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Phase III Double-Blind Placebo-Controlled Trial of Conventional Concurrent Chemoradiation and Adjuvant Temozolomide Plus Bevacizumab Versus Conventional Concurrent Chemoradiation and Adjuvant Temozolomide in Patients With Newly Diagnosed Glioblastoma


Phase 3
18 Years
N/A
Open (Enrolling)
Both
Adult Giant Cell Glioblastoma, Adult Glioblastoma, Adult Gliosarcoma

Thank you

Trial Information

Phase III Double-Blind Placebo-Controlled Trial of Conventional Concurrent Chemoradiation and Adjuvant Temozolomide Plus Bevacizumab Versus Conventional Concurrent Chemoradiation and Adjuvant Temozolomide in Patients With Newly Diagnosed Glioblastoma


PRIMARY OBJECTIVES:

I. To determine whether the addition of bevacizumab to temozolomide and radiotherapy
improves efficacy, as measured by progression-free (PFS) and/or overall survival (OS), in
patients with newly diagnosed glioblastoma. (Gliosarcoma closed to accrual as of 07/13/10).

II. To assess the association between overall survival and K^trans change from T1 to T2.

III. To assess the association between OS and spin echo CBV change from T1 to T2.

SECONDARY OBJECTIVES:

I. To determine whether the tumor molecular profile conferring a mesenchymal/angiogenic
phenotype is associated with a selective increase in benefit from the addition of
bevacizumab to temozolomide and radiotherapy, as measured by OS or PFS, in these patients.

II. To compare the toxicities of chemoradiotherapy with bevacizumab vs conventional
chemoradiotherapy in these patients.

III. To assess the association between PFS and K^trans change from T1 to T2. IV. To assess
the association between PFS and spin echo CBV change from T1 to T2.

V. To assess the association between values of K^trans and spin echo CBV measured separately
at T0 and at T1, and OS and PFS.

VI. To assess the association between OS and K^trans changes from T0 to T1 and from T2 to
T3.

VII. To assess the association between OS and spin echo CBV changes from T0 to T1 and from
T2 to T3.

VIII. To assess the association between OS and apparent diffusion coefficient (ADC) change
from T0 to T1.

IX. To assess the association between OS and ADC change from T1 to T2. X. To assess the
association between PFS and ADC change from T0 to T1. XI. To assess the association between
PFS and ADC change from T1 to T2. XII. To assess the association between T1 values of ADC
and OS and PFS. XIII. To assess the association between change in lesion size between T1 and
T3, as measured by advanced MRI, and OS and PFS.

TERTIARY OBJECTIVES:

I. To determine the differential acute effects associated with the addition of bevacizumab
to temozolomide and radiation, as compared to the conventional arm, on measures of
neurocognitive function (NCF), health-related quality of life (HR-QOL), and symptoms during
radiation and across the longitudinal progression-free interval.

II. To determine the relationship of NCF, HR-QOL, and symptoms, with PFS and OS.

III. To determine the association between tumor molecular profile (i.e.,
mesenchymal/angiogenic phenotype and proneural phenotype) and NCF, HR-QOL, and symptoms.

IV. To describe the association between HR-QOL as measured by the EORTC-QL30/BCM20 and mean
symptom severity as measured by the MDASI-BT in patients enrolled in this study.

V. To evaluate the relationship between self-reported NCF and objectively measured tests of
NCF.

VI. To assess the association between measures of change in enhancing tumor size at week 22
and OS in patients treated with chemoradiotherapy with and without bevacizumab.

VII. To assess the association between measures of change in T2-based tumor size at week 22
and OS in patients treated with these regimens.

VIII. To assess the association between changes in ADC values and OS in patients treated
with these regimens.

IX. To assess the association between measures of change in enhancing tumor size at week 22
and OS in patients with glioma receiving chemoradiotherapy with and without bevacizumab.

X. To assess the association between measures of change in T2-based tumor size at week 22
and OS in patients with glioma receiving chemoradiotherapy with and without bevacizumab.

XI. To assess the association between changes in ADC values and OS in patients with glioma
receiving chemoradiotherapy with and without bevacizumab.

OUTLINE: This is a multicenter study. Patients are stratified according to MGMT methylation
status (methylated vs unmethylated vs invalid) and tumor molecular profile metagene score
(favorable vs unfavorable vs undetermined). Patients are randomized to 1 of 2 treatment
arms.

ARM I: Patients undergo radiotherapy (intensity-modulated radiotherapy or 3-dimensional
conformal radiotherapy) once daily 5 days a week for 6 weeks and receive concurrent oral
temozolomide once daily for up to 7 weeks. Beginning 4 weeks after completion of
chemoradiotherapy, patients receive adjuvant oral temozolomide once daily on days 1-5.
Treatment with adjuvant temozolomide repeats every 28 days for up to 12 courses in the
absence of disease progression or unacceptable toxicity. Patients also receive placebo IV
over 30-90 minutes once every 2 weeks beginning in week 4 of chemoradiotherapy and
continuing until the completion of adjuvant temozolomide.

ARM II: Patients undergo chemoradiotherapy and receive adjuvant temozolomide as in arm I.
Patients also receive bevacizumab IV over 30-90 minutes once every 2 weeks beginning in week
4 of chemoradiotherapy and continuing until the completion of adjuvant temozolomide.

Some patients may undergo Dynamic Susceptibility-Contrast MRI (DSC-MRI) and Dynamic
Contrast-Enhanced (DCE-MRI) imaging at baseline, periodically during the study, and after
completion of treatment.

After completion of study treatment, patients are followed every 3 months for 1 year, every
4 months for 1 year, and then every 6 months thereafter.


Inclusion Criteria:



- Histologically confirmed glioblastoma (gliosarcoma closed to accrual as of 07-13-10)

- WHO grade IV disease

- Tumor must have a supratentorial component

- Has undergone partial or complete surgical resection of tumor within the past 3-5
weeks

- Diagnosis must be made by surgical excision (not by stereotactic biopsy)

- No significant postoperative hemorrhage, defined as > 1 cm diameter of blood in
the tumor cavity by MRI or CT scan

- Has ≥ 1 block of tumor tissue of sufficient size available for analysis of MGMT
status and determination of molecular profile

- At least 1 cm³ of tissue composed primarily of tumor must be present

- No CUSA (Cavitron ultrasonic aspirator)-derived material

- No recurrent or multifocal malignant glioma

- No metastases detected below the tentorium or beyond the cranial vault

- Karnofsky performance status 70-100%

- Absolute neutrophil count ≥ 1,800/mm³

- Platelet count ≥ 100,000/mm³

- Hemoglobin ≥ 10.0 g/dL (transfusion or other intervention allowed)

- ALT and AST ≤ 3 times normal

- Bilirubin ≤ 2.0 mg/dL

- PT/INR < 1.4 (for patients not on warfarin)

- Creatinine ≤ 1.7 mg/dL

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

- BUN ≤ 30 mg/dL

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for ≥ 6 months after
completion of study treatment

- Systolic blood pressure (BP) ≤ 160 mm Hg or diastolic BP ≤ 90 mm Hg

- No evidence of acute cardiac ischemia by electrocardiogram

- No other invasive malignancy within the past 3 years, except for nonmelanomatous skin
cancer or carcinoma in situ of the breast, oral cavity, or cervix

- No severe, active comorbidity, including any of the following:

- Unstable angina and/or congestive heart failure within the past 6 months

- Transmural myocardial infarction within the past 6 months

- Evidence of recent myocardial infarction or ischemia as indicated by ST
elevations of ≥ 2 mm by EKG

- New York Heart Association class II-IV congestive heart failure requiring
hospitalization within the past 12 months

- Stroke, cerebral vascular accident, or transient ischemic attack within the past
6 months

- Serious, inadequately controlled cardiac arrhythmia

- Significant vascular disease (e.g., aortic aneurysm or history of aortic
dissection) or clinically significant peripheral vascular disease

- Evidence of bleeding diathesis or coagulopathy

- Serious or non-healing wound, ulcer, or bone fracture

- Abdominal fistula, gastrointestinal perforation, intra-abdominal abscess, or
significant traumatic injury within the past 28 days

- Acute bacterial or fungal infection requiring IV antibiotics

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

- AIDS based on current CDC definition

- Active connective tissue disorders (e.g., lupus or scleroderma) that, in the
opinion of the treating physician, may place the patient at high risk for
radiation toxicity

- Any other major medical illness or psychiatric impairment that, in the opinion
of the investigator, would preclude study drug administration or completion of
study therapy

- Recovered from prior surgery

- No prior chemotherapy or radiosensitizers for cancer of the head and neck region

- Prior chemotherapy for a different cancer is allowed

- No prior temozolomide or bevacizumab

- No prior Gliadel wafers or any other intratumoral or intracavitary treatment

- No prior radiotherapy to the head and neck (except for T1 glottic cancer) resulting
in overlap of radiotherapy fields

- More than 28 days since prior major surgical procedure or open biopsy other than
craniotomy for tumor resection

- More than 30 days since prior and no concurrent treatment on another therapeutic
clinical trial

- No concurrent growth factors to induce elevations in neutrophil count for the
purposes of administration of temozolomide on the scheduled dosing interval; to allow
treatment with temozolomide at a higher dose; or to avoid interruption of the
treatment during concurrent radiotherapy

- No concurrent erythropoietin

- No concurrent tumor debulking surgery, other chemotherapy, immunotherapy, biologic
therapy, or additional stereotactic boost radiotherapy

- No other concurrent investigational drugs during the "blinded phase" of the study

- Concurrent full-dose anticoagulants (e.g., warfarin or low molecular weight heparin)
allowed provided both of the following criteria are met:

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

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

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Overall survival

Outcome Description:

Estimated using the Kaplan-Meier method and differences between treatment arms will be tested in the log rank test (Mantel 1966).

Outcome Time Frame:

From randomization to the date of death due to any cause or otherwise, the last follow-up date on which the patient was reported alive, assessed up to 2 years

Safety Issue:

No

Principal Investigator

Mark Gilbert

Investigator Role:

Principal Investigator

Investigator Affiliation:

Radiation Therapy Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-01670

NCT ID:

NCT00884741

Start Date:

April 2009

Completion Date:

Related Keywords:

  • Adult Giant Cell Glioblastoma
  • Adult Glioblastoma
  • Adult Gliosarcoma
  • Glioblastoma
  • Gliosarcoma

Name

Location

Louisiana State UniversityNew Orleans, Louisiana  70112-2282
Memorial Sloan Kettering Cancer CenterNew York, New York  10021
Cleveland Clinic FoundationCleveland, Ohio  44195
Mayo ClinicRochester, Minnesota  55905
University of Iowa Hospitals and ClinicsIowa City, Iowa  52242
Washington University School of MedicineSaint Louis, Missouri  63110
Abington Memorial HospitalAbington, Pennsylvania  19001
Fox Chase Cancer CenterPhiladelphia, Pennsylvania  19111
Rhode Island HospitalProvidence, Rhode Island  02903
University of Texas Health Science Center at San AntonioSan Antonio, Texas  78284-7811
Boulder Community HospitalBoulder, Colorado  80301-9019
Porter Adventist HospitalDenver, Colorado  80210
Swedish Medical CenterEnglewood, Colorado  80110
North Suburban Medical CenterThornton, Colorado  80229
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Fairview Ridges HospitalBurnsville, Minnesota  55337
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
Geisinger Medical CenterDanville, Pennsylvania  17822-0001
Loyola University Medical CenterMaywood, Illinois  60153
Massachusetts General Hospital Cancer CenterBoston, Massachusetts  02114
CentraCare ClinicSaint Cloud, Minnesota  56303
Marshfield ClinicMarshfield, Wisconsin  54449
Northwest Community HospitalArlington Heights, Illinois  60005
Ingalls Memorial HospitalHarvey, Illinois  60426
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Mary Bird Perkins Cancer CenterBaton Rouge, Louisiana  70809
Akron General Medical CenterAkron, Ohio  44302
Lehigh Valley HospitalAllentown, Pennsylvania  18103
Reading Hospital and Medical CenterReading, Pennsylvania  19612-6052
Jackson-Madison County General HospitalJackson, Tennessee  38301
LDS HospitalSalt Lake City, Utah  84143
University of Kansas Medical CenterKansas City, Kansas  66160-7353
Hartford HospitalHartford, Connecticut  06102-5037
Providence Alaska Medical CenterAnchorage, Alaska  99508
William Beaumont HospitalRoyal Oak, Michigan  48073
Via Christi Regional Medical CenterWichita, Kansas  67214
Wesley Medical CenterWichita, Kansas  67214
Carolinas Medical CenterCharlotte, North Carolina  28232-2861
John Muir Medical CenterWalnut Creek, California  94598
Iowa Methodist Medical CenterDes Moines, Iowa  50309
Maimonides Medical CenterBrooklyn, New York  11219
Bellin Memorial HospitalGreen Bay, Wisconsin  54301
University of Wisconsin Hospital and ClinicsMadison, Wisconsin  53792-0001
Thompson Cancer Survival CenterKnoxville, Tennessee  37916
Naval Medical Center - PortsmouthPortsmouth, Virginia  23708-2197
McKay-Dee Hospital CenterOgden, Utah  84403
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Rocky Mountain Cancer CenterDenver, Colorado  80218
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
City of Hope Medical CenterDuarte, California  91010
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical CenterColumbus, Ohio  43210-1240
Piedmont HospitalAtlanta, Georgia  30309
Southern Regional Medical CenterRiverdale, Georgia  30274-2600
Mercy Medical CenterSpringfield, Ohio  45504
Bryn Mawr HospitalBryn Mawr, Pennsylvania  19010
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
Mercy HospitalCoon Rapids, Minnesota  55433
Poudre Valley Radiation OncologyFort Collins, Colorado  80528
Anne Arundel Medical CenterAnnapolis, Maryland  21401
Saint Joseph Mercy HospitalAnn Arbor, Michigan  48106
Abbott-Northwestern HospitalMinneapolis, Minnesota  55407
Lancaster General HospitalLancaster, Pennsylvania  17604-3555
Pomona Valley Hospital Medical CenterPomona, California  91767
Northeast Georgia Medical CenterGainesville, Georgia  30501
Central Maine Medical CenterLewiston, Maine  04240
Allegheny Cancer Center at Allegheny General HospitalPittsburgh, Pennsylvania  15212
UW Cancer Center Johnson CreekJohnson Creek, Wisconsin  53038
Saint Joseph's HospitalMarshfield, Wisconsin  54449
Marshfield Clinic - Weston CenterWeston, Wisconsin  54476
Diagnostic and Treatment CenterWeston, Wisconsin  54476
Rocky Mountain Cancer CentersThornton, Colorado  80260
Arizona Oncology Services FoundationPhoenix, Arizona  85013
Lowell General HospitalLowell, Massachusetts  01854
Presbyterian HospitalCharlotte, North Carolina  28233-3549
Mayo Clinic in ArizonaScottsdale, Arizona  85259-5404
Mayo Clinic in FloridaJacksonville, Florida  32224
Solano Radiation Oncology CenterVacaville, California  95687
Tyler Cancer CenterTyler, Texas  75702
Providence HospitalMobile, Alabama  36608
Northwestern UniversityChicago, Illinois  60611
Willamette Valley Cancer CenterEugene, Oregon  97401-8122
Northwest Cancer SpecialistsVancouver, Washington  98664
Cancer Care Center, IncorporatedSalem, Ohio  44460
Nebraska Methodist HospitalOmaha, Nebraska  68114
University of RochesterRochester, New York  14642
Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
University of California at San DiegoLa Jolla, California  92093
Case Western Reserve UniversityCleveland, Ohio  44106
Yale UniversityNew Haven, Connecticut  06520
Emory UniversityAtlanta, Georgia  30322
New Mexico Oncology Hematology ConsultantsAlbuquerque, New Mexico  87102
Radiation Therapy Oncology GroupPhiladelphia, Pennsylvania  19107
Riverside Methodist HospitalColumbus, Ohio  43214
Providence Portland Medical CenterPortland, Oregon  97213-3635
California Pacific Medical CenterSan Francisco, California  94115
Dartmouth Hitchcock Medical CenterLebanon, New Hampshire  03756
Sacred Heart HospitalPensacola, Florida  32503
University of Texas Southwestern Medical CenterDallas, Texas  
Alegent Health Immanuel Medical CenterOmaha, Nebraska  68122
Alegent Health Bergan Mercy Medical CenterOmaha, Nebraska  68124
Flower HospitalSylvania, Ohio  43560-2197
Virginia Mason CCOPSeattle, Washington  98101
Huntsman Cancer Institute/University of UtahSalt Lake City, Utah  84112
Appleton Medical CenterAppleton, Wisconsin  54911
Thomas Jefferson University HospitalPhiladelphia, Pennsylvania  19131
Decatur Memorial HospitalDecatur, Illinois  62526
West Texas Cancer CenterOdessa, Texas  79761
Lankenau HospitalWynnewood, Pennsylvania  19096
UPMC Cancer Center at Jefferson Regional Medical CenterClairton, Pennsylvania  15025
Florida HospitalOrlando, Florida  32803
Memorial Health University Medical CenterSavannah, Georgia  31404
Hillcrest Hospital Cancer CenterMayfield Heights, Ohio  44124
Harrison Medical CenterBremerton, Washington  98310
University of Chicago Comprehensive Cancer CenterChicago, Illinois  60637-1470
M D Anderson Cancer CenterHouston, Texas  77030
University of Southern CaliforniaLos Angeles, California  90033
DeKalb Medical CenterDecatur, Georgia  30033
Inova Alexandria HospitalAlexandria, Virginia  22304
Northern Indiana Cancer Research ConsortiumSouth Bend, Indiana  
Rohnert Park Cancer CenterRohnert Park, California  94928
South Sacramento Cancer CenterSacramento, California  95823
Sands Cancer CenterCanandiaqua, New York  14424
University of CincinnatiCincinnati, Ohio  45267-0502
Penn State Milton S Hershey Medical CenterHershey, Pennsylvania  17033
Saint Joseph HospitalOrange, California  92868
Penrose-Saint Francis HealthcareColorado Springs, Colorado  80907
The Hospital of Central ConnecticutNew Britain, Connecticut  06050
Edna Williams Cancer Center at the Baptist Cancer InstituteJacksonville, Florida  32207
M D Anderson Cancer Center- OrlandoOrlando, Florida  32806
University of HawaiiHonolulu, Hawaii  96813
John H Stroger Jr Hospital of Cook CountyChicago, Illinois  60612-3785
McFarland ClinicAmes, Iowa  50010
Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Ochsner Clinic CCOPNew Orleans, Louisiana  70121
Oakwood HospitalDearborn, Michigan  48123
Saint John Hospital and Medical CenterDetroit, Michigan  48236
Sparrow HospitalLansing, Michigan  48912
Saint Mary's of MichiganSaginaw, Michigan  48601
Saint John Macomb-Oakland HospitalWarren, Michigan  48093
Minnesota Oncology Hematology PA-MaplewoodMaplewood, Minnesota  55109
North Memorial Medical Health CenterRobbinsdale, Minnesota  55422
Park Nicollet Clinic - Saint Louis ParkSaint Louis Park, Minnesota  55416
Truman Medical CenterKansas City, Missouri  64108
Billings ClinicBillings, Montana  59107-7000
Good Samaritan HospitalKearney, Nebraska  68847
Saint Elizabeth Regional Medical CenterLincoln, Nebraska  68510
Nevada Cancer Research Foundation CCOPLas Vegas, Nevada  89106
Saint Barnabas Medical CenterLivingston, New Jersey  07039
Sparta Cancer Treatment CenterSparta, New Jersey  07871
Highland HospitalRochester, New York  14620
State University of New York Upstate Medical UniversitySyracuse, New York  13210
Mission Hospitals IncAsheville, North Carolina  28801
Margaret R Pardee Memorial HospitalHendersonville, North Carolina  28791
Summa Barberton HospitalBarberton, Ohio  44203
Aultman Health FoundationCanton, Ohio  44710
Grant Medical CenterColumbus, Ohio  43215
Saint Charles HospitalOregon, Ohio  43616
North Coast Cancer CareSandusky, Ohio  44870
Mercy Cancer Center at Saint Anne Mercy HospitalToledo, Ohio  43623
Natalie W Bryant Cancer CenterTulsa, Oklahoma  74136
Legacy Good Samaritan Hospital and Medical CenterPortland, Oregon  97210
Providence Saint Vincent Medical CenterPortland, Oregon  97225
Salem HospitalSalem, Oregon  97309
Saint Luke's HospitalBethlehem, Pennsylvania  18015
Pocono Medical CenterEast Stroudsburg, Pennsylvania  18301
Aria Health-Torresdale CampusPhiladelphia, Pennsylvania  19114
Upstate Carolina CCOPSpartanburg, South Carolina  29303
Sanford Cancer Center-Oncology ClinicSioux Falls, South Dakota  57104
Swedish Medical Center-First HillSeattle, Washington  98122-4307
Wheeling HospitalWheeling, West Virginia  26003
Langlade Hospital and Cancer CenterAntigo, Wisconsin  54409
Sacred Heart HospitalEau Claire, Wisconsin  54701
Saint Vincent HospitalGreen Bay, Wisconsin  54301
Saint Mary's HospitalGreen Bay, Wisconsin  54303
Dean Hematology and Oncology ClinicMadison, Wisconsin  53717
Bay Area Medical CenterMarinette, Wisconsin  54143
Marshfield Clinic-Minocqua CenterMinocqua, Wisconsin  54548
Saint Michael's HospitalStevens Point, Wisconsin  54481
Aspirus Regional Cancer CenterWausau, Wisconsin  54401
University of Maryland Greenebaum Cancer CenterBaltimore, Maryland  21201
Northeast Radiation Oncology CenterDunmore, Pennsylvania  18512
Radiological Associates of SacramentoSacramento, California  95816
Lake University Ireland Cancer CenterMentor, Ohio  44060
The Nebraska Medical CenterOmaha, Nebraska  68198
Kansas City Cancer Centers - NorthKansas City, Missouri  64154
Intercommunity Cancer CenterMonroeville, Pennsylvania  15146
Stony Brook University Medical CenterStony Brook, New York  11794
Alle-Kiski Medical CenterNatrona Heights, Pennsylvania  15065
John Muir Medical Center-Concord CampusConcord, California  94520
Saint Jude Medical CenterFullerton, California  92835
Memorial Healthcare System - Joe DiMaggio Children's HospitalHollywood, Florida  33021
Mount Sinai Medical Center CCOPMiami Beach, Florida  33140
Maine Medical Center- Scarborough CampusScarborough, Maine  04074
Saint Agnes HospitalBaltimore, Maryland  21229
The Regional Cancer CenterErie, Pennsylvania  16505
Armstrong Center for Medicine and HealthKittanning, Pennsylvania  16201
Erlanger Medical CenterChattanooga, Tennessee  37403
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
Riverview HospitalWisconsin Rapids, Wisconsin  54494
University of Texas Medical Branch at GalvestonGalveston, Texas  77555
Texas Cancer Center-ShermanSherman, Texas  75090
Kansas City Cancer Centers-SouthwestOverland Park, Kansas  66210
FirstHealth of the Carolinas-Moore Regional HosiptalPinehurst, North Carolina  28374
UPMC Cancer Center at UPMC McKeesportMcKeesport, Pennsylvania  15132
Cancer Centers of North CarolinaRaleigh, North Carolina  27607
Kaiser Permanente Oakland-BroadwayOakland, California  94611
Kaiser Permanente-Rancho Cordova Cancer CenterRancho Cardova, California  95670
The Permanente Medical Group-Roseville Radiation OncologyRoseville, California  95678
Kaiser Permanente Radiation Oncology Cancer Treatment CenterSanta Clara, California  95051
Kaiser Permanente Cancer Treatment CenterSouth San Francisco, California  94080
Saint Vincent's Medical CenterBridgeport, Connecticut  06606
Kansas City Cancer Center - SouthKansas City, Missouri  64131
Forsyth Memorial HospitalWinston-Salem, North Carolina  27103
The Mark H Zangmeister CenterColumbus, Ohio  43219
Southwest General Health Center Ireland Cancer CenterMiddleburg Heights, Ohio  44130
UHHS-Chagrin Highlands Medical CenterOrange Village, Ohio  44122
UHHS-Westlake Medical CenterWestlake, Ohio  44145
New York Oncology Hematology PC - AlbanyAlbany, New York  12206
Central Indiana Cancer Centers - IndianapolisIndianapolis, Indiana  46227
Community Regional Cancer Care-East Radiation OncologyIndianapolis, Indiana  46219
Community Regional Cancer Care-NorthIndianapolis, Indiana  46256
Washington HospitalWashington, Pennsylvania  15301
Fox Chase Cancer Center BuckinghamFurlong, Pennsylvania  18925
Saint Vincent Oncology CenterIndianapolis, Indiana  46260
Radiation Oncology Associates PCFort Wayne, Indiana  46804
University PointeWest Chester, Ohio  45069
Texas Oncology-Longview Cancer CenterLongview, Texas  75601
Alta Bates Summit Medical Center-Herrick CampusBerkeley, California  94704
Sanford Medical Center-FargoFargo, North Dakota  58122
Summa Akron City HospitalAkron, Ohio  44304
William Backus HospitalNorwich, Connecticut  06360
D'Amour Center for Cancer CareSpringfield, Massachusetts  01107
Siteman Cancer Center - Saint PetersSaint Peters, Missouri  63376
Texas Oncology-Arlington SouthArlington, Texas  76014
Texas Oncology-Denton SouthDenton, Texas  76210
Broward Health Medical CenterFort Lauderdale, Florida  33316
Sanford Clinic North-BemidgiBemidji, Minnesota  56601
PeaceHealth Saint Joseph Medical CenterBellingham, Washington  98225
Riverview Medical Center/Booker Cancer CenterRed Bank, New Jersey  07701
Cleveland Clinic Cancer Center/Fairview HospitalCleveland, Ohio  44111
Cancer Specialists of North Florida-SouthsideJacksonville, Florida  32207
Cancer Specialists of North Florida-BeachesJacksonville Beach, Florida  32250
Cancer Specialists of North Florida-Baptist SouthJascksonville, Florida  32258
Cancer Specialists of North Florida-Orange ParkOrange Park, Florida  32073
Cancer Specialists of North Florida-PutnamPalatka, Florida  32177
Cancer Specialists of North Florida-Saint AugustineSaint Augustine, Florida  32086
IU Health Methodist HospitalIndianapolis, Indiana  46202
Sentara HospitalsNorfolk, Virginia  23507
The James Graham Brown Cancer Center at University of LouisvilleLouisville, Kentucky  40202
Fletcher Allen Health Care-Medical CenterBurlington, Vermont  05401
Edward Hospital/Cancer CenterNaperville, Illinois  60540
Toledo Clinic Cancer Centers-MaumeeMaumee, Ohio  43537-1839
PeaceHealth Southwest Medical CenterVancouver, Washington  98664
Auburn Radiation Oncology CenterAuburn, California  95603
Marshall Radiation Oncology CenterCameron Park, California  95682
Mercy San Juan Medical CenterCarmichael, California  95608
Roseville Radiation Oncology CenterRoseville, California  95661
Mercy General Hospital Radiation Oncology CenterSacramento, California  95819
Parkview HospitalFort Wayne, Indiana  46805
IU Health Ball Memorial HospitalMuncie, Indiana  47303
Saint Joseph Regional Cancer CenterBryan, Texas  77802
Covenant Medical Center-LakesideLubbock, Texas  79410
Cape Radiation OncologyCape Girardeau, Missouri  63703
UPMC Cancer Centers - Arnold Palmer PavilionGreensburg, Pennsylvania  15601
University Pittsburgh Medical Cancer Center-JohnstownJohnstown, Pennsylvania  15901
Trinity's Tony Teramana Cancer CenterSteubenville, Ohio  43952
Marshfield Clinic Cancer Center at Sacred HeartEau Claire, Wisconsin  54701
Arizona Oncology Associates-West Orange GroveTucson, Arizona  85704
Robert and Carol Weissman Cancer Center at Martin HealthStuart, Florida  34994
Helen G Nassif Community Cancer CenterCedar Rapids, Iowa  52402
University Radiation OncologyRochester, New York  14626
UPMC - HVHS Cancer Center at Heritage Valley BeaverBeaver, Pennsylvania  15009
UPMC-Passavant HospitalPittsburgh, Pennsylvania  15237
UPMC-Shadyside HospitalPittsburgh, Pennsylvania  15232
Univerisity of Pittsburgh Medical Center NorthwestSeneca, Pennsylvania  16346
Texas Oncology PA - BedfordBedford, Texas  76022
Texas Oncology Methodist Charlton Cancer CenterDallas, Texas  75237
The Klabzuba Cancer CenterFort Worth, Texas  76104
Texas Oncology Cancer Center Sugar LandSugar Land, Texas  77479