MedPath

Chemotherapy With or Without Bevacizumab in Treating Women With Stage I, Stage II, or Stage IIIA Breast Cancer That Can Be Removed By Surgery

Registration Number
NCT00408408
Lead Sponsor
NSABP Foundation Inc
Brief Summary

RATIONALE: Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more tumor cells. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of breast cancer by blocking blood flow to the tumor. Giving chemotherapy and bevacizumab before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving bevacizumab after surgery may kill any tumor cells that remain after surgery. It is not yet known which chemotherapy regimen is more effective with or without bevacizumab in treating breast cancer.

PURPOSE: This randomized phase III trial is studying six different chemotherapy regimens to compare how well they work with or without bevacizumab in treating women with stage I, stage II, or stage IIIA breast cancer that can be removed by surgery.

Detailed Description

OBJECTIVES:

Primary

* Compare the efficacy of docetaxel followed by doxorubicin hydrocloride and cyclophosphamide (AC) vs docetaxel and capecitabine followed by AC vs docetaxel and gemcitabine hydrochloride followed by AC, with or without bevacizumab, in terms of an increase in the rate of pathologic complete response (pCR) in the breast, in women with palpable or operable breast cancer.

Secondary

* Compare docetaxel/capecitabine with AC vs docetaxel/gemcitabine hydrochloride with AC vs docetaxel with AC, with or without bevacizumab, in terms of the rate of pCR in the breast and all post-therapy lymph nodes evaluated histologically (pCR breast and nodes).

* Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based regimens (docetaxel with AC, docetaxel and capecitabine with AC, and docetaxel and gemcitabine hydrochloride with AC) will increase the rate of pCR of the breast and nodes compared to the same docetaxel/anthracycline-based regimens without bevacizumab in these patients.

* Determine whether the addition of capecitabine or gemcitabine hydrochloride to docetaxel, with or without bevacizumab, will increase the rate of clinical overall response (cOR) compared to docetaxel alone with or without bevacizumab in these patients.

* Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based regimens will increase the rate of cOR compared to the same docetaxel/anthracycline-based regimens without bevacizumab in these patients.

* Determine whether the addition of capecitabine or gemcitabine hydrochloride to docetaxel, with or without bevacizumab, will increase the rate of clinical complete response (cCR) compared to docetaxel alone with or without bevacizumab in these patients.

* Determine whether the addition of bevacizumab to the docetaxel/anthracycline-based regimens (docetaxel with AC, docetaxel/capecitabine with AC, and docetaxel/gemcitabine hydrochloride with AC) will increase the rate of cCR compared to the same docetaxel/anthracycline-based regimens without bevacizumab in these patients.

* Identify gene expression profiles that can predict pCR in patients treated with the different sequential docetaxel/anthracycline-based regimens with or without bevacizumab.

* Identify gene expression profiles that can predict cOR in patients treated with docetaxel alone, docetaxel/capecitabine, or docetaxel/gemcitabine hydrochloride with or without bevacizumab.

* Determine the accuracy of an in vitro chemoresponse assay (ChemoFx®) as a predictor of pCR in patients treated with the different sequential docetaxel/anthracycline-based regimens without bevacizumab.

* Determine the accuracy of ChemoFx® as a predictor of cOR in patients treated with docetaxel alone, docetaxel/capecitabine, or docetaxel/gemcitabine hydrochloride without bevacizumab in these patients.

* Determine the impact of preoperative bevacizumab and sequential chemotherapy regimens and postoperative bevacizumab therapy on cardiac function in these patients.

* Determine the impact of bevacizumab on surgical complications in these patients.

* Determine the toxicity of the preoperative regimens and the toxicity of postoperative bevacizumab in these patients.

* Compare the docetaxel/anthracycline-based regimens with vs without bevacizumab, in terms of an increase in disease-free survival, of these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to tumor size (2-4 cm vs \> 4 cm), nodal status (negative vs positive), hormone receptor status (estrogen receptor \[ER\]-positive and/or progesterone-receptor \[PgR\]-positive vs ER- and PgR-negative), and age (\< 50 years vs ≥ 50 years). Patients are randomized to 1 of 6 treatment arms.

Core needle biopsies are performed at baseline. Tumor tissue samples are also collected during definitive surgery. Samples are examined for gene expression and polymorphism by reverse transcriptase-polymerase chain reaction analysis and chemoresponse assay (ChemoFx®).

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

PROJECTED ACCRUAL: A total of 1,200 patients will be accrued for this study.

Recruitment & Eligibility

Status
UNKNOWN
Sex
Female
Target Recruitment
1206
Inclusion Criteria

  • The patient must have consented to participate and must have signed and dated an appropriate Institutional Review Board (IRB)-approved consent form that conforms to federal and institutional guidelines for the study treatment and submission of pre-entry core biopsy material for correlative studies.

  • Patients must be female.

  • Patients must be 18 years of age or older.

  • Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

  • The diagnosis of invasive adenocarcinoma of the breast must have been made by core needle biopsy.

  • The primary breast tumor must be palpable and measure greater than or equal to 2.0 cm on physical exam.

  • All patients must have their left ventricular ejection fraction (LVEF) assessed by multigated acquisition (MUGA) scan or echocardiogram within 3 months prior to study entry. The LVEF must be greater than or equal to the lower limit of normal (LLN) for the cardiac imaging facility performing the study. Note: If the cardiac imaging facility cannot provide a LLN, use 50% as the LLN value.

    • Note: Since the pre-entry LVEF serves as the baseline for comparing subsequent LVEF assessments to determine if bevacizumab therapy can be continued, it is critical that this baseline study be an accurate assessment of the patient's LVEF. If the baseline LVEF is greater than 75%, the investigator should have the study reviewed for accuracy prior to study entry. Following study entry, the LVEF determination may be reviewed up until the time of the post-chemotherapy (preoperative) evaluation. Please note that if a more accurate value is obtained from the review of the baseline MUGA or echocardiogram, the correct value must be submitted to the NSABP before the post-chemotherapy (preoperative) MUGA or echocardiogram is performed or it cannot be used for managing postoperative bevacizumab.

  • All patients must have an EKG within 3 months prior to study entry.

  • At the time of randomization:

    • Absolute neutrophil count (ANC) must be greater than or equal to 1200/mm3.
    • Platelet count must be greater than or equal to 100,000/mm3.
    • Hemoglobin must be greater than or equal to 10 g/dL.
    • There must be evidence of adequate hepatic function by these criteria:
    • Total bilirubin must be less than or equal to the ULN for the lab unless the patient has a grade 1 bilirubin elevation (greater than ULN to 1.5 x ULN) resulting from Gilbert's disease or similar syndrome due to slow conjugation of bilirubin; and
    • Alkaline phosphatase must be less than or equal 2.5 x ULN for the lab; and
    • Aspartate Aminotransferase (AST) must be less than or equal to 1.5 x ULN for the lab.
    • Alkaline phosphatase and AST may not both be greater than the ULN. For example, if the alkaline phosphatase is greater than the ULN but less than or equal 2.5 x ULN, then the AST must be less than or equal the ULN. If the AST is greater than the ULN but less than or equal 1.5 x ULN, then the alkaline phosphatase must be less than or equal ULN.

  • Patients with either skeletal pain or alkaline phosphatase that is greater than ULN but less than or equal 2.5 x ULN are eligible for inclusion in the study if bone scans do not demonstrate metastatic disease. Suspicious findings on bone scan must be confirmed as benign by x-ray, MRI, or biopsy.

  • Patients with AST or alkaline phosphatase greater than ULN are eligible for inclusion in the study if liver imaging does not demonstrate metastatic disease and adequate bone marrow and liver function results as described above are met.

  • The following criteria for evidence of adequate renal function must be met:

  • Serum creatinine less than or equal ULN for the lab.

  • Calculated creatinine clearance must be greater than 50 mL/min.

  • Urine protein/urine creatinine (UPC) ratio must be less than 1.0.

  • Patient must be able to swallow oral medications.

Exclusion criteria:

  • Tumor determined to be strongly human epidermal growth factor receptor 2 (HER2)-positive by immunohistochemistry (3+) or by fluorescent in situ hybridization (positive for gene amplification).

  • Excisional or incisional biopsy for this primary breast tumor.

  • Surgical axillary staging procedure prior to study entry. Exceptions: 1) Fine Needle Aspiration (FNA) or core biopsy of an axillary node is permitted for any patient, and 2) although not recommended, a pre-neoadjuvant therapy sentinel lymph node biopsy for patients with clinically negative axillary nodes is permitted.

  • Tumors clinically staged as T4.

  • Ipsilateral cN2b or cN3 disease. (Patients with cN1 or cN2a disease are eligible.)

  • Definitive clinical or radiologic evidence of metastatic disease.

  • Synchronous bilateral breast cancer (invasive or DCIS).

  • Treatment including radiation therapy, chemotherapy, biotherapy, and/or hormonal therapy for the currently diagnosed breast cancer prior to study entry.

  • Any sex hormonal therapy, e.g., birth control pills, ovarian hormonal replacement therapy, etc. (These patients are eligible if this therapy is discontinued prior to randomization.)

  • Therapy with any hormonal agent such as raloxifene, tamoxifen, or other selective estrogen receptor modulator (SERM), either for osteoporosis or breast cancer prevention. (Patients are eligible only if these medications are discontinued prior to randomization.)

  • Prior history of breast cancer, including DCIS. (Patients with a history of lobular carcinoma in situ [LCIS] are eligible.)

  • Prior therapy with anthracyclines, taxanes, capecitabine, 5-FU (fluorouracil), gemcitabine, or bevacizumab for any malignancy.

  • Other malignancies unless the patient is considered to be disease-free for 5 or more years prior to randomization and is deemed by her physician to be at low risk for recurrence. Patients with the following cancers are eligible if diagnosed and treated within the past 5 years: carcinoma in situ of the cervix, carcinoma in situ of the colon, melanoma in situ, and basal cell and squamous cell carcinoma of the skin.

  • Cardiac disease that would preclude the use of anthracyclines. This includes:

    • angina pectoris that requires the use of anti-anginal medication;
    • history of documented congestive heart failure;
    • serious cardiac arrhythmia requiring medication;
    • severe conduction abnormality;
    • valvular disease with documented cardiac function compromise; and
    • uncontrolled hypertension defined as BP greater than 150/90 on antihypertensive therapy. (Patients with hypertension that is well controlled on medication are eligible.)

  • History of myocardial infarction documented by elevated cardiac enzymes or persistent regional wall abnormalities on assessment of LV function.

  • History of transient ischemic attack (TIA) or cerebrovascular accident (CVA).

  • History of other arterial thrombotic event within 12 months before study entry.

  • Symptomatic peripheral vascular disease.

  • Any significant non-traumatic bleeding within 6 months before study entry.

  • Serious or non-healing wound, skin ulcers, or incompletely healed bone fracture.

  • Gastroduodenal ulcer(s) determined by endoscopy to be active.

  • Invasive procedures defined as follows:

    • Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to planned start of study therapy. (Note: Placement of a vascular access device is not considered a major surgical procedure.)
    • Anticipation of need for major surgical procedures (other than the required breast surgery) during the course of the study.

  • Known bleeding diathesis or coagulopathy. (Patients on warfarin with an in-range international normalized ratio [INR] [usually between 2 and 3] are eligible.)

  • Sensory/motor neuropathy greater than or equal grade 2, as defined by the NCI's Common Terminology Criteria for Adverse Events Version 3.0 (CTCAE v3.0).

  • Other non-malignant systemic disease (cardiovascular, renal, hepatic, etc.) that would preclude treatment with any of the treatment regimens or would prevent required follow-up.

  • Conditions that would prohibit administration of corticosteroids.

  • History of severe hypersensitivity reaction to drugs formulated with polysorbate 80.

  • Administration of any investigational agents within 30 days before study entry.

  • Pregnancy or lactation at the time of proposed randomization.

Exclusion Criteria

Not provided

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Arm 3B: Docetaxel + Gem + Bev then AC + Bevgemcitabine hydrochloridePatients receive docetaxel as in Arm 1A, gemcitabine hydrochloride as in Arm 3A, and bevacizumab as in Arm 1B. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 2B: Docetaxel + Cape + Bev then AC + Bevdoxorubicin hydrochloride (Adriamycin)Patients receive bevacizumab as in Arm 1B and docetaxel and capecitabine as in Arm III. Treatment repeats every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1B. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 1B Docetaxel + Bev then AC + BevbevacizumabPatients receive bevacizumab (bev) IV on day 1 and docetaxel every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab IV every 3 weeks for up to 10 cycles in the absence of disease progression or unacceptable toxicity.
Arm 1A: Docetaxel then ACdoxorubicin hydrochloride (Adriamycin)Patients receive docetaxel IV on day 1 every 3 weeks for up to 4 cycles. Patients then receive AC IV every 3 weeks for up to 4 cycles. Patients then undergo surgery (lumpectomy or mastectomy).
Arm 1B Docetaxel + Bev then AC + Bevdoxorubicin hydrochloride (Adriamycin)Patients receive bevacizumab (bev) IV on day 1 and docetaxel every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab IV every 3 weeks for up to 10 cycles in the absence of disease progression or unacceptable toxicity.
Arm 3A: Docetaxel + Gem then ACdoxorubicin hydrochloride (Adriamycin)Patients receive docetaxel as in Arm 1A and gemcitabine hydrochloride IV on days 1 and 8 of each cycle every 3 weeks for up to 4 cycles. Patients then receive AC as in Arm 1A. Patients then undergo surgery as in Arm 1A.
Arm 3B: Docetaxel + Gem + Bev then AC + Bevdoxorubicin hydrochloride (Adriamycin)Patients receive docetaxel as in Arm 1A, gemcitabine hydrochloride as in Arm 3A, and bevacizumab as in Arm 1B. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 2A: Docetaxel + Capecitabine then ACdoxorubicin hydrochloride (Adriamycin)Patients receive docetaxel as in Arm 1A and oral capecitabine (cape) twice daily on days 1-14 every 3 weeks for up to 4 cycles. Patients then receive AC as in Arm 1A. Patients then undergo surgery as in Arm 1A.
Arm 3B: Docetaxel + Gem + Bev then AC + BevbevacizumabPatients receive docetaxel as in Arm 1A, gemcitabine hydrochloride as in Arm 3A, and bevacizumab as in Arm 1B. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 2B: Docetaxel + Cape + Bev then AC + BevbevacizumabPatients receive bevacizumab as in Arm 1B and docetaxel and capecitabine as in Arm III. Treatment repeats every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1B. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 3A: Docetaxel + Gem then ACgemcitabine hydrochloridePatients receive docetaxel as in Arm 1A and gemcitabine hydrochloride IV on days 1 and 8 of each cycle every 3 weeks for up to 4 cycles. Patients then receive AC as in Arm 1A. Patients then undergo surgery as in Arm 1A.
Arm 1A: Docetaxel then ACcyclophosphamidePatients receive docetaxel IV on day 1 every 3 weeks for up to 4 cycles. Patients then receive AC IV every 3 weeks for up to 4 cycles. Patients then undergo surgery (lumpectomy or mastectomy).
Arm 1A: Docetaxel then ACdocetaxelPatients receive docetaxel IV on day 1 every 3 weeks for up to 4 cycles. Patients then receive AC IV every 3 weeks for up to 4 cycles. Patients then undergo surgery (lumpectomy or mastectomy).
Arm 1B Docetaxel + Bev then AC + BevcyclophosphamidePatients receive bevacizumab (bev) IV on day 1 and docetaxel every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab IV every 3 weeks for up to 10 cycles in the absence of disease progression or unacceptable toxicity.
Arm 1B Docetaxel + Bev then AC + BevdocetaxelPatients receive bevacizumab (bev) IV on day 1 and docetaxel every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab IV every 3 weeks for up to 10 cycles in the absence of disease progression or unacceptable toxicity.
Arm 2A: Docetaxel + Capecitabine then ACcyclophosphamidePatients receive docetaxel as in Arm 1A and oral capecitabine (cape) twice daily on days 1-14 every 3 weeks for up to 4 cycles. Patients then receive AC as in Arm 1A. Patients then undergo surgery as in Arm 1A.
Arm 2A: Docetaxel + Capecitabine then ACcapecitabinePatients receive docetaxel as in Arm 1A and oral capecitabine (cape) twice daily on days 1-14 every 3 weeks for up to 4 cycles. Patients then receive AC as in Arm 1A. Patients then undergo surgery as in Arm 1A.
Arm 2A: Docetaxel + Capecitabine then ACdocetaxelPatients receive docetaxel as in Arm 1A and oral capecitabine (cape) twice daily on days 1-14 every 3 weeks for up to 4 cycles. Patients then receive AC as in Arm 1A. Patients then undergo surgery as in Arm 1A.
Arm 2B: Docetaxel + Cape + Bev then AC + BevcapecitabinePatients receive bevacizumab as in Arm 1B and docetaxel and capecitabine as in Arm III. Treatment repeats every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1B. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 2B: Docetaxel + Cape + Bev then AC + BevcyclophosphamidePatients receive bevacizumab as in Arm 1B and docetaxel and capecitabine as in Arm III. Treatment repeats every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1B. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 2B: Docetaxel + Cape + Bev then AC + BevdocetaxelPatients receive bevacizumab as in Arm 1B and docetaxel and capecitabine as in Arm III. Treatment repeats every 3 weeks for up to 4 cycles. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1B. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 3A: Docetaxel + Gem then ACcyclophosphamidePatients receive docetaxel as in Arm 1A and gemcitabine hydrochloride IV on days 1 and 8 of each cycle every 3 weeks for up to 4 cycles. Patients then receive AC as in Arm 1A. Patients then undergo surgery as in Arm 1A.
Arm 3A: Docetaxel + Gem then ACdocetaxelPatients receive docetaxel as in Arm 1A and gemcitabine hydrochloride IV on days 1 and 8 of each cycle every 3 weeks for up to 4 cycles. Patients then receive AC as in Arm 1A. Patients then undergo surgery as in Arm 1A.
Arm 3B: Docetaxel + Gem + Bev then AC + BevcyclophosphamidePatients receive docetaxel as in Arm 1A, gemcitabine hydrochloride as in Arm 3A, and bevacizumab as in Arm 1B. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Arm 3B: Docetaxel + Gem + Bev then AC + BevdocetaxelPatients receive docetaxel as in Arm 1A, gemcitabine hydrochloride as in Arm 3A, and bevacizumab as in Arm 1B. Patients then receive AC every 3 weeks for up to 4 cycles and 2 additional cycles of bevacizumab concurrent with the first 2 cycles of AC. Patients then undergo surgery as in Arm 1A. At least 4-6 weeks after surgery, patients receive adjuvant bevacizumab as in Arm 1B.
Primary Outcome Measures
NameTimeMethod
Pathologic Complete Response (pCR) of the Primary Tumor in the BreastTime of surgery, on average 6 or 13 months

Percentage of patients absent of histologic evidence of invasive tumor cells in the surgical breast specimen.

Secondary Outcome Measures
NameTimeMethod
pCR in the Breast and NodesTime of surgery, on average 6 or 13 months

Percentage of patients absent of histologic evidence of invasive tumor cells in the surgical breast specimen and axillary lymph nodes.

Clinical Overall Response (cOR) Following Docetaxel Alone, Docetaxel/Capecitabine, and Docetaxel/Gemcitabine Hydrochloride, With or Without Bevacizumab, as Assessed by Physical Exam at the Completion of the Docetaxel-based Portion of ChemotherapyAssessed at cycle 5 of chemotherapy, on average at 15 weeks

Percentages of patients assessed as Clinical Complete Response or Clinical Partial Response according to RECIST.

Clinical Overall Response: cOR as Assessed by Physical Exam at the Completion of the Sequential Chemotherapy RegimensThree to four weeks after the last chemotherapy dose on average 6 or 13 months

The percentage of patients assessed by physical exam as Clinical Complete Response or Clinical Partial Response according to RECIST.

Clinical Complete Response (cCR) Following Docetaxel Alone, Docetaxel/Capecitabine, and Docetaxel/Gemcitabine Hydrochloride, With or Without Bevacizumab, as Assessed by Physical Exam at Completion of TherapyAssessed at cycle 5 of chemotherapy, on average at 15 weeks

Percentages of patients assessed as Clinical Complete Response or Clinical Partial Response according to RECIST.

Clinical Complete Resonse: cCR as Assessed by Physical Exam at the Completion of the Sequential Chemotherapy RegimensThree to four weeks after the last chemotherapy dose, on average at 6 or 13 months

The percentage of patients assessed by physical exam as Clinical Complete Response according to RECIST.

Percentage of Cardiac EventsAfter each cycle, 3-5 weeks postoperative, 9 and 12 months from study entry, every 6 month years 2-5, and annually years 6-10, for postoperative bevacizumab patients, every 6 weeks during postoperative therapy and at 18 months following study entry.
Surgical Complication24 months after study entry

Number of patients with Grade 4 or above surgery-related toxicities

Toxicities Including Events Other Than Congestive Heart Failure, of Chemotherapy Alone, Bevacizumab With Chemotherapy, and Bevacizumab Alone24 months after study entry

The number of patients who experienced Grade 1 or above Adverse Events. Referring to the Adverse Events tables for specifics.

Disease-free Survival (DFS)Measured through 5 years after study enrollment

Percentage of patients free from local recurrence following mastectomy, local recurrence in the ipsilateral breast following lumpectomy, regional recurrence, distant recurrence, contralateral breast cancer, second primary cancer after 5 years.

Trial Locations

Locations (438)

Iredell Memorial Hospital

🇺🇸

Statesville, North Carolina, United States

Hattiesburg Clinic, PA at Forrest General

🇺🇸

Hattiesburg, Mississippi, United States

Cancer Care Center, Incorporated

🇺🇸

Salem, Ohio, United States

Edmond Odette Cancer Centre at Sunnybrook

🇨🇦

Toronto, Ontario, Canada

John H. Stroger, Jr. Hospital of Cook County

🇺🇸

Chicago, Illinois, United States

Rush University Medical Center

🇺🇸

Chicago, Illinois, United States

Western Pennsylvania Cancer Institute at Western Pennsylvania Hospital

🇺🇸

Pittsburgh, Pennsylvania, United States

Kaiser Permanente Medical Office -Vandever Medical Office

🇺🇸

San Diego, California, United States

Virginia Piper Cancer Institute at Abbott - Northwestern Hospital

🇺🇸

Minneapolis, Minnesota, United States

Cancer Center of Kansas, PA - Newton

🇺🇸

Newton, Kansas, United States

LDS Hospital

🇺🇸

Salt Lake City, Utah, United States

Huntsman Cancer Institute at University of Utah

🇺🇸

Salt Lake City, Utah, United States

Arkansas Cancer Research Center at University of Arkansas for Medical Sciences

🇺🇸

Little Rock, Arkansas, United States

Valley Medical Oncology Consultants - Castro Valley

🇺🇸

Castro Valley, California, United States

Kaiser Permanente Medical Center - Oakland

🇺🇸

Oakland, California, United States

St. Joseph Hospital Regional Cancer Center - Orange

🇺🇸

Orange, California, United States

Kaiser Permanente Medical Center - Richmond

🇺🇸

Richmond, California, United States

Kaiser Permanente Medical Center - Roseville

🇺🇸

Roseville, California, United States

Kaiser Permanente Medical Center - Santa Teresa

🇺🇸

San Jose, California, United States

Kaiser Permanente Medical Center - Vallejo

🇺🇸

Vallejo, California, United States

Memorial Hospital Cancer Center - Colorado Springs

🇺🇸

Colorado Springs, Colorado, United States

Kaiser Permanente - Lafayette

🇺🇸

Lafayette, Colorado, United States

Hope Cancer Care Center at Longmont United Hospital

🇺🇸

Longmont, Colorado, United States

St. Mary - Corwin Regional Medical Center

🇺🇸

Pueblo, Colorado, United States

Exempla Lutheran Medical Center

🇺🇸

Wheat Ridge, Colorado, United States

Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center

🇺🇸

Farmington, Connecticut, United States

Tunnell Cancer Center at Beebe Medical Center

🇺🇸

Lewes, Delaware, United States

Helen and Harry Gray Cancer Center at Hartford Hospital

🇺🇸

Hartford, Connecticut, United States

Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital

🇺🇸

Fort Lauderdale, Florida, United States

Ella Milbank Foshay Cancer Center at Jupiter Medical Center

🇺🇸

Jupiter, Florida, United States

Baptist Cancer Institute - Jacksonville

🇺🇸

Jacksonville, Florida, United States

Broward General Medical Center Cancer Center

🇺🇸

Fort Lauderdale, Florida, United States

Northeast Georgia Medical Center

🇺🇸

Gainesville, Georgia, United States

Phoebe Cancer Center at Phoebe Putney Memorial Hospital

🇺🇸

Albany, Georgia, United States

Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center

🇺🇸

Savannah, Georgia, United States

Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler

🇺🇸

Savannah, Georgia, United States

Maui Memorial Medical Center

🇺🇸

Wailuku, Hawaii, United States

Pacific Cancer Institute - Maui

🇺🇸

Wailuku, Hawaii, United States

Kootenai Cancer Center - Coeur d'Alene

🇺🇸

Coeur d'Alene, Idaho, United States

Illinois CancerCare - Bloomington

🇺🇸

Bloomington, Illinois, United States

Graham Hospital

🇺🇸

Canton, Illinois, United States

Memorial Hospital

🇺🇸

Carthage, Illinois, United States

Illinois CancerCare - Canton

🇺🇸

Canton, Illinois, United States

Illinois CancerCare - Carthage

🇺🇸

Carthage, Illinois, United States

Mount Sinai Hospital Medical Center

🇺🇸

Chicago, Illinois, United States

Alexian Brothers Radiation Oncology

🇺🇸

Elk Grove Village, Illinois, United States

Decatur Memorial Hospital Cancer Care Institute

🇺🇸

Decatur, Illinois, United States

Illinois CancerCare - Eureka

🇺🇸

Eureka, Illinois, United States

St. Francis Hospital

🇺🇸

Federal Way, Washington, United States

Eureka Community Hospital

🇺🇸

Eureka, Illinois, United States

Galesburg Cottage Hospital

🇺🇸

Galesburg, Illinois, United States

Illinois CancerCare - Cottage

🇺🇸

Galesburg, Illinois, United States

Galesburg Clinic, PC

🇺🇸

Galesburg, Illinois, United States

Illinois CancerCare - Galesburg

🇺🇸

Galesburg, Illinois, United States

Mason District Hospital

🇺🇸

Havana, Illinois, United States

Illinois CancerCare - Kewanee Clinic

🇺🇸

Kewanee, Illinois, United States

Illinois CancerCare - Macomb

🇺🇸

Macomb, Illinois, United States

Illinois CancerCare - Monmouth

🇺🇸

Monmouth, Illinois, United States

OSF Holy Family Medical Center

🇺🇸

Monmouth, Illinois, United States

McDonough District Hospital

🇺🇸

Macomb, Illinois, United States

Cardinal Bernardin Cancer Center at Loyola University Medical Center

🇺🇸

Maywood, Illinois, United States

Good Samaritan Regional Health Center

🇺🇸

Mount Vernon, Illinois, United States

BroMenn Regional Medical Center

🇺🇸

Normal, Illinois, United States

Edward Hospital Cancer Center

🇺🇸

Naperville, Illinois, United States

Community Cancer Center

🇺🇸

Elyria, Ohio, United States

Illinois CancerCare - Community Cancer Center

🇺🇸

Normal, Illinois, United States

Community Hospital of Ottawa

🇺🇸

Ottawa, Illinois, United States

Illinois CancerCare - Pekin

🇺🇸

Pekin, Illinois, United States

Oncology Hematology Associates of Central Illinois, PC - Ottawa

🇺🇸

Ottawa, Illinois, United States

Illinois CancerCare - Peru

🇺🇸

Peru, Illinois, United States

OSF St. Francis Medical Center

🇺🇸

Peoria, Illinois, United States

CCOP - Illinois Oncology Research Association

🇺🇸

Peoria, Illinois, United States

Swedish-American Regional Cancer Center

🇺🇸

Rockford, Illinois, United States

Illinois CancerCare - Spring Valley

🇺🇸

Spring Valley, Illinois, United States

Illinois CancerCare - Princeton

🇺🇸

Princeton, Illinois, United States

Perry Memorial Hospital

🇺🇸

Princeton, Illinois, United States

Illinois Valley Community Hospital

🇺🇸

Peru, Illinois, United States

Elkhart Clinic, LLC

🇺🇸

Elkhart, Indiana, United States

Regional Cancer Center at Memorial Medical Center

🇺🇸

Springfield, Illinois, United States

St. Francis Hospital and Health Centers - Beech Grove Campus

🇺🇸

Beech Grove, Indiana, United States

Fort Wayne Medical Oncology and Hematology

🇺🇸

Fort Wayne, Indiana, United States

St. Vincent Indianapolis Hospital

🇺🇸

Indianapolis, Indiana, United States

Elkhart General Hospital

🇺🇸

Elkhart, Indiana, United States

Center for Cancer Care at Goshen General Hospital

🇺🇸

Goshen, Indiana, United States

Howard Community Hospital

🇺🇸

Kokomo, Indiana, United States

Community Hospital

🇺🇸

Munster, Indiana, United States

CCOP - Northern Indiana CR Consortium

🇺🇸

South Bend, Indiana, United States

Reid Hospital & Health Care Services

🇺🇸

Richmond, Indiana, United States

Memorial Hospital of South Bend

🇺🇸

South Bend, Indiana, United States

Saint Joseph Regional Medical Center

🇺🇸

South Bend, Indiana, United States

Michiana Hematology-Oncology, PC - South Bend

🇺🇸

South Bend, Indiana, United States

South Bend Clinic

🇺🇸

South Bend, Indiana, United States

Holden Comprehensive Cancer Center at University of Iowa

🇺🇸

Iowa City, Iowa, United States

McFarland Clinic, PC

🇺🇸

Ames, Iowa, United States

Cancer Center of Kansas, PA - Dodge City

🇺🇸

Dodge City, Kansas, United States

Cancer Center of Kansas-Independence

🇺🇸

Independence, Kansas, United States

Cancer Center of Kansas, PA - Medical Arts Tower

🇺🇸

Wichita, Kansas, United States

Associates in Womens Health, PA - North Review

🇺🇸

Wichita, Kansas, United States

Wesley Medical Center

🇺🇸

Wichita, Kansas, United States

Cancer Resource Center at King's Daughters Medical Center

🇺🇸

Ashland, Kentucky, United States

Greater Baltimore Medical Center Cancer Center

🇺🇸

Baltimore, Maryland, United States

Frederick Memorial Hospital Regional Cancer Therapy Center

🇺🇸

Frederick, Maryland, United States

Associates in Oncology and Hematology - Medical Center Drive

🇺🇸

Rockville, Maryland, United States

Hickman Cancer Center at Bixby Medical Center

🇺🇸

Adrian, Michigan, United States

MetroWest Medical Center - Framingham Union Hospital

🇺🇸

Framingham, Massachusetts, United States

Genesys Hurley Cancer Institute

🇺🇸

Flint, Michigan, United States

Oakwood Cancer Center at Oakwood Hospital and Medical Center

🇺🇸

Dearborn, Michigan, United States

Great Lakes Cancer Institute at McLaren Regional Medical Center

🇺🇸

Flint, Michigan, United States

Van Elslander Cancer Center at St. John Hospital and Medical Center

🇺🇸

Grosse Pointe Woods, Michigan, United States

Foote Memorial Hospital

🇺🇸

Jackson, Michigan, United States

West Michigan Cancer Center

🇺🇸

Kalamazoo, Michigan, United States

Borgess Medical Center

🇺🇸

Kalamazoo, Michigan, United States

Bronson Methodist Hospital

🇺🇸

Kalamazoo, Michigan, United States

Breslin Cancer Center at Ingham Regional Medical Center

🇺🇸

Lansing, Michigan, United States

Sparrow Regional Cancer Center

🇺🇸

Lansing, Michigan, United States

Lapeer Regional Hospital

🇺🇸

Lapeer, Michigan, United States

St. Mary Mercy Hospital

🇺🇸

Livonia, Michigan, United States

Community Cancer Center of Monroe

🇺🇸

Monroe, Michigan, United States

St. Joseph Mercy Oakland

🇺🇸

Pontiac, Michigan, United States

Lakeland Regional Cancer Care Center - St. Joseph

🇺🇸

Saint Joseph, Michigan, United States

Mercy Memorial Hospital - Monroe

🇺🇸

Monroe, Michigan, United States

Mercy Regional Cancer Center at Mercy Hospital

🇺🇸

Port Huron, Michigan, United States

Seton Cancer Institute at Saint Mary's - Saginaw

🇺🇸

Saginaw, Michigan, United States

Lakeside Cancer Specialists, PLLC

🇺🇸

Saint Joseph, Michigan, United States

Providence Cancer Institute at Providence Hospital - Southfield Campus

🇺🇸

Southfield, Michigan, United States

Mercy and Unity Cancer Center at Mercy Hospital

🇺🇸

Coon Rapids, Minnesota, United States

Duluth Clinic Cancer Center - Duluth

🇺🇸

Duluth, Minnesota, United States

St. John Macomb Hospital

🇺🇸

Warren, Michigan, United States

Fairview Ridges Hospital

🇺🇸

Burnsville, Minnesota, United States

Fairview Southdale Hospital

🇺🇸

Edina, Minnesota, United States

CCOP - Duluth

🇺🇸

Duluth, Minnesota, United States

Mercy and Unity Cancer Center at Unity Hospital

🇺🇸

Fridley, Minnesota, United States

Miller - Dwan Medical Center

🇺🇸

Duluth, Minnesota, United States

Hutchinson Area Health Care

🇺🇸

Hutchinson, Minnesota, United States

HealthEast Cancer Care at St. John's Hospital

🇺🇸

Maplewood, Minnesota, United States

Minnesota Oncology Hematology, PA - Maplewood

🇺🇸

Maplewood, Minnesota, United States

Hennepin County Medical Center - Minneapolis

🇺🇸

Minneapolis, Minnesota, United States

CCOP - Metro-Minnesota

🇺🇸

Saint Louis Park, Minnesota, United States

Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center

🇺🇸

Robbinsdale, Minnesota, United States

Regions Hospital Cancer Care Center

🇺🇸

Saint Paul, Minnesota, United States

Saint Francis Medical Center

🇺🇸

Cape Girardeau, Missouri, United States

Liberty Hospital

🇺🇸

Liberty, Missouri, United States

Midwest Hematology Oncology Group, Incorporated

🇺🇸

Saint Louis, Missouri, United States

Hematology-Oncology Centers of the Northern Rockies - Billings

🇺🇸

Billings, Montana, United States

Kalispell Medical Oncology at KRMC

🇺🇸

Kalispell, Montana, United States

Kalispell Regional Medical Center

🇺🇸

Kalispell, Montana, United States

Good Samaritan Cancer Center at Good Samaritan Hospital

🇺🇸

Kearney, Nebraska, United States

Montana Cancer Center at St. Patrick Hospital and Health Sciences Center

🇺🇸

Missoula, Montana, United States

Cancer Institute of New Jersey at Hamilton

🇺🇸

Hamilton, New Jersey, United States

Newark Beth Israel Medical Center

🇺🇸

Newark, New Jersey, United States

Saint Francis Hospital Cancer Center

🇺🇸

Poughkeepsie, New York, United States

Our Lady of Mercy Medical Center Comprehensive Cancer Center

🇺🇸

The Bronx, New York, United States

Tucker Center for Cancer Care at Orange Regional Medical Center

🇺🇸

Middletown, New York, United States

Blumenthal Cancer Center at Carolinas Medical Center

🇺🇸

Charlotte, North Carolina, United States

Alamance Cancer Center at Alamance Regional Medical Center

🇺🇸

Burlington, North Carolina, United States

Randolph Hospital

🇺🇸

Asheboro, North Carolina, United States

Hope A Women's Cancer Center

🇺🇸

Asheville, North Carolina, United States

Wayne Memorial Hospital, Incorporated

🇺🇸

Goldsboro, North Carolina, United States

Presbyterian Cancer Center at Presbyterian Hospital

🇺🇸

Charlotte, North Carolina, United States

St. Luke's Hospital

🇺🇸

Maumee, Ohio, United States

Flower Hospital Cancer Center

🇺🇸

Sylvania, Ohio, United States

Bryn Mawr Hospital

🇺🇸

Bryn Mawr, Pennsylvania, United States

Cherry Tree Cancer Center

🇺🇸

Hanover, Pennsylvania, United States

Mount Nittany Medical Center

🇺🇸

State College, Pennsylvania, United States

CCOP - Main Line Health

🇺🇸

Wynnewood, Pennsylvania, United States

Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center

🇺🇸

Wilkes-Barre, Pennsylvania, United States

Gibbs Regional Cancer Center at Spartanburg Regional Medical Center

🇺🇸

Spartanburg, South Carolina, United States

Thompson Cancer Survival Center

🇺🇸

Knoxville, Tennessee, United States

University of Tennessee Cancer Institute - Memphis

🇺🇸

Memphis, Tennessee, United States

Nashville Oncology Associates, PC

🇺🇸

Nashville, Tennessee, United States

MBCCOP - Meharry Medical College - Nashville

🇺🇸

Nashville, Tennessee, United States

University of Texas Health Science Center at San Antonio

🇺🇸

San Antonio, Texas, United States

Val and Ann Browning Cancer Center at McKay-Dee Hospital Center

🇺🇸

Ogden, Utah, United States

Jon and Karen Huntsman Cancer Center at Intermountain Medical Center

🇺🇸

Murray, Utah, United States

Utah Cancer Specialists at UCS Cancer Center

🇺🇸

Salt Lake City, Utah, United States

Utah Valley Regional Medical Center - Provo

🇺🇸

Provo, Utah, United States

Fredericksburg Oncology, Incorporated

🇺🇸

Fredericksburg, Virginia, United States

Fletcher Allen Health Care - University Health Center Campus

🇺🇸

Burlington, Vermont, United States

Providence Centralia Hospital

🇺🇸

Centralia, Washington, United States

Marshfield Clinic - Lakeland Center

🇺🇸

Minocqua, Wisconsin, United States

Vince Lombardi Cancer Clinic - Oshkosh

🇺🇸

Oshkosh, Wisconsin, United States

Marshfield Clinic - Indianhead Center

🇺🇸

Rice Lake, Wisconsin, United States

Marshfield Clinic - Weston Center

🇺🇸

Weston, Wisconsin, United States

CHUM - Hopital Saint-Luc

🇨🇦

Montreal, Quebec, Canada

Kapiolani Medical Center at Pali Momi

🇺🇸

'Aiea, Hawaii, United States

Cancer Center of Kansas, PA - El Dorado

🇺🇸

El Dorado, Kansas, United States

Cancer Center of Kansas - Fort Scott

🇺🇸

Fort Scott, Kansas, United States

Cancer Center of Kansas, PA - Pratt

🇺🇸

Pratt, Kansas, United States

Cancer Center of Kansas, PA - Kingman

🇺🇸

Kingman, Kansas, United States

Cancer Center of Kansas, PA - Parsons

🇺🇸

Parsons, Kansas, United States

Shawnee Mission Medical Center

🇺🇸

Shawnee, Kansas, United States

Cancer Center of Kansas, PA - Wichita

🇺🇸

Wichita, Kansas, United States

CCOP - Wichita

🇺🇸

Wichita, Kansas, United States

Southwest Medical Center

🇺🇸

Liberal, Kansas, United States

Lawrence Memorial Hospital

🇺🇸

Lawrence, Kansas, United States

Cancer Center of Kansas, PA - Wellington

🇺🇸

Wellington, Kansas, United States

Via Christi Cancer Center at Via Christi Regional Medical Center

🇺🇸

Wichita, Kansas, United States

Cancer Center of Kansas, PA - Winfield

🇺🇸

Winfield, Kansas, United States

Menorah Medical Center

🇺🇸

Overland Park, Kansas, United States

Saint Luke's Hospital - South

🇺🇸

Overland Park, Kansas, United States

Cancer Center of Kansas, PA - Salina

🇺🇸

Salina, Kansas, United States

St. Anthony Central Hospital

🇺🇸

Denver, Colorado, United States

Presbyterian - St. Luke's Medical Center

🇺🇸

Denver, Colorado, United States

Josephine Ford Cancer Center at Henry Ford Hospital

🇺🇸

Detroit, Michigan, United States

Kaiser Permanente Health Care - Portland

🇺🇸

Portland, Oregon, United States

Valley Medical Oncology

🇺🇸

Fremont, California, United States

Alta Bates Summit Medical Center - Summit Campus

🇺🇸

Oakland, California, United States

Tom K Lee, Incorporated

🇺🇸

Oakland, California, United States

Kaiser Permanente Medical Center - Santa Clara Kiely Campus

🇺🇸

Santa Clara, California, United States

Kaiser Permanente Medical Center - Redwood City

🇺🇸

Redwood City, California, United States

Salinas Valley Memorial Hospital

🇺🇸

Salinas, California, United States

Doctors Medical Center - San Pablo Campus

🇺🇸

San Pablo, California, United States

Kaiser Permanente Medical Center - Walnut Creek

🇺🇸

Walnut Creek, California, United States

Kaiser Permanente Medical Center - Santa Rosa

🇺🇸

Santa Rosa, California, United States

Kaiser Permanente Medical Facility - Stockton

🇺🇸

Stockton, California, United States

Case Comprehensive Cancer Center

🇺🇸

Cleveland, Ohio, United States

Wood County Oncology Center

🇺🇸

Bowling Green, Ohio, United States

North Coast Cancer Care - Clyde

🇺🇸

Clyde, Ohio, United States

Grandview Hospital

🇺🇸

Dayton, Ohio, United States

David L. Rike Cancer Center at Miami Valley Hospital

🇺🇸

Dayton, Ohio, United States

Charles F. Kettering Memorial Hospital

🇺🇸

Kettering, Ohio, United States

Toledo Clinic - Oregon

🇺🇸

Oregon, Ohio, United States

Toledo Clinic, Incorporated - Main Clinic

🇺🇸

Toledo, Ohio, United States

Fisher-Titus Medical Center

🇺🇸

Norwalk, Ohio, United States

Mercy Hospital of Tiffin

🇺🇸

Tiffin, Ohio, United States

St. Charles Mercy Hospital

🇺🇸

Oregon, Ohio, United States

Fulton County Health Center

🇺🇸

Wauseon, Ohio, United States

St. Luke's Cancer Network at St. Luke's Hospital

🇺🇸

Bethlehem, Pennsylvania, United States

Allegheny Cancer Center at Allegheny General Hospital

🇺🇸

Pittsburgh, Pennsylvania, United States

Auburn Regional Center for Cancer Care

🇺🇸

Auburn, Washington, United States

Scripps Cancer Center - San Diego

🇺🇸

La Jolla, California, United States

Eden Medical Center

🇺🇸

Castro Valley, California, United States

Kaiser Permanente - Fremont

🇺🇸

Fremont, California, United States

East Bay Radiation Oncology Center

🇺🇸

Castro Valley, California, United States

Kaiser Permanente Medical Center - Hayward

🇺🇸

Hayward, California, United States

Cancer Care Associates

🇺🇸

Fresno, California, United States

Highland General Hospital

🇺🇸

Oakland, California, United States

Bay Area Breast Surgeons, Incorporated

🇺🇸

Oakland, California, United States

Loma Linda University Cancer Institute at Loma Linda University Medical Center

🇺🇸

Loma Linda, California, United States

CCOP - Bay Area Tumor Institute

🇺🇸

Oakland, California, United States

El Camino Hospital Cancer Center

🇺🇸

Mountain View, California, United States

Sibley Memorial Hospital

🇺🇸

Washington, D.C., District of Columbia, United States

Kaiser Permanente Medical Center - South San Francisco

🇺🇸

South San Francisco, California, United States

Kaiser Foundation Hospital - San Rafael

🇺🇸

San Rafael, California, United States

Center for Cancer Therapy at LaPorte Hospital and Health Services

🇺🇸

La Porte, Indiana, United States

Swedish Medical Center

🇺🇸

Englewood, Colorado, United States

Kaiser Permanente Medical Center - San Francisco Geary Campus

🇺🇸

San Francisco, California, United States

Porter Adventist Hospital

🇺🇸

Denver, Colorado, United States

Saint Anthony's Hospital at Saint Anthony's Health Center

🇺🇸

Alton, Illinois, United States

Kaiser Permanente - Denver

🇺🇸

Denver, Colorado, United States

St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center

🇺🇸

Grand Junction, Colorado, United States

Sky Ridge Medical Center

🇺🇸

Lone Tree, Colorado, United States

Penrose Cancer Center at Penrose Hospital

🇺🇸

Colorado Springs, Colorado, United States

Illinois CancerCare - Havana

🇺🇸

Havana, Illinois, United States

Proctor Hospital

🇺🇸

Peoria, Illinois, United States

Rose Medical Center

🇺🇸

Denver, Colorado, United States

St. Joseph Hospital

🇺🇸

Denver, Colorado, United States

Cancer Center of Kansas, PA - Chanute

🇺🇸

Chanute, Kansas, United States

CCOP - Colorado Cancer Research Program

🇺🇸

Denver, Colorado, United States

McKee Medical Center

🇺🇸

Loveland, Colorado, United States

North Suburban Medical Center

🇺🇸

Thornton, Colorado, United States

North Colorado Medical Center

🇺🇸

Greeley, Colorado, United States

Valley Care Medical Center

🇺🇸

Pleasanton, California, United States

Valley Medical Oncology Consultants - Pleasanton

🇺🇸

Pleasanton, California, United States

Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center

🇺🇸

Hartford, Connecticut, United States

Hurley Medical Center

🇺🇸

Flint, Michigan, United States

St. Francis Cancer Center at St. Francis Medical Center

🇺🇸

Shakopee, Minnesota, United States

Haematology-Oncology Associates of Ohio and Michigan, PC

🇺🇸

Lambertville, Michigan, United States

United Hospital

🇺🇸

Saint Paul, Minnesota, United States

Ridgeview Medical Center

🇺🇸

Waconia, Minnesota, United States

Ellis Fischel Cancer Center at University of Missouri - Columbia

🇺🇸

Columbia, Missouri, United States

Minnesota Oncology Hematology, PA - Woodbury

🇺🇸

Woodbury, Minnesota, United States

St. James Healthcare Cancer Care

🇺🇸

Butte, Montana, United States

Northern Rockies Radiation Oncology Center

🇺🇸

Billings, Montana, United States

Saint Louis University Cancer Center

🇺🇸

Saint Louis, Missouri, United States

St. John's Regional Medical Center

🇺🇸

Joplin, Missouri, United States

Heartland Regional Medical Center

🇺🇸

Saint Joseph, Missouri, United States

CCOP - Cancer Research for the Ozarks

🇺🇸

Springfield, Missouri, United States

St. John's Regional Health Center

🇺🇸

Springfield, Missouri, United States

David C. Pratt Cancer Center at St. John's Mercy

🇺🇸

Saint Louis, Missouri, United States

CCOP - Montana Cancer Consortium

🇺🇸

Billings, Montana, United States

Great Falls Clinic - Main Facility

🇺🇸

Great Falls, Montana, United States

Glacier Oncology, PLLC

🇺🇸

Kalispell, Montana, United States

St. Peter's Hospital

🇺🇸

Helena, Montana, United States

Big Sky Oncology

🇺🇸

Great Falls, Montana, United States

Billings Clinic - Downtown

🇺🇸

Billings, Montana, United States

Community Medical Center

🇺🇸

Missoula, Montana, United States

Sletten Cancer Institute at Benefis Healthcare

🇺🇸

Great Falls, Montana, United States

Summa Center for Cancer Care at Akron City Hospital

🇺🇸

Akron, Ohio, United States

Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center

🇺🇸

Columbus, Ohio, United States

Wake Forest University Comprehensive Cancer Center

🇺🇸

Winston-Salem, North Carolina, United States

Charles R. Wood Cancer Center at Glens Falls Hospital

🇺🇸

Glens Falls, New York, United States

Annie Penn Cancer Center

🇺🇸

Reidsville, North Carolina, United States

Rutherford Hospital

🇺🇸

Rutherfordton, North Carolina, United States

Barberton Citizens Hospital

🇺🇸

Barberton, Ohio, United States

Montana Cancer Specialists at Montana Cancer Center

🇺🇸

Missoula, Montana, United States

Cancer Resource Center - Lincoln

🇺🇸

Lincoln, Nebraska, United States

Aultman Cancer Center at Aultman Hospital

🇺🇸

Canton, Ohio, United States

Altru Cancer Center at Altru Hospital

🇺🇸

Grand Forks, North Dakota, United States

Northwest Ohio Oncology Center

🇺🇸

Maumee, Ohio, United States

CCOP - Dayton

🇺🇸

Dayton, Ohio, United States

Hematology Oncology Center

🇺🇸

Elyria, Ohio, United States

Moses Cone Regional Cancer Center at Wesley Long Community Hospital

🇺🇸

Greensboro, North Carolina, United States

Lima Memorial Hospital

🇺🇸

Lima, Ohio, United States

Cancer Institute of New Jersey at Cooper - Voorhees

🇺🇸

Voorhees, New Jersey, United States

Geisinger Medical Group - Scenery Park

🇺🇸

State College, Pennsylvania, United States

Penn State Cancer Institute at Milton S. Hershey Medical Center

🇺🇸

Hershey, Pennsylvania, United States

Medical University of Ohio Cancer Center

🇺🇸

Toledo, Ohio, United States

Middletown Regional Hospital

🇺🇸

Franklin, Ohio, United States

Cancer Center of Paoli Memorial Hospital

🇺🇸

Paoli, Pennsylvania, United States

Geisinger Cancer Institute at Geisinger Health

🇺🇸

Danville, Pennsylvania, United States

CHUM - Hotel Dieu Hospital

🇨🇦

Montreal, Quebec, Canada

Allenmore Hospital

🇺🇸

Tacoma, Washington, United States

Gundersen Lutheran Center for Cancer and Blood

🇺🇸

La Crosse, Wisconsin, United States

Providence St. Peter Hospital Regional Cancer Center

🇺🇸

Olympia, Washington, United States

Marshfield Clinic - Chippewa Center

🇺🇸

Chippewa Falls, Wisconsin, United States

Mary Babb Randolph Cancer Center at West Virginia University Hospitals

🇺🇸

Morgantown, West Virginia, United States

McDowell Cancer Center at Akron General Medical Center

🇺🇸

Akron, Ohio, United States

Good Samaritan Cancer Center

🇺🇸

Puyallup, Washington, United States

MultiCare Regional Cancer Center at Tacoma General Hospital

🇺🇸

Tacoma, Washington, United States

West Virginia University Health Sciences Center - Charleston

🇺🇸

Charleston, West Virginia, United States

Medical X-Ray Center, PC

🇺🇸

Sioux Falls, South Dakota, United States

Doctor's Hospital of Laredo

🇺🇸

Laredo, Texas, United States

Aurora Women's Pavilion of West Allis Memorial Hospital

🇺🇸

West Allis, Wisconsin, United States

Welch Cancer Center at Sheridan Memorial Hospital

🇺🇸

Sheridan, Wyoming, United States

Hopital Notre-Dame du CHUM

🇨🇦

Montreal, Quebec, Canada

Hopital du Saint-Sacrement - Quebec

🇨🇦

Quebec City, Quebec, Canada

Royal Victoria Hospital - Montreal

🇨🇦

Montreal, Quebec, Canada

Montreal General Hospital

🇨🇦

Montreal, Quebec, Canada

Lankenau Cancer Center at Lankenau Hospital

🇺🇸

Wynnewood, Pennsylvania, United States

CCOP - Upstate Carolina

🇺🇸

Spartanburg, South Carolina, United States

Blanchard Valley Medical Associates

🇺🇸

Findlay, Ohio, United States

McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center

🇺🇸

Reading, Pennsylvania, United States

Wayne Hospital

🇺🇸

Greenville, Ohio, United States

York Cancer Center at Apple Hill Medical Center

🇺🇸

York, Pennsylvania, United States

AnMed Cancer Center

🇺🇸

Anderson, South Carolina, United States

CCOP - Northwest

🇺🇸

Tacoma, Washington, United States

Marshfield Clinic Cancer Care at Regional Cancer Center

🇺🇸

Eau Claire, Wisconsin, United States

American Fork Hospital

🇺🇸

American Fork, Utah, United States

Samaritan North Cancer Care Center

🇺🇸

Dayton, Ohio, United States

CCOP - Greenville

🇺🇸

Greenville, South Carolina, United States

St. Vincent Mercy Medical Center

🇺🇸

Toledo, Ohio, United States

Sanford Cancer Center at Sanford USD Medical Center

🇺🇸

Sioux Falls, South Dakota, United States

Saint Joseph's Hospital

🇺🇸

Marshfield, Wisconsin, United States

Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center

🇺🇸

Green Bay, Wisconsin, United States

Marshfield Clinic - Marshfield Center

🇺🇸

Marshfield, Wisconsin, United States

CCOP - Toledo Community Hospital

🇺🇸

Toledo, Ohio, United States

Ruth G. McMillan Cancer Center at Greene Memorial Hospital

🇺🇸

Xenia, Ohio, United States

Clinton Memorial Hospital

🇺🇸

Wilmington, Ohio, United States

Cancer Treatment Center

🇺🇸

Wooster, Ohio, United States

Cleo Craig Cancer Research Clinic

🇺🇸

Lawton, Oklahoma, United States

Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest

🇺🇸

Allentown, Pennsylvania, United States

Dixie Regional Medical Center - East Campus

🇺🇸

Saint George, Utah, United States

Franciscan Cancer Center at St. Joseph Medical Center

🇺🇸

Tacoma, Washington, United States

Marshfield Clinic - Wausau Center

🇺🇸

Wausau, Wisconsin, United States

Park Nicollet Cancer Center

🇺🇸

Saint Louis Park, Minnesota, United States

UVMC Cancer Care Center at Upper Valley Medical Center

🇺🇸

Troy, Ohio, United States

Contra Costa Regional Medical Center

🇺🇸

Martinez, California, United States

Saint Luke's East - Lee's Summit

🇺🇸

Lee's Summit, Missouri, United States

Sandra L. Maxwell Cancer Center

🇺🇸

Cedar City, Utah, United States

CCOP - Michigan Cancer Research Consortium

🇺🇸

Ann Arbor, Michigan, United States

South Sacramento Kaiser-Permanente Medical Center

🇺🇸

Sacramento, California, United States

Kaiser Permanente Medical Center - Sacramento

🇺🇸

Sacramento, California, United States

Aurora Presbyterian Hospital

🇺🇸

Aurora, Colorado, United States

Forsyth Regional Cancer Center at Forsyth Medical Center

🇺🇸

Winston-Salem, North Carolina, United States

Bozeman Deaconess Cancer Center

🇺🇸

Bozeman, Montana, United States

Saint Joseph Mercy Cancer Center

🇺🇸

Ann Arbor, Michigan, United States

CCOP - Missouri Valley Cancer Consortium

🇺🇸

Omaha, Nebraska, United States

Immanuel Medical Center

🇺🇸

Omaha, Nebraska, United States

Alegant Health Cancer Center at Bergan Mercy Medical Center

🇺🇸

Omaha, Nebraska, United States

Creighton University Medical Center

🇺🇸

Omaha, Nebraska, United States

Aurora Sinai Medical Center

🇺🇸

Milwaukee, Wisconsin, United States

Medical College of Wisconsin Cancer Center

🇺🇸

Milwaukee, Wisconsin, United States

Larry G Strieff MD Medical Corporation

🇺🇸

Oakland, California, United States

North Coast Cancer Care, Incorporated

🇺🇸

Sandusky, Ohio, United States

Ministry Medical Group at Saint Mary's Hospital

🇺🇸

Rhinelander, Wisconsin, United States

Herbert D. Kerman Regional Oncology Center - Daytona Beach

🇺🇸

Daytona Beach, Florida, United States

Boulder Community Hospital

🇺🇸

Boulder, Colorado, United States

Desert Regional Medical Center Comprehensive Cancer Center

🇺🇸

Palm Springs, California, United States

Toledo Hospital

🇺🇸

Toledo, Ohio, United States

St. Anne Mercy Hospital

🇺🇸

Toledo, Ohio, United States

Cancer Research Center of Hawaii

🇺🇸

Honolulu, Hawaii, United States

Marshfield Clinic at Saint Michael's Hospital

🇺🇸

Stevens Point, Wisconsin, United States

Marshfield Clinic - Wisconsin Rapids Center

🇺🇸

Wisconsin Rapids, Wisconsin, United States

Hulston Cancer Center at Cox Medical Center South

🇺🇸

Springfield, Missouri, United States

St. Clare Hospital

🇺🇸

Tacoma, Washington, United States

CCOP - St. Louis-Cape Girardeau

🇺🇸

Saint Louis, Missouri, United States

UPMC Cancer Centers

🇺🇸

Pittsburgh, Pennsylvania, United States

Good Samaritan Hospital

🇺🇸

Dayton, Ohio, United States

Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School

🇺🇸

New Brunswick, New Jersey, United States

Florida Hospital Cancer Institute at Florida Hospital Orlando

🇺🇸

Orlando, Florida, United States

M.D. Anderson Cancer Center at Orlando

🇺🇸

Orlando, Florida, United States

St. Joseph Medical Center

🇺🇸

Kansas City, Missouri, United States

North Kansas City Hospital

🇺🇸

Kansas City, Missouri, United States

Parvin Radiation Oncology

🇺🇸

Kansas City, Missouri, United States

Heartland Hematology Oncology Associates, Incorporated

🇺🇸

Kansas City, Missouri, United States

Roper St. Francis Cancer Center at Roper Hospital

🇺🇸

Charleston, South Carolina, United States

Louisville Oncology at Norton Cancer Institute - Louisville

🇺🇸

Louisville, Kentucky, United States

James Graham Brown Cancer Center at University of Louisville

🇺🇸

Louisville, Kentucky, United States

Saint Luke's Cancer Institute at Saint Luke's Hospital

🇺🇸

Kansas City, Missouri, United States

Research Medical Center

🇺🇸

Kansas City, Missouri, United States

Truman Medical Center - Hospital Hill

🇺🇸

Kansas City, Missouri, United States

CCOP - Kansas City

🇺🇸

Kansas City, Missouri, United States

Hollings Cancer Center at Medical University of South Carolina

🇺🇸

Charleston, South Carolina, United States

CCOP - Christiana Care Health Services

🇺🇸

Newark, Delaware, United States

Eastern Connecticut Hematology and Oncology Associates

🇺🇸

Norwich, Connecticut, United States

York Hospital's Oncology Treatment Center

🇺🇸

York, Maine, United States

Mary Bird Perkins Cancer Center - Baton Rouge

🇺🇸

Baton Rouge, Louisiana, United States

Ochsner Health Center - Bluebonnet

🇺🇸

Baton Rouge, Louisiana, United States

Greenebaum Cancer Center at University of Maryland Medical Center

🇺🇸

Baltimore, Maryland, United States

St. Agnes Hospital Cancer Center

🇺🇸

Baltimore, Maryland, United States

Harry & Jeanette Weinberg Cancer Institute at Franklin Square Hospital Center

🇺🇸

Baltimore, Maryland, United States

St. Vincent Healthcare Cancer Care Services

🇺🇸

Billings, Montana, United States

Guardian Oncology and Center for Wellness

🇺🇸

Missoula, Montana, United States

Mountainview Medical

🇺🇸

Berlin Corners, Vermont, United States

San Juan City Hospital

🇵🇷

San Juan, Puerto Rico

Community Comprehensive Cancer Center at Camden-Clark Memorial Hospital

🇺🇸

Parkersburg, West Virginia, United States

Jewish General Hospital - Montreal

🇨🇦

Montreal, Quebec, Canada

St. Mary's Hospital Center

🇨🇦

Montreal, Quebec, Canada

MBCCOP - LSU Health Sciences Center

🇺🇸

New Orleans, Louisiana, United States

Medical Center of Louisiana - New Orleans

🇺🇸

New Orleans, Louisiana, United States

CCOP - Ochsner

🇺🇸

New Orleans, Louisiana, United States

Ochsner Cancer Institute at Ochsner Clinic Foundation

🇺🇸

New Orleans, Louisiana, United States

Virginia Commonwealth University Massey Cancer Center

🇺🇸

Richmond, Virginia, United States

OnCare Hawaii, Incorporated - Lusitana

🇺🇸

Honolulu, Hawaii, United States

Queen's Cancer Institute at Queen's Medical Center

🇺🇸

Honolulu, Hawaii, United States

Straub Clinic and Hospital, Incorporated

🇺🇸

Honolulu, Hawaii, United States

Hawaii Medical Center - East

🇺🇸

Honolulu, Hawaii, United States

OnCare Hawaii, Incorporated - Kuakini

🇺🇸

Honolulu, Hawaii, United States

Kaiser Permanente - Moanalua Medical Center and Clinic

🇺🇸

Honolulu, Hawaii, United States

Kapiolani Medical Center for Women and Children

🇺🇸

Honolulu, Hawaii, United States

Lucille P. Markey Cancer Center at University of Kentucky

🇺🇸

Lexington, Kentucky, United States

Oncology Hematology Associates of Central Illinois, PC - Peoria

🇺🇸

Peoria, Illinois, United States

Methodist Medical Center of Illinois

🇺🇸

Peoria, Illinois, United States

CCOP - Mount Sinai Medical Center

🇺🇸

Miami Beach, Florida, United States

Marion L. Shepard Cancer Center at Beaufort County Hospital

🇺🇸

Washington, North Carolina, United States

Peninsula Regional Medical Center

🇺🇸

Salisbury, Maryland, United States

Batte Cancer Center at Northeast Medical Center

🇺🇸

Concord, North Carolina, United States

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