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Phase III Study Comparing Sequential Chemotherapy (AG-ITP) To Cisplatin And Gemcitabine As Adjuvant Treatment After Cystectomy For Transitional Cell Carcinoma Of The Bladder


Phase 3
18 Years
N/A
Not Enrolling
Both
Bladder Cancer

Thank you

Trial Information

Phase III Study Comparing Sequential Chemotherapy (AG-ITP) To Cisplatin And Gemcitabine As Adjuvant Treatment After Cystectomy For Transitional Cell Carcinoma Of The Bladder


OBJECTIVES:

Primary

- Compare the survival of patients with completely resected locally advanced transitional
cell carcinoma of the bladder treated with adjuvant doxorubicin and gemcitabine
followed by paclitaxel and cisplatin vs adjuvant cisplatin and gemcitabine.

Secondary

- Compare the toxicity profiles of these regimens in these patients.

OUTLINE: This is a randomized study. Patients are stratified according to primary tumor
status (5), and number
of dissected nodes (0-10 or unknown vs > 10). Patients are randomized to one of two
treatment arms.

- Arm I: Patients receive adjuvant gemcitabine IV over 30 minutes on days 1, 8, and 15
and cisplatin IV over 30-60 minutes on day 1. Treatment repeats every 4 weeks for up to
4 courses in the absence of disease progression or unacceptable toxicity.

- Arm II: Patients receive adjuvant doxorubicin IV over 45 minutes followed by
gemcitabine IV over 2 hours on day 1. Patients also receive filgrastim (G-CSF)
subcutaneously (SC) daily on days 3-10. Treatment repeats every 14 days for up to 4
courses in the absence of disease progression or unacceptable toxicity. Beginning 14
days after the completion of doxorubicin and gemcitabine, patients receive paclitaxel
IV over 3 hours and cisplatin IV over 20-30 minutes on day 1. Patients also receive
G-CSF SC daily on days 3-10 or 4-11. Treatment repeats every 14 days for up to 4
courses in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 18 months, every 6 months for 18 months, and then
annually thereafter.

PROJECTED ACCRUAL: A total of 800 patients will be accrued for this study within 6 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed transitional cell carcinoma of the bladder

- Any T, N+, M0 OR

- T3a-4a, N0, M0

- At least 6 weeks but no more than 3 months since prior complete resection of bladder

- Cystoprostatectomy plus pelvic lymph node dissection in males

- Cystectomy/total abdominal hysterectomy/bilateral salpingo-oophorectomy plus
pelvic lymph node dissection in females

- Negative surgical margins

- Carcinoma in situ allowed

- No partial cystectomy or transurethral bladder tumor resection as definitive
loco-regional therapy

- Prostate cancer detected in resected specimen allowed if post-operative PSA is no
more than 0.05 mg/dL

- No metastatic or recurrent disease by post-operative chest x-ray and CT scan of
abdomen and pelvis

PATIENT CHARACTERISTICS:

Age:

- 18 and over

Performance status:

- ECOG 0-1

Life expectancy:

- Not specified

Hematopoietic:

- Absolute neutrophil count ≥ 1,500/mm^3

- Platelet count ≥ 150,000/mm^3

Hepatic:

- Bilirubin ≤ 1.5 times upper limit of normal (ULN)

- Alkaline phosphatase ≤ 2 times ULN

- AST ≤ 2 times ULN

Renal:

- Creatinine ≤ 1.5 mg/dL OR

- Creatinine clearance ≥ 60 mL/min

Cardiovascular:

- Normal cardiac function by history, physical exam, or chest radiograph

- Left ventricular ejection fraction at least 50% by radionuclide ventriculogram or
echocardiogram, for prior cardiac disease

- No New York Heart Association class III or IV heart disease

- No serious cardiac arrhythmias including first-, second-, and third-degree heart
block

Other:

- Negative pregnancy test

- No uncontrolled infection

- No other active cancer within the past 5 years except non-melanoma skin cancer or
curatively treated carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- Not specified

Chemotherapy:

- No prior systemic chemotherapy

Endocrine therapy:

- Not specified

Radiotherapy:

- No prior radiotherapy to bladder

Surgery:

- See Disease Characteristics

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Overall survival

Outcome Time Frame:

4 years

Safety Issue:

No

Principal Investigator

Dean F. Bajorin, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Memorial Sloan-Kettering Cancer Center

Authority:

United States: Federal Government

Study ID:

CDR0000068554

NCT ID:

NCT00014534

Start Date:

March 2004

Completion Date:

April 2009

Related Keywords:

  • Bladder Cancer
  • stage III bladder cancer
  • stage IV bladder cancer
  • transitional cell carcinoma of the bladder
  • Urinary Bladder Neoplasms
  • Carcinoma, Transitional Cell

Name

Location

Roswell Park Cancer Institute Buffalo, New York  14263
Mayo Clinic - Jacksonville Jacksonville, Florida  32224
Mayo Clinic Cancer Center Rochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical Center Maywood, Illinois  60153-5500
Walter Reed Army Medical Center Washington, District of Columbia  20307-5000
Emory University Hospital - Atlanta Atlanta, Georgia  30322
University of Chicago Cancer Research Center Chicago, Illinois  60637
Indiana University Cancer Center Indianapolis, Indiana  46202-5265
Duke Comprehensive Cancer Center Durham, North Carolina  27710
CCOP - Upstate Carolina Spartanburg, South Carolina  29303
CCOP - Wichita Wichita, Kansas  67214-3882
Rhode Island Hospital Providence, Rhode Island  02903
CCOP - Kansas City Kansas City, Missouri  64131
CCOP - Southern Nevada Cancer Research Foundation Las Vegas, Nevada  89106
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Mount Sinai Medical Center Miami Beach, Florida  33140
CCOP - Illinois Oncology Research Association Peoria, Illinois  61602
CCOP - Carle Cancer Center Urbana, Illinois  61801
CCOP - Iowa Oncology Research Association Des Moines, Iowa  50309-1016
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Veterans Affairs Medical Center - East Orange East Orange, New Jersey  07018-1095
CCOP - Northern New Jersey Hackensack, New Jersey  07601
Aurora Presbyterian Hospital Aurora, Colorado  80012
Boulder Community Hospital Boulder, Colorado  80301-9019
Penrose Cancer Center at Penrose Hospital Colorado Springs, Colorado  80933
Porter Adventist Hospital Denver, Colorado  80210
Presbyterian - St. Luke's Medical Center Denver, Colorado  80218
St. Joseph Hospital Denver, Colorado  80218
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United Hospital Longmont, Colorado  80502
North Suburban Medical Center Thornton, Colorado  80229
Rush-Copley Cancer Care Center Aurora, Illinois  60507
Carle Cancer Center at Carle Foundation Hospital Urbana, Illinois  61801
Saint Anthony Memorial Health Centers Michigan City, Indiana  46360
Cedar Rapids Oncology Associates Cedar Rapids, Iowa  52403
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
St. Luke's Regional Medical Center Sioux City, Iowa  51104
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Fairview Ridges Hospital Burnsville, Minnesota  55337
Fairview Southdale Hospital Edina, Minnesota  55435
Hutchinson Area Health Care Hutchinson, Minnesota  55350
Meeker County Memorial Hospital Lichfield, Minnesota  55355
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Penn State Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
Abramson Cancer Center of the University of Pennsylvania Philadelphia, Pennsylvania  19104-4283
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center La Crosse, Wisconsin  54601
Marshfield Clinic - Marshfield Center Marshfield, Wisconsin  54449
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
Comprehensive Cancer Center at Wake Forest University Winston-Salem, North Carolina  27157-1082
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
Veterans Affairs Medical Center - Dayton Dayton, Ohio  45428
CCOP - Dayton Kettering, Ohio  45429
CCOP - Greenville Greenville, South Carolina  29615
University of Wisconsin Comprehensive Cancer Center Madison, Wisconsin  53792
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
Holden Comprehensive Cancer Center at University of Iowa Iowa City, Iowa  52242-1002
Cancer Institute of New Jersey at the Cooper University Hospital Camden, New Jersey  08103-1489
Long Island Cancer Center at Stony Brook University Hospital Stony Brook, New York  11790-7775
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Columbus, Ohio  43210-1240
CCOP - Columbia River Oncology Program Portland, Oregon  97225
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia Philadelphia, Pennsylvania  19107
Vanderbilt-Ingram Cancer Center at Vanderbilt Medical Center Nashville, Tennessee  37232-2516
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
Veterans Affairs Medical Center - San Francisco San Francisco, California  94121
CCOP - Syracuse Hematology-Oncology Associates of Central New York, P.C. Syracuse, New York  13217
Veterans Affairs Medical Center - Minneapolis Minneapolis, Minnesota  55417
Veterans Affairs Medical Center - Syracuse Syracuse, New York  13210
Rebecca and John Moores UCSD Cancer Center La Jolla, California  92093-0658
Veterans Affairs Medical Center - San Diego San Diego, California  92161
UCSF Comprehensive Cancer Center San Francisco, California  94115
Louis A. Weiss Memorial Hospital Chicago, Illinois  60640
St. Mary's Medical Center Huntington, West Virginia  25701
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
CCOP - Colorado Cancer Research Program, Incorporated Denver, Colorado  80224
Hillman Cancer Center at University of Pittsburgh Cancer Institute Pittsburgh, Pennsylvania  15236
Great Falls Clinic Great Falls, Montana  59405
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences Little Rock, Arkansas  72205
Maine Center for Cancer Medicine and Blood Disorders - Scarborough Scarborough, Maine  04074
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University Cleveland, Ohio  44106
Oklahoma University Medical Center Oklahoma City, Oklahoma  73104
Sioux Valley Hospital and University of South Dakota Medical Center Sioux Falls, South Dakota  57117-5134
Cancer Institute of New Jersey at Hamilton Hamilton, New Jersey  08690
Curtis & Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center Savannah, Georgia  31403-3089
Via Christi Cancer Center at Via Christi Regional Medical Center Wichita, Kansas  67214
Greenville Hospital System Cancer Center Greenville, South Carolina  29605
Providence Cancer Center at Sacred Heart Medical Center Spokane, Washington  99220-2555
West Virginia University - Robert C. Byrd Health Sciences Center - Charleston Division Charleston, West Virginia  25302
Mary Babb Randolph Cancer Center at West Virginia University Hospitals Morgantown, West Virginia  26506
James P. Wilmot Cancer Center at University of Rochester Medical Center Rochester, New York  14642
Lewistown Hospital Lewistown, Pennsylvania  17044
Mount Nittany Medical Center State College, Pennsylvania  16803
Batte Cancer Center at Northeast Medical Center Concord, North Carolina  28025
Siouxland Hematology-Oncology Associates Sioux City, Iowa  51101
Siouxland Regional Cancer Center Sioux City, Iowa  51101-1733
Cancer Center of Kansas - Chanute Chanute, Kansas  66720
Cancer Center of Kansas - Dodge City Dodge City, Kansas  67801
Cancer Center of Kansas, P.A. - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas - Kingman Kingman, Kansas  67068
Southwest Medical Center Liberal, Kansas  67901
Cancer Center of Kansas - Newton Newton, Kansas  67114
Cancer Center of Kansas, P.A. - Parsons Parsons, Kansas  67357
Pratt Cancer Center of Kansas Pratt, Kansas  67124
Cancer Center of Kansas - Salina Salina, Kansas  67042
Cancer Center of Kansas - Wellington Wellington, Kansas  67152
Cancer Center of Kansas, P.A. Wichita, Kansas  67208
Associates in Womens Health Wichita, Kansas  67203
Cancer Center of Kansas, P.A. - Wichita Wichita, Kansas  67214
Cancer Center of Kansas - Winfield Winfield, Kansas  67156
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
Northern Rockies Radiation Oncology Center Billings, Montana  59101
St. Vincent Healthcare Billings, Montana  59101
Deaconess Billings Clinic - Downtown Billings, Montana  59101
Deaconess Billings Clinic Cancer Center Billings, Montana  59107
Bozeman Deaconess Hospital Bozeman, Montana  59715
St. James Community Hospital Butte, Montana  59701
Sletten Regional Cancer Institute Great Falls, Montana  59405
St. Peter's Hospital Helena, Montana  59601
Kalispell Regional Medical Center Kalispell, Montana  59901
Eastern Montana Cancer Center Miles City, Montana  59301
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Missoula, Montana  59802
Community Medical Center Missoula, Montana  59801
Fox Chase Virtua Health Cancer Program - Marlton Marlton, New Jersey  08053
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
Grant Riverside Cancer Services Columbus, Ohio  43215
Mount Carmel West Hospital Columbus, Ohio  43222
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
Mercy Medical Center Oncology Unit Springfield, Ohio  45504
Mount Carmel Cancer Services at Mount Carmel St. Ann's Hospital Westerville, Ohio  43081
Genesis - Good Samaritan Hospital Zanesville, Ohio  43701
Avera McKennan Hospital and University Health Center Sioux Falls, South Dakota  57105
Medical X-Ray Center Sioux Falls, South Dakota  57105
Welch Cancer Center Sheridan, Wyoming  82801
Lombardi Cancer Center at Georgetown University Medical Center Washington, District of Columbia  20007
Memorial Cancer Institute at Memorial Regional Hospital Hollywood, Florida  33021
Lenoir Memorial Cancer Center Kinston, North Carolina  28503-1678
Miriam Hospital at Lifespan Providence, Rhode Island  02906
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School New Brunswick, New Jersey  08903
MBCCOP-Medical College of Georgia Cancer Center Augusta, Georgia  30912-4000
Medcenter One Health System Bismarck, North Dakota  58501
Oncology/Hematology Associates of Central Illinois, P.C. Peoria, Illinois  61602
Elkhart General Hospital Elkhart, Indiana  46515
Fox Chase Virtua Health Cancer Program at Virtua West Jersey Voorhees, New Jersey  08043
Front Range Cancer Specialists Fort Collins, Colorado  80528
University Medical Center of Southern Nevada Las Vegas, Nevada  89102
Joan Karnell Cancer Center at Pennsylvania Hospital Philadelphia, Pennsylvania  19107
Kaiser Permanente Medical Office -Vandever Medical Office San Diego, California  92120
Poudre Valley Hospital Fort Collins, Colorado  80524
St. Mary-Corwin Regional Medical Center Pueblo, Colorado  81004
Beebe Medical Center Lewes, Delaware  19958
St. Francis Hospital Wilmington, Delaware  19805
Michael & Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital Fort Lauderdale, Florida  33308
Ella Milbank Foshay Cancer Center at Jupiter Medical Center Jupiter, Florida  33458
St. Joseph Medical Center Bloomington, Illinois  61701
Graham Hospital Canton, Illinois  61520
Memorial Hospital Carthage, Illinois  62321
Galesburg Cottage Hospital Galesburg, Illinois  61401
Galesburg Clinic Galesburg, Illinois  61401
InterCommunity Cancer Center of Western Illinois Galesburg, Illinois  61401
Mason District Hospital Havana, Illinois  62644
Hopedale Medical Complex Hopedale, Illinois  61747
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
Cancer Treatment Center at Pekin Hospital Pekin, Illinois  61554
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
Valley Cancer Center Spring Valley, Illinois  61362
Center for Cancer Therapy at LaPorte Hospital and Health Services La Porte, Indiana  46350
St. Luke's Hospital Cedar Rapids, Iowa  52402
Genesis Medical Center - West Campus Davenport, Iowa  52804
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
Medical Oncology and Hematology Associates - West Des Moines West Des Moines, Iowa  50266
Union Hospital Cancer Center at Union Hospital Elkton MD, Maryland  21921
Virginia Piper Cancer Institute at Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Medical Center Robbinsdale, Minnesota  55422-2900
Charles R. Wood Cancer Center at Glens Falls Hospital Glens Falls, New York  12801
Community General Hospital of Greater Syracuse Syracuse, New York  13215
Wilson Medical Center Wilson, North Carolina  27893-3428
Bismarck Cancer Center Bismarck, North Dakota  58501
St. Alexius Medical Center Bismarck, North Dakota  58502
Samaritan North Cancer Care Center Dayton, Ohio  45415
Grandview Hospital Dayton, Ohio  45405
Good Samaritan Hospital Dayton, Ohio  45406
Charles F. Kettering Memorial Hospital Kettering, Ohio  45429
Middletown Regional Hospital Middletown, Ohio  45044
UVMC Cancer Care Center at Upper Valley Medical Center Troy, Ohio  45373-1300
Cleveland Clinic - Wooster Wooster, Ohio  44691
Ruth G. McMillan Cancer Center at Greene Memorial Hospital Xenia, Ohio  45385
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
Bon Secours St. Francis Health System Greenville, South Carolina  29601
Danville Regional Medical Center Danville, Virginia  24541
Providence Cancer Center at Holy Family Hospital Spokane, Washington  99207
Eureka Hospital Eureka, Illinois  61530
Joliet Oncology Hematology Associates, Limited - West Joliet, Illinois  60435
Oncology Hematology Associates of Central Illinois - Ottawa Ottawa, Illinois  61350
Mercy Hospital Coon Rapids, Minnesota  55433
Mercy and Unity Cancer Center at Mercy and Unity Hospitals Fridley, Minnesota  55432-2799
Park Nicollet Clinic St. Louis Park, Minnesota  55416
Community Oncology Group - Independence Independence, Ohio  44131
Rose Ramer Cancer Clinic at Anderson Area Medical Center Anderson, South Carolina  29621
McFarland Clinic, P.C. Ames, Iowa  50010
St. John's Hospital Maplewood, Minnesota  55109
Mid Dakota Clinic, P.C. Bismarck, North Dakota  58501
Pottstown Memorial Regional Cancer Center Pottstown, Pennsylvania  19464
Geisinger Medical Group State College, Pennsylvania  16801
Geisinger Wyoming Valley Medical Center Wilkes-Barre, Pennsylvania  18711
Fox Valley Hematology and Oncology Appleton, Wisconsin  54911
CCOP - Mayo Clinic Scottsdale Oncology Program Scottsdale, Arizona  85259
St. Francis Hospital and Health Centers Beech Grove, Indiana  46107
Saint Joseph Regional Medical Center - Plymouth Campus Plymouth, Indiana  46544
Mercy Cancer Center at Mercy Medical Center Cedar Rapids, Iowa  52403
Wendt Regional Cancer Center at Finley Hospital Dubuque, Iowa  52001
Central Maine Medical Center Lewiston, Maine  04240
Cancer Care Center at Regions Hospital Saint Paul, Minnesota  55101
Saint Francis Cancer Center Shakopee, Minnesota  55379
St. Joseph's Hospital St Paul, Minnesota  55102
Woodwinds Hospital Woodbury, Minnesota  55125
Missouri Cancer Associates Columbia, Missouri  65201
Randolph Hospital Asheboro, North Carolina  27203
John Smith, Jr./Dalton McMichael Cancer Center at Morehead Memorial Hospital Eden, North Carolina  27288
Moses Cone Regional Cancer Center at Wesley Long Community Hospital Greensboro, North Carolina  27401
Annie Penn Cancer Center Reidsville, North Carolina  27320
Akron City Hospital at Summa Health System Akron, Ohio  44304
Miami Valley Hospital Dayton, Ohio  45409
Comprehensive Cancer Center at Legacy Good Samaritan Hospital & Medical Center Portland, Oregon  97210
Institute of Oncology at Vilnius University Portland, Oregon  97227
Cancer Center at Southwest Washington Medical Center Vancouver, Washington  98668
William N. Wishard Memorial Hospital Indianapolis, Indiana  46202
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
Watson Clinic Lakeland, Florida  33805
Phoebe Cancer Center at Phoebe Putney Memorial Hospital Albany, Georgia  31702
Rutherford Hospital Rutherfordton, North Carolina  28139
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Riddle Memorial Hospital Media, Pennsylvania  19063
Roper St. Francis Healthcare - Roper Hospital Charleston, South Carolina  29401
Central Pennsylvania Hematology and Medical Oncology Associates, PC Lemoyne, Pennsylvania  17043
Lipson Cancer and Blood Center at Rochester General Hospital Rochester, New York  14621
Arroyo Grande Community Hospital Arroyo Grande, California  93420
Lynn Regional Cancer Center of Boca Raton Community Hospital Boca Raton, Florida  33486
Hematology and Oncology of Northeast Georgia Athens, Georgia  30607
John B. Amos Community Cancer Center Columbus, Georgia  31902
Provena St. Mary's Wasser Regional Cancer Center - Kankakee Kankakee, Illinois  60901
Lawrence Memorial Hospital of Medford Medford, Massachusetts  02155
St. Anthony's Cancer Center St. Louis, Missouri  63128
St. Elizabeth Boardman Cancer Center Boardman, Ohio  44512
St. Joseph Health Care Center Warren, Ohio  44484
St. Elizabeth Cancer Center at St. Elizabeth Health Center - Youngstown Youngstown, Ohio  44510
Cancer Treatment Center at Merle West Medical Center Klamath Falls, Oregon  97601
UW Health Oncology Madison, Wisconsin  53715
University of Wisconsin Cancer Center at Aspirus Wausau Hospital Wausau, Wisconsin  54401