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Phase I/Randomized Phase II Double Blind Study of Either Dasatinib or Placebo Combined With Bevacizumab in Recurrent Glioblastoma


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Brain and Central Nervous System Tumors

Thank you

Trial Information

Phase I/Randomized Phase II Double Blind Study of Either Dasatinib or Placebo Combined With Bevacizumab in Recurrent Glioblastoma


OBJECTIVES:

Primary

- Determine the maximum-tolerated dose of dasatinib in combination with bevacizumab in
patients with recurrent or progressive high-grade glioma or glioblastoma multiforme.
(Phase I*)

- Assess the safety and adverse events of this regimen in these patients. (Phase I*)

- Estimate and compare the efficacy of these regimens in these patients as measured by
progression-free survival at six months. (Phase II)

Secondary

- Describe any preliminary evidence of antitumor activity. (Phase I*)

- Describe the overall toxicity associated with this regimen in these patients. (Phase
I*)

- Estimate and compare the efficacy of these regimens in these patients as measured by
overall survival (Phase II)

- Assess the impact of these regimens on the patient's quality of life using FACT-Br (no
longer assessed as of 5/18/2009) (newly added as of 2/2/2010). (Phase II)

- Assess the time to disease progression. (Phase II)

- Assess the safety and toxicity of these regimens in this patient population. (Phase II)

- Determine the relationship between tumor biomarkers and clinical outcome of patients
treated with these regimens. (Phase II) (exploratory)

- Assess the utility of dynamic contrast-enhanced MRI as a predictor of response to these
regimens. (Phase II) (exploratory)

- To assess the utility of MRI diffusion-weighted images (DWI), and specifically the
apparent diffusion coefficient (ADC), as a predictor of response and survival in
patients treated with bevacizumab/dasatinib combination treatment. (Phase II)
(exploratory)

- Bank leftover tissue for future NCCTG studies. (Phase II) (exploratory) NOTE: *Phase I
completed.

OUTLINE: This is a multicenter, phase I, dose-escalation study (Phase I completed) of
dasatinib followed by a phase II randomized study. Patients are grouped according to study
(1 vs 2). Patients in the phase II portion are stratified according to age (> 70 years of
age vs ≤ 70 years of age), and ECOG performance status (0 vs 1 or 2).

Phase I: Patients receive bevacizumab IV over 30-90 minutes on day 1. Patients also receive
oral dasatinib once or twice daily on days 1-14 until the maximum-tolerated dose (MTD) is
determined. Courses repeat every 14 days in the absence of disease progression or
unacceptable toxicity. (Phase I completed)

Phase II (patients are randomized to 1 of 2 treatment arms):

- Arm I: Patients receive bevacizumab as in phase I and dasatinib at the MTD as
determined in phase I. Courses repeat every 14 days in the absence of disease
progression or unacceptable toxicity.

- Arm II: Patients receive bevacizumab as in phase I and oral placebo once or twice daily
on days 1-14. Courses repeat every 14 days in the absence of disease progression or
unacceptable toxicity.

Quality of life is assessed by FACT-Br questionnaire at baseline and prior to every other
course (no longer assessed as of 5/18/2009)(newly added as of 2/2/2010). Tissue samples are
collected at baseline for biomarker studies and assessed by IHC, RT-PCR, and FISH. Patients
undergo dynamic contrast-enhanced MRI at baseline, day 3 of course 1, and day 1 of course 2.

After completion of study therapy, patients are followed up periodically for up to 3 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed diagnosis of 1 of the following:

- Grade 3 or 4 glioma, including astrocytoma, oligodendroglioma, and mixed gliomas
(Phase I)

- Glioblastoma* multiforme (grade 4 astrocytoma) (Phase II) NOTE: *Variant
gliosarcomas are allowed

- Evidence of tumor recurrence or progression by MRI or CT scan following radiotherapy
or most recent antitumor therapy

- Patients who have had surgical treatment at recurrence are eligible if they had
a subtotal resection with measurable or non-measurable residual disease on
postoperative imaging or if there is imaging evidence of disease progression as
compared to the first postoperative scan

- Bidimensionally measurable or evaluable disease by MRI or CT scan

- Patients who have had a gross total resection (GTR) are eligible on the basis of
evaluable disease

- No known pleural or pericardial effusion of any grade

PATIENT CHARACTERISTICS:

- ECOG performance status 0-2

- ANC ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

- Hemoglobin > 9.0 g/dL

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

- SGOT ≤ 3 times ULN

- Creatinine normal

- Urine protein:creatinine ratio < 1 or urine protein < 1,000 mg on 24-hour urine
collection

- Not pregnant or nursing

- Negative pregnancy test

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

- Able to complete questionnaires with or without assistance

- Willing to return to NCCTG enrolling institution for follow-up

- Willing to provide mandatory tissue samples for research purposes

- QTc interval ≤ 450 msec

- No congenital long QT syndrome

- No uncontrolled hypertension (systolic BP of > 150 mm Hg or diastolic BP > 100 mm Hg
on antihypertensive medications)

- Well-controlled hypertension allowed

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

- No NYHA class II-IV congestive heart failure

- No significant vascular disease (e.g., aortic aneurysm, aortic dissection) or recent
peripheral arterial thrombosis within the past 6 months

- No history of any clinically significant ventricular arrhythmias (i.e., ventricular
tachycardia, ventricular fibrillation, or Torsades de pointes)

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

- No history of hypertensive crisis or hypertensive encephalopathy

- No evidence of any CNS hemorrhage on baseline CT or MRI

- No co-morbid systemic illnesses or other severe concurrent disease that, in the
judgment of the investigator, would make the patient inappropriate for entry into
this study or interfere significantly with the proper assessment of safety and
toxicity of the prescribed regimens

- No immunocompromised patients (other than that related to the use of corticosteroids)

- Known HIV positivity without clinical evidence of an immunocompromised state
allowed

- No condition (e.g., gastrointestinal tract disease resulting in an inability to take
oral medication or a requirement for IV alimentation or prior surgical procedures
affecting absorption) that impairs ability to swallow pills

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

- No evidence of bleeding diathesis (greater than normal risk of bleeding) or
coagulopathy (in the absence of therapeutic anticoagulation)

- No active or recent history of hemoptysis (≥ ½ teaspoon of bright red blood per
episode) within the past 30 days

- No uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection or psychiatric illness or social situations that would limit compliance
with study requirements

- No other active malignancy within the past 3 years except for nonmelanoma skin cancer
or carcinoma in situ of the cervix

- No known hypersensitivity to any of the components of dasatinib or bevacizumab

- No significant traumatic injury within the past 28 days

- No serious nonhealing wounds, active ulcers, or untreated bone fractures

- No hypokalemia or hypomagnesemia that cannot be corrected prior to dasatinib
administration

- Patients may not have any clinically significant cardiovascular disease including the
following:

- Myocardial infarction or ventricular tachyarrhythmia within 6 months

- Prolonged QTc ≥ 480 msec (Fridericia correction)

- Ejection fraction less than institutional normal

- Major conduction abnormality (unless a cardiac pacemaker is present)

- Patients with any cardiopulmonary symptoms of unknown cause (e.g., shortness of
breath, chest pain, etc.) should be evaluated by a baseline echocardiogram with
or without stress test as needed in addition to electrocardiogram (ECG) to rule
out QTc prolongation

- Patients with underlying cardiopulmonary dysfunction should be excluded
from the study

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Any number of prior chemotherapy regimens for recurrent disease allowed (Phase I)

- No more than 4 weeks since prior chemotherapy, small-molecule cell-cycle inhibitors,
or other investigational agents (≥ 6 weeks since nitrosoureas) at the time of
registration

- More than 1 week since prior aspirin or medications that inhibit platelet function

- No more than 2 prior chemotherapy regimens with ≤ 1 regimen for recurrent disease
(Phase II)

- No prior bevacizumab or VEGF-Trap (Aflibercept)

- No prior intratumoral therapy, stereotactic radiosurgery, or interstitial
brachytherapy except for the following:

- Separate lesion on MRI that is not part of the previous treatment field

- Evidence of recurrent disease based on biopsy, MRI spectroscopy, or PET scan

- At least 7 days since prior core biopsy or other minor surgical procedures (placement
of a vascular access device is allowed)

- At least 7 days since prior drugs that have a risk of causing Torsades de Pointes,
including any of the following:

- Quinidine, procainamide, disopyramide

- Amiodarone, sotalol, ibutilide, dofetilide

- Erythromycin, clarithromycin

- Chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide

- Cisapride, bepridil, droperidol, methadone, arsenic, chloroquine, domperidone,
halofantrine, levomethadyl, pentamidine, sparfloxacin, lidoflazine

- Prochlorperazine

- At least 28 days since prior and no concurrent major surgical procedure or open
biopsy

- At least 12 weeks since prior radiotherapy

- No concurrent therapeutic anticoagulation with warfarin, except low-dose warfarin for
venous or arterial access devices, provided INR < 1.5

- Therapeutic anticoagulation with low molecular weight heparin allowed

- No other concurrent investigational agent considered as a therapy for the primary
neoplasm

- No concurrent therapy (other than hormonal therapy) for other prior malignancy

- No concurrent H_2 blockers or proton pump inhibitors that cannot be discontinued or
switched to locally acting agents (i.e., famotidine, omeprazole, Maalox, Mylanta, or
Tums)

- Use of the following enzyme-inducing anticonvulsive (EIAC) medications is prohibited
≤ 7 days prior to registration: carbemazepine (Tegretol®, Tegretol XR®, Carbatrol®),
phenytoin (Dilantin®, Phenytek®), fosphenytoin (Cerebyx®), phenobarbital,
pentobarbital, and primidone (Mysoline®)

- The following agents are not known to affect dasatinib metabolism and are acceptable
for use: valproic acid (Depakote®, Depacon®), gabapentin (Neurontin®), lomotrigine
(Lamictal®), topiramate (Topamax®), tiagabine (Gabitril®), zonisamid (Zonegram®),
levetriacetam (Keppra®), clonazepam (Klonipin®), and clonozam (Frisium®)

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Masking: Double-Blind, Primary Purpose: Treatment

Outcome Measure:

Time to treatment-related toxicity (Phase I)

Safety Issue:

Yes

Principal Investigator

Evanthia Galanis, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Mayo Clinic

Authority:

Unspecified

Study ID:

CDR0000641746

NCT ID:

NCT00892177

Start Date:

October 2009

Completion Date:

Related Keywords:

  • Brain and Central Nervous System Tumors
  • adult giant cell glioblastoma
  • adult glioblastoma
  • adult gliosarcoma
  • adult mixed glioma
  • recurrent adult brain tumor
  • adult anaplastic oligodendroglioma
  • adult oligodendroglioma
  • adult anaplastic astrocytoma
  • Glioblastoma
  • Nervous System Neoplasms
  • Central Nervous System Neoplasms

Name

Location

Mayo Clinic ScottsdaleScottsdale, Arizona  85259
Mayo Clinic - JacksonvilleJacksonville, Florida  32224
Mayo Clinic Cancer CenterRochester, Minnesota  55905
CCOP - WichitaWichita, Kansas  67214-3882
Hurley Medical CenterFlint, Michigan  48503
CCOP - Missouri Valley Cancer ConsortiumOmaha, Nebraska  68131
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - Mount Sinai Medical CenterMiami Beach, Florida  33140
CCOP - Illinois Oncology Research AssociationPeoria, Illinois  61602
CCOP - Carle Cancer CenterUrbana, Illinois  61801
CCOP - Iowa Oncology Research AssociationDes Moines, Iowa  50309-1016
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
Aurora Presbyterian HospitalAurora, Colorado  80012
Boulder Community HospitalBoulder, Colorado  80301-9019
Penrose Cancer Center at Penrose HospitalColorado Springs, Colorado  80933
Porter Adventist HospitalDenver, Colorado  80210
Presbyterian - St. Luke's Medical CenterDenver, Colorado  80218
St. Joseph HospitalDenver, Colorado  80218
Rose Medical CenterDenver, Colorado  80220
Swedish Medical CenterEnglewood, Colorado  80110
Sky Ridge Medical CenterLone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United HospitalLongmont, Colorado  80502
St. Mary - Corwin Regional Medical CenterPueblo, Colorado  81004
Rush-Copley Cancer Care CenterAurora, Illinois  60507
Mercy Medical Center - Sioux CitySioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLPSioux City, Iowa  51101
St. Luke's Regional Medical CenterSioux City, Iowa  51104
CCOP - Michigan Cancer Research ConsortiumAnn Arbor, Michigan  48106
Saint Joseph Mercy Cancer CenterAnn Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical CenterDearborn, Michigan  48123-2500
Van Elslander Cancer Center at St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  48236
Sparrow Regional Cancer CenterLansing, Michigan  48912-1811
St. John Macomb HospitalWarren, Michigan  48093
MeritCare BemidjiBemidji, Minnesota  56601
Fairview Ridges HospitalBurnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy HospitalCoon Rapids, Minnesota  55433
CCOP - DuluthDuluth, Minnesota  55805
Miller - Dwan Medical CenterDuluth, Minnesota  55805
Fairview Southdale HospitalEdina, Minnesota  55435
Mercy and Unity Cancer Center at Unity HospitalFridley, Minnesota  55432
Hutchinson Area Health CareHutchinson, Minnesota  55350
HealthEast Cancer Care at St. John's HospitalMaplewood, Minnesota  55109
Hennepin County Medical Center - MinneapolisMinneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern HospitalMinneapolis, Minnesota  55407
St. Francis Cancer Center at St. Francis Medical CenterShakopee, Minnesota  55379
Park Nicollet Cancer CenterSt. Louis Park, Minnesota  55416
Regions Hospital Cancer Care CenterSt. Paul, Minnesota  55101
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
MeritCare BroadwayFargo, North Dakota  58122
Sanford Cancer Center at Sanford USD Medical CenterSioux Falls, South Dakota  57117-5039
Avera Cancer InstituteSioux Falls, South Dakota  57105
Rapid City Regional HospitalRapid City, South Dakota  57709
Methodist Medical Center of IllinoisPeoria, Illinois  61636
CCOP - Montana Cancer ConsortiumBillings, Montana  59101
CCOP - DaytonKettering, Ohio  45429
CCOP - GreenvilleGreenville, South Carolina  29615
Rush University Medical CenterChicago, Illinois  60612-3824
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical CenterLebanon, New Hampshire  03756-0002
Charles M. Barrett Cancer Center at University HospitalCincinnati, Ohio  45267-0526
Cancer Research Center of HawaiiHonolulu, Hawaii  96813
Rebecca and John Moores UCSD Cancer CenterLa Jolla, California  92093-0658
Wesley Medical CenterWichita, Kansas  67214
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
St. Vincent Mercy Medical CenterToledo, Ohio  43608
Waukesha Memorial Hospital Regional Cancer CenterWaukesha, Wisconsin  53188
Florida Hospital Cancer Institute at Florida Hospital OrlandoOrlando, Florida  32803-1273
Via Christi Cancer Center at Via Christi Regional Medical CenterWichita, Kansas  67214
Mount Sinai Medical CenterNew York, New York  10029
Medical University of Ohio Cancer CenterToledo, Ohio  43614
Toledo HospitalToledo, Ohio  43606
North Colorado Medical CenterGreeley, Colorado  80631
McKee Medical CenterLoveland, Colorado  80539
Hematology-Oncology Centers of the Northern Rockies - BillingsBillings, Montana  59101
St. Peter's HospitalHelena, Montana  59601
Kalispell Regional Medical CenterKalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences CenterMissoula, Montana  59802
Montana Cancer Specialists at Montana Cancer CenterMissoula, Montana  59802
Wayne Memorial Hospital, IncorporatedGoldsboro, North Carolina  27534
UNMC Eppley Cancer Center at the University of Nebraska Medical CenterOmaha, Nebraska  68198-7680
Memorial Cancer Institute at Memorial Regional HospitalHollywood, Florida  33021
Lombardi Comprehensive Cancer Center at Georgetown University Medical CenterWashington, District of Columbia  20007
CancerCare of Maine at Eastern Maine Medical CenterBangor, Maine  04401
Siteman Cancer Center at Barnes-Jewish Hospital - Saint LouisSt. Louis, Missouri  63110
Dakota Cancer Institute at Dakota Clinic - South UniversityFargo, North Dakota  58103-4940
Gundersen Lutheran Center for Cancer and BloodLa Crosse, Wisconsin  54601
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical CenterHartford, Connecticut  06105
Morgan Cancer Center at Lehigh Valley Hospital - Cedar CrestAllentown, Pennsylvania  18105
Ella Milbank Foshay Cancer Center at Jupiter Medical CenterJupiter, Florida  33458
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
Eureka Community HospitalEureka, Illinois  61530
BroMenn Regional Medical CenterNormal, Illinois  61761
Community Cancer CenterNormal, Illinois  61761
Community Hospital of OttawaOttawa, Illinois  61350
Oncology Hematology Associates of Central Illinois, PC - OttawaOttawa, Illinois  61350
Cancer Treatment Center at Pekin HospitalPekin, Illinois  61554
Oncology Hematology Associates of Central Illinois, PC - PeoriaPeoria, Illinois  61615
Proctor HospitalPeoria, Illinois  61614
Illinois Valley Community HospitalPeru, Illinois  61354
John Stoddard Cancer Center at Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
Medical Oncology and Hematology Associates at John Stoddard Cancer CenterDes Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer CenterDes Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des MoinesWest Des Moines, Iowa  50266
Cancer Center of Kansas, PA - Dodge CityDodge City, Kansas  67801
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
Community Cancer Center of MonroeMonroe, Michigan  48162
Coborn Cancer CenterSaint Cloud, Minnesota  56303
CentraCare Clinic - River CampusSt. Cloud, Minnesota  56303
Saint Francis Cancer Treatment Center at Saint Francis Memorial Health CenterGrand Island, Nebraska  68803
Immanuel Medical CenterOmaha, Nebraska  68122
Creighton University Medical CenterOmaha, Nebraska  68131-2197
Cancer Institute of New Jersey at Cooper - VoorheesVoorhees, New Jersey  08043
Wood County Oncology CenterBowling Green, Ohio  43402
Samaritan North Cancer Care CenterDayton, Ohio  45415
Grandview HospitalDayton, Ohio  45405
David L. Rike Cancer Center at Miami Valley HospitalDayton, Ohio  45409
Good Samaritan HospitalDayton, Ohio  45406
Blanchard Valley Medical AssociatesFindlay, Ohio  45840
Charles F. Kettering Memorial HospitalKettering, Ohio  45429
Lima Memorial HospitalLima, Ohio  45804
Northwest Ohio Oncology CenterMaumee, Ohio  43537
Middletown Regional HospitalMiddletown, Ohio  45044
Toledo Clinic - OregonOregon, Ohio  43616
St. Charles Mercy HospitalOregon, Ohio  43616
Mercy Hospital of TiffinTiffin, Ohio  44883
Toledo Clinic, Incorporated - Main ClinicToledo, Ohio  43623
UVMC Cancer Care Center at Upper Valley Medical CenterTroy, Ohio  45373-1300
Fulton County Health CenterWauseon, Ohio  43567
Ruth G. McMillan Cancer Center at Greene Memorial HospitalXenia, Ohio  45385
St. Anthony Central HospitalDenver, Colorado  80204-1335
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
Mercy Cancer Center at Mercy Medical Center - North IowaMason City, Iowa  50401
Cancer Resource Center - LincolnLincoln, Nebraska  68510
Altru Cancer Center at Altru HospitalGrand Forks, North Dakota  58201
Tunnell Cancer Center at Beebe Medical CenterLewes, Delaware  19958
Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross HospitalFort Lauderdale, Florida  33308
Reid Hospital & Health Care ServicesRichmond, Indiana  47374
McFarland Clinic, PCAmes, Iowa  50010
Cancer Center of Kansas, PA - ChanuteChanute, Kansas  66720
Cancer Center of Kansas, PA - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas - Fort ScottFort Scott, Kansas  66701
Cancer Center of Kansas-IndependenceIndependence, Kansas  67301
Cancer Center of Kansas, PA - KingmanKingman, Kansas  67068
Lawrence Memorial HospitalLawrence, Kansas  66044
Cancer Center of Kansas, PA - LiberalLiberal, Kansas  67905
Cancer Center of Kansas, PA - NewtonNewton, Kansas  67114
Cancer Center of Kansas, PA - ParsonsParsons, Kansas  67357
Cancer Center of Kansas, PA - PrattPratt, Kansas  67124
Cancer Center of Kansas, PA - SalinaSalina, Kansas  67401
Cancer Center of Kansas, PA - WellingtonWellington, Kansas  67152
Cancer Center of Kansas, PA - WichitaWichita, Kansas  67214
Associates in Womens Health, PA - North ReviewWichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts TowerWichita, Kansas  67208
Cancer Center of Kansas, PA - WinfieldWinfield, Kansas  67156
Foote Memorial HospitalJackson, Michigan  49201
St. Mary Mercy HospitalLivonia, Michigan  48154
Mercy Memorial Hospital - MonroeMonroe, Michigan  48162
St. Joseph Mercy OaklandPontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy HospitalPort Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - SaginawSaginaw, Michigan  48601
Willmar Cancer Center at Rice Memorial HospitalWillmar, Minnesota  56201
Billings Clinic - DowntownBillings, Montana  59107-7000
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
St. James Healthcare Cancer CareButte, Montana  59701
Alegant Health Cancer Center at Bergan Mercy Medical CenterOmaha, Nebraska  68124
Hematology Oncology CenterElyria, Ohio  44035
Community Cancer CenterElyria, Ohio  44035
Wayne HospitalGreenville, Ohio  45331
Flower Hospital Cancer CenterSylvania, Ohio  43560
St. Anne Mercy HospitalToledo, Ohio  43623
Cancer Care Associates - Mercy CampusOklahoma City, Oklahoma  73120
Fredericksburg Oncology, IncorporatedFredericksburg, Virginia  22401
Mid Dakota Clinic, PCBismarck, North Dakota  58501
Queen's Cancer Institute at Queen's Medical CenterHonolulu, Hawaii  96813
Regional Cancer Center at Oconomowoc Memorial HospitalOconomowoc, Wisconsin  53066
Harold Alfond Center for Cancer CareAugusta, Maine  04330
Union Hospital of Cecil CountyElkton MD, Maryland  21921
Kinston Medical SpecialistsKinston, North Carolina  28501
Greenville Hospital Cancer CenterGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Grove CommonsGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Faris RoadGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Greer Medical OncologyGreer, South Carolina  29650
Cancer Centers of the Carolinas - SenecaSeneca, South Carolina  29672
Cancer Centers of the Carolinas - SpartanburgSpartanburg, South Carolina  29307
McLeod Regional Medical CenterFlorence, South Carolina  29501
Lakes Region General HospitalLaconia, New Hampshire  03246
Galesburg Clinic, PCGalesburg, Illinois  61401
St. Vincent Healthcare Cancer Care ServicesBillings, Montana  59101
Kapiolani Medical Center at Pali MomiAiea, Hawaii  96701
Kapiolani Medical Center for Women and ChildrenHonolulu, Hawaii  96826
Straub Clinic and Hospital, IncorporatedHonolulu, Hawaii  96813
OnCare Hawaii, Incorporated - KuakiniHonolulu, Hawaii  96817
OnCare Hawaii, Incorporated - LusitanaHonolulu, Hawaii  96813
Illinois CancerCare - BloomingtonBloomington%, Illinois  61701
Illinois CancerCare - CantonCanton, Illinois  61520
Illinois CancerCare - CarthageCarthage, Illinois  62321
Illinois CancerCare - EurekaEureka, Illinois  61530
Illinois CancerCare - HavanaHavana, Illinois  62644
Illinois CancerCare - Kewanee ClinicKewanee, Illinois  61443
Illinois CancerCare - MacombMacomb, Illinois  61455
Illinois CancerCare - MonmouthMonmouth, Illinois  61462
Illinois CancerCare - Community Cancer CenterNormal, Illinois  61761
Illinois CancerCare - PekinPekin, Illinois  61603
Illinois CancerCare - PeruPeru, Illinois  61354
Illinois CancerCare - PrincetonPrinceton, Illinois  61356
Illinois CancerCare - Spring ValleySpring Valley, Illinois  61362
New Hampshire Oncology - Hematology, PA at Payson Center for Cancer CareConcord, New Hampshire  03301
New Hampshire Oncology - Hematology, PA - HooksettHooksett, New Hampshire  03106
Valley Hospital - RidgewoodRidgewood, New Jersey  07450
Medcenter One Hospital Cancer Care CenterBismarck, North Dakota  58501
St. Alexius Medical Center Cancer CenterBismarck, North Dakota  58502
Precision Radiotherapy at University PointeWest Chester, Ohio  45069
Callahan Cancer Center at Great Plains Regional Medical CenterNorth Platte, Nebraska  69103
Minnesota Oncology - MaplewoodMaplewood, Minnesota  55109
Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
Lakeview HospitalStillwater, Minnesota  55082
Minnesota Oncology - WoodburyWoodbury, Minnesota  55125
Castle Medical CenterKailua, Hawaii  96734
Kauai Medical ClinicLihue, Hawaii  96766
Lakeside HospitalOmaha, Nebraska  68130
Cancer Care Associates - NormanNorman, Oklahoma  73071
Kuakini Medical CenterHonolulu, Hawaii  96817
St. Francis Hospital Cancer Care ServicesIndianapolis, Indiana  46237
Oncare Hawaii, Incorporated - Pali MomiAiea, Hawaii  96701
Mercy Cancer Center - West LakesClive, Iowa  50325
Methodist West HospitalWest Des Moines, Iowa  50266-7700
Benefis Sletten Cancer InstituteGreat Falls, Montana  59405
Essentia Health - Duluth ClinicDuluth, Minnesota  55805-1983