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A Clinical Trial Of Adjuvant Therapy Comparing Six Cycles Of 5-Fluorouracil, Epirubicin And Cyclophosphamide (FEC) To Four Cycles Of Adriamycin And Cyclophosphamide (AC) In Patients With Node-Negative Breast Cancer

Phase 3
18 Years
Open (Enrolling)
Breast Cancer

Thank you

Trial Information

A Clinical Trial Of Adjuvant Therapy Comparing Six Cycles Of 5-Fluorouracil, Epirubicin And Cyclophosphamide (FEC) To Four Cycles Of Adriamycin And Cyclophosphamide (AC) In Patients With Node-Negative Breast Cancer



- Compare disease-free survival of women with node-negative breast cancer treated with
adjuvant fluorouracil, epirubicin, and cyclophosphamide vs doxorubicin and


- Compare survival, recurrence-free interval, and distant recurrence-free interval in
patients treated with these regimens.

- Compare adverse events in patients treated with these regimens.

- Compare quality of life, with regard to physical functioning, vitality, symptoms, and
rates of post-chemotherapy amenorrhea, in premenopausal patients treated with these

- Determine the effect of induction of post-chemotherapy amenorrhea on disease-free
survival in premenopausal patients treated with these regimens.

- Correlate post-chemotherapy amenorrhea and disease-free survival with hormone receptor
status in premenopausal patients treated with these regimens.

- Correlate changes in left ventricular ejection fraction (LVEF) with self-reported
physical functioning in patients treated with these regimens.

- Compare the efficacy of these regimens in patients with Human Epidermal Growth Factor
Receptor 2 (HER2)/neu and/or topoisomerase-2-alpha gene amplification.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to
hormone receptor status (estrogen receptor [ER] positive or progesterone receptor [PR]
positive vs ER negative or PR negative) and type of prior surgery (lumpectomy vs total
mastectomy). Patients are randomized to 1 of 2 treatment arms.

- Arm 1: Patients receive doxorubicin IV over 15 minutes followed by cyclophosphamide IV
over 30 minutes on day 1. Treatment repeats every 21 days for 4 courses.

- Arm 2: Patients receive fluorouracil IV, epirubicin IV over 15 minutes, and
cyclophosphamide IV over 30 minutes on day 1. Treatment repeats every 21 days for 6

In both arms, treatment continues in the absence of disease progression or unacceptable

All patients with ER- or PR-positive tumors receive hormonal therapy daily beginning within
3-12 weeks after the completion of chemotherapy and continuing for at least 5 years.

All patients who have undergone prior lumpectomy undergo whole-breast radiotherapy beginning
as soon as possible after the completion of chemotherapy. Patients who have undergone prior
total mastectomy may undergo chest wall radiotherapy at the investigator's discretion.
Patients assigned to the partial breast irradiation (PBI) group of protocol NSABP-B-39
undergo PBI according to protocol-specific guidelines.

Quality of life is assessed at baseline, on day 1 of course 4 of chemotherapy, and then
every 6 months for 3 years.

Patients are followed every 6 months for up to 5 years and then annually thereafter.

PROJECTED ACCRUAL: A total of 2,700 patients (1,350 per treatment arm) will be accrued for
this study within 3.75 years.

Inclusion Criteria


- Patients must be greater than or equal to 18 years of age.

- The patient must have a life expectancy of at least 10 years, excluding her diagnosis
of breast cancer. (Comorbid conditions and performance status should be taken into
consideration, but not the diagnosis of breast cancer.)

- The interval between the last surgery for breast cancer treatment (lumpectomy,
mastectomy, sentinel lymph node biopsy, axillary surgery, or re-excision of
lumpectomy margins) and randomization must be no more than 84 days.

- The tumor must be invasive adenocarcinoma on histologic examination. (Patients with
tumors that are pure tubular or mucinous adenocarcinomas are not eligible.)

- The primary tumor must be T1-3 by clinical and pathologic evaluation.

- Lymph nodes obtained from all axillary staging procedures must be pN0 according to
pathologic staging criteria of the 6th edition of the American Joint Committee on
Cancer (AJCC) Cancer Staging Manual.

- Patients must have undergone axillary nodal staging procedures, for example sentinel
node (SN) biopsy alone, SN biopsy followed by axillary sampling or completion
dissection, or axillary node dissection to obtain lymph nodes for pathologic
evaluation. If the patient has palpable nodes, axillary dissection is required.

- Patients must have an estrogen receptor (ER) analysis performed on the primary tumor
prior to randomization. If ER is negative, then progesterone receptor (PgR) analysis
must be performed. If ER is positive, PgR analysis is desired, but not mandatory.
("Marginal" or "borderline" results [i.e., those not definitively negative] will be
considered positive regardless of the methodology used.)

- Patients must have had either a lumpectomy or total mastectomy.

- Patients must have no clinical or radiologic evidence of metastatic disease.

- Patients with skeletal pain are eligible for inclusion in the study if bone scan or
roentgenological examination fail to disclose metastatic disease. Suspicious
findings must be confirmed as benign by x-ray, MRI, or biopsy.

- The patient's menopausal status must be determined prior to randomization.

- Pre- and postmenopausal women are eligible. The following criteria will be used
to define postmenopausal:

- a prior documented bilateral oophorectomy, or

- a history of at least 12 months without spontaneous menstrual bleeding, or

- age 55 or older with a prior hysterectomy or

- age 54 or younger with a prior hysterectomy without oophorectomy (or in whom the
status of the ovaries is unknown), with a documented follicle-stimulating
hormone (FSH) level demonstrating confirmatory elevation in the lab's
postmenopausal range.

- Women failing to meet one of these criteria will be classified as premenopausal.

- At the time of randomization, the patient must have had the following: history and
physical exam, EKG, and PA and lateral chest x-ray or chest CT within the past 3
months; bilateral mammogram within the past 6 months; and pelvic exam (for women who
have a uterus and who will be receiving tamoxifen) within the past year.

- Within 3 months prior to entry, the patient must have a baseline LVEF measured by
Multi Gated Acquisition (MUGA) scan or echocardiogram equal to or greater than the
lower limit of normal for the facility performing the procedure.

- At the time of randomization:

- The postoperative absolute granulocyte count (AGC) must be greater than or equal
to 1500/mm3 (or greater than or equal to 1200/mm3 if, in the opinion of the
investigator, this represents an ethnic or racial variant of normal).

- Postoperative platelet count must be greater than or equal to 100,000/mm3.
Significant underlying hematologic disorders must be excluded when the platelet
count is above the ULN for the lab.

- There must be postoperative evidence of adequate hepatic function, i.e.,

- total bilirubin must be less than or equal to ULN for the lab unless the patient
has a chronic Grade 1 bilirubin elevation (greater than ULN to 1.5 x ULN) due
to Gilbert's disease or similar syndrome due to slow conjugation of bilirubin;

- alkaline phosphatase must be less than 2.5 x ULN for the lab; and

- the aspartate transaminase (AST) [serum glutamic-oxaloacetic transaminase
(SGOT)] must be less than or equal to 1.5 x ULN for the lab.

- There must be postoperative evidence of normal renal function (serum creatinine
less than or equal to ULN).

- Patients with a history of non-breast malignancies are eligible if they have been
disease-free for 5 or more years prior to randomization and are deemed by their
physician to be at low risk for recurrence. Patients with the following cancers are
eligible if diagnosed and treated within the past 5 years: carcinoma in situ of the
cervix, melanoma in situ, and basal cell and squamous cell carcinoma of the skin.

- Special conditions for eligibility of lumpectomy patients: radiation therapy and
surgery Patients treated by lumpectomy followed by breast radiation therapy must meet
all the eligibility criteria in addition to the following:

- Generally, lumpectomy should be reserved for tumors less than 5 cm. However, at
the investigator's discretion, patients treated with lumpectomy for tumors
greater than or equal to 5 cm are eligible if eligibility criteria for
lumpectomy are met.

- The margins of the resected specimen must be histologically free of invasive
tumor and DCIS as determined by the local pathologist. In patients in whom
pathologic examination demonstrates tumor present at the line of resection,
additional operative procedures may be performed to obtain clear margins. This
is permissible even if axillary dissection has been performed. Patients in whom
tumor is still present at the resected margin after re-excision(s) must undergo
total mastectomy to be eligible.

- This is a node-negative study, therefore irradiation of regional lymph nodes is
prohibited in this trial.

- Whole breast irradiation is required unless the patient is assigned to the
partial breast irradiation group on NSABP B-39.

- Postmastectomy chest wall irradiation at the investigator's discretion is
permitted. However, this is a node-negative study; therefore irradiation of
regional lymph nodes is prohibited in this trial.


- Male patients are not eligible for this study.

- Pure tubular or mucinous adenocarcinomas.

- Bilateral malignancy (including DCIS) or a mass or mammographic abnormality in the
opposite breast suspicious for malignancy unless there is biopsy proof that the mass
is not malignant.

- Primary tumor staged as T4 for any reason.

- Suspicious palpable nodes in the ipsilateral or contralateral axilla or palpable
supraclavicular or infraclavicular nodes. Patients with these conditions are
considered ineligible unless there is biopsy evidence that these are not involved
with tumor.

- Prior history of breast cancer, including DCIS (patients with a history of lobular
carcinoma in situ [LCIS] are eligible).

- Treatment including radiation therapy, chemotherapy, biotherapy, and/or hormonal
therapy administered for the currently diagnosed breast cancer prior to
randomization. The only exceptions are:

- Hormonal therapy, which may have been given for up to a total of 28 days anytime
after diagnosis and before study entry. In such a case, hormonal therapy must
stop at or before randomization and be re-started, if indicated, following

- If patient is enrolled in NSABP B-39 and randomized to Group 2, partial breast
irradiation (PBI) may be completed prior to beginning treatment on NSABP B-36.

- Prior anthracycline therapy for any malignancy.

- Any sex hormonal therapy, e.g., birth control pills, ovarian hormonal replacement
therapy, etc.. (These patients are eligible if this therapy is discontinued prior to

- Therapy with any hormonal agents such as raloxifene (Evista®), tamoxifen, or other
selective estrogen receptor modulators (SERMs), either for osteoporosis or breast
cancer prevention. (Patients are eligible only if these medications are discontinued
prior to randomization. With the exception of tamoxifen, these medications are not
permitted while on the study.)

- Cardiac disease that would preclude the use of anthracyclines. This includes:

- any documented myocardial infarction;

- angina pectoris that requires the use of anti-anginal medication;

- any history of documented congestive heart failure;

- serious cardiac arrhythmia requiring medication,

- severe conduction abnormality;

- valvular disease with documented cardiac function compromise; and

- poorly controlled hypertension, i.e., diastolic greater than 100 mm/Hg.
(Patients with hypertension that is well controlled on medication are eligible
for entry.)

- Non-malignant systemic disease (cardiovascular, renal, hepatic, etc.) that would
preclude a patient from being subjected to any of the treatment options or would
prevent prolonged follow-up.

- Pregnancy or lactation at the time of proposed randomization. Women of reproductive
potential must agree to use an effective non-hormonal method of contraception.

- Concurrent treatment with investigational agents.

- Psychiatric or addictive disorders or other conditions that, in the opinion of the
investigator, would preclude the patient from meeting the study requirements.

- Special conditions for ineligibility of lumpectomy patients: radiation therapy and
surgery. For patients treated by lumpectomy, breast irradiation is required. The
following patients will be ineligible:

- Patients with diffuse tumors (as demonstrated on mammography) that would not be
considered surgically amenable to lumpectomy. (These patients are eligible if
they undergo mastectomy.)

- Patients treated with lumpectomy in whom there is another clinically dominant
mass or mammographically suspicious abnormality within the ipsilateral breast
remnant. Such a mass must be biopsied and demonstrated to be histologically
benign prior to randomization or, if malignant, must be surgically removed with
clear margins.

- Patients in whom the margins of the resected specimen are involved with invasive
tumor or ductal carcinoma in situ (DCIS). Additional surgical resections to
obtain free margins are allowed. Patients in whom tumor is still present after
the additional resection(s) must undergo mastectomy to be eligible. (Patients
with margins positive for LCIS are eligible without additional resection.)

Type of Study:


Study Design:

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

Outcome Measure:

Disease free survival or no breast cancer (BC) at time of local recurrence (LR) after mastectomy, LR in the ipsilateral breast following lumpectomy, regional or distant recurrence, contralateral BC, 2nd primary cancer, or death

Outcome Time Frame:

Time from randomization to local recurrence regional recurrence, distant recurrence, contralateral BC, second primary cancer or death from any cause prior to recurrence or second primary cancer.

Safety Issue:


Principal Investigator

Norman Wolmark, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

NSABP Foundation, Inc.


United States: Institutional Review Board

Study ID:




Start Date:

May 2004

Completion Date:

April 2016

Related Keywords:

  • Breast Cancer
  • stage I breast cancer
  • stage II breast cancer
  • Breast Neoplasms



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North Bay Cancer Center Fairfield, California  94533
Kaiser Permanente - Fremont Fremont, California  94538
Sutter Health - Western Division Cancer Research Group Greenbrae, California  94904
Marin Cancer Institute at Marin General Hospital Greenbrae, California  94904
Kaiser Permanente Medical Center - Hayward Hayward, California  94545
Alta Bates Summit Medical Center - Summit Campus Oakland, California  94609
Valley Care Medical Center Pleasanton, California  94588
Kaiser Permanente Medical Center - Redwood City Redwood City, California  94063
Kaiser Permanente Medical Center - Richmond Richmond, California  94801
Kaiser Permanente Medical Center - Roseville Roseville, California  95661
Sutter Cancer Center at Roseville Medical Center Roseville, California  95661
South Sacramento Kaiser-Permanente Medical Center Sacramento, California  95823
Kaiser Permanente Medical Office -Vandever Medical Office San Diego, California  92120
California Pacific Medical Center - California Campus San Francisco, California  94118
Kaiser Permanente Medical Center - Santa Teresa San Jose, California  95119
Kaiser Foundation Hospital - San Rafael San Rafael, California  94903
Kaiser Permanente Medical Center - Santa Rosa Santa Rosa, California  95403
Kaiser Permanente Medical Center - South San Francisco South San Francisco, California  94080
Kaiser Permanente Medical Facility - Stockton Stockton, California  95210
Sutter Solano Medical Center Vallejo, California  94589
Kaiser Permanente Medical Center - Walnut Creek Walnut Creek, California  94596
Poudre Valley Hospital Fort Collins, Colorado  80524
Ella Milbank Foshay Cancer Center at Jupiter Medical Center Jupiter, Florida  33458
Saint Joseph's Hospital of Atlanta Atlanta, Georgia  30342-1701
Piedmont Hospital Atlanta, Georgia  30309
WellStar Cobb Hospital Austell, Georgia  30106
Charles B. Eberhart Cancer Center at DeKalb Medical Center Decatur, Georgia  30033
Gwinnett Medical Center Lawrenceville, Georgia  30045
Kennestone Cancer Center at Wellstar Kennestone Hospital Marietta, Georgia  30060
Southern Regional Medical Center Riverdale, Georgia  30274-2600
St. Joseph Medical Center Bloomington, Illinois  61701
Graham Hospital Canton, Illinois  61520
Memorial Hospital Carthage, Illinois  62321
Eureka Community Hospital Eureka, Illinois  61530
Galesburg Cottage Hospital Galesburg, Illinois  61401
Mason District Hospital Havana, Illinois  62644
Hopedale Medical Complex Hopedale, Illinois  61747
McDonough District Hospital Macomb, Illinois  61455
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
Perry Memorial Hospital Princeton, Illinois  61356
St. Margaret's Hospital Spring Valley, Illinois  61362
St. Francis Hospital and Health Centers - Beech Grove Campus Beech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Fort Wayne, Indiana  46815
Center for Cancer Therapy at LaPorte Hospital and Health Services La Porte, Indiana  46350
Genesis Regional Cancer Center at Genesis Medical Center Davenport, Iowa  52803
John Stoddard Cancer Center at Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Mercy Capitol Hospital Des Moines, Iowa  50307
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
Cancer Center of Kansas, PA - Dodge City Dodge City, Kansas  67801
Pennington Cancer Center at Baton Rouge General Baton Rouge, Louisiana  70806
Terrebonne General Medical Center Houma, Louisiana  70360
Bay Regional Medical Center Bay City, Michigan  48708
Mecosta County Medical Center Big Rapids, Michigan  49307
Upper Michigan Cancer Center at Marquette General Hospital Marquette, Michigan  49855
Providence Cancer Institute at Providence Hospital - Southfield Campus Southfield, Michigan  48075
Alexandria, Minnesota  56308
CentraCare Clinic - River Campus St. Cloud, Minnesota  56303
Saint Francis Medical Center Cape Girardeau, Missouri  63701
Immanuel Medical Center Omaha, Nebraska  68122
Creighton University Medical Center Omaha, Nebraska  68131-2197
Mountainside Hospital Cancer Center Montclair, New Jersey  07042
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
Bismarck Cancer Center Bismarck, North Dakota  58501
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
Charles F. Kettering Memorial Hospital Kettering, Ohio  45429
Middletown Regional Hospital Middletown, Ohio  45044
Mercy Medical Center Springfield, Ohio  45504
UVMC Cancer Care Center at Upper Valley Medical Center Troy, Ohio  45373-1300
Ruth G. McMillan Cancer Center at Greene Memorial Hospital Xenia, Ohio  45385
LaFortune Cancer Center at St. John Medical Center Tulsa, Oklahoma  74104
Legacy Mount Hood Medical Center Gresham, Oregon  97030
Providence Milwaukie Hospital Milwaukie, Oregon  97222
Kaiser Permanente Health Care - Portland Portland, Oregon  97232
Providence Cancer Center at Providence Portland Medical Center Portland, Oregon  97213-2967
Providence St. Vincent Medical Center Portland, Oregon  97225
Legacy Meridian Park Hospital Tualatin, Oregon  97062
Oncology Services of Aberdeen Aberdeen, South Dakota  57401
Dixie Regional Medical Center - East Campus Saint George, Utah  84770
Virginia Oncology Associates - Hampton Hampton, Virginia  23666
Providence Cancer Center at Holy Family Hospital Spokane, Washington  99207
Southwest Washington Medical Center Cancer Center Vancouver, Washington  98668
Welch Cancer Center at Sheridan Memorial Hospital Sheridan, Wyoming  82801
St. Anthony Central Hospital Denver, Colorado  80204-1335
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
St. Francis Hospital Federal Way, Washington  98003
St. Clare Hospital Lakewood, Washington  98499-0998
Olympic Medical Center Port Angeles, Washington  98362
Good Samaritan Cancer Center Puyallup, Washington  98371
Allenmore Hospital Tacoma, Washington  98411-0414
Pottstown Memorial Regional Cancer Center Pottstown, Pennsylvania  19464
Highland General Hospital Oakland, California  94602
Northeast Georgia Medical Center Gainesville, Georgia  30501
Creticos Cancer Center at Advocate Illinois Masonic Medical Center Chicago, Illinois  60657
Mercy Cancer Center at Mercy Medical Center - North Iowa Mason City, Iowa  50401
Great Lakes Cancer Institute at McLaren Regional Medical Center Flint, Michigan  48532
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Saint Luke's Hospital Chesterfield, Missouri  63017
Missouri Baptist Cancer Center St. Louis, Missouri  63131
Cancer Resource Center - Lincoln Lincoln, Nebraska  68510
Randolph Hospital Asheboro, North Carolina  27203
Moses Cone Regional Cancer Center at Wesley Long Community Hospital Greensboro, North Carolina  27401
Annie Penn Cancer Center Reidsville, North Carolina  27320
Cancer Treatment Center Wooster, Ohio  44691
Allegheny Cancer Center at Allegheny General Hospital Pittsburgh, Pennsylvania  15212
Western Pennsylvania Cancer Institute at Western Pennsylvania Hospital Pittsburgh, Pennsylvania  15224-1791
Alta Bates Summit Comprehensive Cancer Center Berkeley, California  94704
Stanford Cancer Center Stanford, California  94305-5824
Eastern Connecticut Hematology and Oncology Associates Norwich, Connecticut  06360
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
Herbert D. Kerman Regional Oncology Center - Daytona Beach Daytona Beach, Florida  32114
Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital Fort Lauderdale, Florida  33308
Florida Cancer Specialists - Sarasota Downtown Sarasota, Florida  34236
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler Savannah, Georgia  31405
Reid Hospital & Health Care Services Richmond, Indiana  47374
McFarland Clinic, PC Ames, Iowa  50010
Covenant Cancer Treatment Center Waterloo, Iowa  50702
Cancer Center of Kansas, PA - Chanute Chanute, Kansas  66720
Cancer Center of Kansas, PA - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas-Independence Independence, Kansas  67301
Cancer Center of Kansas, PA - Kingman Kingman, Kansas  67068
Lawrence Memorial Hospital Lawrence, Kansas  66044
Cancer Center of Kansas, PA - Newton Newton, Kansas  67114
Menorah Medical Center Overland Park, Kansas  66209
Cancer Center of Kansas, PA - Parsons Parsons, Kansas  67357
Cancer Center of Kansas, PA - Pratt Pratt, Kansas  67124
Cancer Center of Kansas, PA - Salina Salina, Kansas  67401
Shawnee Mission Medical Center Shawnee Mission, Kansas  66204
Cancer Center of Kansas, PA - Wellington Wellington, Kansas  67152
Cancer Center of Kansas, PA - Wichita Wichita, Kansas  67214
Associates in Womens Health, PA - North Review Wichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas, PA - Winfield Winfield, Kansas  67156
Ochsner Health Center - Bluebonnet Baton Rouge, Louisiana  70809
Greater Baltimore Medical Center Cancer Center Baltimore, Maryland  21204
Union Hospital Cancer Program at Union Hospital Elkton MD, Maryland  21921
Foote Memorial Hospital Jackson, Michigan  49201
St. Mary Mercy Hospital Livonia, Michigan  48154
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
St. Luke's Hospital Cancer Care Center Duluth, Minnesota  55805
Truman Medical Center - Hospital Hill Kansas City, Missouri  64108
St. Joseph Medical Center Kansas City, Missouri  64114
North Kansas City Hospital Kansas City, Missouri  64116
Saint Luke's Cancer Institute at Saint Luke's Hospital Kansas City, Missouri  64111
Heartland Regional Medical Center Saint Joseph, Missouri  64506
Arch Medical Services, Incorporated at Center for Cancer Care and Research Saint Louis, Missouri  63141
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
Sletten Cancer Institute at Benefis Healthcare Great Falls, Montana  59405
Kalispell Medical Oncology at KRMC Kalispell, Montana  59901
Alegant Health Cancer Center at Bergan Mercy Medical Center Omaha, Nebraska  68124
Leo W. Jenkins Cancer Center at ECU Medical School Greenville, North Carolina  27834
Summa Center for Cancer Care at Akron City Hospital Akron, Ohio  44309-2090
Mary Rutan Hospital Bellefontaine, Ohio  43311
Christ Hospital Cancer Center Cincinnati, Ohio  45219
Grant Medical Center Cancer Care Columbus, Ohio  43215
Mount Carmel St. Ann's Cancer Center Westerville, Ohio  43081
Clinton Memorial Hospital Wilmington, Ohio  45177
Cleo Craig Cancer Research Clinic Lawton, Oklahoma  73505
Cancer Care Associates - Mercy Campus Oklahoma City, Oklahoma  73120
Adventist Medical Center Portland, Oregon  97216
Legacy Good Samaritan Hospital & Comprehensive Cancer Center Portland, Oregon  97210
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Guthrie Cancer Center at Guthrie Clinic Sayre Sayre, Pennsylvania  18840
Hematology and Oncology Associates of Northeastern Pennsylvania Scranton, Pennsylvania  18510
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
Sandra L. Maxwell Cancer Center Cedar City, Utah  84720
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center Murray, Utah  84157
Val and Ann Browning Cancer Center at McKay-Dee Hospital Center Ogden, Utah  84403
St. Joseph Cancer Center Bellingham, Washington  98225
Franciscan Cancer Center at St. Joseph Medical Center Tacoma, Washington  98405-3004
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
Community Comprehensive Cancer Center at Camden-Clark Memorial Hospital Parkersburg, West Virginia  26102
Center for Cancer Treatment & Prevention at Sacred Heart Hospital Eau Claire, Wisconsin  54701
Marshfield Clinic Cancer Care at Regional Cancer Center Eau Claire, Wisconsin  54701
Vince Lombardi Cancer Center at Aurora Lakeland Medical Center - Elkhorn Elkhorn, Wisconsin  53121
Oncology Alliance, SC - Milwaukee - East Glendale, Wisconsin  53212-1038
Saint Joseph's Hospital Marshfield, Wisconsin  54449
Medical Consultants, Limited Milwaukee, Wisconsin  53215
Marshfield Clinic - Lakeland Center Minocqua, Wisconsin  54548
Ministry Medical Group at Saint Mary's Hospital Rhinelander, Wisconsin  54501
Saint Michael's Hospital Cancer Center Stevens Point, Wisconsin  54481
Vince Lombardi Cancer Clinic - Two Rivers Two Rivers, Wisconsin  54241
Marshfield Clinic - Wausau Center Wausau, Wisconsin  54401
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494
Cancer Resource Center at King's Daughters Medical Center Ashland, Kentucky  41101
Mid Dakota Clinic, PC Bismarck, North Dakota  58501
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
Saint Louis University Cancer Center Saint Louis, Missouri  63110
Morton Plant Hospital Clearwater, Florida  33756
John H. Stroger, Jr. Hospital of Cook County Chicago, Illinois  60612-9985
Community Hospital Munster, Indiana  46321
Aurora Sinai Medical Center Milwaukee, Wisconsin  53201-0342
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Rutherford Hospital Rutherfordton, North Carolina  28139
Easton Regional Cancer Center at Easton Hospital Easton, Pennsylvania  18042
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Regional Cancer Center - Erie Erie, Pennsylvania  16505
Glendale Memorial Hospital Comprehensive Cancer Center Glendale, California  91204
North Valley Breast Clinic Redding, California  96001
Sherman Hospital Elgin, Illinois  60120-2198
Jordan Hospital Club Cancer Center Plymouth, Massachusetts  02360
Lapeer Regional Hospital Lapeer, Michigan  48446
St. John's Regional Medical Center Joplin, Missouri  64804
Freeman Cancer Institute at Freeman Health System Joplin, Missouri  64803-2644
New Mexico Cancer Care Associates Santa Fe, New Mexico  87505-7670
Providence Cancer Center Anchorage, Alaska  99508
La Grange Memorial Hospital La Grange, Illinois  60525
Lacks Cancer Center at Saint Mary's Health Care Grand Rapids, Michigan  49503
Metro Health Hospital Grand Rapids, Michigan  49506
Great Falls, Montana  59405
Guardian Oncology and Center for Wellness Missoula, Montana  59804
PinnacleHealth Regional Cancer Center at Polyclinic Hospital Harrisburg, Pennsylvania  17105
Rockwood Clinic Cancer Treatment Center Spokane, Washington  99204-2967
Franklin & Edith Scarpa Regional Cancer Center at South Jersey Healthcare Vineland, New Jersey  08360
Oncology Hematology Associates of Northern Pennsylvania, PC at Hahne Regional Cancer Center Dubois, Pennsylvania  15801
Center for Cancer Care at OSF Saint Anthony Medical Center Rockford, Illinois  61108
Louisville Oncology at Norton Cancer Institute - Louisville Louisville, Kentucky  40202
Scripps Cancer Center - San Diego San Diego, California  92121
Doctors Medical Center - San Pablo Campus San Pablo, California  94806
Galesburg Clinic, PC Galesburg, Illinois  61401
Boston University Cancer Research Center Boston, Massachusetts  02118
St. Vincent Healthcare Cancer Care Services Billings, Montana  59101
Lovelace Medical Center - Gibson Albuquerque, New Mexico  87108
Center for Cancer Care and Research at Watson Clinic, LLP Lakeland, Florida  33805
Providence Medical Center Kansas City, Kansas  66112
Johnson County Radiation Therapy Overland Park, Kansas  66210
Berkshire Hematology Oncology, PC Pittsfield, Massachusetts  01201
Oncology Care Associates, PLLC Saint Joseph, Michigan  49085
Independence Regional Health Center Independence, Missouri  64050
Kansas City Cancer Center at St. Joseph's Medical Mall Kansas City, Missouri  64114
Parvin Radiation Oncology Kansas City, Missouri  64116
Radiation Oncology Associates of Kansas City at Northland Radiation Oncology Center Kansas City, Missouri  64154
Midwest Hematology Oncology Group, Incorporated Saint Louis, Missouri  63109
Lynchburg Hematology-Oncology Clinic Lynchburg, Virginia  24501
East Bay Radiation Oncology Center Castro Valley, California  94546
Larry G Strieff MD Medical Corporation Oakland, California  94609
Tom K Lee, Incorporated Oakland, California  94609
Bay Area Breast Surgeons, Incorporated Oakland, California  94609
Valley Medical Oncology Consultants - Pleasanton Pleasanton, California  94588
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
Alexian Brothers Radiation Oncology Elk Grove Village, Illinois  60007
Hattiesburg Clinic, PA at Forrest General Hattiesburg, Mississippi  39401
Center for Cancer Care at Exeter Hospital Exeter, New Hampshire  03833
John Smith, Jr. - Dalton McMichael Cancer Center at Morehead Memorial Hospital Eden, North Carolina  27288
United States Air Force Medical Center - Wright-Patterson Wright-Patterson AFB, Ohio  45433-5529
Riddle Memorial Hospital Cancer Center Media, Pennsylvania  19063
AnMed Cancer Center Anderson, South Carolina  29621
U.T. Medical Center Cancer Institute Knoxville, Tennessee  37920-6999
Dale and Frances Hughes Cancer Center at Pocono Medical Center East Stroudsburg, Pennsylvania  18301
Associates in Hematology-Oncology, PC at Crozer Regional Cancer Center Upland, Pennsylvania  19013
Saint James Hospital and Health Centers Comprehensive Cancer Institute - Olympia Fields Olympia Fields, Illinois  60461
Medcenter One Hospital Cancer Care Center Bismarck, North Dakota  58501
St. Alexius Medical Center Cancer Center Bismarck, North Dakota  58502
St. Mary's Regional Cancer Center at St. Mary's Medical Center Huntington, West Virginia  25702
Augusta Oncology Associates - Walton Way Augusta, Georgia  30901
Christus Schumpert Cancer Treatment Center Shreveport, Louisiana  71101
CaroMont Cancer Center at Gaston Memorial Hospital Gastonia, North Carolina  28053
Commonwealth Hematology-Oncology, PC - Worcester Worcester, Massachusetts  01605
Hematology Oncology Associates, PC Albuquerque, New Mexico  87106
Valley Medical Oncology Consultants - Castro Valley Castro Valley, California  94546
Valley Medical Oncology Fremont, California  94538
Provena St. Mary's Regional Cancer Center - Kankakee Kankakee, Illinois  60901
Hudner Oncology Center at Saint Anne's Hospital - Fall River Fall River, Massachusetts  02721
Hematology & Oncology Clinic Hattiesburg, Mississippi  39402
Alamance Cancer Center at Alamance Regional Medical Center Burlington, North Carolina  27216
Cape Fear Valley Medical Center Cancer Center Fayetteville, North Carolina  28302-2000
Marion L. Shepard Cancer Center at Beaufort County Hospital Washington, North Carolina  27889
Virginia Cancer Institute - West End Richmond, Virginia  23230
Frankford Hospital Cancer Center - Torresdale Campus Philadelphia, Pennsylvania  19114
Mercy Medical Center Baltimore, Maryland  21202
Hematology and Oncology Associates of Rhode Island Cranston, Rhode Island  02920
Princeton Community Hospital Princeton, West Virginia  24740
Delnor Community Hospital - Geneva Geneva, Illinois  60134
St. Mary's Hospital Leonardtown, Maryland  20650
Kaiser Permanente Capital Area Medical Group - Shady Grove Facility Rockville, Maryland  20850
New York Oncology Hematology, PC at Albany Regional Cancer Care Albany, New York  12208
Amsterdam Community Cancer Program Amsterdam, New York  12010
Riverview Cancer Care Medical Associates, PC Rexford, New York  12148
Samaritan Hospital at Northeast Health Troy, New York  12180
Oncology Hematology Care, Incorporated - Blue Ash Cincinnati, Ohio  45242
Ephrata Cancer Center at Ephrata Community Hospital Ephrata, Pennsylvania  17522
St. Mary Regional Cancer Center at St. Mary Medical Center Walla Walla, Washington  99362
Central Wisconsin Cancer Program at Agnesian HealthCare Fond du Lac, Wisconsin  54935
Richard G. Laube Cancer Center at ACMH Kittanning, Pennsylvania  16201
Clarian Arnett Cancer Care Lafayette, Indiana  47904
St. Agnes Hospital Cancer Center Baltimore, Maryland  21229
Renown Institute for Cancer at Renown Regional Medical Center Reno, Nevada  89502
Clearview Cancer Institute Huntsville, Alabama  35805
California Cancer Care, Incorporated - Greenbrae Greenbrae, California  94904
Kaiser Permanente Mid-Atlantic Medical Group-Largo Medical Facility Largo, Maryland  20774
Kaiser Permanente - Towson Lutherville, Maryland  21093
Kaiser Permanente Medical Center - Fair Oaks Fairfax, Virginia  22033
New York Oncology Hematology, PC at Albany Medical Center Albany, New York  12208
New York Oncology Hematology, PC - Hudson Hudson, New York  12534
Kent General Hospital Dover, Delaware  19901
Pacific Shores Medical Group - Long Beach Long Beach, California  90813
Drs Gurtler Brinz and Russo APMC-Metairie Oncologists Metairie, Louisiana  70006
Harbor View Cancer Center at Harbor Hospital Baltimore, Maryland  21225
Commonwealth Hematology-Oncology, PC - Concord Concord, Massachusetts  01742
Commonwealth Hematology Oncology PC - Dorchester Dorchester, Massachusetts  02124
Commonwealth Hematology-Oncology, PC - Haverhill Haverhill, Massachusetts  01830
Commonwealth Hematology-Oncology, PC - Lawrence Lawrence, Massachusetts  01842
Commonwealth Hematology Oncology PC - Leominster Leominster, Massachusetts  01453
Commonwealth Hematology Oncology PC - Milton Milton, Massachusetts  02186
Commonwealth Hematology-Oncology, PC - Quincy Quincy, Massachusetts  02169
Commonwealth Hematology-Oncology, PC - Stoneham Stoneham, Massachusetts  02180
Commonwealth Hematology-Oncology, PC - Weymouth Weymouth, Massachusetts  02190
New York Oncology Hematology, PC - Latham Latham, New York  12110
Saint Vincent Health Center Erie, Pennsylvania  16544
Texas Oncology, PA at Texas Oncology Cancer Center - Central Austin, Texas  78731
Texas Oncology, PA at South Austin Cancer Center Austin, Texas  78745
Texas Oncology - Midtown Austin Austin, Texas  78705
Texas Oncology, PA at Texas Cancer Center Round Rock Round Rock, Texas  78681
Overlake Cancer Center at Overlake Hospital Medical Center Bellevue, Washington  98004
Cancer Care Northwest - North Spokane, Washington  99218