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A Randomized Phase III Double Blind Trial Evaluating Selective COX-2 Inhibition in COX-2 Expressing Advanced Non-Small Cell Lung Cancer


Phase 3
18 Years
N/A
Open (Enrolling)
Both
Lung Cancer

Thank you

Trial Information

A Randomized Phase III Double Blind Trial Evaluating Selective COX-2 Inhibition in COX-2 Expressing Advanced Non-Small Cell Lung Cancer


OBJECTIVES:

Primary

- To confirm the beneficial effect of gemcitabine hydrochloride or pemetrexed disodium in
combination with carboplatin with or without celecoxib in patients with advanced
non-small cell lung cancer that expresses COX-2.

Secondary

- To describe the response rate in patients treated with these regimens.

- To describe the distribution of progression-free survival (PFS) and overall survival of
patients treated with these regimens.

- To compare the PFS of patients with COX-2 index ≥ 2 (adjusting for CYP2C9 genotype and
celecoxib trough concentrations as covariates) treated with these regimens.

- To correlate urinary PGE-M level with COX-2 expression, COX-2 inhibition, and outcome.

- To evaluate the association between the -765G/C polymorphism in PTGS2 and COX-2
expression in non-small cell lung cancer specimens.

- To characterize a trough plasma celecoxib concentration which will be used as a measure
of patient adherence to study treatment and which may be used in future studies for
correlations with genotype and pharmacodynamic outcomes.

OUTLINE: This is a multicenter study. Patients are stratified according to gender, disease
stage (IIIB vs IV), histology (squamous cell carcinoma vs non-squamous cell carcinoma),
smoking status (never/former light smoker [defined as ≤ 10 pack years AND quit ≥ 1 year ago]
vs smoker), and COX-2 expression status (COX-2 index ≥ 4 vs COX-2 index ≥ 2 but < 4).
Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive gemcitabine hydrochloride* IV on days 1 and 8 OR pemetrexed
disodium* IV on day 1. Patients also receive carboplatin IV on day 1 and oral celecoxib
twice daily on days 1-21.

- Arm II: Patients receive gemcitabine hydrochloride* OR pemetrexed disodium* and
carboplatin as in arm I. Patients also receive oral placebo twice daily on days 1-21.

- NOTE: *Patients with squamous cell carcinoma receive gemcitabine hydrochloride;
patients with non-squamous cell carcinoma receive pemetrexed disodium.

In both arms, treatment repeats every 21 days for up to 6 courses in the absence of disease
progression or unacceptable toxicity. After completion of 6 courses, patients with
responding or stable disease may continue to receive celecoxib or placebo alone in the
absence of disease progression or unacceptable toxicity.

Patients may undergo blood and urine sample collection periodically for correlative
laboratory studies.

After completion of study therapy, patients are followed up every 2 months for 2 years and
then every 6 months for 3 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically or cytologically confirmed non-small cell carcinoma of the lung,
including the following cell types:

- Adenocarcinoma

- Large cell carcinoma

- Squamous cell carcinoma

- Mixture of these types

- A tissue block must be available at the time of registration

- Tumor expresses COX-2 (COX-2 index ≥ 2)

- Stage IIIB disease with malignant pleural effusion, supraclavicular node involvement,
or contralateral hilar node involvement OR stage IV disease

- Patients with stage IIIB disease who are eligible for clinical trials that
involve combined chemotherapy and chest irradiation are not eligible for this
study

- Patients with stage IV disease are eligible

- Patients with recurrent disease, not amenable to (or refusing) a potentially
"curative therapy," are eligible

- Measurable or non-measurable disease

- Measurable disease is defined as lesions that can be accurately measured in ≥ 1
dimension (longest diameter to be recorded) as ≥ 2 cm with conventional
techniques or as ≥ 1 cm with spiral CT scan

- Non-measurable disease is defined as all other lesions, including small lesions
(longest diameter < 20 mm with conventional techniques or < 10 mm with spiral CT
scan) and truly nonmeasurable lesions, including any of the following:

- Bone lesions

- Leptomeningeal disease

- Ascites

- Pleural/pericardial effusion

- Inflammatory breast disease

- Lymphangitis cutis/pulmonis

- Abdominal masses that are not confirmed and followed by imaging techniques

- Cystic lesions

- Patients with symptomatic CNS metastases are eligible provided they received prior
therapy (e.g., surgery, radiotherapy, or gamma knife), are neurologically stable, and
are off steroids for ≥ 14 days before study entry

- Patients with asymptomatic CNS metastases without associated edema, shift, or
requirement for steroids or antiseizure medications may be eligible after
discussion with the Study Chair

- Patients should be off steroids at least 7 days before preregistration

- No leptomeningeal disease or carcinomatous meningitis

PATIENT CHARACTERISTICS:

- ECOG performance status 0-2

- Granulocytes ≥ 1,500/μL

- Platelet count ≥ 100,000/μL

- Creatinine clearance ≥ 45 mL/min

- Bilirubin ≤ 1.5 mg/dL

- AST and ALT ≤ 2.0 times upper limit of normal (ULN) (≤ 5.0 times ULN if liver
metastases are present)

- Serum albumin ≥ 2.5 mg/dL

- Not pregnant or nursing

- Negative pregnancy test

- No "currently active" second malignancy other than non-melanoma skin cancer

- Patients are not considered to have a "currently active" malignancy if they have
completed therapy and are considered by their physician to be at < 30% risk of
relapse

- No known hypersensitivity to aspirin, NSAIDs, or sulfonamides

- No active ulcer disease

- No history of gastrointestinal bleeding within the past three years

- None of the following cardiovascular conditions within the past 6 months:

- Myocardial infarction

- Unstable angina

- Symptomatic congestive heart failure

- Serious uncontrolled cardiac arrhythmia

- Cerebrovascular accident or transient ischemic attack

- Pulmonary embolism

- Symptomatic carotid artery or peripheral vascular disease

- Deep vein thrombosis

- Other significant thromboembolic event

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No prior chemotherapy, immunotherapy, or other systemic therapy for non-small cell
lung cancer, including adjuvant therapy

- At least 2 weeks since prior surgery and recovered

- At least 7 days since prior radiotherapy

- At least 14 days since prior NSAIDs (other than low-dose aspirin [≤ 325 mg daily]),
including any of the following:

- Celecoxib

- Choline Mg

- Trisalicylate (Trilisate®)

- Ibuprofen (Advil® or Motrin®)

- Naproxen (Aleve®, Naprosyn® or Anaprox®)

- Etodolac (Lodine®)

- Oxaprozin (Daypro®)

- Diflunisal (Dolobid®)

- Nabumetone (Relafen®)

- Tolmetin (Tolectin®)

- Valdecoxib (Bextra®)

- No chronic use of NSAIDs (i.e., > 4 weeks of daily use)

- Patients on low-dose aspirin are eligible

- No other concurrent chemotherapy or hormonal therapy (other than megestrol acetate
[Megace] for appetite stimulation)

- No other concurrent investigational therapy

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Progression-free survival

Safety Issue:

No

Principal Investigator

Martin J. Edelman, MD

Investigator Role:

Study Chair

Investigator Affiliation:

University of Maryland Greenebaum Cancer Center

Authority:

Unspecified

Study ID:

CDR0000662707

NCT ID:

NCT01041781

Start Date:

February 2010

Completion Date:

Related Keywords:

  • Lung Cancer
  • adenocarcinoma of the lung
  • adenosquamous cell lung cancer
  • large cell lung cancer
  • squamous cell lung cancer
  • recurrent non-small cell lung cancer
  • stage IIIB non-small cell lung cancer
  • stage IV non-small cell lung cancer
  • Carcinoma, Non-Small-Cell Lung
  • Lung Neoplasms

Name

Location

National Naval Medical CenterBethesda, Maryland  20889
Fred Hutchinson Cancer Research CenterSeattle, Washington  98109
Mayo Clinic ScottsdaleScottsdale, Arizona  85259
University of Chicago Cancer Research CenterChicago, Illinois  60637
Hurley Medical CenterFlint, Michigan  48503
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - North Shore University HospitalManhasset, New York  11030
Veterans Affairs Medical Center - Atlanta (Decatur)Decatur, Georgia  30033
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
Rush-Copley Cancer Care CenterAurora, Illinois  60507
Saint Anthony Memorial Health CentersMichigan City, Indiana  46360
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
Genesys Hurley Cancer InstituteFlint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  48236
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
Sparrow Regional Cancer CenterLansing, Michigan  48912-1811
St. John Macomb HospitalWarren, Michigan  48093
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
St. Rita's Medical CenterLima, Ohio  45801
Marshfield Clinic - Marshfield CenterMarshfield, Wisconsin  54449
Marshfield Clinic - Indianhead CenterRice Lake, Wisconsin  54868
Rapid City Regional HospitalRapid City, South Dakota  57709
Methodist Medical Center of IllinoisPeoria, Illinois  61636
CCOP - Cancer Research for the OzarksSpringfield, Missouri  65807
CCOP - Montana Cancer ConsortiumBillings, Montana  59101
Newark Beth Israel Medical CenterNewark, New Jersey  07112
CCOP - DaytonKettering, Ohio  45429
Veterans Affairs Medical Center - White River JunctionWhite River Junction, Vermont  05009
Hinsdale, Illinois  60521
Holden Comprehensive Cancer Center at University of IowaIowa City, Iowa  52242-1002
CCOP - Grand RapidsGrand Rapids, Michigan  49503
Ellis Fischel Cancer Center at University of Missouri - ColumbiaColumbia, Missouri  65203
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
Dwight David Eisenhower Army Medical CenterFort Gordon, Georgia  30905-5650
Naval Medical Center - San DiegoSan Diego, California  92134-3202
Veterans Affairs Medical Center - BuffaloBuffalo, New York  14215
Veterans Affairs Medical Center - SyracuseSyracuse, New York  13210
Veterans Affairs Medical Center - DurhamDurham, North Carolina  27705
Rebecca and John Moores UCSD Cancer CenterLa Jolla, California  92093-0658
City of Hope Comprehensive Cancer CenterDuarte, California  91010
Veterans Affairs Medical Center - Washington, DCWashington, District of Columbia  20422
Veterans Affairs Medical Center - BaltimoreBaltimore, Maryland  21201
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
St. Vincent Mercy Medical CenterToledo, Ohio  43608
Veterans Affairs Medical Center - BrooklynBrooklyn, New York  11209
Arkansas Cancer Research Center at University of Arkansas for Medical SciencesLittle Rock, Arkansas  72205
Swedish Cancer Institute at Swedish Medical Center - First Hill CampusSeattle, Washington  98104
Washington Cancer Institute at Washington Hospital CenterWashington, District of Columbia  20010
Hulston Cancer Center at Cox Medical Center SouthSpringfield, Missouri  65807
St. John's Regional Health CenterSpringfield, Missouri  65804
Central Baptist HospitalLexington, Kentucky  40503
CCOP - Toledo Community HospitalToledo, Ohio  43623-3456
Waukesha Memorial Hospital Regional Cancer CenterWaukesha, Wisconsin  53188
Long Island Jewish Medical CenterNew Hyde Park, New York  11040
Advocate Christ Medical CenterOak Lawn, Illinois  60453
Alvin and Lois Lapidus Cancer Institute at Sinai HospitalBaltimore, Maryland  21215
SUNY Upstate Medical University HospitalSyracuse, New York  13210
Mission Hospitals - Memorial CampusAsheville, North Carolina  28801
Medical University of Ohio Cancer CenterToledo, Ohio  43614
Toledo HospitalToledo, Ohio  43606
Rhode Island Hospital Comprehensive Cancer CenterProvidence, Rhode Island  02903
Edwards Comprehensive Cancer Center at Cabell Huntington HospitalHuntington, West Virginia  25701
Mary Babb Randolph Cancer Center at West Virginia University HospitalsMorgantown, West Virginia  26506
St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54307-3508
McCreery Cancer Center at Ottumwa RegionalOttumwa, Iowa  52501
Green Bay Oncology, Limited - EscanabaEscanaba, Michigan  49431
Dickinson County Healthcare SystemIron Mountain, Michigan  49801
CCOP - Hematology-Oncology Associates of Central New YorkEast Syracuse, New York  13057
St. Mary's Hospital Medical Center - Green BayGreen Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54301-3526
Green Bay Oncology, Limited at St. Mary's HospitalGreen Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical CenterMarinette, Wisconsin  54143
Green Bay Oncology, Limited - Oconto FallsOconto Falls, Wisconsin  54154
Green Bay Oncology, Limited - Sturgeon BaySturgeon Bay, Wisconsin  54235
Hematology Oncology Associates of the Quad CitiesBettendorf, Iowa  52722
Battle Creek Health System Cancer Care CenterBattle Creek, Michigan  49017
Munson Medical CenterTraverse City, Michigan  49684
Hematology-Oncology Centers of the Northern Rockies - BillingsBillings, Montana  59101
Big Sky OncologyGreat Falls, Montana  59405
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
Olympic Hematology and OncologyBremerton, Washington  98310
Skagit Valley Hospital Cancer Care CenterMt. Vernon, Washington  98273
University Cancer Center at University of Washington Medical CenterSeattle, Washington  98195
Harborview Medical CenterSeattle, Washington  98104
Group Health Central HospitalSeattle, Washington  98104
North Puget Oncology at United General HospitalSedro-Wooley, Washington  98284
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Greenebaum Cancer Center at University of Maryland Medical CenterBaltimore, Maryland  21201
New York Weill Cornell Cancer Center at Cornell UniversityNew York, New York  10021
Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical CenterLos Angeles, California  90048-1865
UCSF Helen Diller Family Comprehensive Cancer CenterSan Francisco, California  94115
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical CenterSavannah, Georgia  31403-3089
University of Illinois Cancer CenterChicago, Illinois  60612-7243
Swedish-American Regional Cancer CenterRockford, Illinois  61104-2315
CancerCare of Maine at Eastern Maine Medical CenterBangor, Maine  04401
Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer InstituteBoston, Massachusetts  02115
Butterworth Hospital at Spectrum HealthGrand Rapids, Michigan  49503-2560
Masonic Cancer Center at University of MinnesotaMinneapolis, Minnesota  55455
University of Mississippi Cancer ClinicJackson, Mississippi  39216-4505
Siteman Cancer Center at Barnes-Jewish Hospital - Saint LouisSt. Louis, Missouri  63110
Don Monti Comprehensive Cancer Center at North Shore University HospitalManhasset, New York  11030
Dakota Cancer Institute at Dakota Clinic - South UniversityFargo, North Dakota  58103-4940
Oklahoma University Cancer InstituteOklahoma City, Oklahoma  73104
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
Rosenfeld Cancer Center at Abington Memorial HospitalAbington, Pennsylvania  19001
Poudre Valley HospitalFort Collins, Colorado  80524
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
St. Joseph Medical CenterBloomington, Illinois  61701
Eureka Community HospitalEureka, Illinois  61530
Hematology Oncology Consultants - NapervilleNaperville, Illinois  60540
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
OSF St. Francis Medical CenterPeoria, Illinois  61637
Proctor HospitalPeoria, Illinois  61614
Illinois Valley Community HospitalPeru, Illinois  61354
Bettendorf, Iowa  52722
St. Luke's HospitalCedar Rapids, Iowa  52402
Mercy Regional Cancer Center at Mercy Medical CenterCedar Rapids, Iowa  52403
Genesis Regional Cancer Center at Genesis Medical CenterDavenport, Iowa  52803
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
Mary Bird Perkins Cancer Center - Baton RougeBaton Rouge, Louisiana  70809
Louisiana State University Health Sciences Center - MonroeMonroe, Louisiana  71210
Feist-Weiller Cancer Center at Louisiana State University Health SciencesShreveport, Louisiana  71130-3932
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
Mecosta County Medical CenterBig Rapids, Michigan  49307
Community Cancer Center of MonroeMonroe, Michigan  48162
Providence Cancer Institute at Providence Hospital - Southfield CampusSouthfield, Michigan  48075
St. Joseph's Medical CenterBrainerd, Minnesota  56401
Cancer Institute of New Jersey at Cooper - VoorheesVoorhees, New Jersey  08043
Charles R. Wood Cancer Center at Glens Falls HospitalGlens Falls, New York  12801
Iredell Memorial HospitalStatesville, North Carolina  28677
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
Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical CenterKingsport, Tennessee  37662
Danville Regional Medical CenterDanville, Virginia  24541
Holy Family Memorial Medical Center Cancer Care CenterManitowoc, Wisconsin  54221-1450
Welch Cancer Center at Sheridan Memorial HospitalSheridan, Wyoming  82801
Palo Alto Medical FoundationPalo Alto, California  94301
Middlesex Hospital Cancer CenterMiddletown, Connecticut  06457
Northeast Georgia Medical CenterGainesville, Georgia  30501
Mercy Cancer Center at Mercy Medical Center - North IowaMason City, Iowa  50401
Regional Cancer Center at Singing River HospitalPascagoula, Mississippi  39581
Missouri Baptist Cancer CenterSt. Louis, Missouri  63131
Altru Cancer Center at Altru HospitalGrand Forks, North Dakota  58201
Tunnell Cancer Center at Beebe Medical CenterLewes, Delaware  19958
John B. Amos Cancer CenterColumbus, Georgia  31904
Evanston HospitalEvanston, Illinois  60201-1781
Reid Hospital & Health Care ServicesRichmond, Indiana  47374
McFarland Clinic, PCAmes, Iowa  50010
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
Great Falls Clinic - Main FacilityGreat Falls, Montana  59405
Monter Cancer Center of the North Shore-LIJ Health SystemLake Success, New York  11042
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer CenterColumbus, Ohio  43210-1240
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
Fredericksburg Oncology, IncorporatedFredericksburg, Virginia  22401
Southwest Virginia Regional Cancer Center at Wellmonth HealthNorton, Virginia  24273
St. Joseph Cancer CenterBellingham, Washington  98225
Columbia Basin HematologyKennewick, Washington  99336
Harrison Poulsbo Hematology and OnocologyPoulsbo, Washington  98370
Evergreen Hematology and Oncology, PSSpokane, Washington  99218
Wenatchee Valley Medical CenterWenatchee, Washington  98801-2028
Marshfield Clinic - Chippewa CenterChippewa Falls, Wisconsin  54729
Marshfield Clinic Cancer Care at Regional Cancer CenterEau Claire, Wisconsin  54701
Marshfield Clinic - Lakeland CenterMinocqua, Wisconsin  54548
Ministry Medical Group at Saint Mary's HospitalRhinelander, Wisconsin  54501
Marshfield Clinic at Saint Michael's HospitalStevens Point, Wisconsin  54481
Marshfield Clinic - Weston CenterWeston, Wisconsin  54476
Diagnostic and Treatment CenterWeston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids CenterWisconsin Rapids, Wisconsin  54494
Rocky Mountain OncologyCasper, Wyoming  82609
FirstHealth Moore Regional Community Hospital Comprehensive Cancer CenterPinehurst, North Carolina  28374
Mid Dakota Clinic, PCBismarck, North Dakota  58501
Genesys Regional Medical CenterGrand Blanc, Michigan  48439-8066
Queen's Cancer Institute at Queen's Medical CenterHonolulu, Hawaii  96813
Good Samaritan Cancer Center at Good Samaritan HospitalKearney, Nebraska  68848-1990
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
Duke Cancer InstituteDurham, North Carolina  27710
Kinston Medical SpecialistsKinston, North Carolina  28501
Miriam HospitalProvidence, Rhode Island  02906
Resurrection Medical CenterChicago, Illinois  60631
McLeod Regional Medical CenterFlorence, South Carolina  29501
La Grange Memorial HospitalLa Grange, Illinois  60525
Lacks Cancer Center at Saint Mary's Health CareGrand Rapids, Michigan  49503
Lakes Region General HospitalLaconia, New Hampshire  03246
Veterans Affairs Medical Center - Iowa CityIowa City, Iowa  52246-2208
Lipson Cancer and Blood Center at Rochester General HospitalRochester, New York  14621
Galesburg Clinic, PCGalesburg, Illinois  61401
Boston University Cancer Research CenterBoston, Massachusetts  02118
St. Vincent Healthcare Cancer Care ServicesBillings, Montana  59101
Lynchburg Hematology-Oncology ClinicLynchburg, Virginia  24501
Kapiolani Medical Center at Pali MomiAiea, Hawaii  96701
Kapiolani Medical Center for Women and ChildrenHonolulu, Hawaii  96826
Straub Clinic and Hospital, IncorporatedHonolulu, Hawaii  96813
Hawaii Medical Center - EastHonolulu, Hawaii  96817
OnCare Hawaii, Incorporated - KuakiniHonolulu, Hawaii  96817
OnCare Hawaii, Incorporated - LusitanaHonolulu, Hawaii  96813
Maui Memorial Medical CenterWailuku, Hawaii  96793
Pacific Cancer Institute - MauiWailuku, Hawaii  96793
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
Trinity Cancer Center at Trinity Medical Center - 7th Street CampusMoline, Illinois  61265
OSF Holy Family Medical CenterMonmouth, Illinois  61462
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
Iowa Blood and Cancer CareCedar Rapids, Iowa  52402
Caritas St. Elizabeth's Medical CenterBrighton, Massachusetts  02135-2997
Mercy General Health PartnersMuskegon, Michigan  49443
New Hampshire Oncology - Hematology, PA at Payson Center for Cancer CareConcord, New Hampshire  03301
Center for Cancer Care at Exeter HospitalExeter, New Hampshire  03833
New Hampshire Oncology - Hematology, PA - HooksettHooksett, New Hampshire  03106
Valley Hospital - RidgewoodRidgewood, New Jersey  07450
Trinity CancerCare CenterMinot, North Dakota  58701
Fountain Valley, California  92708
Medcenter One Hospital Cancer Care CenterBismarck, North Dakota  58501
St. Alexius Medical Center Cancer CenterBismarck, North Dakota  58502
Regional Medical CenterAnniston, Alabama  36202
Addison Gilbert HospitalGloucester, Massachusetts  01930
Skaggs Cancer Center at Skaggs Regional Medical CenterBranson, Missouri  65616
Dana-Farber Cancer Institute at LondonderryLondonderry, New Hampshire  03053
Marion L. Shepard Cancer Center at Beaufort County HospitalWashington, North Carolina  27889
Mercy Regional Cancer CenterJanesville, Wisconsin  53547
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
Camino Medical Group - Treatment CenterMountain View, California  94040
Ravenel Oncology Center at Memorial Hospital of Martinsville and Henry CountyMartinsville, Virginia  24115
Renown Institute for Cancer at Renown Regional Medical CenterReno, Nevada  89502
Castle Medical CenterKailua, Hawaii  96734
Kauai Medical ClinicLihue, Hawaii  96766
Southeast Cancer CenterCape Girardeau, Missouri  63703
Goldschmidt Cancer CenterJefferson City, Missouri  65109
Island Hospital Cancer Care Center at Island HospitalAnacortes, Washington  98221
Highline Medical Center Cancer CenterBurien, Washington  98166
New Ulm Medical CenterNew Ulm, Minnesota  56073
St. Nicholas HospitalSheboygan, Wisconsin  53081
North Broward Medical CenterDearfield Beach, Florida  33064-3596
John R. Marsh Cancer Center at Washington County HospitalHagerstown, Maryland  21740
Highland ClinicShreveport, Louisiana  71105
Feather River Hospital Cancer CenterParadise, California  95969
Celilo Cancer Center at Mid-Columbia Medical CenterThe Dalles, Oregon  97058
Central Care Cancer Center at Carrie J. Babb Cancer CenterBolivar, Missouri  65613
Cancer Centers of Southwest Oklahoma, LLC - LawtonLawton, Oklahoma  73505
Spectrum Health Reed City HospitalReed City, Michigan  49677
St. Francis Hospital Cancer Care ServicesIndianapolis, Indiana  46237
D.N. Greenwald CenterMukwonago, Wisconsin  53149
Swedish Medical Center - Issaquah CampusIssaquah, Washington  98029
Dana-Farber/Brigham and Women's Cancer Center at Milford Regional Medical CenterMilford, Massachusetts  01757
Mercy Cancer Center - West LakesClive, Iowa  50325
Methodist West HospitalWest Des Moines, Iowa  50266-7700
NEA Medical Clinic - East MatthewsJonesboro, Arkansas  72401
Dana-Farber/Brigham and Women's Cancer Center at South ShoreSouth Weymouth, Massachusetts  02190
Benefis Sletten Cancer InstituteGreat Falls, Montana  59405
Essentia Health - Duluth ClinicDuluth, Minnesota  55805-1983