A Phase III Randomized Open-Label Study Comparing Gemcitabine Plus Cetuximab (IMC-C225) Versus Gemcitabine As First-Line Therapy Of Patients With Advanced Pancreas Cancer
Phase 3
18 Years
N/A
18 Years
N/A
Not Enrolling
Both
Pancreatic Cancer
Both
Pancreatic Cancer
Trial Information
A Phase III Randomized Open-Label Study Comparing Gemcitabine Plus Cetuximab (IMC-C225) Versus Gemcitabine As First-Line Therapy Of Patients With Advanced Pancreas Cancer
OBJECTIVES:
- Compare the overall survival of patients with locally advanced unresectable or
metastatic adenocarcinoma of the pancreas treated with gemcitabine and cetuximab vs
gemcitabine alone.
- Compare the time to treatment failure in patients treated with these regimens.
- Estimate the percentage of patients with epidermal growth factor receptor (EGFR) tumor
expression in patients treated with these regimens.
- Compare the overall survival of patients in the EGFR-positive subset treated with these
regimens.
- Compare the toxicity of these regimens in these patients.
- Compare the total response rate (confirmed and unconfirmed complete and partial
response) in patients with measurable disease treated with these regimens.
- Compare the patient report of pain and quality of life of patients treated with these
regimens.
OUTLINE: This is an open-label, randomized, multicenter study. Patients are stratified
according to disease status (locally advanced unresectable vs metastatic), Zubrod
performance status (0 or 1 vs 2), and prior pancreatectomy (yes vs no). Patients are
randomized to 1 of 2 treatment arms.
- Arm I: Patients receive cetuximab IV over 1-2 hours on days 1, 8, 15, and 22 and
gemcitabine IV over 30 minutes on days 1, 8, 15, and 22 for course 1 and days 1, 8, and
15 for all subsequent courses.
- Arm II: Patients receive gemcitabine as in arm I. In both arms, courses repeat every 4
weeks in the absence of disease progression or unacceptable toxicity.
Quality of life is assessed at baseline, before each course, and at the end of study
therapy.
Patients are followed every 6 months for 2 years and then annually for 1 year.
PROJECTED ACCRUAL: A total of 704 patients (352 per treatment arm) will be accrued for this
study within 5 years.
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically* or cytologically confirmed pancreatic adenocarcinoma meeting 1 of the
following criteria:
- Locally advanced unresectable disease
- Distant metastatic disease NOTE: If diagnosis is based on a metastatic site the
histology must be compatible with pancreatic cancer
- Measurable or nonmeasurable disease by x-ray, scan, or physical examination
- Tumor tissue must be submitted for evaluation of epidermal growth factor receptor
expression before study entry
- None of the following tumor types are allowed:
- Endocrine tumors
- Lymphoma of the pancreas
- Ampullary cancer
- No known brain metastases
PATIENT CHARACTERISTICS:
Age
- Not specified
Performance status
- Zubrod 0-2
Life expectancy
- At least 3 months
Hematopoietic
- Absolute granulocyte count at least 1,500/mm^3
- Platelet count at least 100,000/mm^3
Hepatic
- Bilirubin no greater than 2.0 times upper limit of normal (ULN)
- SGOT or SGPT no greater than 2.5 times ULN
Renal
- Creatinine no greater than 2.0 mg/dL
Cardiovascular
- No significant history of cardiac disease
- No uncontrolled hypertension
- No unstable angina
- No uncontrolled arrhythmia
- No congestive heart failure
Other
- Not pregnant or nursing
- Fertile patients must use effective contraception
- HIV negative
- No other malignancy within the past 5 years except adequately treated basal cell or
squamous cell skin cancer, carcinoma in situ of the cervix, or adequately treated
stage I or II cancer that is currently in remission
PRIOR CONCURRENT THERAPY:
Biologic therapy
- No prior immunotherapy for advanced pancreatic cancer
- No prior cetuximab or other therapy that targets the epidermal growth factor pathway
- No prior chimerized or murine monoclonal antibody therapy
- No other concurrent anticancer immunotherapy
Chemotherapy
- At least 6 months since prior adjuvant chemotherapy
- No prior chemotherapy or chemoradiotherapy for advanced pancreatic cancer
- No prior gemcitabine
- No other concurrent anticancer chemotherapy
Endocrine therapy
- No prior hormonal therapy for advanced pancreatic cancer
- No concurrent anticancer hormonal therapy
Radiotherapy
- See Chemotherapy
- At least 28 days since prior radiotherapy and recovered
- Prior palliative radiotherapy to metastatic sites allowed
- No concurrent anticancer radiotherapy, including whole brain radiotherapy for
progressive disease (i.e., CNS metastasis)
Surgery
- At least 14 days since prior pancreatic cancer surgery and recovered
Other
- No other concurrent anticancer therapy
Type of Study:
Interventional
Study Design:
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Outcome Measure:
Overall survival comparison between treatment groups
Outcome Time Frame:
every 4 weeks for 3 years
Safety Issue:
No
Principal Investigator
Philip A. Philip, MD, PhD, FRCP
Investigator Role:
Study Chair
Investigator Affiliation:
Barbara Ann Karmanos Cancer Institute
Authority:
United States: Federal Government
Study ID:
CDR0000347414
NCT ID:
NCT00075686
Start Date:
January 2004
Completion Date:
April 2009
Related Keywords:
- Pancreatic Cancer
- adenocarcinoma of the pancreas
- stage III pancreatic cancer
- stage IV pancreatic cancer
- Pancreatic Neoplasms
Name | Location |
|---|---|
| Akron City Hospital | Akron, Ohio 44304 |
| Roswell Park Cancer Institute | Buffalo, New York 14263 |
| Fred Hutchinson Cancer Research Center | Seattle, Washington 98109 |
| University of Michigan Comprehensive Cancer Center | Ann Arbor, Michigan 48109-0752 |
| Barbara Ann Karmanos Cancer Institute | Detroit, Michigan 48201 |
| University of Mississippi Medical Center | Jackson, Mississippi 39216-4505 |
| CCOP - Upstate Carolina | Spartanburg, South Carolina 29303 |
| CCOP - Wichita | Wichita, Kansas 67214-3882 |
| Medical City Dallas Hospital | Dallas, Texas 75230 |
| CCOP - Kansas City | Kansas City, Missouri 64131 |
| CCOP - North Shore University Hospital | Manhasset, New York 11030 |
| 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 |
| Hinsdale Hematology Oncology Associates | Hinsdale, Illinois 60521 |
| 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 |
| 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 |
| Mercy and Unity Cancer Center at Mercy Hospital | Coon Rapids, Minnesota 55433 |
| Fairview Southdale Hospital | Edina, Minnesota 55435 |
| Mercy and Unity Cancer Center at Unity Hospital | Fridley, Minnesota 55432 |
| United Hospital | St. Paul, Minnesota 55102 |
| Ridgeview Medical Center | Waconia, Minnesota 55387 |
| St. Rita's Medical Center | Lima, Ohio 45801 |
| 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 |
| Sutter Health Western Division Cancer Research Group | Greenbrae, California 94904 |
| CCOP - Bay Area Tumor Institute | Oakland, California 94609-3305 |
| Halifax Medical Center | Daytona Beach, Florida 32114 |
| Methodist Medical Center of Illinois | Peoria, Illinois 61636 |
| CCOP - Cancer Research for the Ozarks | Springfield, Missouri 65807 |
| 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 |
| Reading Hospital and Medical Center | Reading, Pennsylvania 19612-6052 |
| CCOP - Greenville | Greenville, South Carolina 29615 |
| Harrington Cancer Center | Amarillo, Texas 79106 |
| LDS Hospital | Salt Lake City, Utah 84143 |
| Green Mountain Oncology Group | Rutland, Vermont 05701 |
| CCOP - Western Regional, Arizona | Phoenix, Arizona 85006-2726 |
| University of Colorado Cancer Center at University of Colorado Health Sciences Center | Denver, Colorado 80010 |
| CCOP - Grand Rapids | Grand Rapids, Michigan 49503 |
| Keesler Medical Center - Keesler Air Force Base | Keesler AFB, Mississippi 39534-2576 |
| Charles M. Barrett Cancer Center at University Hospital | Cincinnati, Ohio 45267-0526 |
| CCOP - Columbia River Oncology Program | Portland, Oregon 97225 |
| MultiCare Regional Cancer Center at Tacoma General Hospital | Tacoma, Washington 98405 |
| Cleveland Clinic Taussig Cancer Center | Cleveland, Ohio 44195 |
| Veterans Affairs Medical Center - Denver | Denver, Colorado 80220 |
| CCOP - St. Louis-Cape Girardeau | Saint Louis, Missouri 63141 |
| Brooke Army Medical Center | Fort Sam Houston, Texas 78234-6200 |
| CCOP - Northwest | Tacoma, Washington 98405-0986 |
| Utah Valley Regional Medical Center - Provo | Provo, Utah 84604 |
| MidMichigan Medical Center - Midland | Midland, Michigan 48670 |
| University of California Davis Cancer Center | Sacramento, California 95817 |
| University of New Mexico Cancer Research and Treatment Center | Albuquerque, New Mexico 87131 |
| City of Hope Comprehensive Cancer Center | Duarte, California 91010 |
| Mobile Infirmary Medical Center | Mobile, Alabama 36640-0460 |
| Medical Center of Central Georgia | Macon, Georgia 31201 |
| St. Vincent Mercy Medical Center | Toledo, Ohio 43608 |
| Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center | Kansas City, Kansas 66160-7353 |
| 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 |
| Cancer Care at Our Lady of Bellefonte Hospital | Ashland, Kentucky 41101 |
| Hulston Cancer Center at Cox Medical Center South | Springfield, Missouri 65807 |
| St. John's Regional Health Center | Springfield, Missouri 65804 |
| McDowell Cancer Center at Akron General Medical Center | Akron, Ohio 44307 |
| Sioux Valley Hospital and University of South Dakota Medical Center | Sioux Falls, South Dakota 57117-5134 |
| M.D. Anderson Cancer Center at University of Texas | Houston, Texas 77030 |
| Central Baptist Hospital | Lexington, Kentucky 40503 |
| 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 |
| Long Island Jewish Medical Center | New Hyde Park, New York 11040 |
| Loma Linda University Cancer Institute at Loma Linda University Medical Center | Loma Linda, California 92354 |
| Broward General Medical Center Cancer Center | Ft. Lauderdale, Florida 33316 |
| University of Florida Shands Cancer Center | Gainesville, Florida 32610-0232 |
| Florida Hospital Cancer Institute at Florida Hospital Orlando | Orlando, Florida 32803-1273 |
| Curtis & Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center | Savannah, Georgia 31403-3089 |
| St. Luke's Mountain States Tumor Institute - Boise | Boise, Idaho 83712-6297 |
| Via Christi Cancer Center at Via Christi Regional Medical Center | Wichita, Kansas 67214 |
| Spectrum Health Cancer Care - Butterworth Campus | Grand Rapids, Michigan 49503-2560 |
| Mission Hospitals - Memorial Campus | Asheville, North Carolina 28801 |
| Presbyterian Cancer Center at Presbyterian Hospital | Charlotte, North Carolina 28233-3549 |
| Toledo Hospital | Toledo, Ohio 43606 |
| Tod Children's Hospital - Forum Health | Youngstown, Ohio 44501 |
| Hollings Cancer Center at Medical University of South Carolina | Charleston, South Carolina 29425 |
| Baylor University Medical Center - Houston | Houston, Texas 77030-2399 |
| Providence Cancer Center at Sacred Heart Medical Center | Spokane, Washington 99220-2555 |
| CCOP - Hematology-Oncology Associates of Central New York | East Syracuse, New York 13057 |
| Sibley Memorial Hospital | Washington, District of Columbia 20016 |
| Hematology Oncology Associates of the Quad Cities | Bettendorf, Iowa 52722 |
| Alaska Regional Hospital Cancer Center | Anchorage, Alaska 99508 |
| Banner Good Samaritan Medical Center | Phoenix, Arizona 85006 |
| Banner Thunderbird Medical Center | Phoenix, Arizona 85306 |
| North Colorado Medical Center | Greeley, Colorado 80631 |
| McKee Medical Center | Loveland, Colorado 80539 |
| Saint Anthony's Hospital at Saint Anthony's Health Center | Alton, Illinois 62002 |
| Good Samaritan Regional Health Center | Mt. Vernon, Illinois 62864 |
| Siouxland Regional Cancer Center | Sioux City, Iowa 51101-1733 |
| Cancer Center of Kansas, P.A. - El Dorado | El Dorado, Kansas 67042 |
| Southwest Medical Center | Liberal, Kansas 67901 |
| Cancer Center of Kansas, P.A. - Parsons | Parsons, Kansas 67357 |
| Cancer Center of Kansas, P.A. - Wichita | Wichita, Kansas 67214 |
| Battle Creek Health System Cancer Care Center | Battle Creek, Michigan 49017 |
| Metropolitan Hospital | Grand Rapids, Michigan 49506 |
| Lacks Cancer Center at Saint Mary's Mercy Medical Center | Grand Rapids, Michigan 49503 |
| Holland Community Hospital | Holland, Michigan 49423 |
| Hackley Hospital | Muskegon, Michigan 49443 |
| Northern Michigan Hospital | Petoskey, Michigan 49770 |
| William Beaumont Hospital - Royal Oak Campus | Royal Oak, Michigan 48073 |
| Munson Medical Center | Traverse City, Michigan 49684 |
| Southeast Missouri Regional Cancer Center at Southeast Missouri Hospital | Gape Girardeau, Missouri 63701 |
| David C. Pratt Cancer Center at St. John's Mercy | St. Louis, Missouri 63141 |
| Northern Rockies Radiation Oncology Center | Billings, Montana 59101 |
| Hematology-Oncology Centers of the Northern Rockies - Billings | Billings, Montana 59101 |
| St. Vincent Healthcare | Billings, Montana 59101 |
| Deaconess Billings Clinic - Downtown | Billings, Montana 59101 |
| Deaconess Billings Clinic Cancer Center | Billings, Montana 59107 |
| Internal Medicine Associates of Bozeman | Bozeman, Montana 59715 |
| Bozeman Deaconess Hospital | Bozeman, Montana 59715 |
| St. James Community Hospital | Butte, Montana 59701 |
| Big Sky Oncology | Great Falls, Montana 59405 |
| Sletten Regional Cancer Institute | Great Falls, Montana 59405 |
| St. Peter's Hospital | Helena, Montana 59601 |
| Kalispell Medical Oncology | Kalispell, Montana 59901 |
| Kalispell Regional Medical Center | Kalispell, Montana 59901 |
| Glacier Oncology, PLLC | 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 |
| 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 |
| 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 |
| Mount Carmel Cancer Services at Mount Carmel St. Ann's Hospital | Westerville, Ohio 43081 |
| Genesis - Good Samaritan Hospital | Zanesville, Ohio 43701 |
| American Fork Hospital | American Fork, Utah 84003 |
| Logan Regional Hospital | Logan, Utah 84321 |
| Cottonwood Hospital Medical Center | Murray, Utah 84107 |
| McKay-Dee Hospital Center | Ogden, Utah 84403 |
| Utah Cancer Specialists at UCS Cancer Center | Salt Lake City, Utah 84106 |
| St. Joseph Hospital Community Cancer Center | Bellingham, Washington 98225 |
| 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 |
| North Puget Oncology at United General Hospital | Sedro-Wooley, Washington 98284 |
| Cancer Care Northwest - Spokane South | Spokane, Washington 99202 |
| Wenatchee Valley Clinic | Wenatchee, Washington 98801 |
| Lenoir Memorial Cancer Center | Kinston, North Carolina 28503-1678 |
| Lombardi Comprehensive Cancer Center at Georgetown University Medical Center | Washington, District of Columbia 20007 |
| Oncology/Hematology Associates of Central Illinois, P.C. | Peoria, Illinois 61602 |
| Chao Family Comprehensive Cancer Center at University of California Irvine Medical Center | Orange, California 92868 |
| Summit Medical Center | Oakland, California 94609 |
| Decatur Memorial Hospital Cancer Care Institute | Decatur, Illinois 62526 |
| Hillcrest Cancer Center at Hillcrest Hospital | Mayfield Heights, Ohio 44124 |
| Front Range Cancer Specialists | Fort Collins, Colorado 80528 |
| Jennersville Regional Hospital | West Grove, Pennsylvania 19390-9499 |
| Fox Valley Hematology and Oncology - East Grant Street | Appleton, Wisconsin 54911-3496 |
| Alta Bates Comprehensive Cancer Center | Berkeley, California 94704 |
| Peninsula Medical Center | Burlingame, California 94010 |
| Mount Diablo Regional Cancer Center | Concord, California 94524-4110 |
| Marin Cancer Institute at Marin General Hospital | Greenbrae, California 94904 |
| Saint Rose Hospital | Hayward, California 94545 |
| Highland General Hospital at St. George's University School of Medicine | Oakland, California 94602 |
| Valley Care Medical Center | Pleasanton, California 94588 |
| California Pacific Medical Center - California Campus | San Francisco, California 94118 |
| J.C. Robinson, M.D. Regional Cancer Center | San Pablo, California 94806 |
| Sutter Solano Medical Center | Vallejo, California 94589 |
| John Muir/Mt. Diablo Comprehensive Cancer Center | Walnut Creek, California 94598 |
| Memorial Hospital | Colorado Springs, Colorado 80909 |
| Poudre Valley Hospital | Fort Collins, Colorado 80524 |
| St. Joseph Medical Center | Bloomington, Illinois 61701 |
| Graham Hospital | Canton, Illinois 61520 |
| Memorial Hospital | Carthage, Illinois 62321 |
| Eureka Community Hospital | Eureka, Illinois 61530 |
| Galesburg Cottage Hospital | Galesburg, Illinois 61401 |
| 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 |
| St. Francis Hospital and Health Centers - Beech Grove Campus | Beech Grove, Indiana 46107 |
| Fort Wayne Medical Oncology and Hematology | Fort Wayne, Indiana 46815 |
| Reid Hospital & Health Care Services, Incorporated | Richmond, Indiana 47374 |
| McFarland Clinic, P. C. | Ames, Iowa 50010 |
| St. Luke's Hospital | Cedar Rapids, Iowa 52402 |
| Mercy Regional Cancer Center at Mercy Medical Center | Cedar Rapids, Iowa 52403 |
| Genesis Medical Center - West Campus | Davenport, Iowa 52804 |
| Genesis Regional Cancer Center at Genesis Medical Center | Davenport, Iowa 52803 |
| Cancer Center of Kansas, P.A. - Chanute | Chanute, Kansas 66720 |
| Cancer Center of Kansas, P.A. - Kingman | Kingman, Kansas 67068 |
| Cancer Center of Kansas, P.A. - Newton | Newton, Kansas 67114 |
| Cancer Center of Kansas, P.A. - Pratt | Pratt, Kansas 67124 |
| Cancer Center of Kansas, P.A. - Salina | Salina, Kansas 67042 |
| Stormont-Vail Cancer Center | Topeka, Kansas 66604 |
| St. Francis Comprehensive Cancer Center | Topeka, Kansas 66606 |
| Cancer Center of Kansas, P.A. - Wellington | Wellington, Kansas 67152 |
| Cancer Center of Kansas, P.A. - Medical Arts Tower | Wichita, Kansas 67208 |
| Associates in Womens Health, P.A. - North Review | Wichita, Kansas 67203 |
| Cancer Center of Kansas, P.A. - Winfield | Winfield, Kansas 67156 |
| Sturdy Memorial Hospital | Attleboro, Massachusetts 02703 |
| Hickman Cancer Center at Bixby Medical Center | Adrian, Michigan 49221 |
| Mecosta County Medical Center | Big Rapids, Michigan 49307 |
| Haematology-Oncology Associates of Ohio and Michigan, P.C. | Lambertville, Michigan 48144 |
| Upper Michigan Cancer Center at Marquette General Hospital | Marquette, Michigan 49855 |
| Community Cancer Center of Monroe | Monroe, Michigan 48162 |
| Mercy Memorial Hospital System | Monroe, Michigan 48162 |
| 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 |
| Park Nicollet Health Services | St. Louis Park, Minnesota 55416 |
| Saint Francis Medical Center | Cape Girardeau, Missouri 63701 |
| Adirondack Cancer Care - Glens Falls | Glens Falls, New York 12801 |
| Wayne Radiation Oncology | Goldsboro, North Carolina 27534 |
| Iredell Memorial Hospital | Statesville, North Carolina 28677 |
| Wilson Medical Center | Wilson, North Carolina 27893-3428 |
| Forsyth Regional Cancer Center at Forsyth Medical Center | Winston-Salem, North Carolina 27103 |
| Wood County Oncology Center | Bowling Green, Ohio 43402 |
| Samaritan North Cancer Care Center | Dayton, Ohio 45415 |
| Grandview Hospital | Dayton, Ohio 45405 |
| Good Samaritan Hospital | Dayton, Ohio 45406 |
| Blanchard Valley Medical Associates | Findlay, Ohio 45840 |
| Fremont Memorial Hospital | Fremont, Ohio 43420 |
| Community Oncology Group at Cleveland Clinic Cancer Center | Independence, Ohio 44131 |
| Kenton Oncology, Incorporated | Kenton, Ohio 43326 |
| 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 |
| North Coast Cancer Care, Incorporated | Sandusky, Ohio 44870 |
| Firelands Regional Medical Center | Sandusky, Ohio 44870 |
| Mercy Medical Center | Springfield, Ohio 45504 |
| Promedica Cancer Center at Flower Hospital | Sylvania, Ohio 43560 |
| Toledo Clinic, Incorporated - Main Clinic | Toledo, Ohio 43623 |
| Toledo Surgical Specialists | Toledo, Ohio 43623 |
| UVMC Cancer Care Center at Upper Valley Medical Center | Troy, Ohio 45373-1300 |
| Fulton County Health Center | Wauseon, Ohio 43567 |
| 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 |
| Legacy Good Samaritan Hospital & Medical Center Comprehensive Cancer Center | Portland, Oregon 97210 |
| 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 |
| St. Mary Regional Cancer Center | Langhorne, Pennsylvania 19047 |
| Bon Secours St. Francis Health System | Greenville, South Carolina 29601 |
| Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical Center | Kingsport, Tennessee 37662 |
| UMC Southwest Cancer and Research Center | Lubbock, Texas 79415-3364 |
| Dixie Regional Medical Center - East Campus | Saint George, Utah 84770 |
| Southwestern Vermont Regional Cancer Center | Bennington, Vermont 05201 |
| Danville Regional Medical Center | Danville, Virginia 24541 |
| Southwest Virginia Regional Cancer Center | Norton, Virginia 24273 |
| Providence Cancer Center at Holy Family Hospital | Spokane, Washington 99207 |
| Southwest Washington Medical Center Cancer Center | Vancouver, Washington 98668 |
| Welch Cancer Center at Sheridan Memorial Hospital | Sheridan, Wyoming 82801 |
| Montrose Memorial Hospital Cancer Center | Montrose, Colorado 81401 |
| Exempla Lutheran Medical Center | Wheat Ridge, Colorado 80033 |
| Joliet Oncology Hematology Associates, Limited - West | Joliet, Illinois 60435 |
| Oncology Hematology Associates of Central Illinois - Ottawa | Ottawa, Illinois 61350 |
| Rose Ramer Cancer Clinic at Anderson Area Medical Center | Anderson, South Carolina 29621 |
| 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 |
| Allenmore Hospital | Tacoma, Washington 98411-0414 |
| Hembree Mercy Cancer Center at St. Edward Mercy Medical Center | Ft. Smith, Arkansas 72903 |
| California Cancer Center - Woodward Park Office | Fresno, California 93720 |
| Northeast Georgia Medical Center | Gainesville, Georgia 30501 |
| Pearlman Comprehensive Cancer Center at South Georgia Medical Center | Valdosta, Georgia 31603 |
| Central Maine Medical Center | Lewiston, Maine 04240 |
| 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 |
| University Hospitals Ireland Cancer Center at Mercy Medical Center | Canton, Ohio 44708 |
| Huron Hospital Cancer Care Center | Cleveland, Ohio 44112 |
| Euclid Hospital | Cleveland, Ohio 44119 |
| Medical College of Ohio Cancer Institute | Toledo, Ohio 43614 |
| South Pointe Hospital Cancer Care Center | Warrensville Heights, Ohio 44122 |
| Institute of Oncology at Vilnius University | Portland, Oregon 97227 |
| Salem Hospital Regional Cancer Center | Salem, Oregon 97309 |
| Allegheny Cancer Center at Allegheny General Hospital | Pittsburgh, Pennsylvania 15212 |
| Midelfort Clinic - Luther | Eau Claire, Wisconsin 54702 |
| Praxair Cancer Center at Danbury Hospital | Danbury, Connecticut 06810 |
| Carl and Dorothy Bennett Cancer Center at Stamford Hospital | Stamford, Connecticut 06904 |
| West Florida Cancer Institute at West Florida Hospital - Pensacola | Pensacola, Florida 32514 |
| Covenant Cancer Treatment Center | Waterloo, Iowa 50702 |
| Community Comprehensive Cancer Center at Camden-Clark Memorial Hospital | Parkersburg, West Virginia 26102 |
| Medical Consultants, Limited | Milwaukee, Wisconsin 53215 |
| Methodist Cancer Center at Methodist Hospital - Omaha | Omaha, Nebraska 68114 |
| Regional Cancer Center at Memorial Medical Center | Springfield, Illinois 62781-0001 |
| Auburn Regional Center for Cancer Care | Auburn, Washington 98002 |
| Ruby L. Golleher Cancer Program at Presbyterian Intercommunity Hospital | Whittier, California 90602 |
| Caritas Norwood Hospital | Norwood, Massachusetts 02062 |
| Seacoast Cancer Center at Wentworth-Douglass Hospital | Dover, New Hampshire 03820 |
| Pardee Memorial Hospital | Hendersonville, North Carolina 28791 |
| Rutherford Hospital | Rutherfordton, North Carolina 28139 |
| Easton Regional Cancer Center at Easton Hospital | Easton, Pennsylvania 18042 |
| Gibbs Regional Cancer Center at Spartanburg Regional Medical Center | Spartanburg, South Carolina 29303 |
| Martha Jefferson Hospital Cancer Care Center | Charlottesville, Virginia 22901 |
| Good Samaritan Health Systems | Kearney, Nebraska 68847 |
| Sherman Hospital | Elgin, Illinois 60120-2198 |
| Cancer Treatment Center at Christus Schumpert St. Mary Place | Shreveport, Louisiana 71101 |
| McLeod Regional Medical Center | Florence, South Carolina 29501 |
| Presbyterian Hospital of Dallas | Dallas, Texas 75231 |
| St. Joseph Mercy Hospital | Pontiac, Michigan 48341-2985 |
| Highlands Oncology Group - Springdale | Springdale, Arkansas 72764 |
| La Grange Memorial Hospital | La Grange, Illinois 60525 |
| St. Charles Medical Center - Bend | Bend, Oregon 97701 |
| Roper St. Francis Cancer Center at Roper Hospital | Charleston, South Carolina 29401 |
| Rockwood Clinic Cancer Treatment Center | Spokane, Washington 99204-2967 |
| Lynn Regional Cancer Center at Boca Raton Community Hospital - Main Center | Boca Raton, Florida 33486 |
| Florida Oncology Associates | Orange Park, Florida 32073 |
| Cancer Center of Kansas, P.A. - Dodge City | Dodge City, Kansas 67801 |
| Mercy General Hospital | Sacramento, California 95819 |
| Caritas St. Elizabeth's Medical Center | Brighton, Massachusetts 02135-2997 |
| Valley Hospital - Ridgewood | Ridgewood, New Jersey 07450 |
| Faxton Regional Cancer Center | Utica, New York 13502 |
| St. Joseph's Hospital Health Center - Syracuse | Syracuse, New York 13203 |
| John B. Amos Community Cancer Center | Columbus, Georgia 31902 |
| St. Anthony's Cancer Center | St. Louis, Missouri 63128 |
| Medical and Surgical Specialists, L L C | Galesburg, Illinois 61401 |
| Saint James Hospital and Health Centers Comprehensive Cancer Institute - Olympia Fields | Olympia Fields, Illinois 60461 |
| Siouxland Hematology-Oncology Associates at June E. Nylen Cancer Center | Sioux City, Iowa 51101 |
| United States Air Force Medical Center Wright-Patterson | Wright-Patterson Afb, Ohio 45433-5529 |
| Providence Centralia Hospital Regional Cancer Center | Centralia, Washington 98531 |
| New York Oncology Hematology, P.C. | Albany, New York 12208 |
| Heartland Oncology & Hematology | Council Bluffs, Iowa 51503 |
| Ottumwa Regional Health Center Cancer Center | Ottumwa, Iowa 52501 |
| All Saints Cancer Center at All Saints Medical Center | Racine, Wisconsin 53405 |
| Luther Midlelfort Hospital | Eau Claire, Wisconsin 54702 |
| East Alabama Medical Center | Opelika, Alabama 36801-5452 |
| Cancer Center at Providence Alaska Medical Center | Anchorage, Alaska 99519-6604 |
| Virginia K. Crosson Cancer Center at St. Jude Medical Center | Fullerton, California 92835 |
| Delnor Community Hospital - Geneva | Geneva, Illinois 60134 |
| Cedar Valley Medical Specialists, P.C. - West Ridgeway Avenue | Waterloo, Iowa 50702 |
| Mount Carmel Regional Cancer Center | Pittsburg, Kansas 66762 |
| Caritas Holy Family Hospital | Methuen, Massachusetts 01844 |
| Oncology Hematology Associates of Northern Pennsylvania, P.C. at Hahne Regional Cancer Center | Dubois, Pennsylvania 15801 |
| Vince Lombardi Cancer Center - Elkhorn | Elkhorn, Wisconsin 53121 |
| Mercy Hospital | Portland, Maine 04101 |
| Cancer Center of Boston - Chestnut Hill | Boston, Massachusetts 02120 |
| San Juan Regional Cancer Center | Farmington, New Mexico 87401-5631 |
| New York Oncology Hematology, PC - Albany | Albany, New York 12208 |
| Center for Cancer Medicine and Blood Disorders, PA | El Paso, Texas 79902 |
| United Hospital Center | Clarksburg, West Virginia 26301 |
