Indiana  46601
Beth Israel Medical CenterNew York, New York  10003
Akron General Medical CenterAkron, Ohio  44302
York HospitalYork, Pennsylvania  17315
LDS HospitalSalt Lake City, Utah  84143
Dana-Farber Cancer InstituteBoston, Massachusetts  02115
University of Kansas Medical CenterKansas City, Kansas  66160-7353
Hartford HospitalHartford, Connecticut  06102-5037
Eastern Maine Medical CenterBangor, Maine  04401
Franklin Square Hospital CenterBaltimore, Maryland  21237
Staten Island University HospitalStaten Island, New York  10305
Peninsula Regional Medical CenterSalisbury, Maryland  21801
Monmouth Medical CenterLong Branch, New Jersey  07740-6395
Via Christi Regional Medical CenterWichita, Kansas  67214
University of Oklahoma Health Sciences CenterOklahoma City, Oklahoma  73104
Elmhurst Hospital CenterElmhurst, New York  11373
Maimonides Medical CenterBrooklyn, New York  11219
Group Health CooperativeSeattle, Washington  98112
Great Falls ClinicGreat Falls, Montana  59405
Thompson Cancer Survival CenterKnoxville, Tennessee  37916
Mount Sinai Medical CenterNew York, New York  10029
Fred Hutchinson Cancer Research Center/University of Washington Cancer ConsortiumSeattle, Washington  98109
Lewistown HospitalLewistown, Pennsylvania  17044
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
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
Bozeman Deaconess HospitalBozeman, Montana  59715
Big Sky OncologyGreat Falls, Montana  59405
Kalispell Medical OncologyKalispell, Montana  59901
Kalispell Regional Medical CenterKalispell, Montana  59901
Avera McKennan Hospital and University Health CenterSioux Falls, South Dakota  57105
Medical X-Ray CenterSioux Falls, South Dakota  57105
American Fork HospitalAmerican Fork, Utah  84003
Logan Regional HospitalLogan, Utah  84321
McKay-Dee Hospital CenterOgden, Utah  84403
Harborview Medical CenterSeattle, Washington  98104
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Welch Cancer CenterSheridan, Wyoming  82801
Brigham and Women's HospitalBoston, Massachusetts  02115
City of Hope Medical CenterDuarte, California  91010
Elkhart General HospitalElkhart, Indiana  46515
South Bend ClinicSouth Bend, Indiana  46617
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical CenterColumbus, Ohio  43210-1240
Front Range Cancer SpecialistsFort Collins, Colorado  80528
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
Sutter Solano Medical CenterVallejo, California  94589
Poudre Valley HospitalFort Collins, Colorado  80524
Beebe Medical CenterLewes, Delaware  19958
Saint Joseph's Hospital of AtlantaAtlanta, Georgia  30342-1701
Piedmont HospitalAtlanta, Georgia  30309
Gwinnett Medical CenterLawrenceville, Georgia  30045
Southern Regional Medical CenterRiverdale, Georgia  30274-2600
Salina Regional Health CenterSalina, Kansas  67401
Community Cancer Center of MonroeMonroe, Michigan  48162
Iredell Memorial HospitalStatesville, North Carolina  28677
Grandview HospitalDayton, Ohio  45405
Lima Memorial HospitalLima, Ohio  45804
Mercy Hospital of TiffinTiffin, Ohio  44883
Fulton County Health CenterWauseon, Ohio  43567
Doctor's Hospital of LaredoLaredo, Texas  78041
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
Mercy HospitalCoon Rapids, Minnesota  55433
Allenmore HospitalTacoma, Washington  98411-0414
Bixby Medical CenterAdrian, Michigan  49221
Fairview-Southdale HospitalEdina, Minnesota  55435
Abbott-Northwestern HospitalMinneapolis, Minnesota  55407
Regions HospitalSaint Paul, Minnesota  55101
Saint Francis Regional Medical CenterShakopee, Minnesota  55379
Rice Memorial HospitalWillmar, Minnesota  56201
Altru Cancer CenterGrand Forks, North Dakota  58206
Saint Luke's HospitalMaumee, Ohio  43537
Highland General HospitalOakland, California  94602
Northeast Georgia Medical CenterGainesville, Georgia  30501
Swedish American HospitalRockford, Illinois  61104
Center for Cancer Care and ResearchSt. Louis, Missouri  63141
Miami Valley HospitalDayton, Ohio  45409
Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Cancer Center of Kansas - Fort ScottFort Scott, Kansas  66701
Cancer Center of Kansas-IndependenceIndependence, Kansas  67301
Lawrence Memorial HospitalLawrence, Kansas  66044
Menorah Medical CenterOverland Park, Kansas  66209
Shawnee Mission Medical CenterShawnee Mission, Kansas  66204
North Kansas City HospitalKansas City, Missouri  64116
Research Medical CenterKansas City, Missouri  64132
Saint Luke's East - Lee's SummitLee's Summit, Missouri  64086
Liberty HospitalLiberty, Missouri  64068
Heartland Regional Medical CenterSaint Joseph, Missouri  64506
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
Northern Montana HospitalHavre, Montana  59501
Wayne HospitalGreenville, Ohio  45331
Fisher-Titus Medical CenterNorwalk, Ohio  44857
Clinton Memorial HospitalWilmington, Ohio  45177
Providence Centralia HospitalCentralia, Washington  98531-9027
Wenatchee Valley Medical CenterWenatchee, Washington  98801-2028
Rocky Mountain OncologyCasper, Wyoming  82609
Longmont United HospitalLongmont, Colorado  80501
Greene Memorial HospitalXenia, Ohio  45385
Greater Baltimore Medical CenterBaltimore, Maryland  21204
Rutherford HospitalRutherfordton, North Carolina  28139
AnMed Health Cancer CenterAnderson, South Carolina  29621
Union Hospital of Cecil CountyElkton MD, Maryland  21921
Miriam HospitalProvidence, Rhode Island  02906
Cancer Centers of the Carolinas - Grove CommonsGreenville, South Carolina  29605
Cancer Centers of the Carolinas - SenecaSeneca, South Carolina  29672
Cancer Centers of the Carolinas - SpartanburgSpartanburg, South Carolina  29307
Presbyterian HospitalCharlotte, North Carolina  28233-3549
Manchester Memorial HospitalManchester, Connecticut  06040-4188
Phelps County Regional Medical CenterRolla, Missouri  65401
La Grange Memorial HospitalLa Grange, Illinois  60525
Queen's Medical CenterHonolulu, Hawaii  96813
Newton-Wellesley HospitalNewton, Massachusetts  02462
University of North CarolinaChapel Hill, North Carolina  27599
Meharry Medical CollegeNashville, Tennessee  37208-3599
East Bay Radiation Oncology CenterCastro Valley, California  94546
Contra Costa Regional Medical CenterMartinez, California  94553-3156
Larry G Strieff MD Medical CorporationOakland, California  94609
Kapiolani Medical Center at Pali MomiAiea, Hawaii  96701
Kapiolani Medical Center for Women and ChildrenHonolulu, Hawaii  96826
Maui Memorial Medical CenterWailuku, Hawaii  96793
Bay Area HospitalCoos Bay, Oregon  97420
Hennepin County Medical CenterMinneapolis, Minnesota  
Queens Hospital CenterJamaica, New York  11432
Saint Louis University HospitalSt. Louis, Missouri  63110-0250
Glens Falls HospitalGlens Falls, New York  12801
Holy Cross HospitalFort Lauderdale, Florida  33308
El Camino HospitalMountain View, California  94040
New Hampshire Oncology-Hematology PAHooksett, New Hampshire  03106
Albert Einstein Medical CenterPhiladelphia, Pennsylvania  19141
Straub Clinic and HospitalHonolulu, Hawaii  96813
Cancer Center of Kansas - McPhersonMcPherson, Kansas  67460
California Pacific Medical CenterSan Francisco, California  94115
Dartmouth Hitchcock Medical CenterLebanon, New Hampshire  03756
Weiss Memorial HospitalChicago,, Illinois  60640
Presbyterian - Saint Lukes Medical Center - Health OneDenver, Colorado  80218
Wichita CCOPWichita, Kansas  67214-3882
Montana Cancer Consortium CCOPBillings, Montana  59101
Flower HospitalSylvania, Ohio  43560-2197
Mount Sinai Hospital Medical CenterChicago, Illinois  60608
Addison Gilbert HospitalGloucester, Massachusetts  01930
Metro-Minnesota CCOPSt. Louis Park, Minnesota  
Cancer Centers of the Carolinas - EasleyEasley, South Carolina  29640
Lakeview HospitalStillwater, Minnesota  55082
Frederick Memorial HospitalFrederick, Maryland  21701
Princeton Community HospitalPrinceton, West Virginia  24740
Montana Cancer SpecialistsMissoula, Montana  59807-7877
Desert Regional Medical CenterPalm Springs, California  92262
Providence Saint Joseph Medical CenterBurbank, California  91505-4866
Florida HospitalOrlando, Florida  32803
Memorial Health University Medical CenterSavannah, Georgia  31404
University of Chicago Comprehensive Cancer CenterChicago, Illinois  60637-1470
DeKalb Medical CenterDecatur, Georgia  30033
Northern Indiana Cancer Research ConsortiumSouth Bend, Indiana  
Hawaii Medical Center EastHonolulu, Hawaii  96817
Norwalk HospitalNorwalk, Connecticut  06856
Penn State Milton S Hershey Medical CenterHershey, Pennsylvania  17033
Piedmont Fayette HospitalFayetteville, Georgia  30214
Castle Medical CenterKailua, Hawaii  96734
Hays Medical CenterHays, Kansas  67601
Southeast Cancer CenterCape Girardeau, Missouri  63703
Butler Memorial HospitalButler, Pennsylvania  16001
Littleton Adventist HospitalLittleton, Colorado  80122
Parker Adventist HospitalParker, Colorado  80138
New Ulm Medical CenterNew Ulm, Minnesota  56073
Northside HospitalAtlanta, Georgia  30342
Mills - Peninsula HospitalsBurlingame, California  94010
Valley Medical Oncology Consultants-Castro ValleyCastro Valley, California  94546
Eden Hospital Medical CenterCastro Valley, California  94546
Valley Medical Oncology Consultants-FremontFremont, California  94538
Palo Alto Medical Foundation-Camino DivisionMountain View, California  94040
Bay Area Breast Surgeons IncOakland, California  94609
Bay Area Tumor Institution CCOPOakland, California  94609
Tom K Lee IncOakland, California  94609
Saint Joseph HospitalOrange, California  92868
Palo Alto Medical Foundation Heath CarePalo Alto, California  94301
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
Lombardi Comprehensive Cancer Center at Georgetown UniversityWashington, District of Columbia  20057
Phoebe Putney Memorial HospitalAlbany, Georgia  31703
Atlanta Regional CCOPAtlanta, Georgia  30342
Well Star Cobb HospitalAustell, Georgia  30106
John B Amos Cancer CenterColumbus, Georgia  31904
Wellstar Kennestone HospitalMarietta, Georgia  30060
Oncare Hawaii Inc-POB IIHonolulu, Hawaii  96813
Oncare Hawaii Inc-KuakiniHonolulu, Hawaii  96817
University of HawaiiHonolulu, Hawaii  96813
Pacific Cancer Institute of MauiWailuku, Hawaii  96793
John H Stroger Jr Hospital of Cook CountyChicago, Illinois  60612-3785
Resurrection HealthcareChicago, Illinois  60631
Hematology Oncology Consultants LimitedNaperville, Illinois  60540
West Suburban Cancer CenterRiver Forest, Illinois  60305
Saint Francis Hospital and Health CentersBeech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Inc - State BoulevardFort Wayne, Indiana  46845
Reid Hospital and Health Care ServicesRichmond, Indiana  47374
Iowa Blood and Cancer Care PLCCedar Rapids, Iowa  52402
Mercy HospitalCedar Rapids, Iowa  52403
Saint Luke's HospitalCedar Rapids, Iowa  52402
Mercy Medical Center-Sioux CitySioux City, Iowa  51104
Saint Luke's Regional Medical CenterSioux City, Iowa  51104
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
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
Hickman Cancer CenterAdrian, Michigan  49221
Green Bay Oncology - EscanabaEscanaba, Michigan  49431
Green Bay Oncology - Iron MountainIron Mountain, Michigan  49801
Mid-Michigan Medical Center - MidlandMidland, Michigan  48670
Mercy Memorial HospitalMonroe, Michigan  48162
Lakeland HospitalSt. Joseph, Michigan  49085
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
Minnesota Oncology and Hematology PA-WoodburyWoodbury, Minnesota  55125
Saint Luke's Cancer InstituteKansas City, Missouri  64111
Saint Luke's Hospital of Kansas CityKansas City, Missouri  64111
Saint Joseph Health CenterKansas City, Missouri  64114
Liberty Radiation Oncology ClinicKansas City, Missouri  64116
Truman Medical CenterKansas City, Missouri  64108
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
Cox Medical CenterSpringfield, Missouri  65807
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
Saint Peter's Community HospitalHelena, Montana  59601
Glacier Oncology PLLCKalispell, Montana  59901
Saint Patrick Hospital - Community HospitalMissoula, Montana  59802
Exeter HospitalExeter, New Hampshire  03833
New Hampshire Oncology Hematology AssociatesHooksett, New Hampshire  03106
LRGHealthcare-Lakes Region General HospitalLaconia, New Hampshire  03246
Cooper Hospital University Medical CenterCamden, New Jersey  08103
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington CountyMount Holly, New Jersey  08060
Virtua West Jersey Hospital VoorheesVoorhees, New Jersey  08043
Orange Regional Medical CenterMiddletown, New York  10940
Saint Luke's Roosevelt Hospital Center - Saint Luke's DivisionNew York, New York  10025
State University of New York Upstate Medical UniversitySyracuse, New York  13210
Mission Hospitals IncAsheville, North Carolina  28801
Wayne Memorial HospitalGoldsboro, North Carolina  27534
Kinston Medical Specialists PAKinston, North Carolina  28501
Summa Barberton HospitalBarberton, Ohio  44203
Aultman Health FoundationCanton, Ohio  44710
Good Samaritan Hospital - DaytonDayton, Ohio  45406
Dayton CCOPDayton, Ohio  45429
Samaritan North Health CenterDayton, Ohio  45415
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
Saint Rita's Medical CenterLima, Ohio  45801
Mansfield General Hospital-MedCentral Health SystemMansfield, Ohio  44903
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 Luke's HospitalBethlehem, Pennsylvania  18015
Aria Health-Torresdale CampusPhiladelphia, Pennsylvania  19114
Kent County HospitalWarwick, Rhode Island  02886
AnMed Health HospitalAnderson, South Carolina  29621
Greenville CCOPGreenville, South Carolina  29615
Greenville Memorial HospitalGreenville, South Carolina  29605
Upstate Carolina CCOPSpartanburg, South Carolina  29303
Sanford Cancer Center-Oncology ClinicSioux Falls, South Dakota  57104
Fredericksburg Oncology IncFredericksburg, Virginia  22401
Auburn Regional Medical CenterAuburn, Washington  98002
Harrison Bremerton Hematology and OncologyBremerton, Washington  98310
Saint Francis HospitalFederal Way, Washington  98003
Columbia Basin Hematology and Oncology PLLCKennewick, Washington  99336
Providence - Saint Peter HospitalOlympia, Washington  98506-5166
Good Samaritan Community HospitalPuyallup, Washington  98372
Minor and James Medical PLLCSeattle, Washington  98104
The PolyclinicSeattle, Washington  98122
Swedish Medical Center-First HillSeattle, Washington  98122-4307
Northwest CCOPTacoma, Washington  98405
Multicare Health SystemTacoma, Washington  98415
Saint Clare HospitalTacoma, Washington  98499
Saint Joseph Medical CenterTacoma, Washington  98405
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
Aurora BayCare Medical CenterGreen Bay, Wisconsin  54311-6519
Vince Lombardi Cancer Clinic-MarinetteMarinette, Wisconsin  54143
Bay Area Medical CenterMarinette, Wisconsin  54143
Green Bay Oncology - Oconto FallsOconto Falls, Wisconsin  54154
Green Bay Oncology - Sturgeon BaySturgeon Bay, Wisconsin  54235
Women and Infants HospitalProvidence, Rhode Island  02905
University of Maryland Greenebaum Cancer CenterBaltimore, Maryland  21201
Jupiter Medical CenterJupiter, Florida  33458
Lahey Clinic Medical CenterBurlington, Massachusetts  01805
Elkhart ClinicElkhart, Indiana  46515
Mount Sinai Medical Center CCOPMiami Beach, Florida  33140
Harbin Clinic Medical Oncology and Clinical ResearchRome, Georgia  30165
Michiana Hematology Oncology PC-ElkhartElkhart, Indiana  46514
Michiana Hematology Oncology PC-PlymouthPlymouth, Indiana  46563
Michiana Hematology Oncology PC-South BendSouth Bend, Indiana  46601
Michiana Hematology Oncology-PC WestvilleWestville, Indiana  46391
Cancer Center of Kansas-LiberalLiberal, Kansas  67901
Michiana Hematology Oncology PC-NilesNiles, Michigan  49120
Central Care Cancer Center-Carrie J Babb Cancer CenterBolivar, Missouri  65613
Skaggs Cancer CenterBranson, Missouri  65616
University of Missouri - Ellis FischelColumbia, Missouri  65203
UMDNJ - New Jersey Medical SchoolNewark, New Jersey  07103
Rex Cancer CenterRaleigh, North Carolina  27607
North Coast Cancer Care-ClydeClyde, Ohio  43410
Community Health Partners Regional Medical CenterElyria, Ohio  44035
Roper HospitalCharleston, South Carolina  29401
Cancer Centers of the Carolinas - FarisGreenville, South Carolina  29605
Cancer Centers of the Carolinas-Greer Medical OncologyGreer, South Carolina  29650
Erlanger Medical CenterChattanooga, Tennessee  37403
Nashville Oncology Associates PCNashville, Tennessee  37203
Sandra L Maxwell Cancer CenterCedar City, Utah  84720
Intermountain Medical CenterMurray, Utah  84157
Utah Valley Regional Medical CenterProvo, Utah  84603
Dixie Medical Center Regional Cancer CenterSaint George, Utah  84770
Utah Cancer Specialists-Salt Lake CitySalt Lake City, Utah  84106
Virginia Oncology Associates-HamptonHampton, Virginia  23666
Skagit Valley HospitalMt. Vernon, Washington  98273
Evergreen Hematology and Oncology PSSpokane, Washington  99218
Holy Family Memorial HospitalManitowoc, Wisconsin  54221
Aurora Medical Center in SummitSummit, Wisconsin  53066
Texas Tech University Health Sciences CenterLubbock, Texas  79430
FirstHealth of the Carolinas-Moore Regional HosiptalPinehurst, North Carolina  28374
Adams Cancer CenterGettysburg, Pennsylvania  17325
Cherry Tree Cancer CenterHanover, Pennsylvania  17331
Epic Care-OaklandOakland, California  94612
Salinas Valley MemorialSalinas, California  93901
Saint Vincent's Medical CenterBridgeport, Connecticut  06606
Greenwich HospitalGreenwich, Connecticut  06830
Wilcox Memorial Hospital and Kauai Medical ClinicLihue, Hawaii  96766-1099
Saint Luke's South HospitalOverland Park, Kansas  66213
Kansas City CCOPPrairie Village, Kansas  66208
Capital Region Medical Center-Goldschmidt Cancer CenterJefferson City, Missouri  65109
Heartland Hematology and Oncology Associates IncorporatedKansas City, Missouri  64118
Saint John's Clinic-Rolla-Cancer and HematologyRolla, Missouri  65401
Saint Joseph Oncology IncSaint Joseph, Missouri  64507
Comprehensive Cancer Care PCSaint Louis, Missouri  63141
Coney Island HospitalBrooklyn, New York  11235
Forsyth Memorial HospitalWinston-Salem, North Carolina  27103
Saint Francis HospitalGreenville, South Carolina  29601
Hematology Oncology Associates of Fredericksburg IncFredericksburg, Virginia  22401
Cancer Care Center at Island HospitalAnacortes, Washington  98221
Highline Medical Center-Main CampusBurien, Washington  98166
United General HospitalSedro-Woolley, Washington  98284
Gundersen LutheranLa Crosse, Wisconsin  54601
Saint Nicholas HospitalMadison, Wisconsin  53715
Siouxland Hematology Oncology AssociatesSioux City, Iowa  51101
Walter Reed National Military Medical CenterBethesda, Maryland  20889
Providence Saint Mary Regional Cancer CenterWalla Walla, Washington  99362
Swedish Cancer Institute-IssaquahIssaquah, Washington  98029
Norris Cotton Cancer Center-ManchesterManchester, New Hampshire  03104
Aurora West Allis Medical CenterWest Allis, Wisconsin  53227
Alta Bates Summit Medical Center-Herrick CampusBerkeley, California  94704
Michiana Hematology Oncology PC-MishawakaMishawaka, Indiana  46545-1470
Marie Yeager Cancer CenterSaint Joseph, Michigan  49085
Hematology Oncology Associates of Central New York PCEast Syracuse, New York  13057
Summa Akron City HospitalAkron, Ohio  44304
Roy and Patricia Disney Family Cancer CenterBurbank, California  91505
The Toledo Hospital/Toledo Children's HospitalToledo, Ohio  43606
Sanford USD Medical Center - Sioux FallsSioux Falls, South Dakota  57117-5134
Essentia Health Duluth Clinic CCOPDuluth, Minnesota  55805
Essentia Health Saint Mary's Medical CenterDuluth, Minnesota  55805
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
Via Christi Hospital-PittsburgPittsburg, Kansas  66762
PeaceHealth Saint Joseph Medical CenterBellingham, Washington  98225
Aurora Cancer Care-Milwaukee WestWauwatosa, Wisconsin  53226
Christiana Care Health System-Christiana HospitalNewark, Delaware  19718
NEA Baptist Memorial HospitalJonesboro, Arkansas  72401
Promise Regional Medical Center-HutchinsonHutchinson, Kansas  65702
Toledo Clinic Cancer Centers-Bowling GreenBowling Green, Ohio  43402
Toledo Clinic Cancer Centers-MaumeeMaumee, Ohio  43537-1839
Toledo Clinic Cancer Centers-ToledoToledo, Ohio  43623
Guthrie Clinic-Robert Packer HospitalSayre, Pennsylvania  18840
Self Regional HealthcareGreenwood, South Carolina  29646
Harrison Poulsbo Hematology and OncologyPoulsbo, Washington  98370
Sutter Pacific Medical FoundationSanta Rosa, California  95403
Maine Center for Cancer Medicine and Blood Disorders-ScarboroughScarborough, Maine  04074
Fox Valley Surgical Associates LimitedAppleton, Wisconsin  54911
NEA Baptist Clinic-MatthewsJonesboro, Arkansas  72401
OnCare Hawaii-LilihaHonolulu, Hawaii  96817-3169
Dana-Farber/Brigham and Women's Cancer Center at Milford RegionalMilford, Massachusetts  01757
Nash General HospitalRocky Mount, North Carolina  27804
Breastlink Medical Group IncLong Beach, California  90806
Cancer Center of South Florida Foundation Inc-Lake WorthLake Worth, Florida  33461