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A Phase III Randomized Controlled Clinical Trial of Carboplatin and Paclitaxel (or Gemcitabine) Alone or in Combination With Bevacizumab (NSC #704865, IND #113912) Followed by Bevacizumab and Secondary Cytoreductive Surgery in Platinum-Sensitive, Recurrent Ovarian, Peritoneal Primary and Fallopian Tube Cancer. NCI-Supplied Agents: Bevacizumab (NSC #704865, IND #113912)


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Brenner Tumor, Fallopian Tube Cancer, Ovarian Clear Cell Cystadenocarcinoma, Ovarian Endometrioid Adenocarcinoma, Ovarian Mixed Epithelial Carcinoma, Ovarian Mucinous Cystadenocarcinoma, Ovarian Serous Cystadenocarcinoma, Ovarian Undifferentiated Adenocarcinoma, Primary Peritoneal Cavity Cancer, Recurrent Ovarian Epithelial Cancer

Thank you

Trial Information

A Phase III Randomized Controlled Clinical Trial of Carboplatin and Paclitaxel (or Gemcitabine) Alone or in Combination With Bevacizumab (NSC #704865, IND #113912) Followed by Bevacizumab and Secondary Cytoreductive Surgery in Platinum-Sensitive, Recurrent Ovarian, Peritoneal Primary and Fallopian Tube Cancer. NCI-Supplied Agents: Bevacizumab (NSC #704865, IND #113912)


PRIMARY OBJECTIVES:

I. To determine if surgical secondary cytoreduction in addition to adjuvant chemotherapy
increases the duration of overall survival in patients with recurrent platinum sensitive
epithelial ovarian cancer, peritoneal primary or fallopian tube cancer.

II. To determine if the addition of bevacizumab to the second-line and maintenance phases of
treatment increases the duration of overall survival relative to second-line paclitaxel and
carboplatin alone in patients with recurrent platinum sensitive epithelial ovarian cancer,
peritoneal primary or fallopian tube cancer.

SECOND OBJECTIVES:

I. To determine if the addition of bevacizumab to the second-line and maintenance phase of
treatment increases the duration of progression-free survival relative to second-line
paclitaxel and carboplatin alone in patients with recurrent platinum sensitive epithelial
ovarian cancer, peritoneal primary or Fallopian tube cancer.

II. To prospectively determine the incidence of carboplatin and paclitaxel hypersensitivity
in these patients undergoing retreatment with both agents as first recurrence therapy.

III. To determine if surgical secondary cytoreduction in addition to adjuvant chemotherapy
increases quality of life (QOL) of patients with recurrent platinum-sensitive ovarian
epithelial cancer or primary peritoneal cavity cancer, as measured by the FACT-O trial
outcome index and Rand SF-36 physical functioning scale.

IV. To determine if the addition of bevacizumab to the second-line and maintenance phases of
treatment increases QOL relative to second-line paclitaxel and carboplatin alone in patients
with recurrent platinum-sensitive ovarian epithelial cancer or primary peritoneal cavity
cancer.

OUTLINE: This is a multicenter study. Patients are assigned to 1 of 4 treatment groups.
Patients who are not candidates for surgical cytoreduction (i.e., those for whom complete
cytoreduction in the estimation of the investigator is impossible or a medical infirmity
precludes exploration and debulking) are eligible to receive chemotherapy after
randomization.

Patients who are eligible for surgery undergo abdominal exploration with cytoreduction and
undergo tumor tissue collection and complete a quality of life questionnaire before and
after surgery. All patients are then randomized to 1 of 4 treatment arms.

ARM I: Patients receive paclitaxel intravenously (IV) over 3 hours or docetaxel IV over 1
hour and carboplatin IV over 60 minutes on day 1.

ARM II: Patients receive chemotherapy as in arm I and bevacizumab IV over 30-90 minutes on
day 1.

ARM III: Patients receive gemcitabine IV over 60 minutes on days 1and 8 and carboplatin as
in arm I.

ARM IV: Patients receive gemcitabine IV as in arm III, bevacizumab IV and carboplatin IV as
in arm II.

In all arms, treatment repeats every 21 days in the absence of disease progression or
unacceptable toxicity.

Patients with measurable disease achieving a clinical response (CR) receive 6-8 courses of
therapy. Patients with stable disease or partial regression receive a maximum of 6 courses.

Patients without measurable lesions as determined by a computed tomography (CT) scan prior
to initiating study treatment continue therapy for 6 courses or, if CA-125 normalizes, for 2
cycles beyond CA-125 normalization, whichever is greater. Patients in arm II then receive a
maintenance regimen comprising bevacizumab IV over 30-90 minutes. Treatment with bevacizumab
alone repeats every 3 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically for 10 years.


Inclusion Criteria:



- Patients must have histologic diagnosis of ovarian epithelial carcinoma, peritoneal
primary or fallopian tube carcinoma, which is now recurrent

- The following histologic epithelial cell types are eligible:

- Serous adenocarcinoma

- Endometrioid adenocarcinoma

- Mucinous adenocarcinoma

- Undifferentiated carcinoma

- Clear cell adenocarcinoma

- Mixed epithelial carcinoma

- Transitional cell carcinoma

- Malignant Brenner Tumor

- Adenocarcinoma not otherwise specified

- Patients must have had a complete response to front-line platinum-taxane therapy (at
least 3 cycles) and a treatment-free interval without clinical evidence of
progressive disease lasting at least 6 months

- A complete response to front-line chemotherapy must include the following:

- Negative physical exam

- Negative pelvic exam

- Normalization of CA125, if elevated at baseline

- Negative radiographic assessment of disease

- All patients must have also had a treatment-free interval without clinical
evidence of progressive disease of at least 6 months from completion of
front-line chemotherapy (both platinum and taxane); front-line therapy may have
included a biologic agent

- Front-line treatment may include maintenance therapy following complete clinical
or pathological response; however, maintenance cytotoxic chemotherapy must be
discontinued for a minimum of 6 months prior to documentation of recurrent
disease; patients receiving maintenance biological therapy or hormonal therapy
are ELIGIBLE provided their recurrence is documented more than 6 months from
primary cytotoxic chemotherapy completion (includes maintenance chemotherapy)
AND a minimum 4 weeks has elapsed since their last infusion of biological
therapy

- Patients must have clinically evident recurrent disease for the purpose of this
study,

- Measurable disease (RECIST) is defined as at least one lesion that can be
accurately measured in at least one dimension (longest dimension to be
recorded); each lesion must be more than or equal to 20 mm when measured by
conventional techniques, MRI or CT, or more than or equal to 10 mm when measured
by spiral CT

- Absolute neutrophil count (ANC) >= 1,500/mm^3 equivalent to Common Toxicity Criteria
for Adverse Events v3.0 (CTCAE) Grade1

- Platelet count >= 100,000/mm^3 (CTCAE Grade 0-1)

- Creatinine (non-isotope dilution mass spectrometry [IDMS]) =< 1.5 times upper limit
of normal (ULN)

- Total bilirubin =< 1.5 times ULN

- Serum glutamic oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST) =<
2.5 times ULN (< 5.0 times ULN in the presence of liver metastasis)

- Alkaline phosphatase =< 2.5 times ULN (< 5.0 times ULN in the presence of liver
metastasis)

- Patients must have a urine protein-to-creatinine ratio (UPCR) < 1.0 mg/dL

- Patients who are not candidates for surgical cytoreduction are eligible for the
chemotherapy randomization; patients are not considered candidates for surgical
cytoreduction if complete cytoreduction in the estimation of the investigator is
impossible or a medical infirmity precludes exploration and debulking

- Patients must have signed an approved informed consent and authorization permitting
release of personal health information

- Gynecologic Oncology Group (GOG) performance status of 0, 1, or 2

Exclusion Criteria:

- Patients who have more than one previous regimen of chemotherapy (maintenance therapy
is not considered a second regimen)

- Patients receiving concurrent immunotherapy, or radiotherapy

- Patients who have received prior radiotherapy to any portion of the abdominal cavity
or pelvis are excluded

- Patients whom have already undergone secondary cytoreduction for recurrent disease
are excluded

- Patients with a prior histologic diagnosis of borderline, low malignant potential
(grade 0) epithelial carcinoma that was surgically resected and who subsequently
developed an unrelated, new invasive epithelial ovarian or peritoneal primary cancer
are eligible provided they meet the inclusion criteria above

- Patients who require parenteral hydration or nutrition and have evidence of partial
bowel obstruction or perforation

- Patients with synchronous primary endometrial cancer, or a past history of primary
endometrial cancer are excluded, unless all of the following conditions are met:

- Stage not greater than I-B;

- No more than superficial myometrial invasion, without vascular or lymphatic
invasion;

- No poorly differentiated subtypes, including papillary serous, clear cell or
other International Federation of Gynecology and Obstetrics (FIGO) Grade 3
lesions

- Patients with uncontrolled infection

- Patients with concurrent severe medical problems unrelated to the malignancy that
would significantly limit full compliance with the study or expose the patient to
extreme risk or decreased life expectancy

- Patients with peripheral neuropathy >= grade 2

- Patients with a history of allergic reactions to carboplatin and/or paclitaxel or
chemically similar compounds; patients with allergic (hypersensitivity) reactions to
these chemotherapeutic agents are NOT excluded IF they were successfully retreated
following a desensitization program or protocol

- Patients with known hypersensitivity to Chinese hamster ovary cell products or other
recombinant human or humanized antibodies

- Patients of childbearing potential, not practicing adequate contraception, patients
who are pregnant or patients who are nursing are not eligible for this trial; to
date, no fetal studies in animal or humans have been performed; the possibility of
harm to a fetus is likely; bevacizumab specifically inhibits VEGF, which is
responsible for the formation of new blood vessels during development, and antibodies
can cross the placenta; therefore, bevacizumab should not be administered to pregnant
women; in addition, there are unknown immediate and long-term consequences of
chemotherapy administration to these women; in addition, surgical exploration as
mandated by randomization during pregnancy may cause imminent mortal consequences;
further, it is not known whether bevacizumab is excreted in human milk; because many
drugs are excreted in human milk, bevacizumab should not be administered to nursing
women; subjects will be apprised of the large potential risk to a developing fetus

- Patients with other invasive malignancies, with the exception of nonmelanoma skin
cancer, or patients who had (or have) any evidence of the other cancer present within
the past 5 years or whose previous cancer treatment contraindicates this protocol
therapy

- Patients with active bleeding or pathologic conditions that carry high risk of
bleeding such as a known bleeding disorder, coagulopathy, or tumor involving major
vessels

- Patients with a history or evidence upon physical examination of central nervous
system (CNS) disease, including primary brain tumor, seizures not controlled with
standard medical therapy, any brain metastases, or a history of stroke within the
past 5 years of the first date of treatment on this study

- Patients with clinically significant cardiovascular disease including any of the
following:

- Significant cardiac conduction abnormalities (e.g., PR interval > 0.24 sec or
2nd or 3rd degree atrioventricular [AV] block )

- Uncontrolled hypertension, defined as systolic blood pressure (BP) > 150 mm Hg
or diastolic BP > 90 mm Hg

- Myocardial infarction, cardiac arrhythmia, or unstable angina within the past 6
months

- New York Heart Association (NYHA) grade II or greater congestive heart failure

- Serious cardiac arrhythmia requiring medication

- Grade II or greater peripheral vascular disease except episodes of ischemia <
24 hrs in duration that are managed non-surgically and without permanent deficit

- History of cerebrovascular accident (CVA) within the past 6 months

- Patients who have had a major surgical procedure, open biopsy, dental extractions or
other dental surgery/procedure that results in an open wound, or significant
traumatic injury within 28 days prior to the first date of treatment on this study,
or anticipation of need for major surgical procedure during the course of the study;
patients with placement of vascular access device or core biopsy within 7 days prior
to the first date of treatment on this study:

- Patients undergoing pre-treatment secondary cytoreduction will undergo therapy
with bevacizumab on cycle 2

- Patients undergoing pre-treatment surgery for purposes other than cytoreduction
may also participate provided they meet eligibility; patients randomized to arms
containing bevacizumab must wait a minimum of 28 days since that procedure to
begin protocol treatment; patients who undergo an uncomplicated port placement
must wait a minimum of 7 days to begin protocol treatment

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:

Up to 10 years

Safety Issue:

No

Principal Investigator

Robert Coleman

Investigator Role:

Principal Investigator

Investigator Affiliation:

Gynecologic Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00587

NCT ID:

NCT00565851

Start Date:

December 2007

Completion Date:

Related Keywords:

  • Brenner Tumor
  • Fallopian Tube Cancer
  • Ovarian Clear Cell Cystadenocarcinoma
  • Ovarian Endometrioid Adenocarcinoma
  • Ovarian Mixed Epithelial Carcinoma
  • Ovarian Mucinous Cystadenocarcinoma
  • Ovarian Serous Cystadenocarcinoma
  • Ovarian Undifferentiated Adenocarcinoma
  • Primary Peritoneal Cavity Cancer
  • Recurrent Ovarian Epithelial Cancer
  • Adenocarcinoma
  • Adenocarcinoma, Mucinous
  • Brenner Tumor
  • Carcinoma
  • Cystadenocarcinoma
  • Peritoneal Neoplasms
  • Fallopian Tube Neoplasms
  • Carcinoma, Endometrioid
  • Cystadenocarcinoma, Mucinous
  • Cystadenocarcinoma, Serous
  • Neoplasms, Glandular and Epithelial
  • Ovarian Neoplasms

Name

Location

Memorial Sloan Kettering Cancer Center New York, New York  10021
Cleveland Clinic Foundation Cleveland, Ohio  44195
University of Iowa Hospitals and Clinics Iowa City, Iowa  52242
University of Mississippi Medical Center Jackson, Mississippi  39216-4505
Washington University School of Medicine Saint Louis, Missouri  63110
Abington Memorial Hospital Abington, Pennsylvania  19001
Fox Chase Cancer Center Philadelphia, Pennsylvania  19111
University of Washington Medical Center Seattle, Washington  98195-6043
Tacoma General Hospital Tacoma, Washington  98405
Hurley Medical Center Flint, Michigan  48503
Pennsylvania Hospital Philadelphia, Pennsylvania  19107
Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
North Suburban Medical Center Thornton, Colorado  80229
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
Hutchinson Area Health Care Hutchinson, Minnesota  55350
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Abramson Cancer Center of the University of Pennsylvania Philadelphia, Pennsylvania  19104-4283
Avera Cancer Institute Sioux Falls, South Dakota  57105
Morristown Memorial Hospital Morristown, New Jersey  07962-1956
Henry Ford Hospital Detroit, Michigan  48202
Memorial Hospital of South Bend South Bend, Indiana  46601
Akron General Medical Center Akron, Ohio  44302
Lehigh Valley Hospital Allentown, Pennsylvania  18103
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
University of Texas Medical Branch Galveston, Texas  77555-1329
LDS Hospital Salt Lake City, Utah  84143
Rush University Medical Center Chicago, Illinois  60612-3824
North Shore University Hospital Manhasset, New York  11030
Brooke Army Medical Center Fort Sam Houston, Texas  78234-6200
Hartford Hospital Hartford, Connecticut  06102-5037
Franklin Square Hospital Center Baltimore, Maryland  21237
Providence Alaska Medical Center Anchorage, Alaska  99508
William Beaumont Hospital Royal Oak, Michigan  48073
Cancer Institute of New Jersey New Brunswick, New Jersey  08901
Via Christi Regional Medical Center Wichita, Kansas  67214
Carolinas Medical Center Charlotte, North Carolina  28232-2861
University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma  73104
Iowa Methodist Medical Center Des Moines, Iowa  50309
Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Group Health Cooperative Seattle, Washington  98112
University of Wisconsin Hospital and Clinics Madison, Wisconsin  53792-0001
MetroHealth Medical Center Cleveland, Ohio  44109
Long Island Jewish Medical Center New Hyde Park, New York  11040
Mount Sinai Medical Center New York, New York  10029
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Seattle, Washington  98109
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Cancer Center of Kansas - Chanute Chanute, Kansas  66720
Cancer Center of Kansas - Dodge City Dodge City, Kansas  67801
Cancer Center of Kansas - Newton Newton, Kansas  67114
Cancer Center of Kansas - Salina Salina, Kansas  67042
Cancer Center of Kansas - Wellington Wellington, Kansas  67152
Associates in Womens Health Wichita, Kansas  67203
Cancer Center of Kansas - Winfield Winfield, Kansas  67156
Munson Medical Center Traverse City, Michigan  49684
McKay-Dee Hospital Center Ogden, Utah  84403
Cancer Care Northwest - Spokane South Spokane, Washington  99202
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Methodist Estabrook Cancer Center Omaha, Nebraska  68114-4199
Elkhart General Hospital Elkhart, Indiana  46515
South Bend Clinic South Bend, Indiana  46617
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center Columbus, Ohio  43210-1240
Beebe Medical Center Lewes, Delaware  19958
Mecosta County Medical Center Big Rapids, Michigan  49307
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Mercy Hospital Coon Rapids, Minnesota  55433
Medical Oncology and Hematology Associates Des Moines, Iowa  50309
Saint Joseph Mercy Hospital Ann Arbor, Michigan  48106
Fairview-Southdale Hospital Edina, Minnesota  55435
Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Regions Hospital Saint Paul, Minnesota  55101
Saint Francis Regional Medical Center Shakopee, Minnesota  55379
Rice Memorial Hospital Willmar, Minnesota  56201
Geisinger Medical Group State College, Pennsylvania  16801
Northeast Georgia Medical Center Gainesville, Georgia  30501
Miami Valley Hospital Dayton, Ohio  45409
Cancer Center of Kansas - Fort Scott Fort Scott, Kansas  66701
Cancer Center of Kansas-Independence Independence, Kansas  67301
Research Medical Center Kansas City, Missouri  64132
Saint Luke's East - Lee's Summit Lee's Summit, Missouri  64086
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
Woman's Hospital Baton Rouge, Louisiana  70815
Seattle Cancer Care Alliance Seattle, Washington  98109
Longmont United Hospital Longmont, Colorado  80501
Temple University Hospital Philadelphia, Pennsylvania  19140
Genesys Regional Medical Center Grand Blanc, Michigan  48439-8066
Singing River Hospital Pascagoula, Mississippi  39581
Methodist Hospital Houston, Texas  77030
Aurora Sinai Medical Center Milwaukee, Wisconsin  53201-0342
Greater Baltimore Medical Center Baltimore, Maryland  21204
Union Hospital of Cecil County Elkton MD, Maryland  21921
Presbyterian Hospital Charlotte, North Carolina  28233-3549
Pacific Gynecology Specialists Seattle, Washington  98104
Washington Hospital Center Washington, District of Columbia  20010
Memorial Medical Center Springfield, Illinois  62781
Metro Health Hospital Grand Rapids, Michigan  49506
University of Virginia Charlottesville, Virginia  22908
University of North Carolina Chapel Hill, North Carolina  27599
Duke University Medical Center Durham, North Carolina  27710
Providence Medical Center Kansas City, Kansas  66112
Northwestern University Chicago, Illinois  60611
Hennepin County Medical Center Minneapolis, Minnesota  
Saint Louis University Hospital St. Louis, Missouri  63110-0250
Saint Alphonsus Regional Medical Center Boise, Idaho  83706
Case Western Reserve University Cleveland, Ohio  44106
Wayne State University Detroit, Michigan  48202
Riverside Methodist Hospital Columbus, Ohio  43214
Indiana University Medical Center Indianapolis, Indiana  46202
Presbyterian - Saint Lukes Medical Center - Health One Denver, Colorado  80218
University of Texas Southwestern Medical Center Dallas, Texas  
Wichita CCOP Wichita, Kansas  67214-3882
Northwest Hospital Seattle, Washington  98133
Huntsman Cancer Institute/University of Utah Salt Lake City, Utah  84112
Metro-Minnesota CCOP St. Louis Park, Minnesota  
Lakeview Hospital Stillwater, Minnesota  55082
Oregon Health and Science University Portland, Oregon  97201
Florida Gynecologic Oncology Fort Myers, Florida  33901
Jersey Shore Medical Center Neptune, New Jersey  07754
Virginia Commonwealth University Richmond, Virginia  
Providence Saint Joseph Medical Center Burbank, California  91505-4866
Memorial Health University Medical Center Savannah, Georgia  31404
Hillcrest Hospital Cancer Center Mayfield Heights, Ohio  44124
Harrison Medical Center Bremerton, Washington  98310
University of Chicago Comprehensive Cancer Center Chicago, Illinois  60637-1470
M D Anderson Cancer Center Houston, Texas  77030
Northern Indiana Cancer Research Consortium South Bend, Indiana  
University of Cincinnati Cincinnati, Ohio  45267-0502
Penn State Milton S Hershey Medical Center Hershey, Pennsylvania  17033
The Community Hospital Munster, Indiana  46321
Littleton Adventist Hospital Littleton, Colorado  80122
Parker Adventist Hospital Parker, Colorado  80138
New Ulm Medical Center New Ulm, Minnesota  56073
Froedtert and the Medical College of Wisconsin Milwaukee, Wisconsin  53226
Wake Forest University Health Sciences Winston-Salem, North Carolina  27157
University of California San Francisco Medical Center-Mount Zion San Francisco, California  94115
The Medical Center of Aurora Aurora, Colorado  80012
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Saint Anthony Central Hospital Denver, Colorado  80204
Exempla Saint Joseph Hospital Denver, Colorado  80218
Colorado Cancer Research Program CCOP Denver, Colorado  80224-2522
Saint Mary's Hospital and Regional Medical Center Grand Junction, Colorado  81502
Saint Mary Corwin Medical Center Pueblo, Colorado  81004
Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
The Hospital of Central Connecticut New Britain, Connecticut  06050
John B Amos Cancer Center Columbus, Georgia  31904
Iowa Oncology Research Association CCOP Des Moines, Iowa  50309
Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Medical Oncology and Hematology Associates-Des Moines Des Moines, Iowa  50309
Cancer Center of Kansas - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas-Kingman Kingman, Kansas  67068
Cancer Center of Kansas - Parsons Parsons, Kansas  67357
Cancer Center of Kansas - Pratt Pratt, Kansas  67124
Cancer Center of Kansas-Wichita Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas - Main Office Wichita, Kansas  67214
Michigan Cancer Research Consortium Community Clinical Oncology Program Ann Arbor, Michigan  48106
Oakwood Hospital Dearborn, Michigan  48123
Saint John Hospital and Medical Center Detroit, Michigan  48236
Grand Rapids Clinical Oncology Program Grand Rapids, Michigan  49503
Saint Mary's Health Care Grand Rapids, Michigan  49503
Spectrum Health at Butterworth Campus Grand Rapids, Michigan  49503
Allegiance Health Jackson, Michigan  49201
Sparrow Hospital Lansing, Michigan  48912
Saint Mary Mercy Hospital Livonia, Michigan  48154
Mercy Health Partners-Mercy Campus Muskegon, Michigan  49443
Mercy Health Partners-Hackley Campus Muskegon, Michigan  49442
Saint Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Saint Joseph Mercy Port Huron Port Huron, Michigan  48060
Saint Mary's of Michigan Saginaw, Michigan  48601
Lakeland Hospital St. Joseph, Michigan  49085
Saint John Macomb-Oakland Hospital Warren, Michigan  48093
Saint Luke's Hospital of Duluth Duluth, Minnesota  55805
Unity Hospital Fridley, Minnesota  55432
Saint John's Hospital - Healtheast Maplewood, Minnesota  55109
Minnesota Oncology Hematology PA-Maplewood Maplewood, Minnesota  55109
North Memorial Medical Health Center Robbinsdale, Minnesota  55422
Park Nicollet Clinic - Saint Louis Park Saint Louis Park, Minnesota  55416
Minnesota Oncology and Hematology PA-Woodbury Woodbury, Minnesota  55125
Saint Luke's Cancer Institute Kansas City, Missouri  64111
Ozark Health Ventures LLC dba Cancer Research for The Ozarks Springfield Springfield, Missouri  65802
Saint John's Hospital Springfield, Missouri  65804
Cox Medical Center Springfield, Missouri  65807
Cooper Hospital University Medical Center Camden, New Jersey  08103
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County Mount Holly, New Jersey  08060
Memorial Medical Center - Las Cruces Las Cruces, New Mexico  88011
New York University Langone Medical Center New York, New York  10016
Columbia University Medical Center New York, New York  10032
State University of New York Upstate Medical University Syracuse, New York  13210
Alamance Regional Medical Center Burlington, North Carolina  27216
Aultman Health Foundation Canton, Ohio  44710
Kettering Medical Center Kettering, Ohio  45429
Northwest Cancer Specialists-Rose Quarter Cancer Center Portland, Oregon  97227
Saint Luke's Hospital Bethlehem, Pennsylvania  18015
Geisinger Wyoming Valley Wilkes-Barre, Pennsylvania  18711
Sanford Cancer Center-Oncology Clinic Sioux Falls, South Dakota  57104
The Don and Sybil Harrington Cancer Center Amarillo, Texas  79106
Harrison Bremerton Hematology and Oncology Bremerton, Washington  98310
Swedish Medical Center-First Hill Seattle, Washington  98122-4307
Saint Joseph Medical Center Tacoma, Washington  98405
Saint Vincent Hospital Green Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's Hospital Green Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent Hospital Green Bay, Wisconsin  54301-3526
Bay Area Medical Center Marinette, Wisconsin  54143
Aspirus Regional Cancer Center Wausau, Wisconsin  54401
University of California Medical Center At Irvine-Orange Campus Orange, California  92868
Cancer Care Associates-Yale Tulsa, Oklahoma  74136-1929
Women and Infants Hospital Providence, Rhode Island  02905
Lake University Ireland Cancer Center Mentor, Ohio  44060
Women's Cancer Associates Saint Petersburg, Florida  33701
University of Illinois Chicago, Illinois  60612
Stony Brook University Medical Center Stony Brook, New York  11794
Elkhart Clinic Elkhart, Indiana  46515
John Muir Medical Center-Concord Campus Concord, California  94520
University of Colorado Cancer Center - Anschutz Cancer Pavilion Aurora, Colorado  80045
Michiana Hematology Oncology PC-Elkhart Elkhart, Indiana  46514
Michiana Hematology Oncology PC-Plymouth Plymouth, Indiana  46563
Michiana Hematology Oncology PC-South Bend South Bend, Indiana  46601
Michiana Hematology Oncology-PC Westville Westville, Indiana  46391
Cancer Center of Kansas-Liberal Liberal, Kansas  67901
University of Michigan University Hospital Ann Arbor, Michigan  48109
Michiana Hematology Oncology PC-Niles Niles, Michigan  49120
University of Missouri - Ellis Fischel Columbia, Missouri  65203
Moses Cone Health System-Regional Cancer Center Greensboro, North Carolina  27403
Duke Raleigh Hospital Raleigh, North Carolina  27609
Utah Valley Regional Medical Center Provo, Utah  84603
Dixie Medical Center Regional Cancer Center Saint George, Utah  84770
Vince Lombardi Cancer Clinic-Sheboygan Sheboygan, Wisconsin  53081
Vince Lombardi Cancer Clinic Two Rivers, Wisconsin  54241
Gynecologic Oncology of West Michigan PLLC Grand Rapids, Michigan  49546
Center of Hope at Renown Medical Center Reno, Nevada  89502
State University of New York Downstate Medical Center Brooklyn, New York  11203
Monter Cancer Center Lake Success, New York  11042
Black Hills Obstetrics and Gynecology Rapid City, South Dakota  57701
Carilion Clinic Gynecological Oncology Roanoke, Virginia  24016
Aurora Women's Pavilion of Aurora West Allis Medical Center West Allis, Wisconsin  53227
Long Beach Memorial Medical Center-Todd Cancer Institute Long Beach, California  90806
Kaiser Permanente Medical Care Program - Los Angeles Medical Center & Sunset Hospital Los Angeles, California  90027
Kaiser Permanente Los Angeles Medical Center Los Angeles, California  90027
Rocky Mountain Gynecologic Oncology PC Englewood, Colorado  80110
Saint Dominic-Jackson Memorial Hospital Jackson, Mississippi  39216
Southwest Gynecologic Oncology Associates Inc Albuquerque, New Mexico  87106
Women's Cancer Center of Nevada Las Vegas, Nevada  89109
Saint Luke's South Hospital Overland Park, Kansas  66213
Kansas City CCOP Prairie Village, Kansas  66208
Spectrum Health Reed City Hospital Reed City, Michigan  49677
Providence Regional Cancer Partnership Everett, Washington  98201
Gundersen Lutheran La Crosse, Wisconsin  54601
Stanford University Hospitals and Clinics Stanford, California  94305
Gynecologic Oncology Group of Arizona Phoenix, Arizona  85012
Palo Alto Medical Foundation-Gynecologic Oncology Mountain View, California  94040
Sudarshan K Sharma MD Limted-Gynecologic Oncology Hinsdale, Illinois  60521
Saint Vincent Oncology Center Indianapolis, Indiana  46260
University of Massachusetts Memorial Health Care Worcester, Massachusetts  01605
The Women's Institute for Gynecologic Cancer and Special Pelvic Surgery Phillipsburg, New Jersey  08865
University Medical Center Brackenridge Austin, Texas  78701
PeaceHealth Medical Group PC Bellingham, Washington  98226
Skagit Valley Hospital Regional Cancer Care Center Mount Vernon, Washington  98274
Olympic Medical Cancer Care Center Sequim, Washington  98384
Rockwood Cancer Treatment Center Spokane, Washington  99204
Providence Saint Mary Regional Cancer Center Walla Walla, Washington  99362
Cancer Institutes of Washington PLLC Yakima, Washington  98902
Aurora Saint Luke's Medical Center Milwaukee, Wisconsin  53215
Georgia Health Sciences University Augusta, Georgia  30912
Jonsson Comprehensive Cancer Center Los Angeles, California  90095
Carle Foundation - Carle Cancer Center Urbana, Illinois  61801
Michiana Hematology Oncology PC-Mishawaka Mishawaka, Indiana  46545-1470
Marie Yeager Cancer Center Saint Joseph, Michigan  49085
Summa Akron City Hospital Akron, Ohio  44304
Gynecologic Oncology Group Philadelphia, Pennsylvania  19103
Sanford USD Medical Center - Sioux Falls Sioux Falls, South Dakota  57117-5134
Geisinger Medical Center-Cancer Center Hazelton Hazleton, Pennsylvania  18201
Community Howard Regional Health Kokomo, Indiana  46904
Indiana University Health La Porte Hospital La Porte, Indiana  46350
Saint Joseph Regional Medical Center-Mishawaka Mishawaka, Indiana  46545-1470
Christiana Care Health System-Christiana Hospital Newark, Delaware  19718
Bronson Battle Creek Battle Creek, Michigan  49017
Cleveland Clinic Cancer Center/Fairview Hospital Cleveland, Ohio  44111
Women's Cancer Care Associates LLC Albany, New York  12208
Fletcher Allen Health Care-Medical Center Burlington, Vermont  05401
Harrison Poulsbo Hematology and Oncology Poulsbo, Washington  98370