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A Phase III Clinical Trial Comparing the Combination of TC Plus Bevacizumab to TC Alone and to TAC for Women With Node-Positive or High-Risk Node-Negative, HER2-Negative Breast Cancer


Phase 3
18 Years
70 Years
Open (Enrolling)
Female
Breast Cancer

Thank you

Trial Information

A Phase III Clinical Trial Comparing the Combination of TC Plus Bevacizumab to TC Alone and to TAC for Women With Node-Positive or High-Risk Node-Negative, HER2-Negative Breast Cancer


The B-46-I/07132 study, a multicenter, open-label, randomized Phase III, adjuvant therapy
trial, will compare the value of adding bevacizumab to a non-anthracycline-based
chemotherapy regimen relative to the same chemotherapy without bevacizumab and relative to
an anthracycline-based chemotherapy regimen in women with resected node-positive or
high-risk node-negative, HER2-negative breast cancer. This trial will determine whether the
addition of bevacizumab to a regimen of docetaxel and cyclophosphamide (TCB) improves
invasive disease-free survival relative to docetaxel and cyclophosphamide alone (TC). A
secondary aim will be to determine whether the addition of bevacizumab to TC improves
invasive disease-free survival compared to a regimen of docetaxel, doxorubicin, and
cyclophosphamide (TAC). Other secondary aims include whether TCB improves disease-free
survival, overall survival, and recurrence-free interval relative to TC alone and to TAC.
The toxicities of the three regimens will also be compared.

Patients in the B-46-I/07132 study will be randomized to one of three treatment regimens:
Group 1 patients will receive 6 cycles of TAC administered every 21 days (docetaxel 75
mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2); Group 2 patients will receive
6 cycles of TC administered every 21 days (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2);
and Group 3 patients will receive 6 cycles of TCB every 21 days with bevacizumab therapy
continuing every 21 days after completion of chemotherapy until 1 year following the first
dose (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2, and bevacizumab 15 mg/kg). Primary
prophylaxis with pegfilgrastim or filgrastim is required for Group 1 patients (optional for
patients in Groups 2 and 3). Patients will also receive adjuvant radiation therapy as
clinically indicated and endocrine therapy for hormone receptor-positive tumors.

Tumor samples will be submitted for correlative science studies to evaluate predictors of
study therapy benefit. Submission of a tumor sample is a study requirement for all
patients.


Inclusion Criteria:



- Patients must be female.

- The patient must be greater than or equal to 18 years of age and less than or equal
to 70 years of age.

- The patient must have an Eastern Cooperative Oncology Group (ECOG) performance status
of 0 or 1.

- The tumor must be unilateral invasive adenocarcinoma of the breast on histologic
examination.

- The breast cancer must be HER2-negative based on current American Society of Clinical
Oncology (ASCO)/College of American Pathologists (CAP) Guideline Recommendations for
Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer. If the result of
the in situ hybridization testing (FISH, chromagen in situ hybridization (CISH), or
other) is equivocal, the patient is eligible if there is no plan to administer
HER2-targeted therapy.

- All of the following staging criteria (according to the 6th edition of the American
Joint Committee on Cancer (AJCC) Cancer Staging Manual) must be met: By pathologic
evaluation, primary tumor must be pT1-3; By pathologic evaluation, ipsilateral nodes
must be pN0, pN1 (pN1mi, pN1a, pN1b, pN1c), pN2a, pN3a, or pN3b. If pN0, at least one
of the following criteria must be met: ER negative and PgR negative; or Pathologic
tumor size greater than 2.0 cm; or T1c (pathologic tumor size greater than 1.0 cm but
less than or equal to 2.0 cm) and ER positive (PgR status may be positive or
negative) and either Oncotype DX® Recurrence Score of greater than or equal to 25 or
grade 3 histology.

- Patients must have undergone either a total mastectomy or breast-conserving surgery
(lumpectomy).

- For patients who undergo lumpectomy, the margins of the resected specimen must be
histologically free of invasive tumor and DCIS as determined by the local
pathologist. If pathologic examination demonstrates tumor at the line of resection,
additional operative procedures must be performed to obtain clear margins. If tumor
is still present at the resected margin after re-excision(s), the patient must
undergo total mastectomy to be eligible. (Patients with margins positive for lobular
carcinoma in situ [LCIS] are eligible without additional resection.)

- For patients who undergo mastectomy, margins must be histologically free of invasive
tumor and DCIS.

- Patients must have completed one of the following procedures for evaluation of
pathologic nodal status: Sentinel lymphadenectomy alone if pathologic nodal staging
based on sentinel lymphadenectomy is pN0, pN1mi, or pN1b; Sentinel lymphadenectomy
followed by removal of additional non-sentinel lymph nodes if the sentinel node (SN)
is positive; or Axillary lymphadenectomy without SN isolation procedure.

- The interval between the last surgery for breast cancer (treatment or staging) and
randomization must be at least 28 days but no more than 84 days.

- Patients must have ER analysis performed on the primary tumor prior to randomization.
If ER analysis is negative, then PgR analysis must also be performed. (Either a
core biopsy or surgical resection specimen can be used for ER/PgR testing.)

- The most recent postoperative blood counts must meet the following criteria: Absolute
neutrophil count (ANC) must be greater than or equal to 1200/mm3; platelet count must
be greater than or equal to 100,000/mm3; and hemoglobin must be greater than or equal
to 10 g/dL.

- The following criteria for evidence of adequate hepatic function must be met based on
the results of the most recent postoperative tests: total bilirubin must be less than
or equal to upper limits of normal (ULN)for the lab unless the patient has a
bilirubin elevation less than ULN to 1.5 x ULN due to Gilbert's disease or similar
syndrome involving slow conjugation of bilirubin; and alkaline phosphatase must be
less than or equal to 2.5 x ULN for the lab; and AST must be less than or equal to
1.5 x ULN for the lab. Alkaline phosphatase and aspartate transaminase (AST) may not
both be greater than the ULN. For example, if the alkaline phosphatase is greater
than the ULN but less than or equal to 2.5 x ULN, then the AST must be less than or
equal to the ULN. If the AST is greater than the ULN but less than or equal to 1.5 x
ULN, then the alkaline phosphatase must be less than or equal to ULN.

- Patients with AST or alkaline phosphatase greater than ULN are eligible for inclusion
in the study if liver imaging (CT, MRI, PET-CT, or PET scan) does not demonstrate
metastatic disease and the requirements for adequate hepatic function are met.

- Patients with alkaline phosphatase that is greater than ULN but less than or equal to
2.5 x ULN are eligible for inclusion in the study if a bone scan, PET-CT, or PET scan
does not demonstrate metastatic disease.

- The most recent postoperative serum creatinine must be less than or equal to ULN for
the lab.

- A urine sample must be tested for proteinuria by the dipstick method. Eligibility
must be based on the most recent postoperative test result(s) performed within 6
weeks prior to randomization. Urine dipstick must indicate 0-1+ protein. If
dipstick reading is greater than or equal to 2+, a 24-hour urine specimen must be
collected and must demonstrate less than 1 gram of protein.

- Left ventricular ejection fraction (LVEF) assessment by 2-D echocardiogram or
multigated acquisition (MUGA) scan must be performed within 90 days prior to
randomization. The LVEF must be greater than or equal to 50% regardless of the
facility's lower limits of normal (LLN).

Exclusion Criteria:

- T4 tumors including inflammatory breast cancer.

- Definitive clinical or radiologic evidence of metastatic disease.

- Synchronous or metachronous contralateral invasive breast cancer. (Patients with
synchronous and/or metachronous contralateral DCIS are eligible.)

- Any history of ipsilateral invasive breast cancer or ipsilateral DCIS.

- History of non-breast malignancies within 5 years prior to randomization, except for
the following: carcinoma in situ of the cervix, colorectal carcinoma in situ,
melanoma in situ, and basal cell and squamous cell carcinomas of the skin.

- Previous therapy with anthracyclines, taxanes, or bevacizumab for any malignancy.

- Chemotherapy administered for the currently diagnosed breast cancer prior to
randomization.

- Continued therapy with any hormonal agent such as raloxifene or tamoxifen (or other
SERM) or an aromatase inhibitor. (Patients are eligible if these medications are
discontinued prior to randomization.)

- Any sex hormonal therapy, e.g., birth control pills, ovarian hormone replacement
therapy. Patients are eligible if these medications are discontinued prior to
randomization.

- Active hepatitis B or hepatitis C with abnormal liver function tests.

- Cardiac disease (history of and/or active disease) that would preclude the use of the
drugs included in the treatment regimens. This includes but is not confined to 1)
Active cardiac disease: angina pectoris that requires the use of anti-anginal
medication; ventricular arrhythmias except for benign premature ventricular
contractions; supraventricular and nodal arrhythmias requiring a pacemaker or not
controlled with medication; conduction abnormality requiring a pacemaker; valvular
disease with documented compromise in cardiac function; and symptomatic pericarditis,
2) History of cardiac disease: myocardial infarction documented by elevated cardiac
enzymes or persistent regional wall abnormalities on assessment of left ventricular
(LV) function; history of documented congestive heart failure (CHF); and documented
cardiomyopathy.

- Uncontrolled hypertension defined as systolic BP greater than 150 mmHg or diastolic
BP greater than 90 mmHg, with or without anti-hypertensive medication. Patients with
initial BP elevations are eligible if initiation or adjustment of BP medication
lowers pressure to meet entry criteria.

- History of hypertensive crisis or hypertensive encephalopathy.

- History of transient ischemic attack (TIA) or cerebrovascular accident (CVA).

- History of any arterial thrombotic event within 12 months prior to randomization.

- Symptomatic peripheral vascular disease.

- Intrinsic lung disease resulting in dyspnea.

- Unstable diabetes mellitus.

- Active infection or chronic infection requiring suppressive antibiotics.

- History of a major organ allograft or condition requiring chronic immunosuppression,
e.g., kidney, liver, lung, heart, bone marrow transplant, or autoimmune diseases.
(Patients who have received corneal transplants, cadaver skin, or bone transplants
are eligible.)

- Any significant bleeding within 180 days prior to randomization, exclusive of
menorrhagia in premenopausal women.

- Non-healing wound, skin ulcers, or incompletely healed bone fracture.

- Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to the planned start of study therapy.

- Anticipation of need for major surgical procedures during study therapy and for at
least 3 months following completion of bevacizumab.

- Gastroduodenal ulcer(s) documented by endoscopy to be active within 6 months before
randomization.

- History of GI perforation, abdominal fistulae, or intra-abdominal abscess.

- Known bleeding diathesis or coagulopathy.

- Requirement for therapeutic doses of coumadin or equivalent.

- Sensory/motor neuropathy greater than or equal to grade 2, as defined by the NCI
Common Terminology Criteria for Adverse Events (CTCAE) v3.0.

- Conditions that would prohibit administration of corticosteroids.

- Chronic daily treatment with corticosteroids (dose of greater than or equal to 10
mg/day methylprednisolone equivalent) (excluding inhaled steroids).

- History of hypersensitivity reaction to drugs formulated with polysorbate 80.

- Pregnancy or lactation at the time of study entry.

- Other non-malignant systemic disease that would preclude the patient from receiving
study treatment or would prevent required follow-up.

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

- Use of any investigational product within 4 weeks prior to randomization.

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Invasive disease-free survival(IDFS)relative to the TAC chemotherapy regimen alone

Outcome Time Frame:

Every 12 months until recurrence

Safety Issue:

No

Principal Investigator

Norman Wolmark, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

NSABP Foundation, Inc.

Authority:

United States: Food and Drug Administration

Study ID:

NSABP B-46-I

NCT ID:

NCT00887536

Start Date:

May 2009

Completion Date:

January 2022

Related Keywords:

  • Breast Cancer
  • National Surgical Adjuvant Breast and Bowel Project (NSABP)
  • Taxotere
  • Docetaxel
  • Doxorubicin
  • Cyclophosphamide
  • Bevacizumab
  • Breast Neoplasms
  • Adenocarcinoma
  • Breast Diseases
  • Carcinoma
  • HER2 negative
  • Node negative
  • High risk node positive
  • Adjuvant Therapy
  • Breast Neoplasms

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Akron City Hospital Akron, Ohio  44304
Suburban Hospital Bethesda, Maryland  20814
University of Iowa Iowa City, Iowa  52242
MD Anderson Cancer Center Houston, Texas  77030-4096
Fred Hutchinson Cancer Research Center Seattle, Washington  98109
Stanford University Medical Center Stanford, California  94305-5408
Medical University of South Carolina Charleston, South Carolina  29425-0721
CCOP - Kansas City Kansas City, Missouri  64131
CCOP - Mount Sinai Medical Center Miami Beach, Florida  33140
CCOP - North Shore University Hospital Manhasset, New York  11030
CCOP - Colorado Cancer Research Program, Inc. Denver, Colorado  80209-5031
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
St. Vincent Hospital and Health Care Center Indianapolis, Indiana  46260
Porter Adventist Hospital Denver, Colorado  80210
Swedish Medical Center Englewood, Colorado  80110
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center Grand Junction, Colorado  81502
Hinsdale Hematology Oncology Associates Hinsdale, Illinois  60521
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
St. Luke's Regional Medical Center Sioux City, Iowa  51104
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
Fairview Southdale Hospital Edina, Minnesota  55435
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
Regions Hospital Cancer Care Center St. Paul, Minnesota  55101
Geisinger Medical Group - Scenery Park State College, Pennsylvania  16801
Avera Cancer Institute Sioux Falls, South Dakota  57105
Medical College of Wisconsin Milwaukee, Wisconsin  53226
Ingalls Memorial Hospital Harvey, Illinois  60426
Marquette General Hospital Marquette, Michigan  49855
St. Louis University Health Sciences Center Saint Louis, Missouri  63110-0250
Newark Beth Israel Medical Center Newark, New Jersey  07112
CCOP - Dayton Kettering, Ohio  45429
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
LDS Hospital Salt Lake City, Utah  84143
Rush University Medical Center Chicago, Illinois  60612-3824
Providence Hospital - Southfield Southfield, Michigan  48075-9975
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Franklin Square Hospital Center Baltimore, Maryland  21237
Michigan State University East Lansing, Michigan  48824
Utah Valley Regional Medical Center - Provo Provo, Utah  84604
Camden-Clark Memorial Hospital Parkersburg, West Virginia  26102
Cancer Institute of New Jersey New Brunswick, New Jersey  08901
Southern California Permanente Medical Group Downey, California  90242
Kaiser Permanente Medical Center - San Francisco Geary Campus San Francisco, California  94115
Creighton University Cancer Center Omaha, Nebraska  68131-2197
Cancer Institute of New Jersey at Hamilton Hamilton, New Jersey  08690
Virginia Oncology Associates Newport News, Virginia  23606
University of Florida Shands Cancer Center Gainesville, Florida  32610-0232
CCOP - Marshfield Clinic Research Foundation Marshfield, Wisconsin  54449
Sibley Memorial Hospital Washington, District of Columbia  20016
Somerset Medical Center Somerville, New Jersey  08876
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Baptist Cancer Institute - Jacksonville Jacksonville, Florida  32207
Siouxland Hematology-Oncology Associates Sioux City, Iowa  51101
Wayne Memorial Hospital, Incorporated Goldsboro, North Carolina  27534
McKay-Dee Hospital Center Ogden, Utah  84403
Rocky Mountain Cancer Center Denver, Colorado  80218
Kaiser Permanente Medical Center - Santa Clara Kiely Campus Santa Clara, California  95051-5386
Advocate Lutheran General Cancer Care Center Park Ridge, Illinois  60068-1174
Ocala Oncology Center Ocala, Florida  34474
Kaiser Permanente Medical Center - Sacramento Sacramento, California  95825
University of Colorado Denver, Colorado  80217
Decatur Memorial Hospital Cancer Care Institute Decatur, Illinois  62526
Florida Cancer Specialists Fort Myers, Florida  33901
Front Range Cancer Specialists Fort Collins, Colorado  80528
Morton Plant Mease Health Care Clearwater, Florida  33756
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Kaiser Permanente Medical Center - Redwood City Redwood City, California  94063
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Poudre Valley Hospital Fort Collins, Colorado  80524
Bay Regional Medical Center Bay City, Michigan  48708
Park Nicollet Health Services St. Louis Park, Minnesota  55416
Good Samaritan Hospital Dayton, Ohio  45406
Providence St. Vincent Medical Center Portland, Oregon  97225
Dixie Regional Medical Center - East Campus Saint George, Utah  84770
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Carle Foundation Hospital Urbana, Illinois  61801
Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Geisinger Wyoming Valley Medical Center Wilkes-Barre, Pennsylvania  18711
Saint Luke's Hospital Chesterfield, Missouri  63017
Missouri Cancer Associates Columbia, Missouri  65201
Covenant Cancer Treatment Center Waterloo, Iowa  50702
Menorah Medical Center Overland Park, Kansas  66209
Research Medical Center Kansas City, Missouri  64132
Wayne Hospital Greenville, Ohio  45331
Clinton Memorial Hospital Wilmington, Ohio  45177
Geisinger Hazleton Cancer Center Hazleton, Pennsylvania  18201
Sandra L. Maxwell Cancer Center Cedar City, Utah  84720
North Memorial Health Care Robbinsdale, Minnesota  55422
Pacific Shores Medical Group Long Beach, California  90813
Rocky Mountain Cancer Centers Thornton, Colorado  80260
Genesis Medical Center Davenport, Iowa  52804
Community Hospital Munster, Indiana  46321
Consultants in Blood Disorders and Cancer Louisville, Kentucky  40207
Tulane University Medical Center New Orleans, Louisiana  70112
St. Luke's Hospital Duluth, Minnesota  55805-2193
Baton Rouge General Medical Center Baton Rouge, Louisiana  70821-2511
Aurora Sinai Medical Center Milwaukee, Wisconsin  53201-0342
Greater Baltimore Medical Center Baltimore, Maryland  21204
AnMed Health Cancer Center Anderson, South Carolina  29621
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
Sutter Roseville Medical Center Roseville, California  95661
Saint Anne's Hospital Fall River, Massachusetts  02721
Lapeer Regional Hospital Lapeer, Michigan  48446
Memorial Healthcare Owosso, Michigan  48867
New Mexico Cancer Care Associates Santa Fe, New Mexico  87505-7670
Ephrata Community Hopital Ephrata, Pennsylvania  17522-1002
Riddle Memorial Hospital Media, Pennsylvania  19063
Spartanburg Regional Healthcare System Spartanburg, South Carolina  29303
St. Charles Medical Center - Bend Bend, Oregon  97701
Rockwood Clinic Cancer Treatment Center Spokane, Washington  99204-2967
University of Pittsburgh Pittsburgh, Pennsylvania  15261
Tyler Cancer Center Tyler, Texas  75702
Rittenhouse Hematology/Oncology Philadelphia, Pennsylvania  19146
San Antonio Tumor and Blood Clinic San Antonio, Texas  78217
Associates in Hematology-Oncology, PC at Crozer Regional Cancer Center Upland, Pennsylvania  19013
Berkshire Hematology Oncology, P.C. Pittsfield, Massachusetts  01201
Froedtert Hospital Milwaukee, Wisconsin  53226-3596
University of Connecticut Farmington, Connecticut  06032
Henry Ford Health System Detroit, Michigan  48202
Holy Cross Hospital Fort Lauderdale, Florida  33308
High Point Regional Hospital High Point, North Carolina  27261
Cancer Center at Glens Falls Hospital Glens Falls, New York  12801
University of Texas Health Science Center San Antonio, Texas  78284
Albert Einstein Healthcare Network Philadelphia, Pennsylvania  19141
New York University School of Medicine New York, New York  10016
Interlakes Oncology & Hematology, P.C. Rochester, New York  14623
University of Kentucky Medical Center Lexington, Kentucky  40536-0093
Alegent Health Immanuel Medical Center Omaha, Nebraska  68122
Alegent Health Bergan Mercy Medical Center Omaha, Nebraska  68124
Cape Fear Valley Medical Center Cancer Center Fayetteville, North Carolina  28302-2000
Cancer Centers of Florida, P.A. Orlando, Florida  
Texas Oncology Dallas, Texas  
North Texas Regional Cancer Center Plano, Texas  75075
Santa Barbara Hematology Oncology Medical Group Lompoc, California  93438
Ventura County Hematology-Oncology Specialists Oxnard, California  93030
Thomas Jefferson University Hospital Philadelphia, Pennsylvania  19131
Medical Oncology Associates Kingston, Pennsylvania  18704
Central Indiana Cancer Centers Indianapolis, Indiana  46227
Mercy Medical Center Baltimore, Maryland  21202
South Austin Cancer Center Austin, Texas  78745
Texas Cancer Center at Medical City Dallas, Texas  75230
Allison Cancer Center Midland, Texas  79701
Texoma Cancer Center Wichita Falls, Texas  76310
Arlington Fairfax Hematology Oncology Arlington, Virginia  22205
Frederick Memorial Hospital Frederick, Maryland  21701
Holy Cross Hospital Silver Spring, Maryland  20910
Amsterdam Community Cancer Program Amsterdam, New York  12010
New York Oncology Hematology, P.C. at Cavell Cancer Treatment Program Hudson, New York  12534
Highline Medical Oncology Burien, Washington  98166
Florida Hospital Orlando, Florida  32803
Suburban Hematology-Oncology Associates Lawrenceville, Georgia  30045
Memorial Health University Medical Center Savannah, Georgia  31404
Southwest Fort Worth Cancer Center Fort Worth, Texas  76132
Clarian Arnett Cancer Care Lafayette, Indiana  47904
Hematology Oncology Associates Phoenix, Arizona  85012
New York Oncology Hematology, PC at Albany Medical Center Albany, New York  12208
Virginia Oncology Associates - Lake Wright Norfolk, Virginia  23502
Northwest Georgia Oncology Centers Marietta, Georgia  30060
Greater Dayton Cancer Center Kettering, Ohio  45409
Vince Lombardi Cancer Clinic - Oshkosh Oshkosh, Wisconsin  54904
Shaw Regional Cancer Center Edwards, Colorado  81632
Birmingham Hematology and Oncology Birmingham, Alabama  35235
Rocky Mountain Cancer Center - Midtown Denver, Colorado  80218
Texas Cancer Center Abilene, Texas  79606
Mamie McFaddin Ward Cancer Center Beaumont, Texas  77702
Lake Vista Cancer Center Lewisville, Texas  75067
Longview Cancer Center Longview, Texas  75601
Texas Cancer Center of Mesquite Mesquite, Texas  75150
Kaiser Permanente-Oakland Oakland, California  94611
Kaiser Permanente-South San Francisco South San Francisco, California  94080
Phoebe Putney Memorial Hospital Albany, Georgia  31703
University of Hawaii Honolulu, Hawaii  96813
Edward Hospital Naperville, Illinois  60566
Finley Hospital Dubuque, Iowa  52001
McLaren Regional Medical Center Flint, Michigan  48532
Unity Hospital Fridley, Minnesota  55432
Alamance Regional Medical Center Burlington, North Carolina  27216
Kettering Medical Center Kettering, Ohio  45429
Upper Valley Medical Center Troy, Ohio  45373
Pocono Medical Center East Stroudsburg, Pennsylvania  18301
Scranton Hematology Oncology Scranton, Pennsylvania  18510
Wheeling Hospital Wheeling, West Virginia  26003
Marshfield Clinic at James Beck Cancer Center Rhinelander, Wisconsin  54501
Aspirus Regional Cancer Center Wausau, Wisconsin  54401
Northern Arizona Hematology & Oncology Associates Sedona, Arizona  86336
New York Oncology Hematology, PC Albany, New York  12208
Breastlink Medical Group, Incorporated at Long Beach Memorial Medical Center Long Beach, California  90806
Minnesota Oncology Hematology Minneapolis, Minnesota  55404
South Texas Cancer Center - McAllen McAllen, Texas  78503-1298
Paris Regional Cancer Center Paris, Texas  75460
University of North Carolina at Chapel Hill Chapel Hill, North Carolina  27599
Antelope Valley Cancer Center Lancaster, California  93534
Central Coast Medical Oncology Corporation Santa Maria, California  93454
Tennessee Oncology Nashville, Tennessee  37203
Aultman Hospital Canton, Ohio  44710
Cancer Care & Hematology Specialists of Chicagoland Niles, Illinois  60714
US Oncology Houston, Texas  77060
Renown Regional Medical Center Reno, Nevada  89502
East Carolina University Greenville, North Carolina  27858
Texas Oncology - Round Rock Cancer Center Round Rock, Texas  78681
Texas Oncology PA Dallas, Texas  75231
HOAST - New Braunfels New Braunfels, Texas  78131
Cancer Care Northwest-South Spokane, Washington  99202
Hematology-Oncology Associates of NNJ, PA Morristown, New Jersey  07960
Alliance Hematology Oncology PA Westminster, Maryland  21157
Kaiser Permanente Santa Teresa San Jose, California  95119
Aurora Women's Pavilion of Aurora West Allis Medical Center West Allis, Wisconsin  53227
Texas Oncology Cancer Care and Research Center Waco, Texas  76712
Geisinger Clinic Danville, Pennsylvania  17822
MD Anderson Cancer Center Orlando, Florida  32806
Fairfax-Northern Virginia Hematology-Oncology PC Fairfax, Virginia  22031
Kansas City Cancer Centers - East Lee's Summit, Missouri  64064
Cancer Centers of North Carolina Raleigh, North Carolina  27607
Mount Clemens Regional Medical Center Mount Clemens, Michigan  48043
Kansas City Cancer Center - South Kansas City, Missouri  64131
Florida Cancer Institute - New Hope New Port Richey, Florida  34655
Texas Oncology, PA - Cedar Park Cedar Park, Texas  78613
Willamette Valley Cancer Institute and Research Center Springfield, Oregon  97477
Clearview Cancer Institute- Huntsville Huntsville, Alabama  35801
Kaiser Permanente-San Diego San Diego, California  92120
NortonHealtcare Inc. Louisville, Kentucky  40202
Allegheny General Hospital/Allegheny-Singer Research Institute Pittsburgh, Pennsylvania  15212
Joe Arrington Cancer Research & Treatment Center Lubbock, Texas  79410
MBCCOP, Virginia Commonwealth University Richmond, Virginia  23298
St. Joseph Hospital Orange, California  92868
Sutter Medical Center Sacramento, California  95816
Kaiser Permanente-Franklin Denver, Colorado  80205
Kaiser Permanente Rock Creek Lafayette, Colorado  80026
Kaiser Permanente Hawaii - Moanalua Med Center Honolulu, Hawaii  96819
CCOP, William Beaumont Hospital Royal Oak, Michigan  48073
University of Missouri-Ellis Fischel Columbia, Missouri  65203
New York Oncology Hematology PC-Albany Albany, New York  12206
West Virginia University Hospitals Inc. Morgantown, West Virginia  26506-9162
Columbia Basin Hematology and Oncology Kennewick, Washington  99336
Raleigh Regional Cancer Center Beckley, West Virginia  25801
Trivalley Oncology Hematology Westlake Village, California  91361
Cancer Care and Hematology Specialists of Chicagoland Niles, Illinois  60714
Sparta Cancer Center Sparta, New Jersey  07871
Texas Oncology - Odessa Odessa, Texas  79761
St. Jude Heritage Healthcare Fullerton, California  92835
Puget Sound Cancer Center - Seattle Seattle, Washington  98133
Texas Oncology Cancer Center - Sugar Land Sugar Land, Texas  77479
Northern Arizona Hematology & Onclogy Associates Flagstaff, Arizona  86001
Central Hematology/Oncology Medical Group, Inc. Alhambra, California  91801
CCOP, St. Joseph Mercy Hospital Ann Arbor, Michigan  48106
CCOP, Sparrow Health System Lansing, Michigan  48909
CCOP, St. Mary's Medical Center Saginaw, Michigan  48601
CCOP, St. John Macomb Hospital Warren, Michigan  48093
Minnesota Oncology Hematology-Burnsville Burnsville, Minnesota  55337
Minnesota Oncology Hematology-Edina Edina, Minnesota  55435
Minnesota Oncology Hematology PA - Maplewood Maplewood, Minnesota  55109
Minnesota Oncology Hematology-Minneapolis Minneapolis, Minnesota  55407
Minnesota Hematology Oncology-St. Paul St. Paul, Minnesota  55102
Comprehensive Cancer Centers of Nevada (Siena) Henderson, Nevada  89052
Troy Cancer Treatment Program Troy, New York  12180
Northwest Cancer Specialists-Portland Portland, Oregon  97213
Texas Oncology- Sammons CC Dallas, Texas  75246
Northwest Cancer Specialists-136th Ave Vancouver, Washington  98684
Northwest Cancer Specialists-134th St. Vancouver, Washington  98686
New York Oncology Hematology PC Albany, New York  12206
Providence Medical Center Portland, Oregon  97213
Methodist Charlton Cancer Center Dallas, Texas  75237
El Paso Cancer Treatment Center - East El Paso, Texas  79915
Birmingham Hematology and Oncology - Pilot Birmingham, Alabama  35235
Birmingham Hematology and Oncology - Princeton Birmingham, Alabama  35211
Birmingham Hematology and Oncology - Montclair Birmingham, Alabama  35213
Birmingham Hematology and Oncology - Brookwood Birmingham, Alabama  35209
Arizona Oncolocy (CASA-Green Valley) Green Valley, Arizona  85614
Arizona Oncology (CASA- Oro Valley) Oro Valley, Arizona  85737
Arizona Oncology (CASA-Safford) Safford, Arizona  85546
Arizona Oncology Associates - Carondelet Tucson, Arizona  85710
Arizona Oncology - CASA St. Mary's Tucson, Arizona  85745
Arizona Oncology (CASA-Office Only) Tucson, Arizona  85715
Arizona Oncology Associates - Rudasill Tucson, Arizona  85704
Arizona Oncology (CASA-Craycroft) Tucson, Arizona  85712
Kaiser Permanente Deer Valley Med Center Antioch, California  94531
Comp Blook and Cancer Center Bakersfield, California  93309
Southwest Cancer Care (E. Grand) Escondido, California  92025
Kaiser Permanente Fremont Fremont, California  94538
Wilshire Oncology Medical Group (Business Office) La Verne, California  91750
Todd Cancer Institute at Long Beach Memorial Med Cent Long Beach, California  90806
TORI- N Valley Hematology Oncology Med Group Mission Hills, California  91345
TORI - Oncology Care Medical Assoc. Montebello, California  90640
Southwest Cancer Care (Medical Center) Murrieta, California  92562
NValley Hematology/Oncology Medical Group Northridge, California  91325
Kaiser Permanente Roseville Roseville, California  95678
TORI - Oncology Care Med Assoc San Gabriel, California  91776
Kaiser Permanente San Rafael San Rafael, California  94903
Santa Barbara II (Samsum Clinic) - TORI Santa Barbara, California  93105
Santa Barbara Hematology/Oncology Medical Group, Inc Solvang, California  93463
Kaiser Permanente, South Sacramento South Sacramento, California  95823
Olive View/UCLA Medical Center Sylmar, California  91342
Kaiser Permanente Medical Center Vacaville Vacaville, California  95688
Westlake Infusion Center Westlake Village, California  91361
Medical Center of Aurora Aurora, Colorado  80012
Rocky Mountain Cancer Centers - Boulder Boulder, Colorado  80303
Rocky Mountain Cancer Center - CO Springs Colorado Springs, Colorado  80909
Rocky Mountain Cancer Center at the Pivillion- Fontanero Colorado Springs, Colorado  80907
Penrose/St. Francis Healthcare System Colorado Springs, Colorado  80907
Rocky Mountain Cancer Center - 9th Avenue Denver, Colorado  80220
Rocky Mountain Cancer Center - Rose Denver, Colorado  80220
Exempla St. Joseph Hospital Denver, Colorado  80218
St. Mary's Hospital and Medical Center Grand Junction, Colorado  81502-1628
Rocky Mountain Cancer Center - Dry Creek Littleton, Colorado  80120-4413
Rocky Mountain Cancer Center- Sky Ridge Lone Tree, Colorado  80124
Rocky Mountain Cancer Center - Longmont Longmont, Colorado  80501
Washington Regional Cancer Center Washington, District of Columbia  20010
SCRI - Florida Cancer Specialists- Bonita Springs Bonita Springs, Florida  34135
SCRI - Florida Cancer Specialists - Bradenton Bradenton, Florida  34209
SCRI Florida Cancer Specialists - Cape Coral (811) Cape Coral, Florida  33990
SCRI Florida Cancer Specialists - Cape Coral (1708) Cape Coral, Florida  33914
SCRI Florida Cancer Specialists - Englewood Englewood, Florida  33990
SCRI Florida Cancer Specialists- Fort Myers (Veronica) Fort Myers, Florida  33916
SCRI Florida Cancer Specialists - Ft. Myers (Broadway) Fort Myers, Florida  33908
SCRI Florida Cancer Specialists - Fort Myers (Hampshire) Fort Myers, Florida  33908
Integrated Community Oncology Network (ICON) Jacksonville, Florida  32207
TORI-ICON St.Aug Jacksonville, Florida  32258
TORI-ICON - Shircl Jacksonville, Florida  32204
CCOP, Jupiter Medical Cener Jupiter, Florida  33458
Ocala Oncology Center - Lady Lake Lady Lake, Florida  32159
Melbourne International Medicine Associates Melbourne, Florida  32901
Advanced Medical Specialties - N. Kendall (STE 905E) Miami, Florida  33176
Advanced Medical Specialties - AMS Miami, Florida  33133
Advanced Medical Specialists- Sunset Miami, Florida  33143
Advanced Medical Specialties - N Kendall (STE 300E) Miami, Florida  33176
SCRI Florida Cancer Specialists - Naples (Goodlette) Naples, Florida  34102
SCRI Florida Cancer Specialists - Naples (Pine) Naples, Florida  34119
Tori-Icon Orange Park, Florida  32073
SCRI - Florida Cancer Specialists - Port Charlotte Port Charlotte, Florida  33980
SCRI Florida Cancer Specialists - Sarasota (Cattleman) Sarasota, Florida  34232
SCRI- Florida Cancer Specialists - Sarasota Sarasota, Florida  34236
SCRI - Florida Cancer Specialists - Armenia Tampa, Florida  33603
SCRI - Florida Cancer Specialists - Tampa Tampa, Florida  33607
SCRI Florida Cancer Specilaists - Venice Venice, Florida  34292
SCRI Florida Cancer Specialists - Venice (Tamiami) Venice, Florida  34285
Dublin Hematology/Oncology Dublin, Georgia  31021
SCRI Chattanooga Oncol & Hematol Assoc, PC - Ringgold Ringgold, Georgia  30736
CCOP NorthShore University HealthSystem Evanston, Illinois  60201
Carle Cancer Center, CCOP Urbana, Illinois  61801
Central Indiana Cancer Centers (E. County) Indianapolis, Indiana  46227
Kansas Cty Cancer Center - West Kansas City, Kansas  66112
Kansas City Cancer Center (CBO) Overland Park, Kansas  66210
Kansas CityCancer Centers - Southwest Overland Park, Kansas  66210
Kansas City Cancer Center, Shawnee Mission Shawnee Mission, Kansas  66204
SCRI Oncology Hematology Care, Inc. Crestview Hills (CVH) Crestview Hills, Kentucky  41017
Christus St. Frances Cabrini Hospital Alexandria, Louisiana  71301
St. Joseph's Medical Center Baltimore, Maryland  21204-7582
SCRI - Center for Cancer and Blood Disorders Bethesda, Maryland  20817
Chevy Chase Healthcare Management, LLC Chevy Chase, Maryland  20815
Maryland Oncology Hematology PA Columbia, Maryland  21044
Penisula Regional Medical Center Salisbury, Maryland  21801
CCOP - Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
CCOP - St. John Hospital and Medical Center Detroit, Michigan  48236-2172
CCOP - Hurley Medical Center Flint, Michigan  48503
CCOP - Genesys Regional Hospital Flint, Michigan  48503
CCOP - Allegiance Health Jackson, Michigan  49201
Ingham Regional Medical Center - Lansing Lansing, Michigan  48910-0817
CCOP - St. Mary Mercy Hospital - Livonia Livonia, Michigan  48154
CCOP - St. Joseph Mercy Hospital - Oakland Pontiac, Michigan  48341
CCOP - St. Joseph Mercy Port Huron Port Huron, Michigan  48060
St. John's Hospital Northeast/HealthEast, Inc. Maplewood, Minnesota  55109
Kansas City Cancer Center - Central Kansas City, Missouri  64111
Kansas City Cancer Center - North Kansas City, Missouri  64154
St. Elizabeth Community Health Center Lincoln, Nebraska  68510
Nebraska Cancer Research Center Lincoln, Nebraska  68510
CCOP, Missouri Valley Cance Consortium Omaha, Nebraska  68131
Alegent Health Midlands Hospital Papillion, Nebraska  68046
Comprehensive Cancer Centers of Nevada (Wigwam) Henderson, Nevada  89074
US Oncology West Region Office (Horizon Ridge) Henderson, Nevada  89052
Comprehensive Cancer Centers of Nevada (Twain) Las Vegas, Nevada  89169
Comprehensive Cancer Centers of Nevada (Peak Dr.) Las Vegas, Nevada  89128
Comprehensive Cancer Centers of Nevada (Southern Hills) Las Vegas, Nevada  89148
Saint Clare's Center at Parsippany Commons Parsippany, New Jersey  07054
Interlakes Oncology Hematology PC Brockport, New York  14420
CCOP, Long Island Jewish Medical Center New Hyde Park, New York  11040
Interlakes Oncology Hematology PC- Long Pond Rochester, New York  14626
Interlakes Oncology Hematology PC - White Spruce Rochester, New York  14623
University Hospital and Medical Center - SUNY Stony Brook Stonybrook, New York  11794
CCOP Carolinas HealthCare System Charlotte, North Carolina  28232-2861
Regional Cancer Care, PA Durham, North Carolina  27704
Virginia Oncology Associates Elizabeth City, North Carolina  27909
CCOP, Moses Cone Health System-Regional CA Cntr Greensboro, North Carolina  27401
Margaret R. Pardee Memorial Hospital Hendersonville, North Carolina  28791
Cancer Centers of North Carolina- North Raleigh Raleigh, North Carolina  27614
CCOP Forsyth Memorial Hospital Winston-Salem, North Carolina  27103
Innovis Health Fargo, North Dakota  58103
SCRI Oncology Hematology Care, Inc. Cincinnati (WST) Cincinnati, Ohio  45248
SCRI Oncology Hematology Care, Inc. - Cincinnati (TFT) Cincinnati, Ohio  45219
SCRI Oncology Hematology Care, Inc - Cincinnati (BAM) Cincinnati, Ohio  45242
SCRI Oncology Hematlogy Care, Inc. - Cincinnati (RPR) Cincinnati, Ohio  45238
SCRI Oncology Hematology Care, Inc. - Cincinnati (KWD) Cincinnati, Ohio  45236
SCRI Oncology Hematology Care, Inc - Cincinnati (AND) Cincinnati, Ohio  45230
HemOnc Care, Inc. Fairfield, Ohio  45014
Atrium Medical Center - Middletown Regional Hosp Franklin, Ohio  45005-1066
SCRI Oncology Hematology Care, Inc. - Hamilton (HAM) Hamilton, Ohio  45013
SCRI Oncology Hematology Care, Inc. - Wilmington (WLM) Wilmington, Ohio  45177
Northwest Cancer Specialists- Rose Qtr Portland, Oregon  97227
Northwest Cancer Specialists- St. Vincent Portland, Oregon  97225
Williamette Valley Cancer Institute and Research Center Springfield, Oregon  97477
Celilo Center for Cancer Care The Dalles, Oregon  97058
Northwest Cancer Specialists-Tualatin Tualatin, Oregon  97062
Oncology Hematology Associates of Northern PA Dubois, Pennsylvania  15801
Hematology and Oncology Associates of NEPA Scranton, Pennsylvania  18501
Roper Hosp & Med Asso (Care Alliance Health) Charleston, South Carolina  29401
SCRI - South Carolina Oncology Associates - Stoneridge Columbia, South Carolina  29210
Cancer Centers of the Carolinas Easley, SC Easley, South Carolina  29640
Georgetown Hospital System Georgetown, South Carolina  29440
Cancer Centers of the Carolinas-W. Faris Road Greenville, South Carolina  29605
Cancer Centers of the Carolinas (International) Greenville, South Carolina  29615
Cancer Centers of the Carolinas (Butternut) Greenville, South Carolina  29605
Avera McKenna Hospital Sioux Falls, South Dakota  57101
CCOP, Sanford Cancer Center - Oncology Clinic Sioux Falls, South Dakota  57105
SCRI Chattanooga Oncol & Hematol Assoc, PC - Chattanooga Chattanooga, Tennessee  37404
SCRI Tennessee Oncology - PLLC Franklin Franklin, Tennessee  37067
SCRI Tennessee Oncology- Gallatin Gallatin, Tennessee  37066
SCRI Tennessee Oncology, PLLC Hermitage Hermitage, Tennessee  37076
SCRI Chattanooga Oncol & Hematol Assoc, PC Hixson Hixson, Tennessee  37404
CCOP Holston Valley Medical Center Kingsport, Tennessee  37662
SCRI Tennessee Oncology Lebanon Lebanon, Tennessee  37087
SCRI Tennessee Oncology Murfreesboro Murfreesboro, Tennessee  37130
SCRI Tennessee Oncology, PLLC (Harding) Nashville, Tennessee  37205
SCRI - Tennessee Oncology PLLC Nashville, Tennessee  37203
SCRI Tennessee Onclogy, PLLC (Dickerson) Nashville, Tennessee  37207
SCRI Tennessee Oncology, PLLC (Wallace) Nashville, Tennessee  37211
SCRI Tennessee Oncology, PLLC Smyrna Smyrna, Tennessee  37167
Texas Cancer Center - Abilene South Abilene, Texas  79606-5208
Texas Oncology PA - Amarillo Amarillo, Texas  79106
Texas Onclogy - Arlington South Arlington, Texas  76014
Texas Oncology PA - Arlington North Arlington, Texas  76012
Southwest Regional Cancer Center- North Austin, Texas  78759
Texas Oncology Cancer Center - Balcones Austin, Texas  78731
Texas Oncology Central Austin Austin, Texas  78705
Texas Oncology North Austin- Renfert Austin, Texas  78759
Edwards Cancer Center - Bedford Bedford, Texas  76022
Texas Oncology PA - Harris HEB Bedford, Texas  76022
Texas Oncology PA- Presbyterian Dallas, Texas  75231-4400
El Paso Cancer Treatment Center - West El Paso, Texas  79902
Texas Oncology at Klabzuba Fort Worth, Texas  76104
Texas Oncology - 8th Avenue Fort Worth, Texas  76104
Texas Oncology PA - 12th Avenue Fort Worth, Texas  76104
Texas Oncology PA - Frostwood Houston, Texas  77024
Texas Oncology PA Las Cruces Las Cruces, Texas  88011
Texas Oncology Plano West Cancer Center Plano, Texas  75093
Texas Oncology Seton Williamson Round Rock, Texas  78665
San Antonio Tumor and Blood Clinic - M.Oak San Antonio, Texas  78258-3912
HOAST - Medical Drive San Antonio, Texas  78229
Cancer Care Centers of South Texas- Brooklyn San Antonio, Texas  78212
Cancer Care Centers of South Texas - Loop 410 San Antonio, Texas  78217
Texas Oncology - San Marcos San Marcos, Texas  78666
Texas Oncology - Clear Lake Webster, Texas  77598
South Texas Cancer Clinic Weslaco, Texas  78596
Huntsman Cancer Inst. at the University of Utah- Salt Lake City Salt Lake City, Utah  84132
Southwestern Regional Cancer Center (SWORD) Bennington, Vermont  05201
Virginia Oncology Associates - Medical Pkwy Chesapeake, Virginia  23320
Oncology and Hematology Associates of SW VA, Inc Christiansburg, Virginia  24073
Fair Oaks Office Fairfax, Virginia  22033
Fairfax Northern VA Hematology-Oncology PC Fairfax, Virginia  22031
SCRI Virginia Cancer Institute (Flank) Mechanicsville, Virginia  23116
SCRI Virginia Cancer Institute Midlothian, Virginia  23114
SCRI Virginia Cancer Institute (6605) Richmond, Virginia  23226
SCRI Virginia Cancer Institute (1401) Richmond, Virginia  23235
Fairfax Northern Virginia Hematology-Oncology - Winchester Winchester, Virginia  22601
Puget Sound Cancer Center- Edmonds Edmonds, Washington  98026
Cancer Care Northwest- Valley - Mission Spokane, Washington  99216
Evergreen Hematology & Oncology (Farwell) Spokane, Washington  99218
Cancer Care Northwest-North - Holland Spokane, Washington  99218
Cancer Care Northwest-Radiation Therapy (XRT) Spokane, Washington  99204
Yakima Valley Memorial Hospital - North Star Lodge Yakima, Washington  98902
CAMC Health Education & Research Institute, Inc. Charleston, West Virginia  25304
Marshfield Clinic Chippewa Falls Center Chippewa, Wisconsin  54729
Marshfield Clinic Regional CA Cntr - Sacred Heart Hospital Eau Claire, Wisconsin  54701
CCOP, St. Mary's Hospital Medical Center Green Bay, Wisconsin  54303
CCOP, St. Vincent Hospital Green Bay, Wisconsin  54301
Marshfield Clinic Minocqua Center Minocqua, Wisconsin  54548
Marshfield Clinic Rice Lake Center Rice Lake, Wisconsin  54868
Marshfield Clinic Cancer Care at St. Michael's Hospital Stevens Point, Wisconsin  54481
CCOP Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Marshfield Clinic Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494