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Randomized Phase II Study of Everolimus Alone Versus Everolimus Plus Bevacizumab in Patients With Locally Advanced or Metastatic Pancreatic Neuroendocrine Tumors


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Gastrinoma, Glucagonoma, Insulinoma, Pancreatic Alpha Cell Adenoma, Pancreatic Alpha Cell Carcinoma, Pancreatic Beta Islet Cell Adenoma, Pancreatic Beta Islet Cell Carcinoma, Pancreatic Delta Cell Adenoma, Pancreatic Delta Cell Carcinoma, Pancreatic G-cell Adenoma, Pancreatic G-cell Carcinoma, Pancreatic Polypeptide Tumor, Recurrent Islet Cell Carcinoma, Recurrent Pancreatic Cancer, Somatostatinoma, Stage III Pancreatic Cancer, Stage IV Pancreatic Cancer

Thank you

Trial Information

Randomized Phase II Study of Everolimus Alone Versus Everolimus Plus Bevacizumab in Patients With Locally Advanced or Metastatic Pancreatic Neuroendocrine Tumors


PRIMARY OBJECTIVES:

l. To assess the progression-free survival rate of patients with locally advanced or
metastatic pancreatic neuroendocrine tumors treated with everolimus alone or everolimus plus
bevacizumab.

SECONDARY OBJECTIVES:

I. To compare PFS among treatment arms shown to be efficacious. II. To estimate the overall
tumor response rate in patients with metastatic pancreatic neuroendocrine tumors treated
with one of two novel regimens.

III. To estimate the overall biochemical response rate (as measured by plasma chromogranin A
levels) in patients with metastatic pancreatic neuroendocrine tumors treated with these
regimens.

IV. To assess the toxicity of each regimen in patients with metastatic pancreatic
neuroendocrine tumors.

V. To assess the overall survival of patients with pancreatic neuroendocrine tumors treated
with these regimens.

OUTLINE: This is a multicenter study. Patients are stratified according to prior treatment
with cytotoxic chemotherapy (no vs yes), prior use of octreotide (no vs yes), and prior
therapy with sunitinib (no vs yes). Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive oral everolimus once daily on days 1-28 and intramuscular octreotide
LAR on day 1.

ARM II: Patients receive everolimus and octreotide LAR as in arm I. Patients also receive
bevacizumab IV over 30-90 minutes on days 1 and 15.

In both arms, courses repeat every 28 days in the absence of disease progression or
unacceptable toxicity.

After completion of study treatment, patients are followed up every 3-6 months for 3 years.


Inclusion Criteria:



- Patients must have histologic documentation of well-differentiated or moderately
differentiated neuroendocrine tumor from either a primary or metastatic site

- If different histologic classification schemes are used, equivalent histologic
classifications (for example "grade 1", "low-grade", or "intermediate-grade")
are allowed

- Patients with poorly differentiated neuroendocrine carcinoma or small cell
carcinoma are excluded

- Documentation from a metastatic disease site is sufficient if there is clinical
evidence of a pancreatic primary site

- Locally unresectable or metastatic disease

- Patients must have either histologic documentation of a pancreatic primary site, or
clinical evidence of a pancreatic neuroendocrine primary tumor as determined by the
treating physician

- Patients with neuroendocrine tumors (e.g., gastrinoma, VIPoma) in whom a
pancreatic or peripancreatic primary site is strongly suspected are also
eligible

- Patients must have evidence of disease (measurable or non-measurable) with evidence
of progression within the past 12 months

- Measurable disease is defined as lesions that can be accurately measured in at
least one 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

- Lesions that are considered non-measurable include 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

- Treatment with somatostatin analogs is a requirement of the study

- Patients receiving octreotide at the time of study entry may continue at the
same dose level for the duration of the study

- Patients not receiving octreotide will initiate treatment according to study
guidelines

- Prior progression on somatostatin analogs or a negative octreotide scan does not
exclude patient participation in this study

- No clinical evidence of brain metastases or carcinomatous meningitis

- ECOG performance status 0-1

- Granulocytes >= 1,500/uL

- Platelets >= 100,000/uL

- Creatinine =< 1.5 x upper limit of normal (ULN)

- Bilirubin =< 1.5 x ULN

- ALT and AST =< 2.5 x ULN (=< 5 x ULN if liver metastases present)

- Urine protein =< 1+ OR urine creatinine ratio < 1 by urinalysis (if UPC ratio is > 1
on urinalysis, then 24-hour urine collection for protein must be obtained and level
must be < 1,000 mg for patient enrollment

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during study treatment

- No concurrent condition resulting in immune compromise, including chronic treatment
with corticosteroids or other immuno suppressive agents

- No active or severe liver disease (e.g., acute or chronic hepatitis, cirrhosis); no
positive anti-HBV; HBV seropositive patients (HBsAg positive) are eligible if they
are closely monitored for evidence of active HBV infection by HBV DNA testing, and
they agree to receive suppressive therapy with lamivudine or other HBV-suppressive
therapy until at least 4 weeks after the last dose of everolimus; patients who are
hepatitis C antibody positive are eligible provided that hepatitis C viral load
(hepatitis C RNA) is undetectable

- No history of GI perforation within 12 months prior to registration

- No history of clinically significant bleeding episodes

- Patients with a history of hypertension must be adequately controlled (baseline BP <
150/90 mm Hg) on antihypertensives

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

- No symptomatic arterial peripheral vascular disease

- No history of aortic aneurysm, aortic dissection, angina, myocardial infarction,
stroke, or other arterial thrombotic events within 6 months of registration

- No uncontrolled diabetes mellitus

- Patients with a history of severely impaired lung function as defined as spirometry
and DLCO that is 50% of the normal predicted value and/or O_2 saturation that is 88%
or less at rest on room air are excluded

- Patients with fasting serum cholesterol >= 300 mg/dL OR >= 7.75 mmol/L AND fasting
triglycerides >= 2.5 X ULN should initiate lipid-lowering medications with the goal
of achieving levels below these thresholds

- No history of intolerance or allergies to octreotide

- No concurrent palliative radiotherapy

- No prior treatment with bevacizumab, everolimus, or other mTOR inhibitors

- Other prior treatments, including but not limited to prior cytotoxic chemotherapy,
alpha interferon, tyrosine kinase inhibitors, external beam radiation therapy, and
radiopeptide therapy are allowed

- There is no limit on the number of prior treatment regimens

- Any prior treatment (with the exception of octreotide) must be completed at
least 4 weeks prior to initiation of treatment

- Prior treatment with embolization or ablative therapies is allowed if measurable
disease remains outside of the treated area

- There is no limit on the prior number of procedures

- Patients should have completed any major surgery ≥ 4 weeks from start of treatment

- Patients must have completed any minor surgery ≥ 2 weeks prior to start of
treatment

- Patients must have fully recovered from the procedure

- Insertion of a vascular access device is not considered major or minor surgery

- Patients should not receive immunization with attenuated live vaccines within one
week prior to registration or during protocol therapy

- Patients on therapeutic anticoagulation are eligible for the study provided that they
are on a stable dose of anticoagulants

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Progression-free survival

Outcome Description:

The Kaplan-Meier will be used to estimate the PFS curves within each treatment arm.

Outcome Time Frame:

From study entry to the date of documented progression or death from any cause, up to 3 years

Safety Issue:

No

Principal Investigator

Matthew Kulke

Investigator Role:

Principal Investigator

Investigator Affiliation:

Cancer and Leukemia Group B

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2011-02609

NCT ID:

NCT01229943

Start Date:

October 2010

Completion Date:

Related Keywords:

  • Gastrinoma
  • Glucagonoma
  • Insulinoma
  • Pancreatic Alpha Cell Adenoma
  • Pancreatic Alpha Cell Carcinoma
  • Pancreatic Beta Islet Cell Adenoma
  • Pancreatic Beta Islet Cell Carcinoma
  • Pancreatic Delta Cell Adenoma
  • Pancreatic Delta Cell Carcinoma
  • Pancreatic G-cell Adenoma
  • Pancreatic G-cell Carcinoma
  • Pancreatic Polypeptide Tumor
  • Recurrent Islet Cell Carcinoma
  • Recurrent Pancreatic Cancer
  • Somatostatinoma
  • Stage III Pancreatic Cancer
  • Stage IV Pancreatic Cancer
  • Adenoma
  • Carcinoma
  • Gastrinoma
  • Zollinger-Ellison Syndrome
  • Glucagonoma
  • Insulinoma
  • Adenoma, Islet Cell
  • Pancreatic Neoplasms
  • Somatostatinoma
  • Neuroendocrine Tumors
  • Carcinoma, Islet Cell

Name

Location

Roswell Park Cancer Institute Buffalo, New York  14263
Mayo Clinic Rochester, Minnesota  55905
University of Iowa Hospitals and Clinics Iowa City, Iowa  52242
Washington University School of Medicine Saint Louis, Missouri  63110
University of Washington Medical Center Seattle, Washington  98195-6043
Hurley Medical Center Flint, Michigan  48503
Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
North Suburban Medical Center Thornton, Colorado  80229
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Fairview Ridges Hospital Burnsville, Minnesota  55337
Hutchinson Area Health Care Hutchinson, Minnesota  55350
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Avera Cancer Institute Sioux Falls, South Dakota  57105
Loyola University Medical Center Maywood, Illinois  60153
Massachusetts General Hospital Cancer Center Boston, Massachusetts  02114
Sutter Health Western Division Cancer Research Group Greenbrae, California  94904
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Dana-Farber Cancer Institute Boston, Massachusetts  02115
Cedars-Sinai Medical Center Los Angeles, California  90048
William Beaumont Hospital Royal Oak, Michigan  48073
University of Nebraska Medical Center Omaha, Nebraska  68198-3330
Kaiser Permanente Medical Center - Santa Clara Santa Clara, California  95051-5386
Via Christi Regional Medical Center Wichita, Kansas  67214
Ochsner Clinic Foundation New Orleans, Louisiana  70121
University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma  73104
Iowa Methodist Medical Center Des Moines, Iowa  50309
Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Southern California Permanente Medical Group Downey, California  90242
Group Health Cooperative Seattle, Washington  98112
Great Falls Clinic Great Falls, Montana  59405
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Seattle, Washington  98109
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Cancer Center of Kansas - Chanute Chanute, Kansas  66720
Cancer Center of Kansas - Dodge City Dodge City, Kansas  67801
Cancer Center of Kansas - Newton Newton, Kansas  67114
Cancer Center of Kansas - Salina Salina, Kansas  67042
Cancer Center of Kansas - Wellington Wellington, Kansas  67152
Associates in Womens Health Wichita, Kansas  67203
Cancer Center of Kansas - Winfield Winfield, Kansas  67156
Munson Medical Center Traverse City, Michigan  49684
Bozeman Deaconess Hospital Bozeman, Montana  59715
Big Sky Oncology Great Falls, Montana  59405
Kalispell Medical Oncology Kalispell, Montana  59901
Kalispell Regional Medical Center Kalispell, Montana  59901
Adena Regional Medical Center Chillicothe, Ohio  54601
Grady Memorial Hospital Delaware, Ohio  43015
Fairfield Medical Center Lancaster, Ohio  43130
Avera McKennan Hospital and University Health Center Sioux Falls, South Dakota  57105
Harborview Medical Center Seattle, Washington  98104
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Welch Cancer Center Sheridan, Wyoming  82801
Methodist Estabrook Cancer Center Omaha, Nebraska  68114-4199
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center Columbus, Ohio  43210-1240
Parkland Memorial Hospital Dallas, Texas  75235
Sutter Solano Medical Center Vallejo, California  94589
Beebe Medical Center Lewes, Delaware  19958
Hematology and Oncology Associates Chicago, Illinois  60611
Mecosta County Medical Center Big Rapids, Michigan  49307
Community Cancer Center of Monroe Monroe, Michigan  48162
Great Plains Regional Medical Center North Platte, Nebraska  69101-6598
Iredell Memorial Hospital Statesville, North Carolina  28677
Bismarck Cancer Center Bismarck, North Dakota  58501
Grandview Hospital Dayton, Ohio  45405
Lima Memorial Hospital Lima, Ohio  45804
Mercy Hospital of Tiffin Tiffin, Ohio  44883
Fulton County Health Center Wauseon, Ohio  43567
Providence Milwaukie Hospital Milwaukie, Oregon  97222
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Mercy Hospital Coon Rapids, Minnesota  55433
Hematology Oncology Associates of Illinois-Highland Park Highland Park, Illinois  60035
Trinity Medical Center Moline, Illinois  61265-1291
Medical Oncology and Hematology Associates Des Moines, Iowa  50309
Ottumwa Regional Health Center Ottumwa, Iowa  52501
Bixby Medical Center Adrian, Michigan  49221
Saint Joseph Mercy Hospital Ann Arbor, Michigan  48106
Fairview-Southdale Hospital Edina, Minnesota  55435
Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Regions Hospital Saint Paul, Minnesota  55101
Saint Francis Regional Medical Center Shakopee, Minnesota  55379
Rice Memorial Hospital Willmar, Minnesota  56201
Saint Luke's Hospital Maumee, Ohio  43537
Geisinger Medical Group State College, Pennsylvania  16801
Swedish American Hospital Rockford, Illinois  61104
Miami Valley Hospital Dayton, Ohio  45409
Cancer Center of Kansas - Fort Scott Fort Scott, Kansas  66701
Cancer Center of Kansas-Independence Independence, Kansas  67301
Lawrence Memorial Hospital Lawrence, Kansas  66044
Menorah Medical Center Overland Park, Kansas  66209
North Kansas City Hospital Kansas City, Missouri  64116
Research Medical Center Kansas City, Missouri  64132
Saint Luke's East - Lee's Summit Lee's Summit, Missouri  64086
Heartland Regional Medical Center Saint Joseph, Missouri  64506
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
Northern Montana Hospital Havre, Montana  59501
Mary Rutan Hospital Bellefontaine, Ohio  43311
Wayne Hospital Greenville, Ohio  45331
Knox Community Hospital Mount Vernon, Ohio  43050
Fisher-Titus Medical Center Norwalk, Ohio  44857
Clinton Memorial Hospital Wilmington, Ohio  45177
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
Rocky Mountain Oncology Casper, Wyoming  82609
Longmont United Hospital Longmont, Colorado  80501
Genesys Regional Medical Center Grand Blanc, Michigan  48439-8066
Zale Lipshy University Hospital Dallas, Texas  75235-7786
Greene Memorial Hospital Xenia, Ohio  45385
Union Hospital of Cecil County Elkton MD, Maryland  21921
Cancer Centers of the Carolinas - Grove Commons Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Presbyterian Hospital Charlotte, North Carolina  28233-3549
Washington Hospital Center Washington, District of Columbia  20010
Sherman Hospital Elgin, Illinois  60120-2198
Saint Francis Medical Center Grand Island, Nebraska  68802
La Grange Memorial Hospital La Grange, Illinois  60525
Queen's Medical Center Honolulu, Hawaii  96813
Providence Hospital Mobile, Alabama  36608
Northwestern University Chicago, Illinois  60611
Northwest Cancer Specialists Vancouver, Washington  98664
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Kapiolani Medical Center for Women and Children Honolulu, Hawaii  96826
Maui Memorial Medical Center Wailuku, Hawaii  96793
Hennepin County Medical Center Minneapolis, Minnesota  
Saint Louis University Hospital St. Louis, Missouri  63110-0250
Glens Falls Hospital Glens Falls, New York  12801
Saint Alphonsus Regional Medical Center Boise, Idaho  83706
Kaiser Permanente Medical Center Vallejo, California  94589
Straub Clinic and Hospital Honolulu, Hawaii  96813
Lakeland Regional Cancer Center Lakeland, Florida  33805
Riverside Methodist Hospital Columbus, Ohio  43214
Licking Memorial Hospital Newark, Ohio  43055-2899
Cancer Center of Kansas - McPherson McPherson, Kansas  67460
Providence Portland Medical Center Portland, Oregon  97213-3635
California Pacific Medical Center San Francisco, California  94115
Dartmouth Hitchcock Medical Center Lebanon, New Hampshire  03756
Mid Dakota Clinic Bismarck, North Dakota  58501
Columbus CCOP Columbus, Ohio  43206
Indiana University Medical Center Indianapolis, Indiana  46202
Presbyterian - Saint Lukes Medical Center - Health One Denver, Colorado  80218
Kaiser Permanente Sacramento, California  
University of Texas Southwestern Medical Center Dallas, Texas  
Wichita CCOP Wichita, Kansas  67214-3882
Montana Cancer Consortium CCOP Billings, Montana  59101
Flower Hospital Sylvania, Ohio  43560-2197
Huntsman Cancer Institute/University of Utah Salt Lake City, Utah  84112
Metro-Minnesota CCOP St. Louis Park, Minnesota  
Lakeview Hospital Stillwater, Minnesota  55082
Mercy Medical Center Baltimore, Maryland  21202
Montana Cancer Specialists Missoula, Montana  59807-7877
Florida Hospital Orlando, Florida  32803
University of Chicago Comprehensive Cancer Center Chicago, Illinois  60637-1470
Hawaii Medical Center East Honolulu, Hawaii  96817
Castle Medical Center Kailua, Hawaii  96734
Southeast Cancer Center Cape Girardeau, Missouri  63703
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
Providence Newberg Medical Center Newberg, Oregon  97132
Butler Memorial Hospital Butler, Pennsylvania  16001
Littleton Adventist Hospital Littleton, Colorado  80122
Parker Adventist Hospital Parker, Colorado  80138
New Ulm Medical Center New Ulm, Minnesota  56073
Wake Forest University Health Sciences Winston-Salem, North Carolina  27157
Mills - Peninsula Hospitals Burlingame, California  94010
Kaiser Permanente, Fremont Fremont, California  94538
Kaiser Permanente, Hayward Hayward, California  94545
Kaiser Permanente-Oakland Oakland, California  94611
Kaiser Permanente-Redwood City Redwood City, California  94063
Kaiser Permanente-Richmond Richmond, California  94801
Kaiser Permanente-Roseville Roseville, California  95661
Kaiser Permanente-South Sacramento Sacramento, California  95823
Kaiser Permanente - Sacramento Sacramento, California  95825
Kaiser Permanente-San Francisco San Francisco, California  94115
University of California San Francisco Medical Center-Mount Zion San Francisco, California  94115
Kaiser Permanente-Santa Teresa-San Jose San Jose, California  95119
Kaiser Permanente-San Rafael San Rafael, California  94903
Kaiser Permanente-Santa Rosa Santa Rosa, California  95403
Kaiser Permanente-South San Francisco South San Francisco, California  94080
Kaiser Permanente-Stockton Stockton, California  95210
Kaiser Permanente-Vallejo Vallejo, California  94589
Kaiser Permanente-Walnut Creek Walnut Creek, California  94596
The Medical Center of Aurora Aurora, Colorado  80012
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Saint Anthony Central Hospital Denver, Colorado  80204
Exempla Saint Joseph Hospital Denver, Colorado  80218
Colorado Cancer Research Program CCOP Denver, Colorado  80224-2522
Saint Mary's Hospital and Regional Medical Center Grand Junction, Colorado  81502
Saint Mary Corwin Medical Center Pueblo, Colorado  81004
Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
The Hospital of Central Connecticut New Britain, Connecticut  06050
Lombardi Comprehensive Cancer Center at Georgetown University Washington, District of Columbia  20057
Oncare Hawaii Inc-POB II Honolulu, Hawaii  96813
Oncare Hawaii Inc-Kuakini Honolulu, Hawaii  96817
University of Hawaii Honolulu, Hawaii  96813
Pacific Cancer Institute of Maui Wailuku, Hawaii  96793
Provena Saint Mary's Hospital Kankakee, Illinois  60901
North Shore Hematology Oncology Libertyville, Illinois  60048
Garneau, Stewart C MD (UIA Investigator) Moline, Illinois  61265
Porubcin, Michael MD (UIA Investigator) Moline, Illinois  61265
Hematology Oncology Associates of Illinois - Skokie Skokie, Illinois  60076
Saint Francis Hospital and Health Centers Beech Grove, Indiana  46107
Wishard Hospital Indianapolis, Indiana  46202
Reid Hospital and Health Care Services Richmond, Indiana  47374
McFarland Clinic Ames, Iowa  50010
Constantinou, Costas L MD (UIA Investigator) Bettendorf, Iowa  52722
Medical Oncology and Hematology Associates-West Des Moines Clive, Iowa  50325
Iowa Oncology Research Association CCOP Des Moines, Iowa  50309
Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Medical Oncology and Hematology Associates-Des Moines Des Moines, Iowa  50309
Mercy Medical Center-Sioux City Sioux City, Iowa  51104
Saint Luke's Regional Medical Center Sioux City, Iowa  51104
Cancer Center of Kansas - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas-Kingman Kingman, Kansas  67068
Cancer Center of Kansas - Parsons Parsons, Kansas  67357
Cancer Center of Kansas - Pratt Pratt, Kansas  67124
Stormont-Vail Regional Health Center Topeka, Kansas  66604
Cancer Center of Kansas-Wichita Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas - Main Office Wichita, Kansas  67214
Ochsner Clinic Foundation-Baton Rouge Baton Rouge, Louisiana  70809
Ochsner Clinic CCOP New Orleans, Louisiana  70121
Hickman Cancer Center Adrian, Michigan  49221
Michigan Cancer Research Consortium Community Clinical Oncology Program Ann Arbor, Michigan  48106
Oakwood Hospital Dearborn, Michigan  48123
Saint John Hospital and Medical Center Detroit, Michigan  48236
Green Bay Oncology - Escanaba Escanaba, Michigan  49431
Grand Rapids Clinical Oncology Program Grand Rapids, Michigan  49503
Saint Mary's Health Care Grand Rapids, Michigan  49503
Spectrum Health at Butterworth Campus Grand Rapids, Michigan  49503
Green Bay Oncology - Iron Mountain Iron Mountain, Michigan  49801
Allegiance Health Jackson, Michigan  49201
Sparrow Hospital Lansing, Michigan  48912
Saint Mary Mercy Hospital Livonia, Michigan  48154
Mercy Memorial Hospital Monroe, Michigan  48162
Mercy Health Partners-Mercy Campus Muskegon, Michigan  49443
Saint Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Saint Joseph Mercy Port Huron Port Huron, Michigan  48060
Saint Mary's of Michigan Saginaw, Michigan  48601
Saint John Macomb-Oakland Hospital Warren, Michigan  48093
Miller-Dwan Hospital Duluth, Minnesota  55805
Unity Hospital Fridley, Minnesota  55432
Saint John's Hospital - Healtheast Maplewood, Minnesota  55109
Minnesota Oncology Hematology PA-Maplewood Maplewood, Minnesota  55109
North Memorial Medical Health Center Robbinsdale, Minnesota  55422
Park Nicollet Clinic - Saint Louis Park Saint Louis Park, Minnesota  55416
Minnesota Oncology and Hematology PA-Woodbury Woodbury, Minnesota  55125
Saint Luke's Cancer Institute Kansas City, Missouri  64111
Saint Luke's Hospital of Kansas City Kansas City, Missouri  64111
Liberty Radiation Oncology Clinic Kansas City, Missouri  64116
Missouri Baptist Medical Center Saint Louis, Missouri  63131
Hematology-Oncology Centers of the Northern Rockies PC Billings, Montana  59101
Saint Vincent Healthcare Billings, Montana  59101
Billings Clinic Billings, Montana  59107-7000
Saint James Community Hospital and Cancer Treatment Center Butte, Montana  59701
Benefis Healthcare- Sletten Cancer Institute Great Falls, Montana  59405
Saint Peter's Community Hospital Helena, Montana  59601
Glacier Oncology PLLC Kalispell, Montana  59901
Saint Patrick Hospital - Community Hospital Missoula, Montana  59802
Cooper Hospital University Medical Center Camden, New Jersey  08103
Orange Regional Medical Center Middletown, New York  10940
Wayne Memorial Hospital Goldsboro, North Carolina  27534
Saint Alexius Medical Center Bismarck, North Dakota  58501
Doctors Hospital Columbus, Ohio  43228
Grant Medical Center Columbus, Ohio  43215
Mount Carmel Health Center West Columbus, Ohio  43222
Good Samaritan Hospital - Dayton Dayton, Ohio  45406
Dayton CCOP Dayton, Ohio  45429
Samaritan North Health Center Dayton, Ohio  45415
Hematology Oncology Center Incorporated Elyria, Ohio  44035
Blanchard Valley Hospital Findlay, Ohio  45840
Atrium Medical Center-Middletown Regional Hospital Franklin, Ohio  45005-1066
Kettering Medical Center Kettering, Ohio  45429
Marietta Memorial Hospital Marietta, Ohio  45750
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center Maumee, Ohio  43537
Saint Charles Hospital Oregon, Ohio  43616
North Coast Cancer Care Sandusky, Ohio  44870
Toledo Community Hospital Oncology Program CCOP Toledo, Ohio  43617
Mercy Cancer Center at Saint Anne Mercy Hospital Toledo, Ohio  43623
University of Toledo Toledo, Ohio  43614
Saint Vincent Mercy Medical Center Toledo, Ohio  43608
Upper Valley Medical Center Troy, Ohio  45373
Saint Ann's Hospital Westerville, Ohio  43081
Genesis HealthCare System Zanesville, Ohio  43701
Providence Saint Vincent Medical Center Portland, Oregon  97225
Columbia River Oncology Program Portland, Oregon  97225
Pottstown Memorial Medical Center Pottstown, Pennsylvania  19464
Geisinger Wyoming Valley Wilkes-Barre, Pennsylvania  18711
Greenville CCOP Greenville, South Carolina  29615
Greenville Memorial Hospital Greenville, South Carolina  29605
The Don and Sybil Harrington Cancer Center Amarillo, Texas  79106
Fredericksburg Oncology Inc Fredericksburg, Virginia  22401
Harrison Bremerton Hematology and Oncology Bremerton, Washington  98310
Columbia Basin Hematology and Oncology PLLC Kennewick, Washington  99336
The Polyclinic Seattle, Washington  98122
Swedish Medical Center-First Hill Seattle, Washington  98122-4307
Saint Vincent Hospital Green Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's Hospital Green Bay, Wisconsin  54303
Saint Mary's Hospital Green Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent Hospital Green Bay, Wisconsin  54301-3526
Bay Area Medical Center Marinette, Wisconsin  54143
Green Bay Oncology - Oconto Falls Oconto Falls, Wisconsin  54154
Green Bay Oncology - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
Cancer Center of Kansas-Liberal Liberal, Kansas  67901
University of Missouri - Ellis Fischel Columbia, Missouri  65203
UMDNJ - New Jersey Medical School Newark, New Jersey  07103
North Coast Cancer Care-Clyde Clyde, Ohio  43410
Community Health Partners Regional Medical Center Elyria, Ohio  44035
Roper Hospital Charleston, South Carolina  29401
Cancer Centers of the Carolinas - Faris Greenville, South Carolina  29605
Cancer Centers of the Carolinas-Greer Medical Oncology Greer, South Carolina  29650
University of Tennessee - Knoxville Knoxville, Tennessee  37920
Skagit Valley Hospital Mt. Vernon, Washington  98273
Evergreen Hematology and Oncology PS Spokane, Washington  99218
Holy Family Memorial Hospital Manitowoc, Wisconsin  54221
Kaiser Permanente Los Angeles Medical Center Los Angeles, California  90027
Kaiser Anaheim Medical Center Anaheim, California  92807
Kaiser Permanente-Deer Valley Medical Center Antioch, California  94531
Kaiser Permanente Medical Group - Baldwin Park Baldwin Park, California  91706
Kaiser Foundation Hospital Bellflower, California  90706
Kaiser Permanente Hospital Fontana, California  92335
Kaiser Permanente - Harbor City Harbor City, California  90710
Kaiser Permanente-West Los Angeles Los Angeles, California  90034
Kaiser Permanente - Panorama City Panorama City, California  91402
Kaiser Permanente at San Diego San Diego, California  92120
Kaiser Permanente Health Care San Marcos, California  92069
Kaiser Permanente Medical Center-Vacaville Vacaville, California  95688
Kaiser Permanente Moanalua Medical Center Honolulu, Hawaii  96819
Wilcox Memorial Hospital and Kauai Medical Clinic Lihue, Hawaii  96766-1099
Spector, David MD (UIA Investigator) Moline, Illinois  61265
Saint Luke's South Hospital Overland Park, Kansas  66213
Kansas City CCOP Prairie Village, Kansas  66208
Ochsner North Shore Medical Center Covington, Louisiana  70433
Spectrum Health Reed City Hospital Reed City, Michigan  49677
Capital Region Medical Center-Goldschmidt Cancer Center Jefferson City, Missouri  65109
Heartland Hematology and Oncology Associates Incorporated Kansas City, Missouri  64118
Saint Joseph Oncology Inc Saint Joseph, Missouri  64507
Comprehensive Cancer Care PC Saint Louis, Missouri  63141
Southern Ohio Medical Center Portsmouth, Ohio  45662
Cancer Care Center at Island Hospital Anacortes, Washington  98221
Highline Medical Center-Main Campus Burien, Washington  98166
United General Hospital Sedro-Woolley, Washington  98284
Gundersen Lutheran La Crosse, Wisconsin  54601
Saint Nicholas Hospital Madison, Wisconsin  53715
New York Oncology Hematology PC -Albany Medical Center Albany, New York  12208
New York Oncology Hematology PC - Albany Albany, New York  12206
New York Oncology Hematology PC - Amsterdam Amsterdam, New York  12010
New York Oncology Hematology PC-Hudson Hudson, New York  12534
New York Oncology Hematology PC - Latham Latham, New York  12110
New York Oncology Hematology PC - Rexford Rexford, New York  12148
New York Oncology Hematology PC - Troy Troy, New York  12180
Stanford University Hospitals and Clinics Stanford, California  94305
Siouxland Hematology Oncology Associates Sioux City, Iowa  51101
Kaiser Permanente-Mission San Diego, California  92108
Swedish Cancer Institute-Issaquah Issaquah, Washington  98029
Norris Cotton Cancer Center-Manchester Manchester, New Hampshire  03104
Methodist West Hospital West Des Moines, Iowa  50266-7700
Georgia Health Sciences University Augusta, Georgia  30912
Alta Bates Summit Medical Center-Herrick Campus Berkeley, California  94704
Hematology Oncology Associates of Central New York PC East Syracuse, New York  13057
The Toledo Hospital/Toledo Children's Hospital Toledo, Ohio  43606
Genesys Regional Medical Center-West Flint Campus Flint, Michigan  48532
Essentia Health Saint Joseph's Medical Center Brainerd, Minnesota  56401
Essentia Health Duluth Clinic CCOP Duluth, Minnesota  55805
Essentia Health Saint Mary's Medical Center Duluth, Minnesota  55805
Sanford Bismarck Medical Center Bismarck, North Dakota  58501
Toledo Clinic Cancer Centers-Oregon Oregon, Ohio  43616
Geisinger Medical Center-Cancer Center Hazelton Hazleton, Pennsylvania  18201
PeaceHealth Saint Joseph Medical Center Bellingham, Washington  98225
Christiana Care Health System-Christiana Hospital Newark, Delaware  19718
Illinois Cancer Specialists-Niles Niles, Illinois  60714
Bronson Battle Creek Battle Creek, Michigan  49017
Springfield Regional Medical Center Springfield, Ohio  45505
Toledo Clinic Cancer Centers-Bowling Green Bowling Green, Ohio  43402
Toledo Clinic Cancer Centers-Maumee Maumee, Ohio  43537-1839
Toledo Clinic Cancer Centers-Toledo Toledo, Ohio  43623
Self Regional Healthcare Greenwood, South Carolina  29646
Harrison Poulsbo Hematology and Oncology Poulsbo, Washington  98370
PeaceHealth Southwest Medical Center Vancouver, Washington  98664
Mayo Clinic Health System-Franciscan Healthcare La Crosse, Wisconsin  54601
Sutter Pacific Medical Foundation Santa Rosa, California  95403
OnCare Hawaii-Liliha Honolulu, Hawaii  96817-3169
Ochsner Baptist Medical Center New Orleans, Louisiana  70115
Providence Willamette Falls Medical Center Oregon City, Oregon  97045
Mercy Cancer Center-West Lakes Clive, Iowa  50325
Mercy Medical Center-West Lakes West Des Moines, Iowa  50266