Know Cancer

forgot password

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
Open (Enrolling)
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



- 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.


- 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


- 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

- 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


- 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

- 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


- 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:


Study Design:

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

Outcome Measure:

Progression-free survival

Safety Issue:


Principal Investigator

Martin J. Edelman, MD

Investigator Role:

Study Chair

Investigator Affiliation:

University of Maryland Greenebaum Cancer Center



Study ID:




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



National Naval Medical Center Bethesda, Maryland  20889
Fred Hutchinson Cancer Research Center Seattle, Washington  98109
Mayo Clinic Scottsdale Scottsdale, Arizona  85259
University of Chicago Cancer Research Center Chicago, Illinois  60637
Hurley Medical Center Flint, Michigan  48503
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - North Shore University Hospital Manhasset, New York  11030
Veterans Affairs Medical Center - Atlanta (Decatur) Decatur, Georgia  30033
CCOP - Illinois Oncology Research Association Peoria, Illinois  61602
CCOP - Carle Cancer Center Urbana, Illinois  61801
CCOP - Iowa Oncology Research Association Des Moines, Iowa  50309-1016
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Rush-Copley Cancer Care Center Aurora, Illinois  60507
Saint Anthony Memorial Health Centers Michigan City, Indiana  46360
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLP Sioux City, Iowa  51101
St. Luke's Regional Medical Center Sioux City, Iowa  51104
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
Genesys Hurley Cancer Institute Flint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Sparrow Regional Cancer Center Lansing, Michigan  48912-1811
St. John Macomb Hospital Warren, Michigan  48093
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
CCOP - Duluth Duluth, Minnesota  55805
Miller - Dwan Medical Center Duluth, Minnesota  55805
Fairview Southdale Hospital Edina, Minnesota  55435
Mercy and Unity Cancer Center at Unity Hospital Fridley, Minnesota  55432
Hutchinson Area Health Care Hutchinson, Minnesota  55350
HealthEast Cancer Care at St. John's Hospital Maplewood, Minnesota  55109
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital Minneapolis, Minnesota  55407
St. Francis Cancer Center at St. Francis Medical Center Shakopee, Minnesota  55379
Park Nicollet Cancer Center St. Louis Park, Minnesota  55416
Regions Hospital Cancer Care Center St. Paul, Minnesota  55101
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
St. Rita's Medical Center Lima, Ohio  45801
Marshfield Clinic - Marshfield Center Marshfield, Wisconsin  54449
Marshfield Clinic - Indianhead Center Rice Lake, Wisconsin  54868
Rapid City Regional Hospital Rapid City, South Dakota  57709
Methodist Medical Center of Illinois Peoria, Illinois  61636
CCOP - Cancer Research for the Ozarks Springfield, Missouri  65807
CCOP - Montana Cancer Consortium Billings, Montana  59101
Newark Beth Israel Medical Center Newark, New Jersey  07112
CCOP - Dayton Kettering, Ohio  45429
Veterans Affairs Medical Center - White River Junction White River Junction, Vermont  05009
Hinsdale, Illinois  60521
Holden Comprehensive Cancer Center at University of Iowa Iowa City, Iowa  52242-1002
CCOP - Grand Rapids Grand Rapids, Michigan  49503
Ellis Fischel Cancer Center at University of Missouri - Columbia Columbia, Missouri  65203
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
Charles M. Barrett Cancer Center at University Hospital Cincinnati, Ohio  45267-0526
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
Dwight David Eisenhower Army Medical Center Fort Gordon, Georgia  30905-5650
Naval Medical Center - San Diego San Diego, California  92134-3202
Veterans Affairs Medical Center - Buffalo Buffalo, New York  14215
Veterans Affairs Medical Center - Syracuse Syracuse, New York  13210
Veterans Affairs Medical Center - Durham Durham, North Carolina  27705
Rebecca and John Moores UCSD Cancer Center La Jolla, California  92093-0658
City of Hope Comprehensive Cancer Center Duarte, California  91010
Veterans Affairs Medical Center - Washington, DC Washington, District of Columbia  20422
Veterans Affairs Medical Center - Baltimore Baltimore, Maryland  21201
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
St. Vincent Mercy Medical Center Toledo, Ohio  43608
Veterans Affairs Medical Center - Brooklyn Brooklyn, New York  11209
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences Little Rock, Arkansas  72205
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus Seattle, Washington  98104
Washington Cancer Institute at Washington Hospital Center Washington, District of Columbia  20010
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
Central Baptist Hospital Lexington, Kentucky  40503
CCOP - Toledo Community Hospital Toledo, Ohio  43623-3456
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
Long Island Jewish Medical Center New Hyde Park, New York  11040
Advocate Christ Medical Center Oak Lawn, Illinois  60453
Alvin and Lois Lapidus Cancer Institute at Sinai Hospital Baltimore, Maryland  21215
SUNY Upstate Medical University Hospital Syracuse, New York  13210
Mission Hospitals - Memorial Campus Asheville, North Carolina  28801
Medical University of Ohio Cancer Center Toledo, Ohio  43614
Toledo Hospital Toledo, Ohio  43606
Rhode Island Hospital Comprehensive Cancer Center Providence, Rhode Island  02903
Edwards Comprehensive Cancer Center at Cabell Huntington Hospital Huntington, West Virginia  25701
Mary Babb Randolph Cancer Center at West Virginia University Hospitals Morgantown, West Virginia  26506
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
McCreery Cancer Center at Ottumwa Regional Ottumwa, Iowa  52501
Green Bay Oncology, Limited - Escanaba Escanaba, Michigan  49431
Dickinson County Healthcare System Iron Mountain, Michigan  49801
CCOP - Hematology-Oncology Associates of Central New York East Syracuse, New York  13057
St. Mary's Hospital Medical Center - Green Bay Green Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54301-3526
Green Bay Oncology, Limited at St. Mary's Hospital Green Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical Center Marinette, Wisconsin  54143
Green Bay Oncology, Limited - Oconto Falls Oconto Falls, Wisconsin  54154
Green Bay Oncology, Limited - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
Hematology Oncology Associates of the Quad Cities Bettendorf, Iowa  52722
Battle Creek Health System Cancer Care Center Battle Creek, Michigan  49017
Munson Medical Center Traverse City, Michigan  49684
Hematology-Oncology Centers of the Northern Rockies - Billings Billings, Montana  59101
Big Sky Oncology Great Falls, Montana  59405
St. Peter's Hospital Helena, Montana  59601
Kalispell Regional Medical Center Kalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Missoula, Montana  59802
Montana Cancer Specialists at Montana Cancer Center Missoula, Montana  59802
Wayne Memorial Hospital, Incorporated Goldsboro, North Carolina  27534
Olympic Hematology and Oncology Bremerton, Washington  98310
Skagit Valley Hospital Cancer Care Center Mt. Vernon, Washington  98273
University Cancer Center at University of Washington Medical Center Seattle, Washington  98195
Harborview Medical Center Seattle, Washington  98104
Group Health Central Hospital Seattle, Washington  98104
North Puget Oncology at United General Hospital Sedro-Wooley, Washington  98284
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Greenebaum Cancer Center at University of Maryland Medical Center Baltimore, Maryland  21201
New York Weill Cornell Cancer Center at Cornell University New York, New York  10021
Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center Los Angeles, California  90048-1865
UCSF Helen Diller Family Comprehensive Cancer Center San Francisco, California  94115
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center Savannah, Georgia  31403-3089
University of Illinois Cancer Center Chicago, Illinois  60612-7243
Swedish-American Regional Cancer Center Rockford, Illinois  61104-2315
CancerCare of Maine at Eastern Maine Medical Center Bangor, Maine  04401
Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer Institute Boston, Massachusetts  02115
Butterworth Hospital at Spectrum Health Grand Rapids, Michigan  49503-2560
Masonic Cancer Center at University of Minnesota Minneapolis, Minnesota  55455
University of Mississippi Cancer Clinic Jackson, Mississippi  39216-4505
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis St. Louis, Missouri  63110
Don Monti Comprehensive Cancer Center at North Shore University Hospital Manhasset, New York  11030
Dakota Cancer Institute at Dakota Clinic - South University Fargo, North Dakota  58103-4940
Oklahoma University Cancer Institute Oklahoma City, Oklahoma  73104
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
Rosenfeld Cancer Center at Abington Memorial Hospital Abington, Pennsylvania  19001
Poudre Valley Hospital Fort Collins, Colorado  80524
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center Boise, Idaho  83706
St. Joseph Medical Center Bloomington, Illinois  61701
Eureka Community Hospital Eureka, Illinois  61530
Hematology Oncology Consultants - Naperville Naperville, Illinois  60540
BroMenn Regional Medical Center Normal, Illinois  61761
Community Cancer Center Normal, Illinois  61761
Community Hospital of Ottawa Ottawa, Illinois  61350
Oncology Hematology Associates of Central Illinois, PC - Ottawa Ottawa, Illinois  61350
Cancer Treatment Center at Pekin Hospital Pekin, Illinois  61554
Oncology Hematology Associates of Central Illinois, PC - Peoria Peoria, Illinois  61615
OSF St. Francis Medical Center Peoria, Illinois  61637
Proctor Hospital Peoria, Illinois  61614
Illinois Valley Community Hospital Peru, Illinois  61354
Bettendorf, Iowa  52722
St. Luke's Hospital Cedar Rapids, Iowa  52402
Mercy Regional Cancer Center at Mercy Medical Center Cedar Rapids, Iowa  52403
Genesis Regional Cancer Center at Genesis Medical Center Davenport, Iowa  52803
John Stoddard Cancer Center at Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Medical Oncology and Hematology Associates at John Stoddard Cancer Center Des Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer Center Des Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des Moines West Des Moines, Iowa  50266
Mary Bird Perkins Cancer Center - Baton Rouge Baton Rouge, Louisiana  70809
Louisiana State University Health Sciences Center - Monroe Monroe, Louisiana  71210
Feist-Weiller Cancer Center at Louisiana State University Health Sciences Shreveport, Louisiana  71130-3932
Hickman Cancer Center at Bixby Medical Center Adrian, Michigan  49221
Mecosta County Medical Center Big Rapids, Michigan  49307
Community Cancer Center of Monroe Monroe, Michigan  48162
Providence Cancer Institute at Providence Hospital - Southfield Campus Southfield, Michigan  48075
St. Joseph's Medical Center Brainerd, Minnesota  56401
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Charles R. Wood Cancer Center at Glens Falls Hospital Glens Falls, New York  12801
Iredell Memorial Hospital Statesville, North Carolina  28677
Wood County Oncology Center Bowling Green, Ohio  43402
Samaritan North Cancer Care Center Dayton, Ohio  45415
Grandview Hospital Dayton, Ohio  45405
David L. Rike Cancer Center at Miami Valley Hospital Dayton, Ohio  45409
Good Samaritan Hospital Dayton, Ohio  45406
Blanchard Valley Medical Associates Findlay, Ohio  45840
Charles F. Kettering Memorial Hospital Kettering, Ohio  45429
Lima Memorial Hospital Lima, Ohio  45804
Northwest Ohio Oncology Center Maumee, Ohio  43537
Middletown Regional Hospital Middletown, Ohio  45044
Toledo Clinic - Oregon Oregon, Ohio  43616
St. Charles Mercy Hospital Oregon, Ohio  43616
Mercy Hospital of Tiffin Tiffin, Ohio  44883
Toledo Clinic, Incorporated - Main Clinic Toledo, Ohio  43623
UVMC Cancer Care Center at Upper Valley Medical Center Troy, Ohio  45373-1300
Fulton County Health Center Wauseon, Ohio  43567
Ruth G. McMillan Cancer Center at Greene Memorial Hospital Xenia, Ohio  45385
Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical Center Kingsport, Tennessee  37662
Danville Regional Medical Center Danville, Virginia  24541
Holy Family Memorial Medical Center Cancer Care Center Manitowoc, Wisconsin  54221-1450
Welch Cancer Center at Sheridan Memorial Hospital Sheridan, Wyoming  82801
Palo Alto Medical Foundation Palo Alto, California  94301
Middlesex Hospital Cancer Center Middletown, Connecticut  06457
Northeast Georgia Medical Center Gainesville, Georgia  30501
Mercy Cancer Center at Mercy Medical Center - North Iowa Mason City, Iowa  50401
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Missouri Baptist Cancer Center St. Louis, Missouri  63131
Altru Cancer Center at Altru Hospital Grand Forks, North Dakota  58201
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
John B. Amos Cancer Center Columbus, Georgia  31904
Evanston Hospital Evanston, Illinois  60201-1781
Reid Hospital & Health Care Services Richmond, Indiana  47374
McFarland Clinic, PC Ames, Iowa  50010
Foote Memorial Hospital Jackson, Michigan  49201
St. Mary Mercy Hospital Livonia, Michigan  48154
Mercy Memorial Hospital - Monroe Monroe, Michigan  48162
St. Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy Hospital Port Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - Saginaw Saginaw, Michigan  48601
Willmar Cancer Center at Rice Memorial Hospital Willmar, Minnesota  56201
Billings Clinic - Downtown Billings, Montana  59107-7000
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
St. James Healthcare Cancer Care Butte, Montana  59701
Great Falls Clinic - Main Facility Great Falls, Montana  59405
Monter Cancer Center of the North Shore-LIJ Health System Lake Success, New York  11042
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center Columbus, Ohio  43210-1240
Hematology Oncology Center Elyria, Ohio  44035
Community Cancer Center Elyria, Ohio  44035
Wayne Hospital Greenville, Ohio  45331
Flower Hospital Cancer Center Sylvania, Ohio  43560
St. Anne Mercy Hospital Toledo, Ohio  43623
Fredericksburg Oncology, Incorporated Fredericksburg, Virginia  22401
Southwest Virginia Regional Cancer Center at Wellmonth Health Norton, Virginia  24273
St. Joseph Cancer Center Bellingham, Washington  98225
Columbia Basin Hematology Kennewick, Washington  99336
Harrison Poulsbo Hematology and Onocology Poulsbo, Washington  98370
Evergreen Hematology and Oncology, PS Spokane, Washington  99218
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
Marshfield Clinic - Chippewa Center Chippewa Falls, Wisconsin  54729
Marshfield Clinic Cancer Care at Regional Cancer Center Eau Claire, Wisconsin  54701
Marshfield Clinic - Lakeland Center Minocqua, Wisconsin  54548
Ministry Medical Group at Saint Mary's Hospital Rhinelander, Wisconsin  54501
Marshfield Clinic at Saint Michael's Hospital Stevens Point, Wisconsin  54481
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Diagnostic and Treatment Center Weston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494
Rocky Mountain Oncology Casper, Wyoming  82609
FirstHealth Moore Regional Community Hospital Comprehensive Cancer Center Pinehurst, North Carolina  28374
Mid Dakota Clinic, PC Bismarck, North Dakota  58501
Genesys Regional Medical Center Grand Blanc, Michigan  48439-8066
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Good Samaritan Cancer Center at Good Samaritan Hospital Kearney, Nebraska  68848-1990
Regional Cancer Center at Oconomowoc Memorial Hospital Oconomowoc, Wisconsin  53066
Harold Alfond Center for Cancer Care Augusta, Maine  04330
Union Hospital of Cecil County Elkton MD, Maryland  21921
Duke Cancer Institute Durham, North Carolina  27710
Kinston Medical Specialists Kinston, North Carolina  28501
Miriam Hospital Providence, Rhode Island  02906
Resurrection Medical Center Chicago, Illinois  60631
McLeod Regional Medical Center Florence, South Carolina  29501
La Grange Memorial Hospital La Grange, Illinois  60525
Lacks Cancer Center at Saint Mary's Health Care Grand Rapids, Michigan  49503
Lakes Region General Hospital Laconia, New Hampshire  03246
Veterans Affairs Medical Center - Iowa City Iowa City, Iowa  52246-2208
Lipson Cancer and Blood Center at Rochester General Hospital Rochester, New York  14621
Galesburg Clinic, PC Galesburg, Illinois  61401
Boston University Cancer Research Center Boston, Massachusetts  02118
St. Vincent Healthcare Cancer Care Services Billings, Montana  59101
Lynchburg Hematology-Oncology Clinic Lynchburg, Virginia  24501
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Kapiolani Medical Center for Women and Children Honolulu, Hawaii  96826
Straub Clinic and Hospital, Incorporated Honolulu, Hawaii  96813
Hawaii Medical Center - East Honolulu, Hawaii  96817
OnCare Hawaii, Incorporated - Kuakini Honolulu, Hawaii  96817
OnCare Hawaii, Incorporated - Lusitana Honolulu, Hawaii  96813
Maui Memorial Medical Center Wailuku, Hawaii  96793
Pacific Cancer Institute - Maui Wailuku, Hawaii  96793
Illinois CancerCare - Bloomington Bloomington%, Illinois  61701
Illinois CancerCare - Canton Canton, Illinois  61520
Illinois CancerCare - Carthage Carthage, Illinois  62321
Illinois CancerCare - Eureka Eureka, Illinois  61530
Illinois CancerCare - Havana Havana, Illinois  62644
Illinois CancerCare - Kewanee Clinic Kewanee, Illinois  61443
Illinois CancerCare - Macomb Macomb, Illinois  61455
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus Moline, Illinois  61265
OSF Holy Family Medical Center Monmouth, Illinois  61462
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
Iowa Blood and Cancer Care Cedar Rapids, Iowa  52402
Caritas St. Elizabeth's Medical Center Brighton, Massachusetts  02135-2997
Mercy General Health Partners Muskegon, Michigan  49443
New Hampshire Oncology - Hematology, PA at Payson Center for Cancer Care Concord, New Hampshire  03301
Center for Cancer Care at Exeter Hospital Exeter, New Hampshire  03833
New Hampshire Oncology - Hematology, PA - Hooksett Hooksett, New Hampshire  03106
Valley Hospital - Ridgewood Ridgewood, New Jersey  07450
Trinity CancerCare Center Minot, North Dakota  58701
Fountain Valley, California  92708
Medcenter One Hospital Cancer Care Center Bismarck, North Dakota  58501
St. Alexius Medical Center Cancer Center Bismarck, North Dakota  58502
Regional Medical Center Anniston, Alabama  36202
Addison Gilbert Hospital Gloucester, Massachusetts  01930
Skaggs Cancer Center at Skaggs Regional Medical Center Branson, Missouri  65616
Dana-Farber Cancer Institute at Londonderry Londonderry, New Hampshire  03053
Marion L. Shepard Cancer Center at Beaufort County Hospital Washington, North Carolina  27889
Mercy Regional Cancer Center Janesville, Wisconsin  53547
Minnesota Oncology - Maplewood Maplewood, Minnesota  55109
Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
Lakeview Hospital Stillwater, Minnesota  55082
Minnesota Oncology - Woodbury Woodbury, Minnesota  55125
Camino Medical Group - Treatment Center Mountain View, California  94040
Ravenel Oncology Center at Memorial Hospital of Martinsville and Henry County Martinsville, Virginia  24115
Renown Institute for Cancer at Renown Regional Medical Center Reno, Nevada  89502
Castle Medical Center Kailua, Hawaii  96734
Kauai Medical Clinic Lihue, Hawaii  96766
Southeast Cancer Center Cape Girardeau, Missouri  63703
Goldschmidt Cancer Center Jefferson City, Missouri  65109
Island Hospital Cancer Care Center at Island Hospital Anacortes, Washington  98221
Highline Medical Center Cancer Center Burien, Washington  98166
New Ulm Medical Center New Ulm, Minnesota  56073
St. Nicholas Hospital Sheboygan, Wisconsin  53081
North Broward Medical Center Dearfield Beach, Florida  33064-3596
John R. Marsh Cancer Center at Washington County Hospital Hagerstown, Maryland  21740
Highland Clinic Shreveport, Louisiana  71105
Feather River Hospital Cancer Center Paradise, California  95969
Celilo Cancer Center at Mid-Columbia Medical Center The Dalles, Oregon  97058
Central Care Cancer Center at Carrie J. Babb Cancer Center Bolivar, Missouri  65613
Cancer Centers of Southwest Oklahoma, LLC - Lawton Lawton, Oklahoma  73505
Spectrum Health Reed City Hospital Reed City, Michigan  49677
St. Francis Hospital Cancer Care Services Indianapolis, Indiana  46237
D.N. Greenwald Center Mukwonago, Wisconsin  53149
Swedish Medical Center - Issaquah Campus Issaquah, Washington  98029
Dana-Farber/Brigham and Women's Cancer Center at Milford Regional Medical Center Milford, Massachusetts  01757
Mercy Cancer Center - West Lakes Clive, Iowa  50325
Methodist West Hospital West Des Moines, Iowa  50266-7700
NEA Medical Clinic - East Matthews Jonesboro, Arkansas  72401
Dana-Farber/Brigham and Women's Cancer Center at South Shore South Weymouth, Massachusetts  02190
Benefis Sletten Cancer Institute Great Falls, Montana  59405
Essentia Health - Duluth Clinic Duluth, Minnesota  55805-1983