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A Randomized Trial of Adjuvant Chemotherapy With Standard Regimens, Cyclophosphamide, Methotrexate and Fluorouracil - (CMF) or Doxorubicin and Cyclophosphamide - (AC), Versus Capecitabine in Women 65 Years and Older With Node Positive or Node-Negative Breast Cancer


Phase 3
65 Years
N/A
Not Enrolling
Female
Breast Cancer

Thank you

Trial Information

A Randomized Trial of Adjuvant Chemotherapy With Standard Regimens, Cyclophosphamide, Methotrexate and Fluorouracil - (CMF) or Doxorubicin and Cyclophosphamide - (AC), Versus Capecitabine in Women 65 Years and Older With Node Positive or Node-Negative Breast Cancer


OBJECTIVES:

- Compare the effectiveness of adjuvant chemotherapy comprising standard
cyclophosphamide, methotrexate, and fluorouracil (CMF) or doxorubicin and
cyclophosphamide (AC) vs oral capecitabine, in terms of disease-free and overall
survival, in elderly women with operable adenocarcinoma of the breast.

- Compare the quality of life and physical functioning of patients treated with these
regimens.

- Compare the toxicity of these regimens in these patients.

- Evaluate the adherence of older patients to an oral chemotherapy regimen.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to age
(65 to 69 vs 70 to 80 vs over 80), performance status (0-1 vs 2), and HER2 status (positive
vs negative vs unknown). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients with insufficient left ventricular ejection fraction (LVEF) are
assigned to group A. Patients with normal LVEF are assigned to group A or B based on
physician/patient choice.

- Group A (CMF): Patients receive oral cyclophosphamide (CTX) daily on days 1-14 and
methotrexate IV and fluorouracil IV on days 1 and 8. Treatment repeats every 4
weeks for 6 courses in the absence of disease progression or unacceptable
toxicity.

- Group B (AC): Patients receive doxorubicin IV and CTX IV on day 1. Treatment
repeats every 3 weeks for 4 courses in the absence of disease progression or
unacceptable toxicity.

- Arm II: Patients receive oral capecitabine twice daily on days 1-14. Treatment repeats
every 3 weeks for 6 courses in the absence of disease progression or unacceptable
toxicity.

Beginning within 12 weeks after treatment in arm I or II, patients with estrogen or
progesterone receptor-positive disease receive oral tamoxifen or an aromatase inhibitor
daily for 5 years.

Beginning 4-6 weeks after treatment in arm I or II, eligible patients who previously
underwent breast conservation surgery undergo radiotherapy.

Quality of life is assessed at baseline; at 6 weeks (group B), 9 weeks (arm II), or 12 weeks
(group A); and then at 1, 12, 18, and 24 months after study.

Drug adherence is assessed at 9 weeks during study (arm II).

Patients are followed at 1 month, every 6 months for 2 years, and then annually for 15
years.

PROJECTED ACCRUAL: A total of 600-1,800 patients (300-900 per treatment arm) will be accrued
for this study within 2-6 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically proven operable adenocarcinoma of the breast*

- Stage I-IIIC disease

- T1-4 (tumor size ≥ 1 cm), N0, M0 OR

- T1-4, N1-3, M0 NOTE: *Bilateral, synchronous breast cancer allowed provided
1 primary tumor meets the staging criteria

- Must have undergone 1 of the following within the past 12 weeks:

- Modified radical mastectomy

- No evidence of gross or microscopic invasive tumor at the surgical
resection margins

- Close margins (tumor less than 1 mm from margin) allowed

- Lumpectomy (clear margins preferred)

- Ductal carcinoma in situ or lobular carcinoma in situ at the surgical
resection margin allowed

- No invasive tumor at the final resection margin

- Any number of previously excised nodes allowed

- Axillary node dissection not required

- HER2/neu positive, negative, or unknown

- Patients with HER2 positive tumors by immunohistochemistry 3+ staining or that
demonstrate gene amplification by fluorescence in situ hybridization are
eligible to receive trastuzumab (Herceptin) on study

- Hormone receptor status:

- Not specified

PATIENT CHARACTERISTICS:

Age:

- 65 and over

Sex:

- Female

Menopausal status:

- Postmenopausal

Performance status:

- 0-2

Life expectancy:

- More than 5 years

Hematopoietic:

- Granulocyte count at least 1,500/mm^3

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

Hepatic:

- Bilirubin no greater than upper limit of normal

Renal:

- Creatinine clearance at least 30 mL/min

Cardiovascular:

- No uncontrolled cardiac disease that would preclude study entry

- Left ventricular ejection fraction at least lower limit of normal (arm I, group B
only)

Other:

- HIV negative

- No other concurrent active malignancy except nonmelanoma skin cancer

- Disease considered not currently active if completely treated with less than a
30% risk of relapse

- No psychiatric illness that would preclude informed consent

- No other medical condition (e.g., uncontrolled infection) that would preclude study
entry

- No hypersensitivity to fluorouracil

- No known dihydropyrimidine dehydrogenase deficiency

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- Not specified

Chemotherapy:

- No prior chemotherapy for breast cancer

- No other concurrent chemotherapy

Endocrine therapy:

- Up to 4 weeks of prior tamoxifen for current breast cancer allowed

- Prior tamoxifen or raloxifene for chemoprevention (e.g., breast cancer prevention
study) or other indications (including prior breast cancer) allowed but must be
discontinued before study entry

- No concurrent hormonal therapy except steroids for adrenal failure, hormones for
non-disease related conditions (e.g., insulin for diabetes), or intermittent
dexamethasone as an antiemetic

Radiotherapy:

- Not specified

Surgery:

- See Disease Characteristics

Other:

- No concurrent dexrazoxane

- No concurrent bisphosphonates except for treatment of osteoporosis

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:

Relapse-free Survival Rates at 2.4 Years

Outcome Description:

Percentage of participants who were alive and relapse-free at time of analysis were counted as "Alive without relapse" at 2.4 years. Participants who had a first local recurrence, first distant metastasis or death from any cause were counted as "relapse, first occurrence". These rates were estimated using the Kaplan Meier method

Outcome Time Frame:

randomization until date of first event, or date last known to be event free if no event was reported (up to 5 years)

Safety Issue:

No

Principal Investigator

Hyman B. Muss, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Fletcher Allen Health Care - University Health Center Campus

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000068891

NCT ID:

NCT00024102

Start Date:

September 2001

Completion Date:

November 2012

Related Keywords:

  • Breast Cancer
  • stage I breast cancer
  • stage II breast cancer
  • stage IIIA breast cancer
  • stage IIIB breast cancer
  • stage IIIC breast cancer
  • Breast Neoplasms

Name

Location

Akron City Hospital Akron, Ohio  44304
Roswell Park Cancer Institute Buffalo, New York  14263
Memorial Sloan-Kettering Cancer Center New York, New York  10021
Mayo Clinic Scottsdale Scottsdale, Arizona  85259
Mayo Clinic - Jacksonville Jacksonville, Florida  32224
Mayo Clinic Cancer Center Rochester, Minnesota  55905
Walter Reed Army Medical Center Washington, District of Columbia  20307-5000
University of Chicago Cancer Research Center Chicago, Illinois  60637
Duke Comprehensive Cancer Center Durham, North Carolina  27710
CCOP - Upstate Carolina Spartanburg, South Carolina  29303
CCOP - Atlanta Regional Atlanta, Georgia  30342-1701
CCOP - Missouri Valley Cancer Consortium Omaha, Nebraska  68131
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 - Metro-Minnesota Saint Louis Park, Minnesota  55416
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
Cedar Rapids Oncology Associates Cedar Rapids, Iowa  52403
Tufts-NEMC Cancer Center Boston, Massachusetts  02111
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
CCOP - Duluth 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
HealthEast Cancer Care at St. John's Hospital Maplewood, Minnesota  55109
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
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
CCOP - MeritCare Hospital Fargo, North Dakota  58122
Case Comprehensive Cancer Center Cleveland, Ohio  44106-5065
St. Rita's Medical Center Lima, Ohio  45801
Geisinger Medical Center Danville, Pennsylvania  17822-0001
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
Medical X-Ray Center, PC Sioux Falls, South Dakota  57105
Avera Cancer Institute Sioux Falls, South Dakota  57105
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center La Crosse, Wisconsin  54601
Dean Medical Center - Madison Madison, Wisconsin  53717
University of Alabama at Birmingham Comprehensive Cancer Center Birmingham, Alabama  35294-3300
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
Methodist Medical Center of Illinois Peoria, Illinois  61636
Cape Cod Hospital Hyannis, Massachusetts  02601
CCOP - Montana Cancer Consortium Billings, Montana  59101
Veterans Affairs Medical Center - Dayton Dayton, Ohio  45428
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
CCOP - MainLine Health Wynnewood, Pennsylvania  19096
University of Wisconsin Comprehensive Cancer Center Madison, Wisconsin  53792
University of Miami Sylvester Comprehensive Cancer Center Miami, Florida  33136
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
CCOP - Grand Rapids Grand Rapids, Michigan  49503
Ellis Fischel Cancer Center at University of Missouri - Columbia Columbia, Missouri  65203
Siteman Cancer Center at Barnes-Jewish Hospital Saint Louis, Missouri  63110
Charles M. Barrett Cancer Center at University Hospital Cincinnati, Ohio  45267-0526
MetroHealth's Cancer Care Center at MetroHealth Medical Center Cleveland, Ohio  44106
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia Philadelphia, Pennsylvania  19107
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
USC/Norris Comprehensive Cancer Center and Hospital Los Angeles, California  90033-0804
MBCCOP - LSU Health Sciences Center New Orleans, Louisiana  70112
Brooke Army Medical Center Fort Sam Houston, Texas  78234-6200
CCOP - Northwest Tacoma, Washington  98405-0986
Kent County Memorial Hospital Warwick, Rhode Island  02886
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute Boston, Massachusetts  02115
Fletcher Allen Health Care - University Health Center Campus Burlington, Vermont  05401
Mobile Infirmary Medical Center Mobile, Alabama  36640-0460
St. Vincent Mercy Medical Center Toledo, Ohio  43608
Great Falls Clinic Great Falls, Montana  59405
Arizona Cancer Center at University of Arizona Health Sciences Center Tucson, Arizona  85724
Cancer Research Center at Boston Medical Center Boston, Massachusetts  02118
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus Seattle, Washington  98104
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Maine Center for Cancer Medicine and Blood Disorders - Scarborough Scarborough, Maine  04074
Overlook Hospital Summit, New Jersey  07902-0220
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
Carol G. Simon Cancer Center at Morristown Memorial Hospital Morristown, New Jersey  07962
Winthrop University Hospital Mineola, New York  11501
Oklahoma University Medical Center Oklahoma City, Oklahoma  73104
Sioux Valley Hospital and University of South Dakota Medical Center Sioux Falls, South Dakota  57117-5134
Trinity Cancer Care Center Minot, North Dakota  58701
CCOP - Toledo Community Hospital Toledo, Ohio  43623-3456
St. Luke's Hospital Cancer Center Bethlehem, Pennsylvania  18015
Wilford Hall Medical Center Lackland Air Force Base, Texas  78236-5300
Stony Brook University Cancer Center Stony Brook, New York  11794-8174
SUNY Upstate Medical University Hospital Syracuse, New York  13210
Mission Hospitals - Memorial Campus Asheville, North Carolina  28801
Medical University of Ohio Cancer Center Toledo, Ohio  43614
Toledo Hospital Toledo, Ohio  43606
Hollings Cancer Center at Medical University of South Carolina Charleston, South Carolina  29425
Providence Cancer Center at Sacred Heart Medical Center Spokane, Washington  99220-2555
Aultman Hospital Cancer Center at Aultman Health Foundation Canton, Ohio  44710-1799
James P. Wilmot Cancer Center at University of Rochester Medical Center Rochester, New York  14642
McCreery Cancer Center at Ottumwa Regional Ottumwa, Iowa  52501
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
Sibley Memorial Hospital Washington, District of Columbia  20016
Hematology Oncology Associates of the Quad Cities Bettendorf, Iowa  52722
Northern Michigan Hospital Petoskey, Michigan  49770
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
Wayne Memorial Hospital, Incorporated Goldsboro, North Carolina  27534
University Cancer Center at University of Washington Medical Center Seattle, Washington  98195
Group Health Central Hospital Seattle, Washington  98104
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Greenebaum Cancer Center at University of Maryland Medical Center Baltimore, Maryland  21201
UNMC Eppley Cancer Center at the University of Nebraska Medical Center Omaha, Nebraska  68198-7680
New Hampshire Oncology-Hematology, PA - Hooksett Hooksett, New Hampshire  03106
Lakeland Cancer Care Center at Lakeland Hospital - St. Joseph Saint Joseph, Michigan  49085
Zimmer Cancer Center at New Hanover Regional Medical Center Wilmington, North Carolina  28402-9025
University of Illinois Cancer Center Chicago, Illinois  60612-7243
Swedish-American Regional Cancer Center Rockford, Illinois  61104-2315
CCOP - Nevada Cancer Research Foundation Las Vegas, Nevada  89109-2306
Madigan Army Medical Center - Tacoma Tacoma, Washington  98431
East Tennessee State University Cancer Center at Johnson City Medical Center Johnson City, Tennessee  37604
Huntsman Cancer Institute at University of Utah Salt Lake City, Utah  84112
Robert H. Lurie Comprehensive Cancer Center at Northwestern University Chicago, Illinois  60611
Decatur Memorial Hospital Cancer Care Institute Decatur, Illinois  62526
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
Lakeland Regional Cancer Center at Lakeland Regional Medical Center Lakeland, Florida  33805
Veterans Affairs Medical Center - Chicago Westside Hospital Chicago, Illinois  60612
Hematology Oncology Associates - Skokie Skokie, Illinois  60076
University Medical Center of Southern Nevada Las Vegas, Nevada  89102
Jennersville Regional Hospital West Grove, Pennsylvania  19390-9499
Saint Rose Hospital Hayward, California  94545
Moores UCSD Cancer Center La Jolla, California  92093-0658
Highland General Hospital at St. George's University School of Medicine Oakland, California  94602
Alta Bates Summit Medical Center - Summit Campus Oakland, California  94609
Valley Care Medical Center Pleasanton, California  94588
Salinas Valley Memorial Hospital Salinas, California  93901
Kaiser Permanente Medical Office -Vandever Medical Office San Diego, California  92120
Memorial Hospital Colorado Springs, Colorado  80909
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
Gwinnett Medical Center Lawrenceville, Georgia  30045
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
Galesburg Clinic Galesburg, Illinois  61401
Mason District Hospital Havana, Illinois  62644
Hopedale Medical Complex Hopedale, Illinois  61747
Midwest Center for Hematology/Oncology Joliet, Illinois  60432
North Shore Oncology and Hematology Associates, Limited - Libertyville Libertyville, Illinois  60048
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
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
St. Francis Hospital and Health Centers - Beech Grove Campus Beech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Fort Wayne, Indiana  46815
St. Luke's Hospital Cedar Rapids, Iowa  52402
Mercy Regional Cancer Center at Mercy Medical Center Cedar Rapids, Iowa  52403
Genesis Regional Cancer Center at Genesis Medical Center Davenport, Iowa  52803
Stormont-Vail Cancer Center Topeka, Kansas  66604
St. Francis Comprehensive Cancer Center Topeka, Kansas  66606
Hickman Cancer Center at Bixby Medical Center Adrian, Michigan  49221
Community Cancer Center of Monroe Monroe, Michigan  48162
Mercy Memorial Hospital System Monroe, Michigan  48162
Providence Cancer Institute at Providence Hospital - Southfield Campus Southfield, Michigan  48075
MeritCare Clinic - Bemidji Bemidji, Minnesota  56601
Virginia Piper Cancer Institute at Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Chippewa County - Montevideo Hospital Montevideo, Minnesota  56265
Hubert H. Humphrey Cancer Center at North Memorial Medical Center Robbinsdale, Minnesota  55422-2900
CentraCare Clinic - River Campus St. Cloud, Minnesota  56303
Park Nicollet Health Services St. Louis Park, Minnesota  55416
Saint Francis Cancer Treatment Center at Saint Francis Memorial Health Center Grand Island, Nebraska  68803
Immanuel Medical Center Omaha, Nebraska  68122
Creighton University Medical Center Omaha, Nebraska  68131-2197
Booker Cancer Center at Riverview Medical Center Red Bank, New Jersey  07701
Adirondack Cancer Care - Glens Falls Glens Falls, New York  12801
Charles R. Wood Cancer Center at Glens Falls Hospital Glens Falls, New York  12801
Highland Hospital of Rochester Rochester, New York  14620
Cancer Care Center at Medcenter One Hospital Bismarck, North Dakota  58501
MeritCare Medical Group Fargo, North Dakota  58122
Wood County Oncology Center Bowling Green, Ohio  43402
Samaritan North Cancer Care Center Dayton, Ohio  45415
Grandview Hospital Dayton, Ohio  45405
David L. Rike Cancer Center at Miami Valley Hospital Dayton, Ohio  45409
Good Samaritan Hospital Dayton, Ohio  45406
Fremont Memorial Hospital Fremont, Ohio  43420
Charles F. Kettering Memorial Hospital Kettering, Ohio  45429
Lima Memorial Hospital Lima, Ohio  45804
St. Luke's Hospital Maumee, Ohio  43537
Northwest Ohio Oncology Center Maumee, Ohio  43537
Middletown Regional Hospital Middletown, Ohio  45044
Toledo Clinic - Oregon Oregon, Ohio  43616
St. Charles Mercy Hospital Oregon, Ohio  43616
North Coast Cancer Care, Incorporated Sandusky, Ohio  44870
Firelands Regional Medical Center Sandusky, Ohio  44870
Toledo Clinic, Incorporated - Main Clinic Toledo, Ohio  43623
UVMC Cancer Care Center at Upper Valley Medical Center Troy, Ohio  45373-1300
Fulton County Health Center Wauseon, Ohio  43567
Ruth G. McMillan Cancer Center at Greene Memorial Hospital Xenia, Ohio  45385
LaFortune Cancer Center at St. John Medical Center Tulsa, Oklahoma  74104
Bryn Mawr Hospital Bryn Mawr, Pennsylvania  19010
Hematology and Oncology Associates Scranton, Pennsylvania  18510
Lankenau Cancer Center at Lankenau Hospital Wynnewood, Pennsylvania  19096
Oncology Services of Aberdeen Aberdeen, South Dakota  57401
Mountainview Medical Berlin, Vermont  05602
Providence Cancer Center at Holy Family Hospital Spokane, Washington  99207
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital Yakima, Washington  98902
Holy Family Memorial Medical Center Cancer Care Center Manitowoc, Wisconsin  54221-1450
St. Francis Hospital Federal Way, Washington  98003
St. Clare Hospital Lakewood, Washington  98499-0998
Capital Medical Center Olympia, Washington  98502
Providence St. Peter Hospital Regional Cancer Center Olympia, Washington  98506
Good Samaritan Cancer Center Puyallup, Washington  98371
St. Joseph Medical Center at Franciscan Health System Tacoma, Washington  98405-3004
Faulkner Hospital Jamaica Plain, Massachusetts  02130
Leavey Cancer Center at Northridge Hospital Medical Center Northridge, California  91325
Central Maine Medical Center Lewiston, Maine  04240
Bethke Cancer Center at Emerson Hospital Concord, Massachusetts  01742
Cancer Care Center at St. Luke's Hospital Duluth, Minnesota  55805
Saint Francis Cancer Center Shakopee, Minnesota  55379
St. Joseph's Hospital St Paul, Minnesota  55102
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Missouri Baptist Cancer Center St. Louis, Missouri  63131
Randolph Hospital Asheboro, North Carolina  27203
Moses Cone Regional Cancer Center at Wesley Long Community Hospital Greensboro, North Carolina  27401
Annie Penn Cancer Center Reidsville, North Carolina  27320
Altru Cancer Center at Altru Hospital Grand Forks, North Dakota  58201
Western Pennsylvania Cancer Institute at Western Pennsylvania Hospital Pittsburgh, Pennsylvania  15224-1791
St. Joseph Medical Center Reading, Pennsylvania  19604
Eastern Connecticut Hematology and Oncology Associates Norwich, Connecticut  06360
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler Savannah, Georgia  31405
Cancer Care and Hematology Specialists of Chicagoland - Niles Niles, Illinois  60714
McFarland Clinic, PC Ames, Iowa  50010
Haematology-Oncology Associates of Ohio and Michigan, PC Lambertville, Michigan  48144
Willmar Cancer Center at Rice Memorial Hospital Willmar, Minnesota  56201
Alegant Health Cancer Center at Bergan Mercy Medical Center Omaha, Nebraska  68124
Flower Hospital Cancer Center Sylvania, Ohio  43560
Cleo Craig Cancer Research Clinic Lawton, Oklahoma  73505
Cancer Care Associates - Mercy Campus Oklahoma City, Oklahoma  73120
St. Joseph Cancer Center Bellingham, Washington  98225
Vince Lombardi Cancer Center at Aurora Lakeland Medical Center - Elkhorn Elkhorn, Wisconsin  53121
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center Green Bay, Wisconsin  54311
Medical Consultants, Limited Milwaukee, Wisconsin  53215
University of Minnesota Medical Center & Children's Hospital - Fairview Minneapolis, Minnesota  55455
FirstHealth Moore Regional Community Hospital Comprehensive Cancer Center Pinehurst, North Carolina  28374
Mid Dakota Clinic, PC Bismarck, North Dakota  58501
St. Francis Medical Center Honolulu, Hawaii  96817
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
Auburn Regional Center for Cancer Care Auburn, Washington  98002
Community Hospital Munster, Indiana  46321
Memorial Hospital of Rhode Island Pawtucket, Rhode Island  02860
Aurora Sinai Medical Center Milwaukee, Wisconsin  53201-0342
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Hematology Oncology Associates of Eastern Idaho Idaho Falls, Idaho  83404
Regional Cancer Institute at Bloomington Hospital Bloomington, Indiana  47403
Caritas Norwood Hospital Norwood, Massachusetts  02062
Immanuel St. Joseph's Clinic Mankato, Minnesota  56002
Good Samaritan Cancer Center at Good Samaritan Hospital Kearney, Nebraska  68848-1990
Elliot Regional Cancer Center at Elliot Hospital Manchester, New Hampshire  03103
Rutherford Hospital Rutherfordton, North Carolina  28139
AnMed Health Cancer Center Anderson, South Carolina  29621
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Martha Jefferson Hospital Cancer Care Center Charlottesville, Virginia  22901
Glendale Memorial Hospital Comprehensive Cancer Center Glendale, California  91204
St. Francis Hospital Evanston, Illinois  60202
Frederick Memorial Hospital Regional Cancer Therapy Center Frederick, Maryland  21701
MBCCOP - Meharry Medical College - Nashville Nashville, Tennessee  37208-3599
Palm Beach Cancer Institute - West Palm Beach West Palm Beach, Florida  33401
Cedar Valley Medical Specialists, PC - West Ridgeway Avenue Waterloo, Iowa  50702
Sletten Regional Cancer Institute at Benefis Healthcare Great Falls, Montana  59405
Lakes Region General Hospital Laconia, New Hampshire  03246
University of Wisconcin Cancer Center at Aspirus Wausau Hospital Wausau, Wisconsin  54401
Halifax Medical Center - Daytona Beach Daytona Beach, Florida  32115
Woodwinds Health Campus Woodbury, Minnesota  55125
Marshall University Medical Center Huntington, West Virginia  25701
Center for Cancer Care at OSF Saint Anthony Medical Center Rockford, Illinois  61108
Doctors Medical Center - San Pablo Campus San Pablo, California  94806
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Kapiolani Medical Center for Women and Children Honolulu, Hawaii  96826
Straub Clinic and Hospital, Incorporated Honolulu, Hawaii  96813
OnCare Hawaii, Incorporated - Kuakini Honolulu, Hawaii  96817
OnCare Hawaii, Incorporated - Lusitana Honolulu, Hawaii  96813
Pacific Cancer Institute - Maui Wailuku, Hawaii  96793
Cancer Center of Paoli Memorial Hospital Paoli, Pennsylvania  19301-1792
Dale and Frances Hughes Cancer Center at Pocono Medical Center East Stroudsburg, Pennsylvania  18301
Associates in Hematology-Oncology, PC at Crozer Regional Cancer Center Upland, Pennsylvania  19013
Provena St. Mary's Wasser Regional Cancer Center - Kankakee Kankakee, Illinois  60901
Lawrence Memorial Hospital of Medford Medford, Massachusetts  02155
Saint James Hospital and Health Centers Comprehensive Cancer Institute - Olympia Fields Olympia Fields, Illinois  60461
Minnesota Oncology Hematology, PA at Maplewood Cancer Center Maplewood, Minnesota  55109
Kent General Hospital at Bayhealth Medical Center Dover, Delaware  19901
Ocean Medical Center at Meridian Health Brick, New Jersey  08724
J. Phillip Citta Regional Cancer Center at Community Medical Center Toms River, New Jersey  08755
St. Joseph's Mercy Cancer Center Hot Springs, Arkansas  71913
Augusta Oncology Associates - Walton Way Augusta, Georgia  30901
Heartland Oncology & Hematology Council Bluffs, Iowa  51503
Christus Schumpert Cancer Treatment Center Shreveport, Louisiana  71101
Mercy Hospital of Portland Portland, Maine  04101
MaineGeneral Medical Center - Waterville Campus Waterville, Maine  04901
Saints Memorial Cancer Center at Saints Memorial Medical Center Lowell, Massachusetts  01852
South Shore Hospital South Weymouth, Massachusetts  02190
Albert Lea Cancer Center at Albert Lea Medical Center Albert Lea, Minnesota  56007
Carson-Tahoe Cancer Services at Carson Tahoe Regional Healthcare Carson City, Nevada  89703
Parkland Oncology-Hematology Clinic at Parkland Medical Center Derry, New Hampshire  03038
Bronx-Lebanon Hospital Center & BronxCare Adult Medical Practice Bronx, New York  10456
CaroMont Cancer Center at Gaston Memorial Hospital Gastonia, North Carolina  28053
Meadville Medical Center Meadville, Pennsylvania  16335
Nashville Oncology Associates, P.C. Nashville, Tennessee  37203