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Phase III Randomized Study of Sorafenib Plus Doxorubicin Versus Sorafenib in Patients With Advanced Hepatocellular Carcinoma (HCC)


Phase 3
18 Years
N/A
Open (Enrolling)
Both
Adult Primary Hepatocellular Carcinoma, Advanced Adult Primary Liver Cancer, Localized Unresectable Adult Primary Liver Cancer, Recurrent Adult Primary Liver Cancer

Thank you

Trial Information

Phase III Randomized Study of Sorafenib Plus Doxorubicin Versus Sorafenib in Patients With Advanced Hepatocellular Carcinoma (HCC)


PRIMARY OBJECTIVES:

I. To compare the overall survival of patients with locally advanced or metastatic
hepatocellular carcinoma treated with sorafenib tosylate with vs without doxorubicin
hydrochloride.

SECONDARY OBJECTIVES:

I. To compare the time to progression in patients treated with these regimens. II. To
compare the progression-free-survival of patients treated with these regimens.

III. To compare the tumor response using RECIST criteria in patients treated with these
regimens.

OUTLINE: This is a multicenter study. Patients are stratified according to extent of disease
(locally advanced vs metastatic). Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive doxorubicin hydrochloride IV on day 1 and oral sorafenib tosylate
twice daily on days 1-21. Treatment repeats every 21 days for 6 courses in the absence of
disease progression or unacceptable toxicity. After 6 courses, patients may continue to
receive oral sorafenib tosylate twice daily in the absence of disease progression or
unacceptable toxicity.

ARM II: Patients receive oral sorafenib tosylate twice daily on days 1-21. Treatment repeats
every 21 days in the absence of disease progression or unacceptable toxicity.

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


Inclusion Criteria:



- Patients must have pathologically or cytologically proven hepatocelluar carcinoma;
Known mixed histology (e.g. hepatocellular carcinoma plus cholangiocarcinoma) or
fibrolamellar variant is not allowed

- Patients must have locally advanced or metastatic disease; Locally advanced disease
is defined as disease deemed to be unresectable or non-eligible for transplant
without distant metastases

- Lesions must be accurately measurable in at least one dimension (longest diameter to
be recorded) as >= 2 cm with conventional techniques or as >= 1 cm with spiral CT
scan

- No prior adjuvant sorafenib or other Raf/VEGF inhibitors; Other prior adjuvant
therapy is allowed if completed >6 months prior to registration with documented
recurrence of HCC

- Patients may have been treated with loco regional therapies provided that they either
have:

- 1) a target lesion that has not been subjected to local therapy or

- 2) the target lesion(s) within the field of the local therapy has shown an
increase of >= 20% in the size since last treatment.

- Such therapy must be completed at least 4 weeks prior to registration;
Patients that have received palliative radiation therapy to the bone need
not wait 4 weeks to begin protocol therapy

- Prior therapies allowed include the following:

- A) bland embolization, radiation, radioactive microspheres, etc

- B) chemoembolization using any chemotherapy (except, see "D", below)

- C) chemoembolization drug-eluting beads using doxorubicin

- D) prior therapy with chemoembolization using doxorubicin in the non drug
eluting beads form is NOT allowed

- No prior systemic therapy for metastatic disease

- No prior exposure to systemic doxorubicin administered intravenously

- Antiviral treatment is allowed, however interferon therapy must be stopped at least 4
weeks prior to registration

- Allografts are not allowed: No prior history of any allograft, including but not
limited to liver and bone marrow transplants

- No known CNS tumors including brain metastases

- No clinically significant gastrointestinal bleeding events requiring intervention,
transfusion, or admission to hospital within 30 days prior to registration

- Patients must have completed any major surgery >= 4 weeks from registration

- Concomitant treatment with Rifampin or St John's Wort is not allowed; Patients should
discontinue these drugs at least 4 weeks prior to registration

- Patients with a history of hypertension should be well controlled (< 140/90 mmHg) on
a regimen of anti-hypertensive therapy

- Significant history of cardiac disease is not allowed:

- Congestive heart failure > Class II New York Heart Assocation (NYHA)

- Myocardial infarction within 6 months prior to registration

- Cardiac arrhythmias requiring anti-arrhythmic therapy other than beta blockers
or digoxin

- Serious myocardial dysfunction, defined as scintigraphically (MUGA, myocardial
scintigram) determined absolute left ventricular ejection fraction (LVEF) below
45% or an LVEF below the normal limit at the individual institution

- No history of bleeding diathesis

- Patients receiving combination anti-retroviral therapy for human immunodeficiency
virus (HIV) are excluded from the study because of possible pharmacokinetic
interactions with sorafenib

- ECOG performance status 0-2

- Pregnancy/Nursing Status: The effects of sorafenib on the developing fetus at the
recommended therapeutic dose are unknown and may be teratogenic; Thus, women who are
pregnant should not go on study. Women should not breastfeed while participating in
this study

- Granulocytes ≥ 1,500/μL

- Hemoglobin ≥ 8.5 g/dL

- Platelets ≥ 75,000/μL

- Creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 60 mL/min

- Child-Pugh score A

- Bilirubin ≤ 3 mg/dL

- ALT and AST ≤ 5 times upper limit of normal (ULN)

- PT/INR ≤ 1.7 (Patients who are being therapeutically anticoagulated with an agent
such as coumadin or heparin will be allowed to participate provided that no prior
evidence of underlying abnormality in these parameters exists)

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Overall survival

Outcome Description:

The confidence bound estimates for futility will also be adjusted according to the Lan-DeMets analogue of the O'Brien-Fleming boundaries.

Outcome Time Frame:

Up to 3 years

Safety Issue:

No

Principal Investigator

Ghassan Abou-Alfa

Investigator Role:

Principal Investigator

Investigator Affiliation:

Cancer and Leukemia Group B

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2011-01989

NCT ID:

NCT01015833

Start Date:

February 2010

Completion Date:

Related Keywords:

  • Adult Primary Hepatocellular Carcinoma
  • Advanced Adult Primary Liver Cancer
  • Localized Unresectable Adult Primary Liver Cancer
  • Recurrent Adult Primary Liver Cancer
  • Carcinoma
  • Liver Neoplasms
  • Carcinoma, Hepatocellular

Name

Location

Albert Einstein College of MedicineBronx, New York  10461
Baylor College of MedicineHouston, Texas  77030
Johns Hopkins UniversityBaltimore, Maryland  21205
Memorial Sloan Kettering Cancer CenterNew York, New York  10021
University of Iowa Hospitals and ClinicsIowa City, Iowa  52242
University of Mississippi Medical CenterJackson, Mississippi  39216-4505
Washington University School of MedicineSaint Louis, Missouri  63110
Abington Memorial HospitalAbington, Pennsylvania  19001
Hurley Medical CenterFlint, Michigan  48503
Sinai Hospital of BaltimoreBaltimore, Maryland  21225
Genesys Hurley Cancer InstituteFlint, Michigan  48503
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
Fairview Ridges HospitalBurnsville, Minnesota  55337
Hutchinson Area Health CareHutchinson, Minnesota  55350
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
Avera Cancer InstituteSioux Falls, South Dakota  57105
Rapid City Regional HospitalRapid City, South Dakota  57709
Memorial Hospital of South BendSouth Bend, Indiana  46601
Mary Bird Perkins Cancer CenterBaton Rouge, Louisiana  70809
Beth Israel Medical CenterNew York, New York  10003
New York Medical CollegeValhalla, New York  10595
Lehigh Valley HospitalAllentown, Pennsylvania  18103
Jackson-Madison County General HospitalJackson, Tennessee  38301
Waukesha Memorial HospitalWaukesha, Wisconsin  53188
North Shore University HospitalManhasset, New York  11030
Boston Medical CenterBoston, Massachusetts  02118
University of Nebraska Medical CenterOmaha, Nebraska  68198-3330
Kaiser Permanente Medical Center - Santa ClaraSanta Clara, California  95051-5386
Via Christi Regional Medical CenterWichita, Kansas  67214
Ochsner Clinic FoundationNew Orleans, Louisiana  70121
University of Oklahoma Health Sciences CenterOklahoma City, Oklahoma  73104
Southern California Permanente Medical GroupDowney, California  90242
Medical Center of Central GeorgiaMacon, Georgia  31201
MetroHealth Medical CenterCleveland, Ohio  44109
Long Island Jewish Medical CenterNew Hyde Park, New York  11040
Advocate Christ Medical CenterOak Lawn, Illinois  60453
Montefiore Medical CenterBronx, New York  10467-2490
Cancer Center of Kansas - ChanuteChanute, Kansas  66720
Cancer Center of Kansas - Dodge CityDodge City, Kansas  67801
Cancer Center of Kansas - NewtonNewton, Kansas  67114
Cancer Center of Kansas - SalinaSalina, Kansas  67042
Cancer Center of Kansas - WellingtonWellington, Kansas  67152
Associates in Womens HealthWichita, Kansas  67203
Cancer Center of Kansas - WinfieldWinfield, Kansas  67156
Adena Regional Medical CenterChillicothe, Ohio  54601
Grady Memorial HospitalDelaware, Ohio  43015
Fairfield Medical CenterLancaster, Ohio  43130
Avera McKennan Hospital and University Health CenterSioux Falls, South Dakota  57105
Methodist Estabrook Cancer CenterOmaha, Nebraska  68114-4199
Cancer Centers of the CarolinasGreenville, South Carolina  29605
Elkhart General HospitalElkhart, Indiana  46515
South Bend ClinicSouth Bend, Indiana  46617
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical CenterColumbus, Ohio  43210-1240
University Medical Center of Southern NevadaLas Vegas, Nevada  89102
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
Beebe Medical CenterLewes, Delaware  19958
Hematology and Oncology AssociatesChicago, Illinois  60611
Community Cancer Center of MonroeMonroe, Michigan  48162
Great Plains Regional Medical CenterNorth Platte, Nebraska  69101-6598
Iredell Memorial HospitalStatesville, North Carolina  28677
Bismarck Cancer CenterBismarck, North Dakota  58501
Grandview HospitalDayton, Ohio  45405
Lima Memorial HospitalLima, Ohio  45804
Mercy Hospital of TiffinTiffin, Ohio  44883
Fulton County Health CenterWauseon, Ohio  43567
Mountainview MedicalBerlin, Vermont  05602
Danville Regional Medical CenterDanville, Virginia  24541
Mercy HospitalCoon Rapids, Minnesota  55433
Allenmore HospitalTacoma, Washington  98411-0414
Hematology Oncology Associates of Illinois-Highland ParkHighland Park, Illinois  60035
Ottumwa Regional Health CenterOttumwa, Iowa  52501
Bixby Medical CenterAdrian, Michigan  49221
Saint Joseph Mercy HospitalAnn Arbor, Michigan  48106
Fairview-Southdale HospitalEdina, Minnesota  55435
Abbott-Northwestern HospitalMinneapolis, Minnesota  55407
Regions HospitalSaint Paul, Minnesota  55101
Saint Francis Regional Medical CenterShakopee, Minnesota  55379
Rice Memorial HospitalWillmar, Minnesota  56201
Saint Luke's HospitalMaumee, Ohio  43537
Alaska Regional HospitalAnchorage, Alaska  99508
Highland General HospitalOakland, California  94602
Swedish American HospitalRockford, Illinois  61104
Center for Cancer Care and ResearchSt. Louis, Missouri  63141
Miami Valley HospitalDayton, Ohio  45409
Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Cancer Center of Kansas - Fort ScottFort Scott, Kansas  66701
Cancer Center of Kansas-IndependenceIndependence, Kansas  67301
Lawrence Memorial HospitalLawrence, Kansas  66044
Menorah Medical CenterOverland Park, Kansas  66209
Shawnee Mission Medical CenterShawnee Mission, Kansas  66204
North Kansas City HospitalKansas City, Missouri  64116
Research Medical CenterKansas City, Missouri  64132
Saint Luke's East - Lee's SummitLee's Summit, Missouri  64086
Liberty HospitalLiberty, Missouri  64068
Heartland Regional Medical CenterSaint Joseph, Missouri  64506
Mary Rutan HospitalBellefontaine, Ohio  43311
Wayne HospitalGreenville, Ohio  45331
Knox Community HospitalMount Vernon, Ohio  43050
Fisher-Titus Medical CenterNorwalk, Ohio  44857
Clinton Memorial HospitalWilmington, Ohio  45177
Providence Centralia HospitalCentralia, Washington  98531-9027
Genesys Regional Medical CenterGrand Blanc, Michigan  48439-8066
Ben Taub General HospitalHouston, Texas  77030
Methodist HospitalHouston, Texas  77030
Greene Memorial HospitalXenia, Ohio  45385
Greater Baltimore Medical CenterBaltimore, Maryland  21204
Rutherford HospitalRutherfordton, North Carolina  28139
AnMed Health Cancer CenterAnderson, South Carolina  29621
Union Hospital of Cecil CountyElkton MD, Maryland  21921
Cancer Centers of the Carolinas - Grove CommonsGreenville, South Carolina  29605
Cancer Centers of the Carolinas - SenecaSeneca, South Carolina  29672
Cancer Centers of the Carolinas - SpartanburgSpartanburg, South Carolina  29307
Presbyterian HospitalCharlotte, North Carolina  28233-3549
Phelps County Regional Medical CenterRolla, Missouri  65401
Saint Francis Medical CenterGrand Island, Nebraska  68802
Wellmont Holston Valley Hospital and Medical CenterKingsport, Tennessee  37662
La Grange Memorial HospitalLa Grange, Illinois  60525
Queen's Medical CenterHonolulu, Hawaii  96813
University of Alabama at BirminghamBirmingham, Alabama  35294-3300
Providence HospitalMobile, Alabama  36608
Meharry Medical CollegeNashville, Tennessee  37208-3599
Providence Medical CenterKansas City, Kansas  66112
Northwestern UniversityChicago, Illinois  60611
East Bay Radiation Oncology CenterCastro Valley, California  94546
Contra Costa Regional Medical CenterMartinez, California  94553-3156
Larry G Strieff MD Medical CorporationOakland, California  94609
Kapiolani Medical Center at Pali MomiAiea, Hawaii  96701
Kapiolani Medical Center for Women and ChildrenHonolulu, Hawaii  96826
Maui Memorial Medical CenterWailuku, Hawaii  96793
Hennepin County Medical CenterMinneapolis, Minnesota  
University of RochesterRochester, New York  14642
Glens Falls HospitalGlens Falls, New York  12801
Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
El Camino HospitalMountain View, California  94040
Yale UniversityNew Haven, Connecticut  06520
Kaiser Permanente Medical CenterVallejo, California  94589
Straub Clinic and HospitalHonolulu, Hawaii  96813
Lakeland Regional Cancer CenterLakeland, Florida  33805
Riverside Methodist HospitalColumbus, Ohio  43214
Licking Memorial HospitalNewark, Ohio  43055-2899
Cancer Center of Kansas - McPhersonMcPherson, Kansas  67460
Saint Mary's Regional Medical CenterReno, Nevada  89503
Dartmouth Hitchcock Medical CenterLebanon, New Hampshire  03756
Mid Dakota ClinicBismarck, North Dakota  58501
Columbus CCOPColumbus, Ohio  43206
University Of VermontBurlington,, Vermont  05403
Sacred Heart HospitalPensacola, Florida  32503
Kaiser PermanenteSacramento, California  
University of KentuckyLexington, Kentucky  40536-0098
Wichita CCOPWichita, Kansas  67214-3882
Flower HospitalSylvania, Ohio  43560-2197
Metro-Minnesota CCOPSt. Louis Park, Minnesota  
Providence HospitalSouthfield, Michigan  48075
Cancer Centers of the Carolinas - EasleyEasley, South Carolina  29640
Lakeview HospitalStillwater, Minnesota  55082
Tulane University Health Sciences CenterNew Orleans, Louisiana  70112
Louisiana State University Health Science CenterNew Orleans, Louisiana  70112
Kaiser PermanentePortland, Oregon  97227
Florida HospitalOrlando, Florida  32803
Memorial Health University Medical CenterSavannah, Georgia  31404
University of Chicago Comprehensive Cancer CenterChicago, Illinois  60637-1470
Northern Indiana Cancer Research ConsortiumSouth Bend, Indiana  
Rockwood ClinicSpokane, Washington  99220
Hawaii Medical Center EastHonolulu, Hawaii  96817
Valley View Hospital Cancer CenterGlenwood Springs, Colorado  81601
Southeast Cancer CenterCape Girardeau, Missouri  63703
Butler Memorial HospitalButler, Pennsylvania  16001
New Ulm Medical CenterNew Ulm, Minnesota  56073
Valley Medical Oncology Consultants-Castro ValleyCastro Valley, California  94546
Valley Medical Oncology Consultants-FremontFremont, California  94538
Kaiser Permanente, FremontFremont, California  94538
Kaiser Permanente, HaywardHayward, California  94545
Bay Area Breast Surgeons IncOakland, California  94609
Bay Area Tumor Institution CCOPOakland, California  94609
Tom K Lee IncOakland, California  94609
Kaiser Permanente-OaklandOakland, California  94611
Kaiser Permanente-Redwood CityRedwood City, California  94063
Kaiser Permanente-RichmondRichmond, California  94801
Kaiser Permanente-RosevilleRoseville, California  95661
Kaiser Permanente-South SacramentoSacramento, California  95823
Kaiser Permanente - SacramentoSacramento, California  95825
Kaiser Permanente-San FranciscoSan Francisco, California  94115
University of California San Francisco Medical Center-Mount ZionSan Francisco, California  94115
Kaiser Permanente-Santa Teresa-San JoseSan Jose, California  95119
Doctors Medical Center- JC Robinson Regional Cancer CenterSan Pablo, California  94806
Kaiser Permanente-San RafaelSan Rafael, California  94903
Kaiser Permanente-Santa RosaSanta Rosa, California  95403
Kaiser Permanente-South San FranciscoSouth San Francisco, California  94080
Kaiser Permanente-StocktonStockton, California  95210
Kaiser Permanente-VallejoVallejo, California  94589
Kaiser Permanente-Walnut CreekWalnut Creek, California  94596
Saint Mary's Hospital and Regional Medical CenterGrand Junction, Colorado  81502
Saint Francis Hospital and Medical CenterHartford, Connecticut  06105
Middlesex HospitalMiddletown, Connecticut  06457
Lombardi Comprehensive Cancer Center at Georgetown UniversityWashington, District of Columbia  20057
Sacred Heart Medical Oncology Group - Davis HighwayPensacola, Florida  32514
Veterans Administration Medical CenterDecatur, Georgia  30033
Saint Joseph's-Candler Health SystemSavannah, Georgia  31405
Oncare Hawaii Inc-POB IIHonolulu, Hawaii  96813
Oncare Hawaii Inc-KuakiniHonolulu, Hawaii  96817
University of HawaiiHonolulu, Hawaii  96813
Pacific Cancer Institute of MauiWailuku, Hawaii  96793
Rush - Copley Medical CenterAurora, Illinois  60504
Joliet Oncology-Hematology Associates LimitedJoliet, Illinois  60435
Midwest Center for Hematology OncologyJoliet, Illinois  60432
Provena Saint Mary's HospitalKankakee, Illinois  60901
North Shore Hematology OncologyLibertyville, Illinois  60048
Hematology Oncology Associates of Illinois - SkokieSkokie, Illinois  60076
Saint Francis Hospital and Health CentersBeech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Inc - State BoulevardFort Wayne, Indiana  46845
Saint Anthony Memorial Health CenterMichigan City, Indiana  46360
Reid Hospital and Health Care ServicesRichmond, Indiana  47374
McFarland ClinicAmes, Iowa  50010
Hematology Oncology Associates-Quad CitiesBettendorf, Iowa  52722
Mercy Medical Center-Sioux CitySioux City, Iowa  51104
Saint Luke's Regional Medical CenterSioux City, Iowa  51104
Cancer Center of Kansas - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas-KingmanKingman, Kansas  67068
Cancer Center of Kansas - ParsonsParsons, Kansas  67357
Cancer Center of Kansas - PrattPratt, Kansas  67124
Cancer Center of Kansas-Wichita Medical Arts TowerWichita, Kansas  67208
Cancer Center of Kansas - Main OfficeWichita, Kansas  67214
Ochsner Clinic Foundation-Baton RougeBaton Rouge, Louisiana  70809
Medical Center of LouisianaNew Orleans, Louisiana  70112
Ochsner Clinic CCOPNew Orleans, Louisiana  70121
Hickman Cancer CenterAdrian, Michigan  49221
Michigan Cancer Research Consortium Community Clinical Oncology ProgramAnn Arbor, Michigan  48106
Oakwood HospitalDearborn, Michigan  48123
Saint John Hospital and Medical CenterDetroit, Michigan  48236
Green Bay Oncology - EscanabaEscanaba, Michigan  49431
Green Bay Oncology - Iron MountainIron Mountain, Michigan  49801
Allegiance HealthJackson, Michigan  49201
Sparrow HospitalLansing, Michigan  48912
Saint Mary Mercy HospitalLivonia, Michigan  48154
Mercy Memorial HospitalMonroe, Michigan  48162
Saint Joseph Mercy OaklandPontiac, Michigan  48341-2985
Saint Joseph Mercy Port HuronPort Huron, Michigan  48060
Saint Mary's of MichiganSaginaw, Michigan  48601
Lakeland HospitalSt. Joseph, Michigan  49085
Saint John Macomb-Oakland HospitalWarren, Michigan  48093
Miller-Dwan HospitalDuluth, Minnesota  55805
Unity HospitalFridley, Minnesota  55432
Saint John's Hospital - HealtheastMaplewood, Minnesota  55109
Minnesota Oncology Hematology PA-MaplewoodMaplewood, Minnesota  55109
Minneapolis Veterans Medical CenterMinneapolis, Minnesota  55417
North Memorial Medical Health CenterRobbinsdale, Minnesota  55422
Park Nicollet Clinic - Saint Louis ParkSaint Louis Park, Minnesota  55416
Minnesota Oncology and Hematology PA-WoodburyWoodbury, Minnesota  55125
Saint Luke's Cancer InstituteKansas City, Missouri  64111
Saint Luke's Hospital of Kansas CityKansas City, Missouri  64111
Saint Joseph Health CenterKansas City, Missouri  64114
Liberty Radiation Oncology ClinicKansas City, Missouri  64116
Truman Medical CenterKansas City, Missouri  64108
Missouri Baptist Medical CenterSaint Louis, Missouri  63131
Ozark Health Ventures LLC dba Cancer Research for The Ozarks SpringfieldSpringfield, Missouri  65802
Saint John's HospitalSpringfield, Missouri  65804
Cox Medical CenterSpringfield, Missouri  65807
Nevada Cancer Research Foundation CCOPLas Vegas, Nevada  89106
Cooper Hospital University Medical CenterCamden, New Jersey  08103
Veterans Adminstration New Jersey Health Care SystemEast Orange, New Jersey  07018-1095
Veterans Affairs Western New York Health Care System-BuffaloBuffalo, New York  14215
Orange Regional Medical CenterMiddletown, New York  10940
Saint Luke's Roosevelt Hospital Center - Saint Luke's DivisionNew York, New York  10025
Columbia University Medical CenterNew York, New York  10032
State University of New York Upstate Medical UniversitySyracuse, New York  13210
Mission Hospitals IncAsheville, North Carolina  28801
Wayne Memorial HospitalGoldsboro, North Carolina  27534
Kinston Medical Specialists PAKinston, North Carolina  28501
Saint Alexius Medical CenterBismarck, North Dakota  58501
Summa Barberton HospitalBarberton, Ohio  44203
Aultman Health FoundationCanton, Ohio  44710
Doctors HospitalColumbus, Ohio  43228
Grant Medical CenterColumbus, Ohio  43215
Mount Carmel Health Center WestColumbus, Ohio  43222
Good Samaritan Hospital - DaytonDayton, Ohio  45406
Dayton CCOPDayton, Ohio  45429
Samaritan North Health CenterDayton, Ohio  45415
Veteran Affairs Medical CenterDayton, Ohio  45428
Hematology Oncology Center IncorporatedElyria, Ohio  44035
Blanchard Valley HospitalFindlay, Ohio  45840
Atrium Medical Center-Middletown Regional HospitalFranklin, Ohio  45005-1066
Kettering Medical CenterKettering, Ohio  45429
Saint Rita's Medical CenterLima, Ohio  45801
Marietta Memorial HospitalMarietta, Ohio  45750
Toledo Radiation Oncology at Northwest Ohio Onocolgy CenterMaumee, Ohio  43537
Saint Charles HospitalOregon, Ohio  43616
North Coast Cancer CareSandusky, Ohio  44870
Toledo Community Hospital Oncology Program CCOPToledo, Ohio  43617
Mercy Cancer Center at Saint Anne Mercy HospitalToledo, Ohio  43623
University of ToledoToledo, Ohio  43614
Saint Vincent Mercy Medical CenterToledo, Ohio  43608
Upper Valley Medical CenterTroy, Ohio  45373
Saint Ann's HospitalWesterville, Ohio  43081
Genesis HealthCare SystemZanesville, Ohio  43701
AnMed Health HospitalAnderson, South Carolina  29621
Greenville CCOPGreenville, South Carolina  29615
Greenville Memorial HospitalGreenville, South Carolina  29605
Upstate Carolina CCOPSpartanburg, South Carolina  29303
Veterans Administration Medical CenterHouston, Texas  77030
Saint Luke's Episcopal HospitalHouston, Texas  77030
Fredericksburg Oncology IncFredericksburg, Virginia  22401
Southwest VA Regional Cancer CenterNorton, Virginia  24273
Auburn Regional Medical CenterAuburn, Washington  98002
Saint Francis HospitalFederal Way, Washington  98003
Providence - Saint Peter HospitalOlympia, Washington  98506-5166
Good Samaritan Community HospitalPuyallup, Washington  98372
Northwest CCOPTacoma, Washington  98405
Multicare Health SystemTacoma, Washington  98415
Saint Clare HospitalTacoma, Washington  98499
Saint Joseph Medical CenterTacoma, Washington  98405
Langlade Hospital and Cancer CenterAntigo, Wisconsin  54409
Saint Vincent HospitalGreen Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's HospitalGreen Bay, Wisconsin  54303
Saint Mary's HospitalGreen Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent HospitalGreen Bay, Wisconsin  54301-3526
Bay Area Medical CenterMarinette, Wisconsin  54143
Oconomowoc Memorial Hospital-ProHealth Care IncOconomowoc, Wisconsin  53066-3896
Green Bay Oncology - Oconto FallsOconto Falls, Wisconsin  54154
Green Bay Oncology - Sturgeon BaySturgeon Bay, Wisconsin  54235
Aspirus Regional Cancer CenterWausau, Wisconsin  54401
University of California Medical Center At Irvine-Orange CampusOrange, California  92868
University of Maryland Greenebaum Cancer CenterBaltimore, Maryland  21201
University of IllinoisChicago, Illinois  60612
Stony Brook University Medical CenterStony Brook, New York  11794
York HospitalYork, Maine  03909
Elkhart ClinicElkhart, Indiana  46515
University of Colorado Cancer Center - Anschutz Cancer PavilionAurora, Colorado  80045
Montrose Memorial HospitalMontrose, Colorado  81401
Michiana Hematology Oncology PC-ElkhartElkhart, Indiana  46514
Michiana Hematology Oncology PC-PlymouthPlymouth, Indiana  46563
Michiana Hematology Oncology PC-South BendSouth Bend, Indiana  46601
Michiana Hematology Oncology-PC WestvilleWestville, Indiana  46391
Cancer Center of Kansas-LiberalLiberal, Kansas  67901
Saint Agnes HospitalBaltimore, Maryland  21229
Michiana Hematology Oncology PC-NilesNiles, Michigan  49120
Central Care Cancer Center-Carrie J Babb Cancer CenterBolivar, Missouri  65613
Skaggs Cancer CenterBranson, Missouri  65616
University of Missouri - Ellis FischelColumbia, Missouri  65203
Veterans AdministrationColumbia, Missouri  65201
Renown Regional Medical CenterReno, Nevada  89502
UMDNJ - New Jersey Medical SchoolNewark, New Jersey  07103
North Coast Cancer Care-ClydeClyde, Ohio  43410
Community Health Partners Regional Medical CenterElyria, Ohio  44035
Cancer Centers of the Carolinas - FarisGreenville, South Carolina  29605
Cancer Centers of the Carolinas-Greer Radiation OncologyGreer, South Carolina  29650
Cancer Centers of the Carolinas-Greer Medical OncologyGreer, South Carolina  29650
University of Tennessee - KnoxvilleKnoxville, Tennessee  37920
Nashville Oncology Associates PCNashville, Tennessee  37203
Holy Family Memorial HospitalManitowoc, Wisconsin  54221
VA Pittsburgh Healthcare SystemPittsburgh, Pennsylvania  15240
Monter Cancer CenterLake Success, New York  11042
Kaiser Permanente Los Angeles Medical CenterLos Angeles, California  90027
Kaiser Anaheim Medical CenterAnaheim, California  92807
Kaiser Permanente-Deer Valley Medical CenterAntioch, California  94531
Kaiser Permanente Medical Group - Baldwin ParkBaldwin Park, California  91706
Kaiser Foundation HospitalBellflower, California  90706
Kaiser Permanente HospitalFontana, California  92335
Kaiser Permanente - Harbor CityHarbor City, California  90710
Kaiser Permanente-West Los AngelesLos Angeles, California  90034
Epic Care-OaklandOakland, California  94612
Kaiser Permanente - Panorama CityPanorama City, California  91402
Salinas Valley MemorialSalinas, California  93901
Kaiser Permanente at San DiegoSan Diego, California  92120
Kaiser Permanente Health CareSan Marcos, California  92069
Kaiser Permanente Medical Center-VacavilleVacaville, California  95688
Kaiser Permanente-Rock CreekLafayette, Colorado  80026
Kaiser Permanente Moanalua Medical CenterHonolulu, Hawaii  96819
Saint Joseph Regional Medical CenterLewiston, Idaho  83501
Saint Luke's South HospitalOverland Park, Kansas  66213
Kansas City CCOPPrairie Village, Kansas  66208
Doctors Carrol, Sheth, RaghavanLouisville, Kentucky  40215
Hematology and Oncology ClinicBaton Rouge, Louisiana  70809
Ochsner North Shore Medical CenterCovington, Louisiana  70433
Capital Region Medical Center-Goldschmidt Cancer CenterJefferson City, Missouri  65109
Heartland Hematology and Oncology Associates IncorporatedKansas City, Missouri  64118
Saint Joseph Oncology IncSaint Joseph, Missouri  64507
Comprehensive Cancer Care PCSaint Louis, Missouri  63141
Veteran Affairs New York Harbor Healthcare System-Brooklyn CampusBrooklyn, New York  11209
Mount Carmel East HospitalColumbus, Ohio  43213
The Mark H Zangmeister CenterColumbus, Ohio  43219
Southern Ohio Medical CenterPortsmouth, Ohio  45662
Cancer Care Associates-MercyOklahoma City, Oklahoma  73120
Saint Francis HospitalGreenville, South Carolina  29601
Memorial Hospital Of MartinsvilleMartinsville, Virginia  24115
Overlake Hospital Medical CenterBellevue, Washington  98004
Providence Regional Cancer PartnershipEverett, Washington  98201
Gundersen LutheranLa Crosse, Wisconsin  54601
Saint Nicholas HospitalMadison, Wisconsin  53715
Kaiser Permanente-FranklinDenver, Colorado  80205
Siouxland Hematology Oncology AssociatesSioux City, Iowa  51101
Walter Reed National Military Medical CenterBethesda, Maryland  20889
Roger Williams HospitalProvidence, Rhode Island  02908
VA Medical Center - University of IowaIowa City, Iowa  52246
Carle Foundation - Carle Cancer CenterUrbana, Illinois  61801
Michiana Hematology Oncology PC-MishawakaMishawaka, Indiana  46545-1470
Marie Yeager Cancer CenterSaint Joseph, Michigan  49085
Hematology Oncology Associates of Central New York PCEast Syracuse, New York  13057
Summa Akron City HospitalAkron, Ohio  44304
Franciscan St. Francis HealthIndianapolis, Indiana  46237
The Toledo Hospital/Toledo Children's HospitalToledo, Ohio  43606
North Shore-LIJ Health System CCOPManhasset, New York  11030
Genesys Regional Medical Center-West Flint CampusFlint, Michigan  48532
Essentia Health Saint Joseph's Medical CenterBrainerd, Minnesota  56401
Essentia Health Duluth Clinic CCOPDuluth, Minnesota  55805
Essentia Health Saint Mary's Medical CenterDuluth, Minnesota  55805
Sanford Bismarck Medical CenterBismarck, North Dakota  58501
Toledo Clinic Cancer Centers-OregonOregon, Ohio  43616
Presbyterian Intercommunity HospitalWhittier, California  90602
Community Howard Regional HealthKokomo, Indiana  46904
Indiana University Health La Porte HospitalLa Porte, Indiana  46350
Saint Joseph Regional Medical Center-MishawakaMishawaka, Indiana  46545-1470
Essentia Health Cancer Center-South University ClinicFargo, North Dakota  58103
Christiana Care Health System-Christiana HospitalNewark, Delaware  19718
Illinois Cancer Specialists-NilesNiles, Illinois  60714
Springfield Regional Medical CenterSpringfield, Ohio  45505
Toledo Clinic Cancer Centers-Bowling GreenBowling Green, Ohio  43402
Toledo Clinic Cancer Centers-MaumeeMaumee, Ohio  43537-1839
Toledo Clinic Cancer Centers-ToledoToledo, Ohio  43623
Guthrie Clinic-Robert Packer HospitalSayre, Pennsylvania  18840
Self Regional HealthcareGreenwood, South Carolina  29646
NEA Baptist Clinic-MatthewsJonesboro, Arkansas  72401
Cancer Care Associates-NormanNorman, Oklahoma  73071
Mercy Physicians of Oklahoma-LakesideOklahoma City, Oklahoma  73120
Cancer Center of Western WisconsinNew Richmond, Wisconsin  54017
East Bay Medical Oncology Hematology Medical Associates Inc-Pleasant HillPleasant Hill, California  94523
D N Greenwald CenterMukwonago, Wisconsin  53149
Epic Care-DublinDublin, California  94568
Veterans Affairs Medical Center -Washington DCWashington, District of Columbia  20422
Bronx Veterans Administration Medical CenterBronx, New York  10468
White River Junction Veteran Administration Medical CenterWhite River Junction, Vermont  05009