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Phase III Trial of High Dose Interferon Alfa 2-b Versus Cisplatin, Vinblastine, DTIC Plus IL-2 and Interferon in Patients With High Risk Melanoma


Phase 3
18 Years
N/A
Not Enrolling
Both
Melanoma (Skin)

Thank you

Trial Information

Phase III Trial of High Dose Interferon Alfa 2-b Versus Cisplatin, Vinblastine, DTIC Plus IL-2 and Interferon in Patients With High Risk Melanoma


OBJECTIVES:

- Compare the overall survival and disease-free survival of patients with high-risk
melanoma treated with interferon alfa vs cisplatin, vinblastine, and dacarbazine plus
interferon alfa and interleukin-2.

- Compare the toxic effects of these treatment regimens in these patients.

- Determine the relationship between minimal residual disease (MRD) status at 12 weeks
and 52 weeks and overall survival of patients treated with these regimens.

- Compare the effects of these treatment regimens on the MRD status of these patients.

- Determine the relationship between clinical characteristics (number of involved lymph
nodes, ulcerated primary, and extracapsular extension) and MRD in patients treated with
these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to nodal
status (N1 or N2 vs N3), degree of lymph node involvement (micrometastases only vs any
macrometastases, including satellite/in-transit metastases), and ulceration of the primary
tumor (yes vs no vs unknown primary). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive interferon alfa IV on days 1-5 of weeks 1-4 followed by
interferon alfa subcutaneously (SC) on days 1, 3, and 5 of weeks 5-52 in the absence of
disease progression or unacceptable toxicity.

- Arm II: Patients receive cisplatin IV over 30 minutes followed by vinblastine IV on
days 1-4. Patients also receive dacarbazine IV over 1 hour on day 1, interleukin-2 IV
over 96 hours on days 1-4, and interferon alfa SC on days 1-5, 8, 10, and 12. In
addition, patients receive filgrastim (G-CSF) SC on days 6-15. Treatment repeats every
3 weeks for 3 courses in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then
annually for 5 years.

PROJECTED ACCRUAL: A total of 410 patients (205 per treatment arm) will be accrued for this
study within 3 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically proven melanoma of cutaneous origin or from unknown primary at initial
presentation of primary or first clinically detected nodal or satellite/in-transit
recurrence

- No distant metastases

- No melanoma of ocular, mucosal, or other non-cutaneous origin

- One of the following criteria must apply for patients with newly diagnosed melanoma
OR a previously diagnosed primary with current subsequent, clinical, regional nodal
disease and/or satellite/in-transit disease:

- Ulcerated primary melanoma with 1 or more involved lymph nodes (micro/occult or
macro/clinically overt)

- Non-ulcerated or unknown primary melanoma with one macro/clinically overt lymph
node metastasis, including a single matted nodal mass

- No non-ulcerated or unknown primary tumor and a single micrometastatic
lymph node

- Non-ulcerated melanoma with two or more lymph node metastases (micro/occult or
macro/clinically overt) and/or matted nodes

- Any satellite/in transit metastasis with or without lymph node involvement

- Patients with recurrent disease must have recurrent disease in the regional nodal
basin of a prior complete lymphadenectomy

- Multiple regional nodal basin involvement allowed if they are appropriate anatomic
drainage basins for primary site

- Patients must be disease free at time of enrollment based on the following surgical
criteria:

- Patients at initial presentation of melanoma must undergo adequate wide excision
of primary lesion

- Patients with previously diagnosed melanoma must have all disease resected with
pathologically negative margins and no disease at primary site or second
resection of primary

- Full lymphadenectomy required of all patients including those with positive
sentinel nodes or positive satellite/in-transit metastasis

- No more than 56 days since prior lymphadenectomy OR surgery to remove recurrent
disease after prior complete lymphadenectomy

- Must be willing to participate in minimal residual disease studies if registered on
the study on 3/1/2003 or later

PATIENT CHARACTERISTICS:

Age:

- 18 and over

Performance status:

- Zubrod 0-1

Life expectancy:

- Not specified

Hematopoietic:

- Absolute granulocyte count at least 1,500/mm^3

- Platelet count at least 100,000/mm^3

Hepatic:

- Bilirubin no greater than 1.5 times upper limit of normal (ULN)

- SGOT or SGPT no greater than 2 times ULN

- LDH and alkaline phosphatase no greater than 2 times ULN (above normal value requires
a contrast-enhanced CT scan or MRI of liver)

- No known recent hepatitis positivity by PCR

Renal:

- Creatinine no greater than 1.5 mg/dL OR

- Creatinine clearance at least 75 mL/min

Cardiovascular:

- No congestive heart failure

- No coronary artery disease

- No serious cardiac arrhythmia

- No prior myocardial infarction

- Normal cardiac stress test required if any of the following are present:

- Over age 50

- Abnormal EKG

- History of cardiac disease

Pulmonary:

- No symptomatic pulmonary disease

Other:

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No autoimmune disorders or conditions of immunosuppression

- No other prior malignancy within the past 5 years except the following:

- Adequately treated basal cell or squamous cell skin cancer

- Carcinoma in situ of the cervix

- Adequately treated stage I or II cancer in remission

- HIV negative

- No known AIDS or HIV-1 associated complex

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- No prior immunotherapy, including interferon, interleukin, levamisole, or other
biologic response modifiers

- No other concurrent biologic therapy

Chemotherapy:

- No prior chemotherapy (including infusion or perfusion therapy)

- No other concurrent chemotherapy

Endocrine therapy:

- No concurrent systemic corticosteroids or topical steroid creams

- Concurrent steroid antihistamines allowed if no alternative

- No concurrent hormonal therapy

Radiotherapy:

- No prior radiotherapy

- Prior postlumpectomy radiotherapy for breast cancer allowed

- No concurrent radiotherapy

Surgery:

- See Disease Characteristics

- No concurrent surgery

Other:

- No concurrent anti-hypertensive medications (arm II only)

- No concurrent immunosuppressive agents

- No other concurrent anticancer therapy

- Antihistamines allowed if no alternative medication suitable

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

5-year Overall Survival

Outcome Description:

Overall survival was measured from the date of registration to study until death from any cause with observations censored at the date of last contact for patients last known to be alive.

Outcome Time Frame:

Every three months for a year, every six months for years 2-5, annual for years 5-10

Safety Issue:

No

Principal Investigator

Lawrence E. Flaherty, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Barbara Ann Karmanos Cancer Institute

Authority:

United States: Federal Government

Study ID:

CDR0000068162

NCT ID:

NCT00006237

Start Date:

August 2000

Completion Date:

July 2012

Related Keywords:

  • Melanoma (Skin)
  • stage III melanoma
  • recurrent melanoma
  • Melanoma

Name

Location

Fred Hutchinson Cancer Research Center Seattle, Washington  98109
University of Michigan Comprehensive Cancer Center Ann Arbor, Michigan  48109-0752
Cardinal Bernardin Cancer Center at Loyola University Medical Center Maywood, Illinois  60153-5500
Barbara Ann Karmanos Cancer Institute Detroit, Michigan  48201
Duke Comprehensive Cancer Center Durham, North Carolina  27710
Hurley Medical Center Flint, Michigan  48503
University of Texas Health Science Center at San Antonio San Antonio, Texas  78284-7811
CCOP - Kansas City Kansas City, Missouri  64131
CCOP - Missouri Valley Cancer Consortium Omaha, Nebraska  68131
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
Veterans Affairs Medical Center - Atlanta (Decatur) Decatur, Georgia  30033
CCOP - Illinois Oncology Research Association Peoria, Illinois  61602
CCOP - Carle Cancer Center Urbana, Illinois  61801
CCOP - Iowa Oncology Research Association Des Moines, Iowa  50309-1016
Beth Israel Deaconess Medical Center Boston, Massachusetts  02215
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center Farmington, Connecticut  06360-2875
George Bray Cancer Center at the Hospital of Central Connecticut - New Britain Campus New Britain, Connecticut  06050
Rush-Copley Cancer Care Center Aurora, Illinois  60507
Evanston Northwestern Healthcare - Evanston Hospital Evanston, Illinois  60201-1781
Joliet Oncology-Hematology Associates, Limited - West Joliet, Illinois  60435
Carle Cancer Center at Carle Foundation Hospital Urbana, Illinois  61801
Saint Anthony Memorial Health Centers Michigan City, Indiana  46360
Tufts-NEMC Cancer Center Boston, Massachusetts  02111
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
Genesys Hurley Cancer Institute Flint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Sparrow Regional Cancer Center Lansing, Michigan  48912-1811
St. John Macomb Hospital Warren, Michigan  48093
MeritCare Bemidji Bemidji, Minnesota  56601
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
Duluth Clinic Cancer Center - Duluth Duluth, Minnesota  55805-1983
CCOP - Duluth Duluth, Minnesota  55805
Miller - Dwan Medical Center Duluth, Minnesota  55805
Fairview Southdale Hospital Edina, Minnesota  55435
Mercy and Unity Cancer Center at Unity Hospital Fridley, Minnesota  55432
Hutchinson Area Health Care Hutchinson, Minnesota  55350
Meeker County Memorial Hospital Lichfield, Minnesota  55355
Minnesota Oncology Hematology, PA - Maplewood Maplewood, Minnesota  55109
HealthEast Cancer Care at St. John's Hospital Maplewood, Minnesota  55109
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital Minneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
St. Francis Cancer Center at St. Francis Medical Center Shakopee, Minnesota  55379
HealthEast Cancer Care at St. Joseph's Hospital St Paul, Minnesota  55102
Park Nicollet Cancer Center St. Louis Park, Minnesota  55416
Regions Hospital Cancer Care Center St. Paul, Minnesota  55101
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Minnesota Oncology Hematology, PA - Woodbury Woodbury, Minnesota  55125
HealthEast Cancer Care at Woodwinds Health Campus Woodbury, Minnesota  55125
MeritCare Broadway Fargo, North Dakota  58122
CCOP - MeritCare Hospital Fargo, North Dakota  58122
Mercy Cancer Center at Mercy Medical Center Canton, Ohio  44708
MetroHealth Cancer Care Center at MetroHealth Medical Center Cleveland, Ohio  44109
St. Rita's Medical Center Lima, Ohio  45801
Penn State Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
Geisinger Medical Group - Scenery Park State College, Pennsylvania  16801
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center Wilkes-Barre, Pennsylvania  18711
Sanford Cancer Center at Sanford USD Medical Center Sioux Falls, South Dakota  57117-5039
Medical X-Ray Center, PC Sioux Falls, South Dakota  57105
Avera Cancer Institute Sioux Falls, South Dakota  57105
Vanderbilt-Ingram Cancer Center Nashville, Tennessee  37232-6838
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center La Crosse, Wisconsin  54601
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center Madison, Wisconsin  53792-6164
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
CCOP - Santa Rosa Memorial Hospital Santa Rosa, California  95403
Methodist Medical Center of Illinois Peoria, Illinois  61636
Memorial Hospital of South Bend South Bend, Indiana  46601
CCOP - Montana Cancer Consortium Billings, Montana  59101
CCOP - Columbus Columbus, Ohio  43206
CCOP - Greenville Greenville, South Carolina  29615
Harrington Cancer Center Amarillo, Texas  79106
CCOP - Western Regional, Arizona Phoenix, Arizona  85006-2726
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
Saint Joseph Regional Medical Center South Bend, Indiana  46617
Holden Comprehensive Cancer Center at University of Iowa Iowa City, Iowa  52242-1002
CCOP - Grand Rapids Grand Rapids, Michigan  49503
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
Charles M. Barrett Cancer Center at University Hospital Cincinnati, Ohio  45267-0526
CCOP - Columbia River Oncology Program Portland, Oregon  97225
CCOP - Scott and White Hospital Temple, Texas  76508
MultiCare Regional Cancer Center at Tacoma General Hospital Tacoma, Washington  98405
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
Brooke Army Medical Center Fort Sam Houston, Texas  78234-6200
CCOP - Northwest Tacoma, Washington  98405-0986
Children's National Medical Center Washington, District of Columbia  20010-2970
Children's Mercy Hospital Kansas City, Missouri  64108
Rebecca and John Moores UCSD Cancer Center La Jolla, California  92093-0658
All Children's Hospital St. Petersburg, Florida  33701
Saint Jude Midwest Affiliate Peoria, Illinois  61637
St. Christopher's Hospital for Children Philadelphia, Pennsylvania  19134-1095
Cook Children's Medical Center - Fort Worth Fort Worth, Texas  76104
Veterans Affairs Medical Center - San Diego San Diego, California  92161
Mobile Infirmary Medical Center Mobile, Alabama  36640-0460
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
Phoenix Children's Hospital Phoenix, Arizona  85016-7710
Palmetto Health South Carolina Cancer Center Columbia, South Carolina  29203
Arizona Cancer Center at University of Arizona Health Sciences Center Tucson, Arizona  85724
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences Little Rock, Arkansas  72205
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus Seattle, Washington  98104
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Wilford Hall Medical Center Lackland Air Force Base, Texas  78236-5300
Kaiser Permanente Medical Center - Oakland Sacramento, California  95825
St. Joseph's Cancer Institute at St. Joseph's Hospital Tampa, Florida  33607
Kaplan Cancer Center at St. Mary's Medical Center West Palm Beach, Florida  33407
Winship Cancer Institute of Emory University Atlanta, Georgia  30322
SUNY Upstate Medical University Hospital Syracuse, New York  13210
Presbyterian Cancer Center at Presbyterian Hospital Charlotte, North Carolina  28233-3549
Primary Children's Medical Center Salt Lake City, Utah  84113-1100
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
Green Bay Oncology, Limited - Escanaba Escanaba, Michigan  49431
Dickinson County Healthcare System Iron Mountain, Michigan  49801
CCOP - Hematology-Oncology Associates of Central New York East Syracuse, New York  13057
Lewistown Hospital Lewistown, Pennsylvania  17044
Mount Nittany Medical Center State College, Pennsylvania  16803
St. Mary's Hospital Medical Center - Green Bay Green Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54301-3526
Green Bay Oncology, Limited at St. Mary's Hospital Green Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical Center Marinette, Wisconsin  54143
Green Bay Oncology, Limited - Oconto Falls Oconto Falls, Wisconsin  54154
Green Bay Oncology, Limited - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
Banner Good Samaritan Medical Center Phoenix, Arizona  85006
Banner Thunderbird Medical Center Phoenix, Arizona  85306
Baptist Cancer Institute - Jacksonville Jacksonville, Florida  32207
Veterans Affairs Medical Center - Kansas City Kansas City, Kansas  64128
Battle Creek Health System Cancer Care Center Battle Creek, Michigan  49017
Holland Community Hospital Holland, Michigan  49423
Hackley Hospital Muskegon, Michigan  49443
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
Munson Medical Center Traverse City, Michigan  49684
Northern Rockies Radiation Oncology Center Billings, Montana  59101
Hematology-Oncology Centers of the Northern Rockies - Billings Billings, Montana  59101
Big Sky Oncology Great Falls, Montana  59405
St. Peter's Hospital Helena, Montana  59601
Kalispell Regional Medical Center Kalispell, Montana  59901
Glacier Oncology, PLLC Kalispell, Montana  59901
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Missoula, Montana  59802
Montana Cancer Specialists at Montana Cancer Center Missoula, Montana  59802
Community Medical Center Missoula, Montana  59801
Wayne Memorial Hospital, Incorporated Goldsboro, North Carolina  27534
Adena Regional Medical Center Chillicothe, Ohio  54601
Doctors Hospital at Ohio Health Columbus, Ohio  43228
Riverside Methodist Hospital Cancer Care Columbus, Ohio  43214
Grady Memorial Hospital Delaware, Ohio  43015
Fairfield Medical Center Lancaster, Ohio  43130
Strecker Cancer Center at Marietta Memorial Hospital Marietta, Ohio  45750
Licking Memorial Cancer Care Program at Licking Memorial Hospital Newark, Ohio  43055
Community Hospital of Springfield and Clark County Springfield, Ohio  45505
Genesis - Good Samaritan Hospital Zanesville, Ohio  43701
Olympic Hematology and Oncology Bremerton, Washington  98310
Skagit Valley Hospital Cancer Care Center Mt. Vernon, Washington  98273
University Cancer Center at University of Washington Medical Center Seattle, Washington  98195
Harborview Medical Center Seattle, Washington  98104
Group Health Central Hospital Seattle, Washington  98104
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Mountain States Tumor Institute at St. Luke's Regional Medical Center Boise, Idaho  83712-6297
University of Illinois Cancer Center Chicago, Illinois  60612-7243
Swedish-American Regional Cancer Center Rockford, Illinois  61104-2315
Butterworth Hospital at Spectrum Health Grand Rapids, Michigan  49503-2560
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Legacy Emanuel Hospital and Health Center and Children's Hospital Portland, Oregon  97227
Geisinger Cancer Institute at Geisinger Health Danville, Pennsylvania  17822-0001
West Virginia University Health Sciences Center - Charleston Charleston, West Virginia  25302
Huntsman Cancer Institute at University of Utah Salt Lake City, Utah  84112
Robert H. Lurie Comprehensive Cancer Center at Northwestern University Chicago, Illinois  60611
Elkhart General Hospital Elkhart, Indiana  46515
Howard Community Hospital Kokomo, Indiana  46904
Lakeland Regional Cancer Care Center - St. Joseph St. Joseph, Michigan  49085
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton Marlton, New Jersey  08053
Fox Chase Virtua Health Cancer Program at Virtua West Jersey Voorhees, New Jersey  08043
Mount Carmel Health - West Hospital Columbus, Ohio  43222
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center Columbus, Ohio  43210-1240
Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest Allentown, Pennsylvania  18105
Front Range Cancer Specialists Fort Collins, Colorado  80528
Veterans Affairs Medical Center - Chicago Westside Hospital Chicago, Illinois  60612
Hematology Oncology Associates - Skokie Skokie, Illinois  60076
UPMC Cancer Centers Pittsburgh, Pennsylvania  15232
Fox Valley Hematology and Oncology - East Grant Street Appleton, Wisconsin  54911-3496
Eden Medical Center Castro Valley, California  94546
Saint Rose Hospital Hayward, California  94545
Alta Bates Summit Medical Center - Summit Campus Oakland, California  94609
Valley Care Medical Center Pleasanton, California  94588
Poudre Valley Hospital Fort Collins, Colorado  80524
St. Joseph Medical Center Bloomington, Illinois  61701
Graham Hospital Canton, Illinois  61520
Memorial Hospital Carthage, Illinois  62321
Swedish Covenant Hospital Chicago, Illinois  60625
Mercy Hospital and Medical Center Chicago, Illinois  60616
Hematology and Oncology Associates Chicago, Illinois  60611
Eureka Community Hospital Eureka, Illinois  61530
Galesburg Cottage Hospital Galesburg, Illinois  61401
Mason District Hospital Havana, Illinois  62644
Hopedale Medical Complex Hopedale, Illinois  61747
Midwest Center for Hematology/Oncology Joliet, Illinois  60432
Kewanee Hospital Kewanee, Illinois  61443
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
Hematology/Oncology of the North Shore at Gross Point Medical Center Skokie, Illinois  60076
St. Margaret's Hospital Spring Valley, Illinois  61362
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
St. Francis Comprehensive Cancer Center Topeka, Kansas  66606
Louisiana State University Health Sciences Center - Monroe Monroe, Louisiana  71210
Feist-Weiller Cancer Center at Louisiana State University Health Sciences Shreveport, Louisiana  71130-3932
Mecosta County Medical Center Big Rapids, Michigan  49307
Upper Michigan Cancer Center at Marquette General Hospital Marquette, Michigan  49855
Booker Cancer Center at Riverview Medical Center Red Bank, New Jersey  07701
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Adirondack Cancer Care - Glens Falls Glens Falls, New York  12801
Community Oncology Group at Cleveland Clinic Cancer Center Independence, Ohio  44131
Mercy Medical Center Springfield, Ohio  45504
Cleveland Clinic - Wooster Wooster, Ohio  44691
Legacy Mount Hood Medical Center Gresham, Oregon  97030
Providence Milwaukie Hospital Milwaukie, Oregon  97222
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
Minor and James Medical, PLLC Seattle, Washington  98104
Polyclinic First Hill Seattle, Washington  98122
Southwest Washington Medical Center Cancer Center Vancouver, Washington  98668
Welch Cancer Center at Sheridan Memorial Hospital Sheridan, Wyoming  82801
St. Francis Hospital Federal Way, Washington  98003
St. Clare Hospital Lakewood, Washington  98499-0998
Providence St. Peter Hospital Regional Cancer Center Olympia, Washington  98506
Good Samaritan Cancer Center Puyallup, Washington  98371
Allenmore Hospital Tacoma, Washington  98411-0414
Hembree Mercy Cancer Center at St. Edward Mercy Medical Center Ft. Smith, Arkansas  72903
Highland General Hospital Oakland, California  94602
Pearlman Comprehensive Cancer Center at South Georgia Medical Center Valdosta, Georgia  31603
Great Lakes Cancer Institute at McLaren Regional Medical Center Flint, Michigan  48532
Cancer Resource Center - Lincoln Lincoln, Nebraska  68510
Eastern Connecticut Hematology and Oncology Associates Norwich, Connecticut  06360
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
Cancer Care and Hematology Specialists of Chicagoland - Niles Niles, Illinois  60714
McFarland Clinic, PC Ames, Iowa  50010
Tammy Walker Cancer Center at Salina Regional Health Center Salina, Kansas  67401
Cotton-O'Neil Cancer Center Topeka, Kansas  66606
Union Hospital Cancer Program at Union Hospital Elkton MD, Maryland  21921
Foote Memorial Hospital Jackson, Michigan  49201
Seton Cancer Institute at Saint Mary's - Saginaw Saginaw, Michigan  48601
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
Grant Medical Center Cancer Care Columbus, Ohio  43215
Mount Carmel St. Ann's Cancer Center Westerville, Ohio  43081
Adventist Medical Center Portland, Oregon  97216
Legacy Good Samaritan Hospital & Comprehensive Cancer Center Portland, Oregon  97210
Salem Hospital Regional Cancer Care Services Salem, Oregon  97309-5014
St. Joseph Cancer Center Bellingham, Washington  98225
Providence Centralia Hospital Centralia, Washington  98531-9027
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
Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham Birmingham, Alabama  35294
Auburn Regional Center for Cancer Care Auburn, Washington  98002
Good Samaritan Cancer Center at Good Samaritan Hospital Kearney, Nebraska  68848-1990
Martha Jefferson Hospital Cancer Care Center Charlottesville, Virginia  22901
Sherman Hospital Elgin, Illinois  60120-2198
Central Pennsylvania Hematology and Medical Oncology Associates, PC Lemoyne, Pennsylvania  17043
Lacks Cancer Center at Saint Mary's Health Care Grand Rapids, Michigan  49503
Metro Health Hospital Grand Rapids, Michigan  49506
Billings Clinic Cancer Center Billings, Montana  59107-5100
Great Falls, Montana  59405
Guardian Oncology and Center for Wellness Missoula, Montana  59804
Roper St. Francis Cancer Center at Roper Hospital Charleston, South Carolina  29401
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
University of Tennessee Cancer Institute - Memphis Memphis, Tennessee  38104