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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 Scottsdale Scottsdale, Arizona  85259
Mayo Clinic - Jacksonville Jacksonville, Florida  32224
Mayo Clinic Cancer Center Rochester, Minnesota  55905
CCOP - Wichita Wichita, Kansas  67214-3882
Hurley Medical Center Flint, Michigan  48503
CCOP - Missouri Valley Cancer Consortium Omaha, Nebraska  68131
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Mount Sinai Medical Center Miami Beach, Florida  33140
CCOP - Illinois Oncology Research Association Peoria, Illinois  61602
CCOP - Carle Cancer Center Urbana, Illinois  61801
CCOP - Iowa Oncology Research Association Des Moines, Iowa  50309-1016
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Aurora Presbyterian Hospital Aurora, Colorado  80012
Boulder Community Hospital Boulder, Colorado  80301-9019
Penrose Cancer Center at Penrose Hospital Colorado Springs, Colorado  80933
Porter Adventist Hospital Denver, Colorado  80210
Presbyterian - St. Luke's Medical Center Denver, Colorado  80218
St. Joseph Hospital Denver, Colorado  80218
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United Hospital Longmont, Colorado  80502
St. Mary - Corwin Regional Medical Center Pueblo, Colorado  81004
Rush-Copley Cancer Care Center Aurora, Illinois  60507
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLP Sioux City, Iowa  51101
St. Luke's Regional Medical Center Sioux City, Iowa  51104
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
Sparrow Regional Cancer Center Lansing, Michigan  48912-1811
St. John Macomb Hospital Warren, Michigan  48093
MeritCare Bemidji Bemidji, Minnesota  56601
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
CCOP - Duluth Duluth, Minnesota  55805
Miller - Dwan Medical Center Duluth, Minnesota  55805
Fairview Southdale Hospital Edina, Minnesota  55435
Mercy and Unity Cancer Center at Unity Hospital Fridley, Minnesota  55432
Hutchinson Area Health Care Hutchinson, Minnesota  55350
HealthEast Cancer Care at St. John's Hospital Maplewood, Minnesota  55109
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital Minneapolis, Minnesota  55407
St. Francis Cancer Center at St. Francis Medical Center Shakopee, Minnesota  55379
Park Nicollet Cancer Center St. Louis Park, Minnesota  55416
Regions Hospital Cancer Care Center St. Paul, Minnesota  55101
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
MeritCare Broadway Fargo, North Dakota  58122
Sanford Cancer Center at Sanford USD Medical Center Sioux Falls, South Dakota  57117-5039
Avera Cancer Institute Sioux Falls, South Dakota  57105
Rapid City Regional Hospital Rapid City, South Dakota  57709
Methodist Medical Center of Illinois Peoria, Illinois  61636
CCOP - Montana Cancer Consortium Billings, Montana  59101
CCOP - Dayton Kettering, Ohio  45429
CCOP - Greenville Greenville, South Carolina  29615
Rush University Medical Center Chicago, Illinois  60612-3824
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
Charles M. Barrett Cancer Center at University Hospital Cincinnati, Ohio  45267-0526
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
Rebecca and John Moores UCSD Cancer Center La Jolla, California  92093-0658
Wesley Medical Center Wichita, Kansas  67214
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
St. Vincent Mercy Medical Center Toledo, Ohio  43608
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
Florida Hospital Cancer Institute at Florida Hospital Orlando Orlando, Florida  32803-1273
Via Christi Cancer Center at Via Christi Regional Medical Center Wichita, Kansas  67214
Mount Sinai Medical Center New York, New York  10029
Medical University of Ohio Cancer Center Toledo, Ohio  43614
Toledo Hospital Toledo, Ohio  43606
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Hematology-Oncology Centers of the Northern Rockies - Billings Billings, Montana  59101
St. Peter's Hospital Helena, Montana  59601
Kalispell Regional Medical Center Kalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Missoula, Montana  59802
Montana Cancer Specialists at Montana Cancer Center Missoula, Montana  59802
Wayne Memorial Hospital, Incorporated Goldsboro, North Carolina  27534
UNMC Eppley Cancer Center at the University of Nebraska Medical Center Omaha, Nebraska  68198-7680
Memorial Cancer Institute at Memorial Regional Hospital Hollywood, Florida  33021
Lombardi Comprehensive Cancer Center at Georgetown University Medical Center Washington, District of Columbia  20007
CancerCare of Maine at Eastern Maine Medical Center Bangor, Maine  04401
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis St. Louis, Missouri  63110
Dakota Cancer Institute at Dakota Clinic - South University Fargo, North Dakota  58103-4940
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest Allentown, Pennsylvania  18105
Ella Milbank Foshay Cancer Center at Jupiter Medical Center Jupiter, Florida  33458
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center Boise, Idaho  83706
Eureka Community Hospital Eureka, Illinois  61530
BroMenn Regional Medical Center Normal, Illinois  61761
Community Cancer Center Normal, Illinois  61761
Community Hospital of Ottawa Ottawa, Illinois  61350
Oncology Hematology Associates of Central Illinois, PC - Ottawa Ottawa, Illinois  61350
Cancer Treatment Center at Pekin Hospital Pekin, Illinois  61554
Oncology Hematology Associates of Central Illinois, PC - Peoria Peoria, Illinois  61615
Proctor Hospital Peoria, Illinois  61614
Illinois Valley Community Hospital Peru, Illinois  61354
John Stoddard Cancer Center at Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Medical Oncology and Hematology Associates at John Stoddard Cancer Center Des Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer Center Des Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des Moines West Des Moines, Iowa  50266
Cancer Center of Kansas, PA - Dodge City Dodge City, Kansas  67801
Hickman Cancer Center at Bixby Medical Center Adrian, Michigan  49221
Community Cancer Center of Monroe Monroe, Michigan  48162
Coborn Cancer Center Saint Cloud, Minnesota  56303
CentraCare Clinic - River Campus St. Cloud, Minnesota  56303
Saint Francis Cancer Treatment Center at Saint Francis Memorial Health Center Grand Island, Nebraska  68803
Immanuel Medical Center Omaha, Nebraska  68122
Creighton University Medical Center Omaha, Nebraska  68131-2197
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Wood County Oncology Center Bowling Green, Ohio  43402
Samaritan North Cancer Care Center Dayton, Ohio  45415
Grandview Hospital Dayton, Ohio  45405
David L. Rike Cancer Center at Miami Valley Hospital Dayton, Ohio  45409
Good Samaritan Hospital Dayton, Ohio  45406
Blanchard Valley Medical Associates Findlay, Ohio  45840
Charles F. Kettering Memorial Hospital Kettering, Ohio  45429
Lima Memorial Hospital Lima, Ohio  45804
Northwest Ohio Oncology Center Maumee, Ohio  43537
Middletown Regional Hospital Middletown, Ohio  45044
Toledo Clinic - Oregon Oregon, Ohio  43616
St. Charles Mercy Hospital Oregon, Ohio  43616
Mercy Hospital of Tiffin Tiffin, Ohio  44883
Toledo Clinic, Incorporated - Main Clinic Toledo, Ohio  43623
UVMC Cancer Care Center at Upper Valley Medical Center Troy, Ohio  45373-1300
Fulton County Health Center Wauseon, Ohio  43567
Ruth G. McMillan Cancer Center at Greene Memorial Hospital Xenia, Ohio  45385
St. Anthony Central Hospital Denver, Colorado  80204-1335
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Mercy Cancer Center at Mercy Medical Center - North Iowa Mason City, Iowa  50401
Cancer Resource Center - Lincoln Lincoln, Nebraska  68510
Altru Cancer Center at Altru Hospital Grand Forks, North Dakota  58201
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital Fort Lauderdale, Florida  33308
Reid Hospital & Health Care Services Richmond, Indiana  47374
McFarland Clinic, PC Ames, Iowa  50010
Cancer Center of Kansas, PA - Chanute Chanute, Kansas  66720
Cancer Center of Kansas, PA - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas - Fort Scott Fort Scott, Kansas  66701
Cancer Center of Kansas-Independence Independence, Kansas  67301
Cancer Center of Kansas, PA - Kingman Kingman, Kansas  67068
Lawrence Memorial Hospital Lawrence, Kansas  66044
Cancer Center of Kansas, PA - Liberal Liberal, Kansas  67905
Cancer Center of Kansas, PA - Newton Newton, Kansas  67114
Cancer Center of Kansas, PA - Parsons Parsons, Kansas  67357
Cancer Center of Kansas, PA - Pratt Pratt, Kansas  67124
Cancer Center of Kansas, PA - Salina Salina, Kansas  67401
Cancer Center of Kansas, PA - Wellington Wellington, Kansas  67152
Cancer Center of Kansas, PA - Wichita Wichita, Kansas  67214
Associates in Womens Health, PA - North Review Wichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas, PA - Winfield Winfield, Kansas  67156
Foote Memorial Hospital Jackson, Michigan  49201
St. Mary Mercy Hospital Livonia, Michigan  48154
Mercy Memorial Hospital - Monroe Monroe, Michigan  48162
St. Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy Hospital Port Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - Saginaw Saginaw, Michigan  48601
Willmar Cancer Center at Rice Memorial Hospital Willmar, Minnesota  56201
Billings Clinic - Downtown Billings, Montana  59107-7000
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
St. James Healthcare Cancer Care Butte, Montana  59701
Alegant Health Cancer Center at Bergan Mercy Medical Center Omaha, Nebraska  68124
Hematology Oncology Center Elyria, Ohio  44035
Community Cancer Center Elyria, Ohio  44035
Wayne Hospital Greenville, Ohio  45331
Flower Hospital Cancer Center Sylvania, Ohio  43560
St. Anne Mercy Hospital Toledo, Ohio  43623
Cancer Care Associates - Mercy Campus Oklahoma City, Oklahoma  73120
Fredericksburg Oncology, Incorporated Fredericksburg, Virginia  22401
Mid Dakota Clinic, PC Bismarck, North Dakota  58501
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Regional Cancer Center at Oconomowoc Memorial Hospital Oconomowoc, Wisconsin  53066
Harold Alfond Center for Cancer Care Augusta, Maine  04330
Union Hospital of Cecil County Elkton MD, Maryland  21921
Kinston Medical Specialists Kinston, North Carolina  28501
Greenville Hospital Cancer Center Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Grove Commons Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Faris Road Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Greer Medical Oncology Greer, South Carolina  29650
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
McLeod Regional Medical Center Florence, South Carolina  29501
Lakes Region General Hospital Laconia, New Hampshire  03246
Galesburg Clinic, PC Galesburg, Illinois  61401
St. Vincent Healthcare Cancer Care Services Billings, Montana  59101
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Kapiolani Medical Center for Women and Children Honolulu, Hawaii  96826
Straub Clinic and Hospital, Incorporated Honolulu, Hawaii  96813
OnCare Hawaii, Incorporated - Kuakini Honolulu, Hawaii  96817
OnCare Hawaii, Incorporated - Lusitana Honolulu, Hawaii  96813
Illinois CancerCare - Bloomington Bloomington%, Illinois  61701
Illinois CancerCare - Canton Canton, Illinois  61520
Illinois CancerCare - Carthage Carthage, Illinois  62321
Illinois CancerCare - Eureka Eureka, Illinois  61530
Illinois CancerCare - Havana Havana, Illinois  62644
Illinois CancerCare - Kewanee Clinic Kewanee, Illinois  61443
Illinois CancerCare - Macomb Macomb, Illinois  61455
Illinois CancerCare - Monmouth Monmouth, Illinois  61462
Illinois CancerCare - Community Cancer Center Normal, Illinois  61761
Illinois CancerCare - Pekin Pekin, Illinois  61603
Illinois CancerCare - Peru Peru, Illinois  61354
Illinois CancerCare - Princeton Princeton, Illinois  61356
Illinois CancerCare - Spring Valley Spring Valley, Illinois  61362
New Hampshire Oncology - Hematology, PA at Payson Center for Cancer Care Concord, New Hampshire  03301
New Hampshire Oncology - Hematology, PA - Hooksett Hooksett, New Hampshire  03106
Valley Hospital - Ridgewood Ridgewood, New Jersey  07450
Medcenter One Hospital Cancer Care Center Bismarck, North Dakota  58501
St. Alexius Medical Center Cancer Center Bismarck, North Dakota  58502
Precision Radiotherapy at University Pointe West Chester, Ohio  45069
Callahan Cancer Center at Great Plains Regional Medical Center North Platte, Nebraska  69103
Minnesota Oncology - Maplewood Maplewood, Minnesota  55109
Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
Lakeview Hospital Stillwater, Minnesota  55082
Minnesota Oncology - Woodbury Woodbury, Minnesota  55125
Castle Medical Center Kailua, Hawaii  96734
Kauai Medical Clinic Lihue, Hawaii  96766
Lakeside Hospital Omaha, Nebraska  68130
Cancer Care Associates - Norman Norman, Oklahoma  73071
Kuakini Medical Center Honolulu, Hawaii  96817
St. Francis Hospital Cancer Care Services Indianapolis, Indiana  46237
Oncare Hawaii, Incorporated - Pali Momi Aiea, Hawaii  96701
Mercy Cancer Center - West Lakes Clive, Iowa  50325
Methodist West Hospital West Des Moines, Iowa  50266-7700
Benefis Sletten Cancer Institute Great Falls, Montana  59405
Essentia Health - Duluth Clinic Duluth, Minnesota  55805-1983