Docetaxel, Oxaliplatin, Capecitabine, Fluorouracil, and Radiation Therapy in Treating Patients With Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction

Phase 2

Completed

Conditions: Adenocarcinoma of the Gastroesophageal Junction
Esophageal Cancer
Gastric Cancer

Interventions: Drug: fluorouracil
Drug: capecitabine
Drug: docetaxel
Drug: oxaliplatin
Radiation: radiation therapy
Procedure: therapeutic conventional surgery

Registration Number: NCT00938470

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: This randomized phase II trial studies how well docetaxel, oxaliplatin, capecitabine, fluorouracil, and radiation therapy works compared with fluorouracil when given together with oxaliplatin and radiation therapy in treating patients with cancer of the esophagus or gastroesophageal junction that has spread from where it started to nearby tissue or lymph nodes. Drugs used in chemotherapy, such as docetaxel, oxaliplatin, capecitabine, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving more than one drug (combination chemotherapy) together with radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.

Detailed Description: PRIMARY OBJECTIVES:

I. To assess and compare the pathologic complete response (PCR) rate of patients in Arm A receiving the sequence docetaxel, oxaliplatin, and capecitabine (DOC) followed by 5-fluorouracil (5-FU), oxaliplatin, and radiation therapy (RT) with patients in Arm B receiving only 5-FU, oxaliplatin and RT in patients with potentially resectable adenocarcinoma (ACA) of the esophagus, gastroesophageal junction (GEJ), or gastric cardia.

SECONDARY OBJECTIVES:

I. To assess the adverse event (AE) profile and safety of the proposed treatment in this population.

II. To assess and compare the overall survival (OS) between treatment arms. III. To assess and compare the disease-free survival between treatment arms. IV. To assess and compare the clinical tumor response rate of the proposed regiments when administered before surgery between treatment arms.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive docetaxel intravenously (IV) over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive capecitabine orally (PO) twice daily (BID) on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil\* IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy\*\* 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.

ARM II: Patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy and then surgery as in Arm I.

* NOTE: \* Fluorouracil continuous IV infusion begins within 24 hours of radiotherapy and ends within 24 hours of radiotherapy completion.

* NOTE: \*\* Radiotherapy should begin within 2-6 weeks after completion of 2 courses of docetaxel, oxaliplatin, and capecitabine.

After completion of study treatment, patients are followed up every 3 months for 2 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 73

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (combination chemotherapy, radiation therapy, surgery)	radiation therapy	Patients receive docetaxel IV over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive capecitabine PO BID on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
Arm I (combination chemotherapy, radiation therapy, surgery)	therapeutic conventional surgery	Patients receive docetaxel IV over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive capecitabine PO BID on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
Arm II (oxaliplatin, fluorouracil, radiation, and surgery)	fluorouracil	Patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy and then surgery as in Arm I.
Arm II (oxaliplatin, fluorouracil, radiation, and surgery)	radiation therapy	Patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy and then surgery as in Arm I.
Arm II (oxaliplatin, fluorouracil, radiation, and surgery)	therapeutic conventional surgery	Patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy and then surgery as in Arm I.
Arm I (combination chemotherapy, radiation therapy, surgery)	capecitabine	Patients receive docetaxel IV over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive capecitabine PO BID on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
Arm I (combination chemotherapy, radiation therapy, surgery)	docetaxel	Patients receive docetaxel IV over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive capecitabine PO BID on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
Arm I (combination chemotherapy, radiation therapy, surgery)	fluorouracil	Patients receive docetaxel IV over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive capecitabine PO BID on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
Arm I (combination chemotherapy, radiation therapy, surgery)	oxaliplatin	Patients receive docetaxel IV over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive capecitabine PO BID on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
Arm II (oxaliplatin, fluorouracil, radiation, and surgery)	oxaliplatin	Patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy and then surgery as in Arm I.

Primary Outcome Measures

Name	Time	Method
Percentage of Participants With Pathologic Complete Response (PCR)	Up to 2 years	Pathologic complete response was defined as no gross or microscopic tumor identified with the surgical specimen. All lymph nodes should be free of tumor to document a PCR. If no gross tumor is visible, section around the area of inflammation (nodularity) should be made every 2-3 cm and specimens examined.

Secondary Outcome Measures

Name	Time	Method
Overall Survival	Up to 2 years	Overall survival was defined as the time from randomization to the time of death from any cause. Overall survival was censored at the date of last follow-up visit for patients who are still alive or loss of follow-up.
Disease-free Survival	Up to 2 years	Disease-free survival was defined as the time from randomization to the date of recurrent or death, whichever comes first.
Number of Participants Who Experienced a Maximum Grade of 3 or Above Adverse Event	Up to 2 years	Adverse events were assessed using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
Percentage of Participants With Overall Clinical Tumor Response (CR or PR)	Up to 2 years	Overall clinical tumor response rate was defined as the percentage of evaluable participants who achieved either complete response (CR) or partial response (PR) noted on the objective status from pre-surgical staging (for arm II) or either from pre-RT or pre-surgical staging (for arm I).\> CR was defined as disappearance of all non-target lesion (TL) and normalization of tumor biomarker level, all lymph nodes (LN) must be non-pathological in size (\<1 cm short axis); or disappearance of all TL and normalization of tumor biomarkers, any pathological LN (whether target or non-target) must have reduction in short axis to \<1 cm; or \>=30% decrease in the sum of the diameters of TL taking as reference the baseline sum of the diameters.

Trial Locations

Locations (185): Graham Hospital
🇺🇸
Canton, Illinois, United States
Illinois CancerCare - Galesburg
🇺🇸
Galesburg, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Illinois CancerCare - Macomb
🇺🇸
Macomb, Illinois, United States
Humphrey Cancer Center at North Memorial Outpatient Center
🇺🇸
Robbinsdale, Minnesota, United States
Minnesota Oncology - Woodbury
🇺🇸
Woodbury, Minnesota, United States
St. James Healthcare Cancer Care
🇺🇸
Butte, Montana, United States
Great Falls Clinic - Main Facility
🇺🇸
Great Falls, Montana, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Licking Memorial Cancer Care Program at Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Charles F. Kettering Memorial Hospital
🇺🇸
Kettering, Ohio, United States
Geisinger Cancer Institute at Geisinger Health
🇺🇸
Danville, Pennsylvania, United States
AnMed Cancer Center
🇺🇸
Anderson, South Carolina, United States
Grant Medical Center Cancer Care
🇺🇸
Columbus, Ohio, United States
Riverside Methodist Hospital Cancer Care
🇺🇸
Columbus, Ohio, United States
CCOP - Columbus
🇺🇸
Columbus, Ohio, United States
Doctors Hospital at Ohio Health
🇺🇸
Columbus, Ohio, United States
Mayo Clinic Scottsdale
🇺🇸
Scottsdale, Arizona, United States
Front Range Cancer Specialists
🇺🇸
Fort Collins, Colorado, United States
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center
🇺🇸
Boise, Idaho, United States
Illinois CancerCare - Bloomington
🇺🇸
Bloomington, Illinois, United States
St. Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Eureka Community Hospital
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare - Eureka
🇺🇸
Eureka, Illinois, United States
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center
🇺🇸
Hartford, Connecticut, United States
Illinois CancerCare - Canton
🇺🇸
Canton, Illinois, United States
Illinois CancerCare - Carthage
🇺🇸
Carthage, Illinois, United States
Mayo Clinic - Jacksonville
🇺🇸
Jacksonville, Florida, United States
Community Hospital of Ottawa
🇺🇸
Ottawa, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
Reid Hospital & Health Care Services
🇺🇸
Richmond, Indiana, United States
Mercy Cancer Center - West Lakes
🇺🇸
Clive, Iowa, United States
Cancer Center of Kansas, PA - Newton
🇺🇸
Newton, Kansas, United States
St. Francis Hospital and Health Centers - Beech Grove Campus
🇺🇸
Beech Grove, Indiana, United States
Cancer Center of Kansas, PA - Dodge City
🇺🇸
Dodge City, Kansas, United States
Green Bay Oncology, Limited - Escanaba
🇺🇸
Escanaba, Michigan, United States
Foote Memorial Hospital
🇺🇸
Jackson, Michigan, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
CCOP - Duluth
🇺🇸
Duluth, Minnesota, United States
CCOP - Grand Rapids
🇺🇸
Grand Rapids, Michigan, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Seton Cancer Institute at Saint Mary's - Saginaw
🇺🇸
Saginaw, Michigan, United States
Mercy Regional Cancer Center at Mercy Hospital
🇺🇸
Port Huron, Michigan, United States
Miller - Dwan Medical Center
🇺🇸
Duluth, Minnesota, United States
Sletten Cancer Institute at Benefis Healthcare
🇺🇸
Great Falls, Montana, United States
Willmar Cancer Center at Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Midelfort Clinic - Luther
🇺🇸
Eau Claire, Wisconsin, United States
Duluth Clinic Cancer Center - Duluth
🇺🇸
Duluth, Minnesota, United States
Bon Secours St. Francis Health System
🇺🇸
Greenville, South Carolina, United States
St. John's Regional Health Center
🇺🇸
Springfield, Missouri, United States
CCOP - Montana Cancer Consortium
🇺🇸
Billings, Montana, United States
Hulston Cancer Center at Cox Medical Center South
🇺🇸
Springfield, Missouri, United States
Green Bay Oncology, Limited at St. Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
Minnesota Oncology - Maplewood
🇺🇸
Maplewood, Minnesota, United States
Billings Clinic - Downtown
🇺🇸
Billings, Montana, United States
Park Nicollet Cancer Center
🇺🇸
Saint Louis Park, Minnesota, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Hematology-Oncology Centers of the Northern Rockies - Billings
🇺🇸
Billings, Montana, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Green Bay Oncology, Limited - Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
St. Nicholas Hospital
🇺🇸
Sheboygan, Wisconsin, United States
Green Bay Oncology, Limited - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
Welch Cancer Center at Sheridan Memorial Hospital
🇺🇸
Sheridan, Wyoming, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center - Minneapolis
🇺🇸
Minneapolis, Minnesota, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
Kalispell Medical Oncology at KRMC
🇺🇸
Kalispell, Montana, United States
St. Peter's Hospital
🇺🇸
Helena, Montana, United States
Glacier Oncology, PLLC
🇺🇸
Kalispell, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Montana Cancer Specialists at Montana Cancer Center
🇺🇸
Missoula, Montana, United States
Via Christi Cancer Center at Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas, PA - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas, PA - Winfield
🇺🇸
Winfield, Kansas, United States
HealthEast Cancer Care at St. John's Hospital
🇺🇸
Maplewood, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
CCOP - Metro-Minnesota
🇺🇸
Saint Louis Park, Minnesota, United States
Van Elslander Cancer Center at St. John Hospital and Medical Center
🇺🇸
Grosse Pointe Woods, Michigan, United States
St. Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Sparrow Regional Cancer Center
🇺🇸
Lansing, Michigan, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Door County Cancer Center at Door County Memorial Hospital
🇺🇸
Sturgeon Bay, Wisconsin, United States
Poudre Valley Hospital
🇺🇸
Fort Collins, Colorado, United States
Galesburg Clinic, PC
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare - Havana
🇺🇸
Havana, Illinois, United States
McDonough District Hospital
🇺🇸
Macomb, Illinois, United States
Illinois CancerCare - Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus
🇺🇸
Moline, Illinois, United States
Illinois CancerCare - Community Cancer Center
🇺🇸
Normal, Illinois, United States
OSF St. Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare - Peru
🇺🇸
Peru, Illinois, United States
Community Cancer Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare - Monmouth
🇺🇸
Monmouth, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Peoria
🇺🇸
Peoria, Illinois, United States
BroMenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Cancer Treatment Center at Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Ottawa
🇺🇸
Ottawa, Illinois, United States
OSF Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
CCOP - Illinois Oncology Research Association
🇺🇸
Peoria, Illinois, United States
Medical Oncology and Hematology Associates - West Des Moines
🇺🇸
Clive, Iowa, United States
Illinois CancerCare - Princeton
🇺🇸
Princeton, Illinois, United States
Illinois Valley Community Hospital
🇺🇸
Peru, Illinois, United States
St. Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Siouxland Hematology-Oncology Associates, LLP
🇺🇸
Sioux City, Iowa, United States
Mercy Medical Center - Sioux City
🇺🇸
Sioux City, Iowa, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas, PA - Liberal
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas, PA - Pratt
🇺🇸
Pratt, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas, PA - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas, PA - Wellington
🇺🇸
Wellington, Kansas, United States
Cancer Center of Kansas, PA - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas, PA - Kingman
🇺🇸
Kingman, Kansas, United States
Associates in Womens Health, PA - North Review
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
CCOP - Wichita
🇺🇸
Wichita, Kansas, United States
Wesley Medical Center
🇺🇸
Wichita, Kansas, United States
Oakwood Cancer Center at Oakwood Hospital and Medical Center
🇺🇸
Dearborn, Michigan, United States
Battle Creek Health System Cancer Care Center
🇺🇸
Battle Creek, Michigan, United States
Lacks Cancer Center at Saint Mary's Health Care
🇺🇸
Grand Rapids, Michigan, United States
Butterworth Hospital at Spectrum Health
🇺🇸
Grand Rapids, Michigan, United States
Dickinson County Healthcare System
🇺🇸
Iron Mountain, Michigan, United States
St. Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Mercy General Health Partners
🇺🇸
Muskegon, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸
Reed City, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
St. John Macomb Hospital
🇺🇸
Warren, Michigan, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸
Fridley, Minnesota, United States
St. Francis Cancer Center at St. Francis Medical Center
🇺🇸
Shakopee, Minnesota, United States
Regions Hospital Cancer Care Center
🇺🇸
Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Central Care Cancer Center at Carrie J. Babb Cancer Center
🇺🇸
Bolivar, Missouri, United States
CCOP - Cancer Research for the Ozarks
🇺🇸
Springfield, Missouri, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
🇺🇸
Missoula, Montana, United States
Rutherford Hospital
🇺🇸
Rutherfordton, North Carolina, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Dakota Cancer Institute at Dakota Clinic - South University
🇺🇸
Fargo, North Dakota, United States
Altru Cancer Center at Altru Hospital
🇺🇸
Grand Forks, North Dakota, United States
Mount Carmel Health - West Hospital
🇺🇸
Columbus, Ohio, United States
David L. Rike Cancer Center at Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Good Samaritan Hospital
🇺🇸
Dayton, Ohio, United States
CCOP - Dayton
🇺🇸
Dayton, Ohio, United States
Samaritan North Cancer Care Center
🇺🇸
Dayton, Ohio, United States
Blanchard Valley Medical Associates
🇺🇸
Findlay, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Strecker Cancer Center at Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Community Hospital of Springfield and Clark County
🇺🇸
Springfield, Ohio, United States
Mount Carmel St. Ann's Cancer Center
🇺🇸
Westerville, Ohio, United States
UVMC Cancer Care Center at Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Genesis - Good Samaritan Hospital
🇺🇸
Zanesville, Ohio, United States
Ruth G. McMillan Cancer Center at Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Geisinger Hazleton Cancer Center
🇺🇸
Hazleton, Pennsylvania, United States
Geisinger Medical Group - Scenery Park
🇺🇸
State College, Pennsylvania, United States
CCOP - Upstate Carolina
🇺🇸
Spartanburg, South Carolina, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, United States
Luther Midlelfort Hospital
🇺🇸
Eau Claire, Wisconsin, United States
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
St. Mary's Hospital Medical Center - Green Bay
🇺🇸
Green Bay, Wisconsin, United States
Holy Family Memorial Medical Center Cancer Care Center
🇺🇸
Manitowoc, Wisconsin, United States
Saint Joseph Mercy Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
CCOP - Michigan Cancer Research Consortium
🇺🇸
Ann Arbor, Michigan, United States
Mayo Clinic Cancer Center
🇺🇸
Rochester, Minnesota, United States
CCOP - Iowa Oncology Research Association
🇺🇸
Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates at John Stoddard Cancer Center
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates at Mercy Cancer Center
🇺🇸
Des Moines, Iowa, United States
Mercy Cancer Center at Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States