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A Randomized Double-Blinded Phase III Study Comparing Gemcitabine, Cisplatin, and Bevacizumab to Gemcitabine, Cisplatin, and Placebo in Patients With Advanced Transitional Cell Carcinoma

Phase 3
18 Years
Open (Enrolling)
Distal Urethral Cancer, Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter, Proximal Urethral Cancer, Recurrent Bladder Cancer, Recurrent Prostate Cancer, Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter, Recurrent Urethral Cancer, Stage IV Bladder Cancer, Stage IV Prostate Cancer, Transitional Cell Carcinoma of the Bladder, Urethral Cancer Associated With Invasive Bladder Cancer

Thank you

Trial Information

A Randomized Double-Blinded Phase III Study Comparing Gemcitabine, Cisplatin, and Bevacizumab to Gemcitabine, Cisplatin, and Placebo in Patients With Advanced Transitional Cell Carcinoma


I. To determine if patients with advanced transitional cell carcinoma treated with
bevacizumab, gemcitabine and cisplatin will have increased overall survival when compared to
patients treated with gemcitabine, cisplatin, and placebo.


I. To compare the progression-free survival of these two regimens in patients with advanced
transitional cell carcinoma.

II. To compare the proportion of patients who experience an objective response on each

III. To compare the grade 3 and greater toxicities in patients treated on the two regimens.

OUTLINE: This is a multicenter study. Patients are stratified according to presence of
visceral (lung, liver, bone, splenic, or intra-abdominal) metastases (no vs yes) and prior
chemotherapy (including adjuvant therapy, neoadjuvant therapy, and single-agent
radiosensitizers) (no vs yes). Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive gemcitabine hydrochloride intravenously (IV) over 30 minutes on days
1 and 8 and cisplatin IV over 1 hour and placebo IV over 30-90 minutes on day 1. Treatment
repeats every 21 days for 6 courses in the absence of disease progression or unacceptable
toxicity. Patients then receive placebo IV over 30-90 minutes every 21 days in the absence
of disease progression or unacceptable toxicity.

ARM II: Patients receive gemcitabine hydrochloride and cisplatin as in arm I. Patients also
receive bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 6
courses in the absence of disease progression or unacceptable toxicity. Patients then
receive bevacizumab IV over 30-90 minutes every 21 days in the absence of disease
progression or unacceptable toxicity.

After completion of study therapy, patients are followed up periodically for up to 7 years.

Inclusion Criteria:

- Patients must have histologically or cytologically documented metastatic or
unresectable transitional cell (urothelial) carcinoma of the urinary tract (renal
pelvis, ureter, bladder, prostate, or urethra), with metastatic or locally advanced
disease (T4b, N2, N3, or M1); patients must not be candidates for potentially
curative surgery or radiotherapy

- Patients may not have received prior combination systemic chemotherapy for metastatic

- For the purposes of this study, radiosensitizing single-agent chemotherapy is
not considered prior systemic therapy

- Prior neoadjuvant or adjuvant systemic chemotherapy is permissible provided it
was completed >= 1 year prior to the diagnosis of metastatic disease

- At least 4 weeks since prior radiation (including palliative) or major surgery and
fully recovered

- At least 7 days since any minor surgery such as port placement

- At least 4 weeks since any intravesical therapy

- No prior treatment with bevacizumab or other angiogenesis inhibitors

- No known history of brain metastases; brain imaging (magnetic resonance imaging
[MRI]/computed tomography [CT]) is not required

- No current congestive heart failure; New York Heart Association (NYHA) class II, III
or IV

- Patients with history of hypertension must be well controlled (< 150/90) on a regimen
of anti-hypertensive therapy

- Patients on full-dose anticoagulants must be on a stable dose of warfarin and have an
in-range international normalized ratio (INR) (usually between 2 and 3) or be on a
stable dose of low molecular weight (LMW) heparin; patients receiving anti-platelet
agents are also eligible; in addition, patients who are on daily prophylactic aspirin
or anticoagulation for atrial fibrillation are eligible

- No significant history of bleeding events or gastrointestinal (GI) perforation

- Patients with a history of a significant bleeding episode (e.g. hemoptysis,
upper or lower GI bleeding, grade 3 or 4 gross hematuria unable to be controlled
by trans-urethral resection of the bladder tumor) within 6 months of
registration are not eligible

- Patients with a history of GI perforation within 12 months of registration are
not eligible

- Patients with a history of peritoneal carcinomatosis are not eligible

- No arterial thrombotic events within 6 months of registration, including transient
ischemic attack (TIA), cerebrovascular accident (CVA), peripheral arterial thrombus,
unstable angina or angina requiring surgical or medical intervention in the past 6
months, or myocardial infarction (MI); patients with clinically significant
peripheral artery disease (i.e., claudication on less than one block) are ineligible

- Patients who have experienced a deep venous thrombosis or pulmonary embolus within
the past 6 months must be on stable therapeutic anticoagulation to be enrolled to
this study

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

- No sensory or motor peripheral neuropathy >= grade 2

- Patients with known hypersensitivity to Chinese hamster ovary cell products or other
recombinant human antibodies are not eligible

- Patients that are pregnant or nursing are not eligible; women of child bearing
potential must have a negative serum or urine pregnancy test (minimum sensitivity 25
IU/L or equivalent units of human chorionic gonadotropin [HCG]) within 72 hours prior
to registration

- For women of child-bearing potential with an elevated beta-HCG that is believed
to be related to cancer and not pregnancy, a negative trans-vaginal ultrasound
and gynecological examination are required

- Women of child-bearing potential include any female who has experienced menarche
and who has not undergone surgical sterilization (hysterectomy, bilateral tubal
ligation or bilateral oophorectomy) or is not postmenopausal [defined as
amenorrhea >= 12 consecutive months; or women on hormone replacement therapy
[HRT] with documented serum follicle stimulating hormone [FSH] level >
35mIU/mL); even women who are using oral, implanted or injectable contraceptive
hormones or mechanical products such as an intrauterine device or barrier
methods (diaphragm, condoms, spermicides) to prevent pregnancy or practicing
abstinence or where partner is sterile (e.g., vasectomy), should be considered
to be of child bearing potential

- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1 OR Karnofsky PS
>= 80

- Absolute neutrophil count (ANC) >= 1,500/mm^3

- Platelet count >= 100,000/mm^3

- Calculated or measured creatinine clearance >= 50 mL/minute

- Bilirubin =< 1.25 times upper limit of normal (ULN) (for patients with Gilbert's
Disease, =< 2.5 X ULN is allowed)

- Aspartate aminotransferase (AST) =< 2.0 times ULN

- Urine protein to creatinine ratio < 1.0 OR urine protein =< 1+ OR 24-hour urine
protein =< 1 gram

Type of Study:


Study Design:

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

Outcome Measure:

Overall survival (OS)

Outcome Description:

The Kaplan- Meier product-limit estimator will be used to estimate the OS. The stratified log-rank statistic will be the primary analysis to compare the two treatment arms on OS with the stratification factors: presence of visceral metastases (no, yes) and prior chemotherapy (no, yes). In addition, the proportional hazards model will be used to assess the importance of the treatment arm adjusting on patient characteristics, stratification variables and other important covariates in predicting OS.

Outcome Time Frame:

From date of randomization to date of death due to any cause, assessed up to 7 years

Safety Issue:


Principal Investigator

Jonathan Rosenberg

Investigator Role:

Principal Investigator

Investigator Affiliation:

Cancer and Leukemia Group B


United States: Food and Drug Administration

Study ID:




Start Date:

July 2009

Completion Date:

Related Keywords:

  • Distal Urethral Cancer
  • Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter
  • Proximal Urethral Cancer
  • Recurrent Bladder Cancer
  • Recurrent Prostate Cancer
  • Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter
  • Recurrent Urethral Cancer
  • Stage IV Bladder Cancer
  • Stage IV Prostate Cancer
  • Transitional Cell Carcinoma of the Bladder
  • Urethral Cancer Associated With Invasive Bladder Cancer
  • Urinary Bladder Neoplasms
  • Carcinoma
  • Carcinoma, Transitional Cell
  • Prostatic Neoplasms
  • Urethral Neoplasms
  • Kidney Neoplasms
  • Ureteral Neoplasms
  • Urologic Neoplasms



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Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Saint Anthony Central Hospital Denver, Colorado  80204
Exempla Saint Joseph Hospital Denver, Colorado  80218
Colorado Cancer Research Program CCOP Denver, Colorado  80224-2522
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Saint Mary Corwin Medical Center Pueblo, Colorado  81004
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Stamford Hospital Stamford, Connecticut  06904
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M D Anderson Cancer Center- Orlando Orlando, Florida  32806
Atlanta Regional CCOP Atlanta, Georgia  30342
Well Star Cobb Hospital Austell, Georgia  30106
John B Amos Cancer Center Columbus, Georgia  31904
Wellstar Kennestone Hospital Marietta, Georgia  30060
Saint Joseph's-Candler Health System Savannah, Georgia  31405
Oncare Hawaii Inc-POB II Honolulu, Hawaii  96813
Oncare Hawaii Inc-Kuakini Honolulu, Hawaii  96817
University of Hawaii Honolulu, Hawaii  96813
Saint Luke's Mountain States Tumor Institute Boise, Idaho  83712
Saint Anthony's Health Alton, Illinois  62002
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Community Cancer Center Foundation Normal, Illinois  61761
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Ottawa Regional Hospital and Healthcare Center Ottawa, Illinois  61350
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Illinois Oncology Research Association CCOP Peoria, Illinois  61615
Illinois CancerCare-Peoria Peoria, Illinois  61615
Illinois Valley Hospital Peru, Illinois  61354
Hematology Oncology Associates of Illinois - Skokie Skokie, Illinois  60076
Saint Francis Hospital and Health Centers Beech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Inc - State Boulevard Fort Wayne, Indiana  46845
Richard L. Roudebush Veterans Affairs Medical Center Indianapolis, Indiana  46202
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Premier Oncology Hematology Associates Merrillville, Indiana  46410
Saint Anthony Memorial Health Center Michigan City, Indiana  46360
Reid Hospital and Health Care Services Richmond, Indiana  47374
McFarland Clinic Ames, Iowa  50010
Hematology Oncology Associates-Quad Cities Bettendorf, Iowa  52722
Iowa Blood and Cancer Care PLC Cedar Rapids, Iowa  52402
Mercy Hospital Cedar Rapids, Iowa  52403
Saint Luke's Hospital Cedar Rapids, Iowa  52402
Medical Oncology and Hematology Associates-West Des Moines Clive, Iowa  50325
Iowa Oncology Research Association CCOP Des Moines, Iowa  50309
Mercy Capitol Des Moines, Iowa  50307
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Medical Oncology and Hematology Associates-Des Moines Des Moines, Iowa  50309
Mercy Medical Center - North Iowa Mason City, Iowa  50401
Mercy Medical Center-Sioux City Sioux City, Iowa  51104
Saint Luke's Regional Medical Center Sioux City, Iowa  51104
Cancer Center of Kansas - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas-Kingman Kingman, Kansas  67068
Cancer Center of Kansas - Parsons Parsons, Kansas  67357
Cancer Center of Kansas - Pratt Pratt, Kansas  67124
Saint Francis Hospital and Medical Center - Topeka Topeka, Kansas  66606
Cancer Center of Kansas-Wichita Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas - Main Office Wichita, Kansas  67214
Medical Center of Louisiana New Orleans, Louisiana  70112
Caritas Saint Elizabeth's Medical Center Brighton, Massachusetts  02135-2997
Holy Family Hospital Methuen, Massachusetts  01844
Hickman Cancer Center Adrian, Michigan  49221
Michigan Cancer Research Consortium Community Clinical Oncology Program Ann Arbor, Michigan  48106
Oakwood Hospital Dearborn, Michigan  48123
Saint John Hospital and Medical Center Detroit, Michigan  48236
Green Bay Oncology - Escanaba Escanaba, Michigan  49431
Grand Rapids Clinical Oncology Program Grand Rapids, Michigan  49503
Saint Mary's Health Care Grand Rapids, Michigan  49503
Spectrum Health at Butterworth Campus Grand Rapids, Michigan  49503
Green Bay Oncology - Iron Mountain Iron Mountain, Michigan  49801
Allegiance Health Jackson, Michigan  49201
Sparrow Hospital Lansing, Michigan  48912
Saint Mary Mercy Hospital Livonia, Michigan  48154
Mercy Memorial Hospital Monroe, Michigan  48162
Mercy Health Partners-Mercy Campus Muskegon, Michigan  49443
Saint Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Saint Joseph Mercy Port Huron Port Huron, Michigan  48060
Saint Mary's of Michigan Saginaw, Michigan  48601
Lakeland Hospital St. Joseph, Michigan  49085
Saint John Macomb-Oakland Hospital Warren, Michigan  48093
Medini, Eitan MD (UIA Investigator) Alexandria, Minnesota  56308
Miller-Dwan Hospital Duluth, Minnesota  55805
Unity Hospital Fridley, Minnesota  55432
Saint John's Hospital - Healtheast Maplewood, Minnesota  55109
Minnesota Oncology Hematology PA-Maplewood Maplewood, Minnesota  55109
North Memorial Medical Health Center Robbinsdale, Minnesota  55422
Saint Cloud Hospital Saint Cloud, Minnesota  56303
Park Nicollet Clinic - Saint Louis Park Saint Louis Park, Minnesota  55416
Minnesota Oncology and Hematology PA-Woodbury Woodbury, Minnesota  55125
Kansas City Veterans Affairs Medical Center Kansas City, Missouri  64128
Saint Luke's Cancer Institute Kansas City, Missouri  64111
Saint Luke's Hospital of Kansas City Kansas City, Missouri  64111
Saint Joseph Health Center Kansas City, Missouri  64114
Liberty Radiation Oncology Clinic Kansas City, Missouri  64116
Truman Medical Center Kansas City, Missouri  64108
Saint Louis-Cape Girardeau CCOP Saint Louis, Missouri  63141
Missouri Baptist Medical Center Saint Louis, Missouri  63131
Saint John's Mercy Medical Center Saint Louis, Missouri  63141
Ozark Health Ventures LLC dba Cancer Research for The Ozarks Springfield Springfield, Missouri  65802
Saint John's Hospital Springfield, Missouri  65804
Cox Medical Center Springfield, Missouri  65807
Hematology-Oncology Centers of the Northern Rockies PC Billings, Montana  59101
Saint Vincent Healthcare Billings, Montana  59101
Billings Clinic Billings, Montana  59107-7000
Saint James Community Hospital and Cancer Treatment Center Butte, Montana  59701
Benefis Healthcare- Sletten Cancer Institute Great Falls, Montana  59405
Berdeaux, Donald MD (UIA Investigator) Great Falls, Montana  59405
Saint Peter's Community Hospital Helena, Montana  59601
Glacier Oncology PLLC Kalispell, Montana  59901
Saint Patrick Hospital - Community Hospital Missoula, Montana  59802
Good Samaritan Hospital Kearney, Nebraska  68847
Lincoln Medical Education Foundation Cancer Resource Center Lincoln, Nebraska  68510
Missouri Valley Cancer Consortium CCOP Omaha, Nebraska  68106
Nevada Cancer Research Foundation CCOP Las Vegas, Nevada  89106
New Hampshire Oncology Hematology Associates Hooksett, New Hampshire  03106
LRGHealthcare-Lakes Region General Hospital Laconia, New Hampshire  03246
Cooper Hospital University Medical Center Camden, New Jersey  08103
Veterans Adminstration New Jersey Health Care System East Orange, New Jersey  07018-1095
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County Mount Holly, New Jersey  08060
Virtua West Jersey Hospital Voorhees Voorhees, New Jersey  08043
Veterans Affairs Western New York Health Care System-Buffalo Buffalo, New York  14215
Orange Regional Medical Center Middletown, New York  10940
New York University Langone Medical Center New York, New York  10016
Saint Luke's Roosevelt Hospital Center - Saint Luke's Division New York, New York  10025
Columbia University Medical Center New York, New York  10032
Interlakes Foundation Inc-Rochester Rochester, New York  14623
State University of New York Upstate Medical University Syracuse, New York  13210
Wayne Memorial Hospital Goldsboro, North Carolina  27534
Margaret R Pardee Memorial Hospital Hendersonville, North Carolina  28791
Kinston Medical Specialists PA Kinston, North Carolina  28501
Saint Alexius Medical Center Bismarck, North Dakota  58501
Aultman Health Foundation Canton, Ohio  44710
Doctors Hospital Columbus, Ohio  43228
Grant Medical Center Columbus, Ohio  43215
Mount Carmel Health Center West Columbus, Ohio  43222
Good Samaritan Hospital - Dayton Dayton, Ohio  45406
Dayton CCOP Dayton, Ohio  45429
Samaritan North Health Center Dayton, Ohio  45415
Veteran Affairs Medical Center Dayton, Ohio  45428
Hematology Oncology Center Incorporated Elyria, Ohio  44035
Blanchard Valley Hospital Findlay, Ohio  45840
Atrium Medical Center-Middletown Regional Hospital Franklin, Ohio  45005-1066
Cleveland Clinic Cancer Center Independence Independence, Ohio  44131
Kettering Medical Center Kettering, Ohio  45429
Saint Rita's Medical Center Lima, Ohio  45801
Marietta Memorial Hospital Marietta, Ohio  45750
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center Maumee, Ohio  43537
Saint Charles Hospital Oregon, Ohio  43616
North Coast Cancer Care Sandusky, Ohio  44870
Toledo Community Hospital Oncology Program CCOP Toledo, Ohio  43617
Mercy Cancer Center at Saint Anne Mercy Hospital Toledo, Ohio  43623
University of Toledo Toledo, Ohio  43614
Saint Vincent Mercy Medical Center Toledo, Ohio  43608
Upper Valley Medical Center Troy, Ohio  45373
Saint Ann's Hospital Westerville, Ohio  43081
Cleveland Clinic Wooster Specialty Center Wooster, Ohio  44691
Genesis HealthCare System Zanesville, Ohio  43701
Natalie W Bryant Cancer Center Tulsa, Oklahoma  74136
Aria Health-Torresdale Campus Philadelphia, Pennsylvania  19114
Pottstown Memorial Medical Center Pottstown, Pennsylvania  19464
Geisinger Wyoming Valley Wilkes-Barre, Pennsylvania  18711
AnMed Health Hospital Anderson, South Carolina  29621
Greenville CCOP Greenville, South Carolina  29615
Greenville Memorial Hospital Greenville, South Carolina  29605
Upstate Carolina CCOP Spartanburg, South Carolina  29303
Sanford Cancer Center-Oncology Clinic Sioux Falls, South Dakota  57104
Veterans Administration Medical Center Houston, Texas  77030
Saint Luke's Episcopal Hospital Houston, Texas  77030
Southwestern Oncology Research Department Bennington, Vermont  05201
Fredericksburg Oncology Inc Fredericksburg, Virginia  22401
Southwest VA Regional Cancer Center Norton, Virginia  24273
Auburn Regional Medical Center Auburn, Washington  98002
Harrison Bremerton Hematology and Oncology Bremerton, Washington  98310
Saint Francis Hospital Federal Way, Washington  98003
Columbia Basin Hematology and Oncology PLLC Kennewick, Washington  99336
Evergreen Hospital Medical Center Kirkland, Washington  98033
Providence - Saint Peter Hospital Olympia, Washington  98506-5166
Good Samaritan Community Hospital Puyallup, Washington  98372
Minor and James Medical PLLC Seattle, Washington  98104
The Polyclinic Seattle, Washington  98122
Swedish Medical Center-First Hill Seattle, Washington  98122-4307
Northwest CCOP Tacoma, Washington  98405
Multicare Health System Tacoma, Washington  98415
Saint Clare Hospital Tacoma, Washington  98499
Saint Joseph Medical Center Tacoma, Washington  98405
Edwards Comprehensive Cancer Center Huntington, West Virginia  25701
West Virginia University Morgantown, West Virginia  26506
Langlade Hospital and Cancer Center Antigo, Wisconsin  54409
Saint Vincent Hospital Green Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's Hospital Green Bay, Wisconsin  54303
Saint Mary's Hospital Green Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent Hospital Green Bay, Wisconsin  54301-3526
Aurora BayCare Medical Center Green Bay, Wisconsin  54311-6519
Vince Lombardi Cancer Clinic-Marinette Marinette, Wisconsin  54143
Bay Area Medical Center Marinette, Wisconsin  54143
Green Bay Oncology - Oconto Falls Oconto Falls, Wisconsin  54154
Green Bay Oncology - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
Aspirus Regional Cancer Center Wausau, Wisconsin  54401
University of California Medical Center At Irvine-Orange Campus Orange, California  92868
University of Maryland Greenebaum Cancer Center Baltimore, Maryland  21201
Lake University Ireland Cancer Center Mentor, Ohio  44060
Jupiter Medical Center Jupiter, Florida  33458
Kansas City Cancer Centers - North Kansas City, Missouri  64154
Roger Maris Cancer Center Fargo, North Dakota  58122
Elkhart Clinic Elkhart, Indiana  46515
John Muir Medical Center-Concord Campus Concord, California  94520
Marin General Hospital Greenbrae, California  94904
Moores University of California San Diego Cancer Center LA Jolla, California  92093
University of Colorado Cancer Center - Anschutz Cancer Pavilion Aurora, Colorado  80045
Denver Veterans Administration Medical Center Denver, Colorado  80220
The Shaw Regional Cancer Center Edwards, Colorado  81632
Montrose Memorial Hospital Montrose, Colorado  81401
Mount Sinai Medical Center CCOP Miami Beach, Florida  33140
Harbin Clinic Medical Oncology and Clinical Research Rome, Georgia  30165
Illinois CancerCare-Bloomington Bloomington%, Illinois  61701
Illinois CancerCare-Canton Canton, Illinois  61520
Illinois CancerCare-Carthage Carthage, Illinois  62321
Illinois CancerCare-Eureka Eureka, Illinois  61530
Delnor Community Hospital Geneva, Illinois  60134
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
Michiana Hematology Oncology PC-Elkhart Elkhart, Indiana  46514
Michiana Hematology Oncology PC-Plymouth Plymouth, Indiana  46563
Michiana Hematology Oncology PC-South Bend South Bend, Indiana  46601
Michiana Hematology Oncology-PC Westville Westville, Indiana  46391
Cancer Center of Kansas-Liberal Liberal, Kansas  67901
Michiana Hematology Oncology PC-Niles Niles, Michigan  49120
Central Care Cancer Center-Carrie J Babb Cancer Center Bolivar, Missouri  65613
Skaggs Cancer Center Branson, Missouri  65616
University of Missouri - Ellis Fischel Columbia, Missouri  65203
Hackensack University Medical CCOP Hackensack, New Jersey  07601
UMDNJ - New Jersey Medical School Newark, New Jersey  07103
Carolinas Medical Center - Northeast Concord, North Carolina  28025
Moses Cone Health System-Regional Cancer Center Greensboro, North Carolina  27403
East Carolina University Greenville, North Carolina  27858
Duke Raleigh Hospital Raleigh, North Carolina  27609
Annie Penn Memorial Hospital Reidsville, North Carolina  27320
North Coast Cancer Care-Clyde Clyde, Ohio  43410
Community Health Partners Regional Medical Center Elyria, Ohio  44035
Cancer Centers of the Carolinas - Faris Greenville, South Carolina  29605
Cancer Centers of the Carolinas-Greer Radiation Oncology Greer, South Carolina  29650
Cancer Centers of the Carolinas-Greer Medical Oncology Greer, South Carolina  29650
Erlanger Medical Center Chattanooga, Tennessee  37403
Skagit Valley Hospital Mt. Vernon, Washington  98273
Evergreen Hematology and Oncology PS Spokane, Washington  99218
West Virginia University Charleston Charleston, West Virginia  25304
Holy Family Memorial Hospital Manitowoc, Wisconsin  54221
Vince Lombardi Cancer Clinic-Sheboygan Sheboygan, Wisconsin  53081
Aurora Medical Center in Summit Summit, Wisconsin  53066
Vince Lombardi Cancer Clinic Two Rivers, Wisconsin  54241
Kansas City Cancer Centers-Southwest Overland Park, Kansas  66210
University of Minnesota Medical Center-Fairview Minneapolis, Minnesota  55455
FirstHealth of the Carolinas-Moore Regional Hosiptal Pinehurst, North Carolina  28374
Cancer Centers of Southwest Oklahoma Research Lawton, Oklahoma  
Kuakini Medical Center Honolulu, Hawaii  96817
Saint Luke's Mountain States Tumor Institute - Fruitland Fruitland, Idaho  83619
Epic Care-Oakland Oakland, California  94612
Salinas Valley Memorial Salinas, California  93901
Kaiser Permanente-Rock Creek Lafayette, Colorado  80026
Wilcox Memorial Hospital and Kauai Medical Clinic Lihue, Hawaii  96766-1099
Saint Joseph Regional Medical Center Lewiston, Idaho  83501
Saint Luke's Mountain States Tumor Institute - Meridian Meridian, Idaho  83642
Saint Luke's Mountain States Tumor Institute - Nampa Nampa, Idaho  83686
Central DuPage Hospital Cancer Center Warrenville, Illinois  60555
Kansas City Cancer Center-West Kansas City, Kansas  66112
Saint Luke's South Hospital Overland Park, Kansas  66213
Kansas City CCOP Prairie Village, Kansas  66208
Kansas City Cancer Center-Shawnee Mission Shawnee Mission, Kansas  66204
Doctors Carrol, Sheth, Raghavan Louisville, Kentucky  40215
Owensboro Mercy Medical Center Owensboro, Kentucky  42303
Veterans Administration Medical Center Baltimore, Maryland  21201
Spectrum Health Reed City Hospital Reed City, Michigan  49677
Capital Region Medical Center-Goldschmidt Cancer Center Jefferson City, Missouri  65109
Kansas City Cancer Center - South Kansas City, Missouri  64131
Heartland Hematology and Oncology Associates Incorporated Kansas City, Missouri  64118
Kansas City Cancer Center-Lee's Summit Lee's Summit, Missouri  64064
Saint John's Clinic-Rolla-Cancer and Hematology Rolla, Missouri  65401
Saint Joseph Oncology Inc Saint Joseph, Missouri  64507
Comprehensive Cancer Care PC Saint Louis, Missouri  63141
Veteran Affairs New York Harbor Healthcare System-Brooklyn Campus Brooklyn, New York  11209
Cleveland Clinic Cancer Center Beachwood Beachwood, Ohio  44122
Mount Carmel East Hospital Columbus, Ohio  43213
The Mark H Zangmeister Center Columbus, Ohio  43219
Southwest General Health Center Ireland Cancer Center Middleburg Heights, Ohio  44130
UHHS-Chagrin Highlands Medical Center Orange Village, Ohio  44122
Southern Ohio Medical Center Portsmouth, Ohio  45662
UHHS-Westlake Medical Center Westlake, Ohio  44145
Cancer Care Associates-Mercy Oklahoma City, Oklahoma  73120
Susquehanna Cancer Center Williamsport, Pennsylvania  17701
Saint Francis Hospital Greenville, South Carolina  29601
Hematology Oncology Associates of Fredericksburg Inc Fredericksburg, Virginia  22401
Memorial Hospital Of Martinsville Martinsville, Virginia  24115
Cancer Care Center at Island Hospital Anacortes, Washington  98221
Overlake Hospital Medical Center Bellevue, Washington  98004
Highline Medical Center-Main Campus Burien, Washington  98166
Providence Regional Cancer Partnership Everett, Washington  98201
Pacific Medical Center-First Hill Seattle, Washington  98104
United General Hospital Sedro-Woolley, Washington  98284
Gundersen Lutheran La Crosse, Wisconsin  54601
Saint Nicholas Hospital Madison, Wisconsin  53715
Fairbanks Memorial Hospital Fairbanks, Alaska  99701
Alegent Health Lakeside Hospital Omaha, Nebraska  68130
Los Angeles County-USC Medical Center Los Angeles, California  90033
Stanford University Hospitals and Clinics Stanford, California  94305
Kaiser Permanente-Franklin Denver, Colorado  80205
Siouxland Hematology Oncology Associates Sioux City, Iowa  51101
Swedish Cancer Institute-Issaquah Issaquah, Washington  98029
VA Medical Center - University of Iowa Iowa City, Iowa  52246
IU Health Arnett Lafayette, Indiana  
Alta Bates Summit Medical Center-Herrick Campus Berkeley, California  94704
Carle Foundation - Carle Cancer Center Urbana, Illinois  61801
Michiana Hematology Oncology PC-Mishawaka Mishawaka, Indiana  46545-1470
Marie Yeager Cancer Center Saint Joseph, Michigan  49085
The Dana-Farber Cancer Institute at Londonderry Londonderry, New Hampshire  03053
Hematology Oncology Associates of Central New York PC East Syracuse, New York  13057
Sanford Clinic North-Fargo Fargo, North Dakota  58102
Sanford Medical Center-Fargo Fargo, North Dakota  58122
The Toledo Hospital/Toledo Children's Hospital Toledo, Ohio  43606
Sanford USD Medical Center - Sioux Falls Sioux Falls, South Dakota  57117-5134
Genesys Regional Medical Center-West Flint Campus Flint, Michigan  48532
Sanford Clinic North-Bemidgi Bemidji, Minnesota  56601
Essentia Health Duluth Clinic CCOP Duluth, Minnesota  55805
Essentia Health Saint Mary's Medical Center Duluth, Minnesota  55805
Sanford Bismarck Medical Center Bismarck, North Dakota  58501
Toledo Clinic Cancer Centers-Oregon Oregon, Ohio  43616
Geisinger Medical Center-Cancer Center Hazelton Hazleton, Pennsylvania  18201
Community Howard Regional Health Kokomo, Indiana  46904
Indiana University Health La Porte Hospital La Porte, Indiana  46350
Saint Joseph Regional Medical Center-Mishawaka Mishawaka, Indiana  46545-1470
Via Christi Hospital-Pittsburg Pittsburg, Kansas  66762
PeaceHealth Saint Joseph Medical Center Bellingham, Washington  98225
Christiana Care Health System-Christiana Hospital Newark, Delaware  19718
Illinois Cancer Specialists-Niles Niles, Illinois  60714
Bronson Battle Creek Battle Creek, Michigan  49017
Springfield Regional Medical Center Springfield, Ohio  45505
Cleveland Clinic Cancer Center/Fairview Hospital Cleveland, Ohio  44111
Memorial Sloan-Kettering Cancer Center at Suffolk Commack, New York  11725
Promise Regional Medical Center-Hutchinson Hutchinson, Kansas  65702
Lake Region Healthcare Corporation-Cancer Care Fergus Falls, Minnesota  56537
Saint Louis Cancer and Breast Institute-South City Saint Louis, Missouri  63109
Nevada Cancer Institute-Summerlin Campus Las Vegas, Nevada  89135
Toledo Clinic Cancer Centers-Bowling Green Bowling Green, Ohio  43402
Toledo Clinic Cancer Centers-Maumee Maumee, Ohio  43537-1839
Toledo Clinic Cancer Centers-Toledo Toledo, Ohio  43623
Guthrie Clinic-Robert Packer Hospital Sayre, Pennsylvania  18840
Self Regional Healthcare Greenwood, South Carolina  29646
Harrison Poulsbo Hematology and Oncology Poulsbo, Washington  98370
Aurora Cancer Care-Southern Lakes Elkhorn, Wisconsin  53121
IU Health Ball Memorial Hospital Muncie, Indiana  47303
Sutter Pacific Medical Foundation Santa Rosa, California  95403
Maine Center for Cancer Medicine and Blood Disorders-Scarborough Scarborough, Maine  04074
Park Ridge Hospital Breast Health Center Hendersonville, North Carolina  28792
Blue Ridge Medical Specialists PC Bristol, Tennessee  37620
NEA Baptist Clinic-Matthews Jonesboro, Arkansas  72401
Saint Luke's Mountain States Tumor Institute-Twin Falls Twin Falls, Idaho  83301
Saint Rose Ambulatory and Surgery Center Great Bend, Kansas  67530
Carolinas Medical Center-Union Monroe, North Carolina  28112
Cleveland Regional Medical Center Shelby, North Carolina  28150
Ireland Cancer Center at Firelands Regional Medical Center Sandusky, Ohio  44870
Cleveland Clinic Cancer Center-Strongsville Strongsville, Ohio  44136
Cancer Care Associates-Norman Norman, Oklahoma  73071
Mercy Physicians of Oklahoma-Lakeside Oklahoma City, Oklahoma  73120
Capital Health Medical Center-Hopewell Pennington, New Jersey  08534
Cancer Center of Western Wisconsin New Richmond, Wisconsin  54017
Memorial Sloan Kettering Cancer Center at Basking Ridge Basking Ridge, New Jersey  07920
Memorial Sloan-Kettering Cancer Center Rockville Centre Rockville Centre, New York  11570
Memorial Sloan-Kettering Cancer Center at Phelps Sleepy Hollow, New York  10591
Oncare Hawaii Inc - Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Swedish Medical Center-Edmonds Edmonds, Washington  98026
Idaho Urologic Institute PA Meridian, Idaho  83642
Hines Veterans Administration Hospital Hines, Illinois  60141
IU Health North Hospital Carmel, Indiana  46032