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Phase III Double-Blind Placebo-Controlled Trial of Conventional Concurrent Chemoradiation and Adjuvant Temozolomide Plus Bevacizumab Versus Conventional Concurrent Chemoradiation and Adjuvant Temozolomide in Patients With Newly Diagnosed Glioblastoma


Phase 3
18 Years
N/A
Open (Enrolling)
Both
Adult Giant Cell Glioblastoma, Adult Glioblastoma, Adult Gliosarcoma

Thank you

Trial Information

Phase III Double-Blind Placebo-Controlled Trial of Conventional Concurrent Chemoradiation and Adjuvant Temozolomide Plus Bevacizumab Versus Conventional Concurrent Chemoradiation and Adjuvant Temozolomide in Patients With Newly Diagnosed Glioblastoma


PRIMARY OBJECTIVES:

I. To determine whether the addition of bevacizumab to temozolomide and radiotherapy
improves efficacy, as measured by progression-free (PFS) and/or overall survival (OS), in
patients with newly diagnosed glioblastoma. (Gliosarcoma closed to accrual as of 07/13/10).

II. To assess the association between overall survival and K^trans change from T1 to T2.

III. To assess the association between OS and spin echo CBV change from T1 to T2.

SECONDARY OBJECTIVES:

I. To determine whether the tumor molecular profile conferring a mesenchymal/angiogenic
phenotype is associated with a selective increase in benefit from the addition of
bevacizumab to temozolomide and radiotherapy, as measured by OS or PFS, in these patients.

II. To compare the toxicities of chemoradiotherapy with bevacizumab vs conventional
chemoradiotherapy in these patients.

III. To assess the association between PFS and K^trans change from T1 to T2. IV. To assess
the association between PFS and spin echo CBV change from T1 to T2.

V. To assess the association between values of K^trans and spin echo CBV measured separately
at T0 and at T1, and OS and PFS.

VI. To assess the association between OS and K^trans changes from T0 to T1 and from T2 to
T3.

VII. To assess the association between OS and spin echo CBV changes from T0 to T1 and from
T2 to T3.

VIII. To assess the association between OS and apparent diffusion coefficient (ADC) change
from T0 to T1.

IX. To assess the association between OS and ADC change from T1 to T2. X. To assess the
association between PFS and ADC change from T0 to T1. XI. To assess the association between
PFS and ADC change from T1 to T2. XII. To assess the association between T1 values of ADC
and OS and PFS. XIII. To assess the association between change in lesion size between T1 and
T3, as measured by advanced MRI, and OS and PFS.

TERTIARY OBJECTIVES:

I. To determine the differential acute effects associated with the addition of bevacizumab
to temozolomide and radiation, as compared to the conventional arm, on measures of
neurocognitive function (NCF), health-related quality of life (HR-QOL), and symptoms during
radiation and across the longitudinal progression-free interval.

II. To determine the relationship of NCF, HR-QOL, and symptoms, with PFS and OS.

III. To determine the association between tumor molecular profile (i.e.,
mesenchymal/angiogenic phenotype and proneural phenotype) and NCF, HR-QOL, and symptoms.

IV. To describe the association between HR-QOL as measured by the EORTC-QL30/BCM20 and mean
symptom severity as measured by the MDASI-BT in patients enrolled in this study.

V. To evaluate the relationship between self-reported NCF and objectively measured tests of
NCF.

VI. To assess the association between measures of change in enhancing tumor size at week 22
and OS in patients treated with chemoradiotherapy with and without bevacizumab.

VII. To assess the association between measures of change in T2-based tumor size at week 22
and OS in patients treated with these regimens.

VIII. To assess the association between changes in ADC values and OS in patients treated
with these regimens.

IX. To assess the association between measures of change in enhancing tumor size at week 22
and OS in patients with glioma receiving chemoradiotherapy with and without bevacizumab.

X. To assess the association between measures of change in T2-based tumor size at week 22
and OS in patients with glioma receiving chemoradiotherapy with and without bevacizumab.

XI. To assess the association between changes in ADC values and OS in patients with glioma
receiving chemoradiotherapy with and without bevacizumab.

OUTLINE: This is a multicenter study. Patients are stratified according to MGMT methylation
status (methylated vs unmethylated vs invalid) and tumor molecular profile metagene score
(favorable vs unfavorable vs undetermined). Patients are randomized to 1 of 2 treatment
arms.

ARM I: Patients undergo radiotherapy (intensity-modulated radiotherapy or 3-dimensional
conformal radiotherapy) once daily 5 days a week for 6 weeks and receive concurrent oral
temozolomide once daily for up to 7 weeks. Beginning 4 weeks after completion of
chemoradiotherapy, patients receive adjuvant oral temozolomide once daily on days 1-5.
Treatment with adjuvant temozolomide repeats every 28 days for up to 12 courses in the
absence of disease progression or unacceptable toxicity. Patients also receive placebo IV
over 30-90 minutes once every 2 weeks beginning in week 4 of chemoradiotherapy and
continuing until the completion of adjuvant temozolomide.

ARM II: Patients undergo chemoradiotherapy and receive adjuvant temozolomide as in arm I.
Patients also receive bevacizumab IV over 30-90 minutes once every 2 weeks beginning in week
4 of chemoradiotherapy and continuing until the completion of adjuvant temozolomide.

Some patients may undergo Dynamic Susceptibility-Contrast MRI (DSC-MRI) and Dynamic
Contrast-Enhanced (DCE-MRI) imaging at baseline, periodically during the study, and after
completion of treatment.

After completion of study treatment, patients are followed every 3 months for 1 year, every
4 months for 1 year, and then every 6 months thereafter.


Inclusion Criteria:



- Histologically confirmed glioblastoma (gliosarcoma closed to accrual as of 07-13-10)

- WHO grade IV disease

- Tumor must have a supratentorial component

- Has undergone partial or complete surgical resection of tumor within the past 3-5
weeks

- Diagnosis must be made by surgical excision (not by stereotactic biopsy)

- No significant postoperative hemorrhage, defined as > 1 cm diameter of blood in
the tumor cavity by MRI or CT scan

- Has ≥ 1 block of tumor tissue of sufficient size available for analysis of MGMT
status and determination of molecular profile

- At least 1 cm³ of tissue composed primarily of tumor must be present

- No CUSA (Cavitron ultrasonic aspirator)-derived material

- No recurrent or multifocal malignant glioma

- No metastases detected below the tentorium or beyond the cranial vault

- Karnofsky performance status 70-100%

- Absolute neutrophil count ≥ 1,800/mm³

- Platelet count ≥ 100,000/mm³

- Hemoglobin ≥ 10.0 g/dL (transfusion or other intervention allowed)

- ALT and AST ≤ 3 times normal

- Bilirubin ≤ 2.0 mg/dL

- PT/INR < 1.4 (for patients not on warfarin)

- Creatinine ≤ 1.7 mg/dL

- Urine protein: creatinine ratio < 0.5 OR 24-hour urine protein < 1,000 mg

- BUN ≤ 30 mg/dL

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for ≥ 6 months after
completion of study treatment

- Systolic blood pressure (BP) ≤ 160 mm Hg or diastolic BP ≤ 90 mm Hg

- No evidence of acute cardiac ischemia by electrocardiogram

- No other invasive malignancy within the past 3 years, except for nonmelanomatous skin
cancer or carcinoma in situ of the breast, oral cavity, or cervix

- No severe, active comorbidity, including any of the following:

- Unstable angina and/or congestive heart failure within the past 6 months

- Transmural myocardial infarction within the past 6 months

- Evidence of recent myocardial infarction or ischemia as indicated by ST
elevations of ≥ 2 mm by EKG

- New York Heart Association class II-IV congestive heart failure requiring
hospitalization within the past 12 months

- Stroke, cerebral vascular accident, or transient ischemic attack within the past
6 months

- Serious, inadequately controlled cardiac arrhythmia

- Significant vascular disease (e.g., aortic aneurysm or history of aortic
dissection) or clinically significant peripheral vascular disease

- Evidence of bleeding diathesis or coagulopathy

- Serious or non-healing wound, ulcer, or bone fracture

- Abdominal fistula, gastrointestinal perforation, intra-abdominal abscess, or
significant traumatic injury within the past 28 days

- Acute bacterial or fungal infection requiring IV antibiotics

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

- AIDS based on current CDC definition

- Active connective tissue disorders (e.g., lupus or scleroderma) that, in the
opinion of the treating physician, may place the patient at high risk for
radiation toxicity

- Any other major medical illness or psychiatric impairment that, in the opinion
of the investigator, would preclude study drug administration or completion of
study therapy

- Recovered from prior surgery

- No prior chemotherapy or radiosensitizers for cancer of the head and neck region

- Prior chemotherapy for a different cancer is allowed

- No prior temozolomide or bevacizumab

- No prior Gliadel wafers or any other intratumoral or intracavitary treatment

- No prior radiotherapy to the head and neck (except for T1 glottic cancer) resulting
in overlap of radiotherapy fields

- More than 28 days since prior major surgical procedure or open biopsy other than
craniotomy for tumor resection

- More than 30 days since prior and no concurrent treatment on another therapeutic
clinical trial

- No concurrent growth factors to induce elevations in neutrophil count for the
purposes of administration of temozolomide on the scheduled dosing interval; to allow
treatment with temozolomide at a higher dose; or to avoid interruption of the
treatment during concurrent radiotherapy

- No concurrent erythropoietin

- No concurrent tumor debulking surgery, other chemotherapy, immunotherapy, biologic
therapy, or additional stereotactic boost radiotherapy

- No other concurrent investigational drugs during the "blinded phase" of the study

- Concurrent full-dose anticoagulants (e.g., warfarin or low molecular weight heparin)
allowed provided both of the following criteria are met:

- No active bleeding or pathological condition that carries a high risk of
bleeding (e.g., tumor involving major vessels or known varices)

- In-range INR (between 2 and 3) on a stable dose of oral anticoagulant or on a
stable dose of low molecular weight heparin

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Outcome Measure:

Overall survival

Outcome Description:

Estimated using the Kaplan-Meier method and differences between treatment arms will be tested in the log rank test (Mantel 1966).

Outcome Time Frame:

From randomization to the date of death due to any cause or otherwise, the last follow-up date on which the patient was reported alive, assessed up to 2 years

Safety Issue:

No

Principal Investigator

Mark Gilbert

Investigator Role:

Principal Investigator

Investigator Affiliation:

Radiation Therapy Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-01670

NCT ID:

NCT00884741

Start Date:

April 2009

Completion Date:

Related Keywords:

  • Adult Giant Cell Glioblastoma
  • Adult Glioblastoma
  • Adult Gliosarcoma
  • Glioblastoma
  • Gliosarcoma

Name

Location

Louisiana State University New Orleans, Louisiana  70112-2282
Memorial Sloan Kettering Cancer Center New York, New York  10021
Cleveland Clinic Foundation Cleveland, Ohio  44195
Mayo Clinic Rochester, Minnesota  55905
University of Iowa Hospitals and Clinics Iowa City, Iowa  52242
Washington University School of Medicine Saint Louis, Missouri  63110
Abington Memorial Hospital Abington, Pennsylvania  19001
Fox Chase Cancer Center Philadelphia, Pennsylvania  19111
Rhode Island Hospital Providence, Rhode Island  02903
University of Texas Health Science Center at San Antonio San Antonio, Texas  78284-7811
Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Swedish Medical Center Englewood, Colorado  80110
North Suburban Medical Center Thornton, Colorado  80229
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Fairview Ridges Hospital Burnsville, Minnesota  55337
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Loyola University Medical Center Maywood, Illinois  60153
Massachusetts General Hospital Cancer Center Boston, Massachusetts  02114
CentraCare Clinic Saint Cloud, Minnesota  56303
Marshfield Clinic Marshfield, Wisconsin  54449
Northwest Community Hospital Arlington Heights, Illinois  60005
Ingalls Memorial Hospital Harvey, Illinois  60426
Methodist Medical Center of Illinois Peoria, Illinois  61636
Mary Bird Perkins Cancer Center Baton Rouge, Louisiana  70809
Akron General Medical Center Akron, Ohio  44302
Lehigh Valley Hospital Allentown, Pennsylvania  18103
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Jackson-Madison County General Hospital Jackson, Tennessee  38301
LDS Hospital Salt Lake City, Utah  84143
University of Kansas Medical Center Kansas City, Kansas  66160-7353
Hartford Hospital Hartford, Connecticut  06102-5037
Providence Alaska Medical Center Anchorage, Alaska  99508
William Beaumont Hospital Royal Oak, Michigan  48073
Via Christi Regional Medical Center Wichita, Kansas  67214
Wesley Medical Center Wichita, Kansas  67214
Carolinas Medical Center Charlotte, North Carolina  28232-2861
John Muir Medical Center Walnut Creek, California  94598
Iowa Methodist Medical Center Des Moines, Iowa  50309
Maimonides Medical Center Brooklyn, New York  11219
Bellin Memorial Hospital Green Bay, Wisconsin  54301
University of Wisconsin Hospital and Clinics Madison, Wisconsin  53792-0001
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Naval Medical Center - Portsmouth Portsmouth, Virginia  23708-2197
McKay-Dee Hospital Center Ogden, Utah  84403
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Rocky Mountain Cancer Center Denver, Colorado  80218
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
City of Hope Medical Center Duarte, California  91010
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center Columbus, Ohio  43210-1240
Piedmont Hospital Atlanta, Georgia  30309
Southern Regional Medical Center Riverdale, Georgia  30274-2600
Mercy Medical Center Springfield, Ohio  45504
Bryn Mawr Hospital Bryn Mawr, Pennsylvania  19010
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Mercy Hospital Coon Rapids, Minnesota  55433
Poudre Valley Radiation Oncology Fort Collins, Colorado  80528
Anne Arundel Medical Center Annapolis, Maryland  21401
Saint Joseph Mercy Hospital Ann Arbor, Michigan  48106
Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Lancaster General Hospital Lancaster, Pennsylvania  17604-3555
Pomona Valley Hospital Medical Center Pomona, California  91767
Northeast Georgia Medical Center Gainesville, Georgia  30501
Central Maine Medical Center Lewiston, Maine  04240
Allegheny Cancer Center at Allegheny General Hospital Pittsburgh, Pennsylvania  15212
UW Cancer Center Johnson Creek Johnson Creek, Wisconsin  53038
Saint Joseph's Hospital Marshfield, Wisconsin  54449
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Diagnostic and Treatment Center Weston, Wisconsin  54476
Rocky Mountain Cancer Centers Thornton, Colorado  80260
Arizona Oncology Services Foundation Phoenix, Arizona  85013
Lowell General Hospital Lowell, Massachusetts  01854
Presbyterian Hospital Charlotte, North Carolina  28233-3549
Mayo Clinic in Arizona Scottsdale, Arizona  85259-5404
Mayo Clinic in Florida Jacksonville, Florida  32224
Solano Radiation Oncology Center Vacaville, California  95687
Tyler Cancer Center Tyler, Texas  75702
Providence Hospital Mobile, Alabama  36608
Northwestern University Chicago, Illinois  60611
Willamette Valley Cancer Center Eugene, Oregon  97401-8122
Northwest Cancer Specialists Vancouver, Washington  98664
Cancer Care Center, Incorporated Salem, Ohio  44460
Nebraska Methodist Hospital Omaha, Nebraska  68114
University of Rochester Rochester, New York  14642
Saint Alphonsus Regional Medical Center Boise, Idaho  83706
University of California at San Diego La Jolla, California  92093
Case Western Reserve University Cleveland, Ohio  44106
Yale University New Haven, Connecticut  06520
Emory University Atlanta, Georgia  30322
New Mexico Oncology Hematology Consultants Albuquerque, New Mexico  87102
Radiation Therapy Oncology Group Philadelphia, Pennsylvania  19107
Riverside Methodist Hospital Columbus, Ohio  43214
Providence Portland Medical Center Portland, Oregon  97213-3635
California Pacific Medical Center San Francisco, California  94115
Dartmouth Hitchcock Medical Center Lebanon, New Hampshire  03756
Sacred Heart Hospital Pensacola, Florida  32503
University of Texas Southwestern Medical Center Dallas, Texas  
Alegent Health Immanuel Medical Center Omaha, Nebraska  68122
Alegent Health Bergan Mercy Medical Center Omaha, Nebraska  68124
Flower Hospital Sylvania, Ohio  43560-2197
Virginia Mason CCOP Seattle, Washington  98101
Huntsman Cancer Institute/University of Utah Salt Lake City, Utah  84112
Appleton Medical Center Appleton, Wisconsin  54911
Thomas Jefferson University Hospital Philadelphia, Pennsylvania  19131
Decatur Memorial Hospital Decatur, Illinois  62526
West Texas Cancer Center Odessa, Texas  79761
Lankenau Hospital Wynnewood, Pennsylvania  19096
UPMC Cancer Center at Jefferson Regional Medical Center Clairton, Pennsylvania  15025
Florida Hospital Orlando, Florida  32803
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
University of Southern California Los Angeles, California  90033
DeKalb Medical Center Decatur, Georgia  30033
Inova Alexandria Hospital Alexandria, Virginia  22304
Northern Indiana Cancer Research Consortium South Bend, Indiana  
Rohnert Park Cancer Center Rohnert Park, California  94928
South Sacramento Cancer Center Sacramento, California  95823
Sands Cancer Center Canandiaqua, New York  14424
University of Cincinnati Cincinnati, Ohio  45267-0502
Penn State Milton S Hershey Medical Center Hershey, Pennsylvania  17033
Saint Joseph Hospital Orange, California  92868
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
The Hospital of Central Connecticut New Britain, Connecticut  06050
Edna Williams Cancer Center at the Baptist Cancer Institute Jacksonville, Florida  32207
M D Anderson Cancer Center- Orlando Orlando, Florida  32806
University of Hawaii Honolulu, Hawaii  96813
John H Stroger Jr Hospital of Cook County Chicago, Illinois  60612-3785
McFarland Clinic Ames, Iowa  50010
Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Ochsner Clinic CCOP New Orleans, Louisiana  70121
Oakwood Hospital Dearborn, Michigan  48123
Saint John Hospital and Medical Center Detroit, Michigan  48236
Sparrow Hospital Lansing, Michigan  48912
Saint Mary's of Michigan Saginaw, Michigan  48601
Saint John Macomb-Oakland Hospital Warren, Michigan  48093
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
Truman Medical Center Kansas City, Missouri  64108
Billings Clinic Billings, Montana  59107-7000
Good Samaritan Hospital Kearney, Nebraska  68847
Saint Elizabeth Regional Medical Center Lincoln, Nebraska  68510
Nevada Cancer Research Foundation CCOP Las Vegas, Nevada  89106
Saint Barnabas Medical Center Livingston, New Jersey  07039
Sparta Cancer Treatment Center Sparta, New Jersey  07871
Highland Hospital Rochester, New York  14620
State University of New York Upstate Medical University Syracuse, New York  13210
Mission Hospitals Inc Asheville, North Carolina  28801
Margaret R Pardee Memorial Hospital Hendersonville, North Carolina  28791
Summa Barberton Hospital Barberton, Ohio  44203
Aultman Health Foundation Canton, Ohio  44710
Grant Medical Center Columbus, Ohio  43215
Saint Charles Hospital Oregon, Ohio  43616
North Coast Cancer Care Sandusky, Ohio  44870
Mercy Cancer Center at Saint Anne Mercy Hospital Toledo, Ohio  43623
Natalie W Bryant Cancer Center Tulsa, Oklahoma  74136
Legacy Good Samaritan Hospital and Medical Center Portland, Oregon  97210
Providence Saint Vincent Medical Center Portland, Oregon  97225
Salem Hospital Salem, Oregon  97309
Saint Luke's Hospital Bethlehem, Pennsylvania  18015
Pocono Medical Center East Stroudsburg, Pennsylvania  18301
Aria Health-Torresdale Campus Philadelphia, Pennsylvania  19114
Upstate Carolina CCOP Spartanburg, South Carolina  29303
Sanford Cancer Center-Oncology Clinic Sioux Falls, South Dakota  57104
Swedish Medical Center-First Hill Seattle, Washington  98122-4307
Wheeling Hospital Wheeling, West Virginia  26003
Langlade Hospital and Cancer Center Antigo, Wisconsin  54409
Sacred Heart Hospital Eau Claire, Wisconsin  54701
Saint Vincent Hospital Green Bay, Wisconsin  54301
Saint Mary's Hospital Green Bay, Wisconsin  54303
Dean Hematology and Oncology Clinic Madison, Wisconsin  53717
Bay Area Medical Center Marinette, Wisconsin  54143
Marshfield Clinic-Minocqua Center Minocqua, Wisconsin  54548
Saint Michael's Hospital Stevens Point, Wisconsin  54481
Aspirus Regional Cancer Center Wausau, Wisconsin  54401
University of Maryland Greenebaum Cancer Center Baltimore, Maryland  21201
Northeast Radiation Oncology Center Dunmore, Pennsylvania  18512
Radiological Associates of Sacramento Sacramento, California  95816
Lake University Ireland Cancer Center Mentor, Ohio  44060
The Nebraska Medical Center Omaha, Nebraska  68198
Kansas City Cancer Centers - North Kansas City, Missouri  64154
Intercommunity Cancer Center Monroeville, Pennsylvania  15146
Stony Brook University Medical Center Stony Brook, New York  11794
Alle-Kiski Medical Center Natrona Heights, Pennsylvania  15065
John Muir Medical Center-Concord Campus Concord, California  94520
Saint Jude Medical Center Fullerton, California  92835
Memorial Healthcare System - Joe DiMaggio Children's Hospital Hollywood, Florida  33021
Mount Sinai Medical Center CCOP Miami Beach, Florida  33140
Maine Medical Center- Scarborough Campus Scarborough, Maine  04074
Saint Agnes Hospital Baltimore, Maryland  21229
The Regional Cancer Center Erie, Pennsylvania  16505
Armstrong Center for Medicine and Health Kittanning, Pennsylvania  16201
Erlanger Medical Center Chattanooga, Tennessee  37403
Intermountain Medical Center Murray, Utah  84157
Utah Valley Regional Medical Center Provo, Utah  84603
Dixie Medical Center Regional Cancer Center Saint George, Utah  84770
Utah Cancer Specialists-Salt Lake City Salt Lake City, Utah  84106
Riverview Hospital Wisconsin Rapids, Wisconsin  54494
University of Texas Medical Branch at Galveston Galveston, Texas  77555
Texas Cancer Center-Sherman Sherman, Texas  75090
Kansas City Cancer Centers-Southwest Overland Park, Kansas  66210
FirstHealth of the Carolinas-Moore Regional Hosiptal Pinehurst, North Carolina  28374
UPMC Cancer Center at UPMC McKeesport McKeesport, Pennsylvania  15132
Cancer Centers of North Carolina Raleigh, North Carolina  27607
Kaiser Permanente Oakland-Broadway Oakland, California  94611
Kaiser Permanente-Rancho Cordova Cancer Center Rancho Cardova, California  95670
The Permanente Medical Group-Roseville Radiation Oncology Roseville, California  95678
Kaiser Permanente Radiation Oncology Cancer Treatment Center Santa Clara, California  95051
Kaiser Permanente Cancer Treatment Center South San Francisco, California  94080
Saint Vincent's Medical Center Bridgeport, Connecticut  06606
Kansas City Cancer Center - South Kansas City, Missouri  64131
Forsyth Memorial Hospital Winston-Salem, North Carolina  27103
The Mark H Zangmeister Center Columbus, Ohio  43219
Southwest General Health Center Ireland Cancer Center Middleburg Heights, Ohio  44130
UHHS-Chagrin Highlands Medical Center Orange Village, Ohio  44122
UHHS-Westlake Medical Center Westlake, Ohio  44145
New York Oncology Hematology PC - Albany Albany, New York  12206
Central Indiana Cancer Centers - Indianapolis Indianapolis, Indiana  46227
Community Regional Cancer Care-East Radiation Oncology Indianapolis, Indiana  46219
Community Regional Cancer Care-North Indianapolis, Indiana  46256
Washington Hospital Washington, Pennsylvania  15301
Fox Chase Cancer Center Buckingham Furlong, Pennsylvania  18925
Saint Vincent Oncology Center Indianapolis, Indiana  46260
Radiation Oncology Associates PC Fort Wayne, Indiana  46804
University Pointe West Chester, Ohio  45069
Texas Oncology-Longview Cancer Center Longview, Texas  75601
Alta Bates Summit Medical Center-Herrick Campus Berkeley, California  94704
Sanford Medical Center-Fargo Fargo, North Dakota  58122
Summa Akron City Hospital Akron, Ohio  44304
William Backus Hospital Norwich, Connecticut  06360
D'Amour Center for Cancer Care Springfield, Massachusetts  01107
Siteman Cancer Center - Saint Peters Saint Peters, Missouri  63376
Texas Oncology-Arlington South Arlington, Texas  76014
Texas Oncology-Denton South Denton, Texas  76210
Broward Health Medical Center Fort Lauderdale, Florida  33316
Sanford Clinic North-Bemidgi Bemidji, Minnesota  56601
PeaceHealth Saint Joseph Medical Center Bellingham, Washington  98225
Riverview Medical Center/Booker Cancer Center Red Bank, New Jersey  07701
Cleveland Clinic Cancer Center/Fairview Hospital Cleveland, Ohio  44111
Cancer Specialists of North Florida-Southside Jacksonville, Florida  32207
Cancer Specialists of North Florida-Beaches Jacksonville Beach, Florida  32250
Cancer Specialists of North Florida-Baptist South Jascksonville, Florida  32258
Cancer Specialists of North Florida-Orange Park Orange Park, Florida  32073
Cancer Specialists of North Florida-Putnam Palatka, Florida  32177
Cancer Specialists of North Florida-Saint Augustine Saint Augustine, Florida  32086
IU Health Methodist Hospital Indianapolis, Indiana  46202
Sentara Hospitals Norfolk, Virginia  23507
The James Graham Brown Cancer Center at University of Louisville Louisville, Kentucky  40202
Fletcher Allen Health Care-Medical Center Burlington, Vermont  05401
Edward Hospital/Cancer Center Naperville, Illinois  60540
Toledo Clinic Cancer Centers-Maumee Maumee, Ohio  43537-1839
PeaceHealth Southwest Medical Center Vancouver, Washington  98664
Auburn Radiation Oncology Center Auburn, California  95603
Marshall Radiation Oncology Center Cameron Park, California  95682
Mercy San Juan Medical Center Carmichael, California  95608
Roseville Radiation Oncology Center Roseville, California  95661
Mercy General Hospital Radiation Oncology Center Sacramento, California  95819
Parkview Hospital Fort Wayne, Indiana  46805
IU Health Ball Memorial Hospital Muncie, Indiana  47303
Saint Joseph Regional Cancer Center Bryan, Texas  77802
Covenant Medical Center-Lakeside Lubbock, Texas  79410
Cape Radiation Oncology Cape Girardeau, Missouri  63703
UPMC Cancer Centers - Arnold Palmer Pavilion Greensburg, Pennsylvania  15601
University Pittsburgh Medical Cancer Center-Johnstown Johnstown, Pennsylvania  15901
Trinity's Tony Teramana Cancer Center Steubenville, Ohio  43952
Marshfield Clinic Cancer Center at Sacred Heart Eau Claire, Wisconsin  54701
Arizona Oncology Associates-West Orange Grove Tucson, Arizona  85704
Robert and Carol Weissman Cancer Center at Martin Health Stuart, Florida  34994
Helen G Nassif Community Cancer Center Cedar Rapids, Iowa  52402
University Radiation Oncology Rochester, New York  14626
UPMC - HVHS Cancer Center at Heritage Valley Beaver Beaver, Pennsylvania  15009
UPMC-Passavant Hospital Pittsburgh, Pennsylvania  15237
UPMC-Shadyside Hospital Pittsburgh, Pennsylvania  15232
Univerisity of Pittsburgh Medical Center Northwest Seneca, Pennsylvania  16346
Texas Oncology PA - Bedford Bedford, Texas  76022
Texas Oncology Methodist Charlton Cancer Center Dallas, Texas  75237
The Klabzuba Cancer Center Fort Worth, Texas  76104
Texas Oncology Cancer Center Sugar Land Sugar Land, Texas  77479