MedPath

Carboplatin, Paclitaxel, and Radiation Therapy With or Without Thalidomide in Patients With Stage III Non-small Cell Lung Cancer

Phase 3
Terminated
Conditions
Lung Cancer
Interventions
Registration Number
NCT00004859
Lead Sponsor
National Cancer Institute (NCI)
Brief Summary

This randomized phase III trial is studying carboplatin, paclitaxel, radiation therapy, and thalidomide to see how well they work compared to carboplatin, paclitaxel, and radiation therapy alone in treating patients with newly diagnosed stage III non-small cell lung cancer. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Thalidomide may stop the growth of non-small cell lung cancer by stopping blood flow to the tumor. It is not yet known if combination chemotherapy plus radiation therapy is more effective with or without thalidomide.

Detailed Description

OBJECTIVES:

I. Compare the survival and time to progression of patients with stage IIIA or IIIB non-small cell lung cancer when treated with carboplatin, paclitaxel, and chemoradiotherapy with or without thalidomide.

II. Evaluate the toxicity of the thalidomide-containing regimen and compare response rates of the two groups.

III. Determine whether the inactivation of p16, Death-associated protein kinase (DAP-kinase), O6-methylguanine-DNA methyltransferase (MGMT) gene, or tissue-inhibitor of metalloproteinase 3 (TIMP-3) genes can be used to predict survival in these patients treated with this regimen.

IV. Determine whether the detection of a methylation biomarker in serum can be used to predict survival in these patients treated with this regimen.

OUTLINE: This is a randomized study. Patients are stratified according to disease histology (squamous vs nonsquamous), performance status (0 vs 1), disease stage (IIIA vs IIIB), and time of randomization (before addition of chemoradiotherapy vs after). Patients are randomized to one of two treatment arms.

ARM A: Patients receive paclitaxel intravenously (IV) over 3 hours immediately followed by carboplatin IV over 15-30 minutes on days 1 and 22. Treatment continues every 22 days in the absence of unacceptable toxicity or disease progression.

ARM B: Patients receive paclitaxel and carboplatin as in arm A. Patients also receive oral thalidomide and oral low-dose aspirin daily beginning on day 1 for up to 24 months in the absence of disease progression.

Beginning between days 43-50, patients in both arms with stable or responding disease receive chemoradiotherapy comprising paclitaxel IV over 1 hour and carboplatin IV over 15-30 minutes once weekly for 6 weeks and radiotherapy (RT) 5 days a week for 6 weeks. Arm B patients continue oral thalidomide.

Patients are followed every 2 months for 2 years and then every 6 months for 3 years.

Recruitment & Eligibility

Status
TERMINATED
Sex
All
Target Recruitment
589
Inclusion Criteria
  • Histologically confirmed newly diagnosed non-small cell bronchogenic carcinoma

    • Squamous cell
    • Adenocarcinoma
    • Large cell undifferentiated
    • Bronchoalveolar
    • Non-small cell carcinoma not otherwise stated
  • Unresectable stage IIIA

    • Mediastinal lymph node enlargement of at least 1 cm but less than 2 cm on computed tomography (CT) scans must have mediastinotomy or thoracoscopy to rule out resectability

OR

  • Stage IIIB disease without significant pleural effusion

    • Seen on CT scan only (not seen on chest x-ray) or does not reaccumulate after 1 thoracentesis and is cytologically negative
    • Metastases to contralateral, mediastinal, or supraclavicular nodes allowed
  • Bidimensionally measurable or evaluable disease

  • 18 and over

  • ECOG performance status 0-1

  • Adequate hematopoietic, hepatic, and renal function obtained <=4 weeks prior to registration:

    • Platelet count at least 100,000/mm^3
    • White Blood Cell (WBC) count at least 4,000/mm^3 OR absolute neutrophil count at least 2,000/mm^3
    • Bilirubin normal
    • Serum glutamic oxaloacetic transaminase (SGOT) no greater than 2.5 times upper limit of normal
    • Creatinine no greater than 1.5 mg/dL OR creatinine clearance at least 60 mL/min
  • Fertile patients must use 2 methods of effective contraception for 4 weeks prior to, during, and for 4 weeks after study therapy

  • Concurrent filgrastim (G-CSF) allowed for persistent neutropenia

Read More
Exclusion Criteria
  • Positive pregnancy test,pregnant or nursing
  • Uncontrolled high blood pressure, unstable angina, congestive heart failure, or myocardial infarction within the prior year
  • Serious cardiac arrhythmias requiring medication
  • Prior radiotherapy to only area of measurable or active tumor
  • Less than 5 years since prior chemotherapy
  • Other active malignancies
  • Serious uncontrolled active infection
  • Evidence of greater than grade 1 neuropathy by history or physical examination
  • History of seizure disorders
  • Contraindication to daily low-dose (81 mg/day) aspirin
Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Arm A (Paclitaxel + Carboplatin + RT)radiation therapyInduction chemotherapy dosing: Paclitaxel, 225 mg/m² (3 hour infusion) Day 1. Carboplatin, area under the plasma drug concentration versus time curve (AUC) =6.0, 15-30 min IV infusion immediately following paclitaxel, Day 1 Concurrent chemotherapy / radiotherapy dosing: Paclitaxel, 45 mg/m2, administered weekly during radiotherapy over one hour. Carboplatin, AUC=2, 15- 30 minutes IV infusion immediately following paclitaxel; administered weekly during radiotherapy Radiation therapy started between days 43-50 from day 1 of cycle 1. The primary tumor and areas of known nodal disease received 60 Gy at 2.0 Gy fractions, 5 fractions/week for 30 fractions over 6 weeks to the post chemotherapy tumor volume as seen on computed tomography (CT). The initial 50 Gy was delivered to target volume (TV). The final 10 Gy was delivered to a reduced volume targeting defined by TV
Arm B (Paclitaxel + Carboplatin + RT+ Thalidomide)radiation therapypaclitaxel, carboplatin, and radiotherapy are same as those in Arm A. thalidomide: Induction chemotherapy dosing, oral daily, starting Day 1 for 24 months or until disease progression. Concurrent chemotherapy / radiotherapy dosing, oral daily, begin with 200 mg thalidomide as a single dose at bedtime. The dose is then increased by 100 mg every week as tolerated up to a total dose of 1000 mg.
Arm A (Paclitaxel + Carboplatin + RT)carboplatinInduction chemotherapy dosing: Paclitaxel, 225 mg/m² (3 hour infusion) Day 1. Carboplatin, area under the plasma drug concentration versus time curve (AUC) =6.0, 15-30 min IV infusion immediately following paclitaxel, Day 1 Concurrent chemotherapy / radiotherapy dosing: Paclitaxel, 45 mg/m2, administered weekly during radiotherapy over one hour. Carboplatin, AUC=2, 15- 30 minutes IV infusion immediately following paclitaxel; administered weekly during radiotherapy Radiation therapy started between days 43-50 from day 1 of cycle 1. The primary tumor and areas of known nodal disease received 60 Gy at 2.0 Gy fractions, 5 fractions/week for 30 fractions over 6 weeks to the post chemotherapy tumor volume as seen on computed tomography (CT). The initial 50 Gy was delivered to target volume (TV). The final 10 Gy was delivered to a reduced volume targeting defined by TV
Arm A (Paclitaxel + Carboplatin + RT)paclitaxelInduction chemotherapy dosing: Paclitaxel, 225 mg/m² (3 hour infusion) Day 1. Carboplatin, area under the plasma drug concentration versus time curve (AUC) =6.0, 15-30 min IV infusion immediately following paclitaxel, Day 1 Concurrent chemotherapy / radiotherapy dosing: Paclitaxel, 45 mg/m2, administered weekly during radiotherapy over one hour. Carboplatin, AUC=2, 15- 30 minutes IV infusion immediately following paclitaxel; administered weekly during radiotherapy Radiation therapy started between days 43-50 from day 1 of cycle 1. The primary tumor and areas of known nodal disease received 60 Gy at 2.0 Gy fractions, 5 fractions/week for 30 fractions over 6 weeks to the post chemotherapy tumor volume as seen on computed tomography (CT). The initial 50 Gy was delivered to target volume (TV). The final 10 Gy was delivered to a reduced volume targeting defined by TV
Arm B (Paclitaxel + Carboplatin + RT+ Thalidomide)carboplatinpaclitaxel, carboplatin, and radiotherapy are same as those in Arm A. thalidomide: Induction chemotherapy dosing, oral daily, starting Day 1 for 24 months or until disease progression. Concurrent chemotherapy / radiotherapy dosing, oral daily, begin with 200 mg thalidomide as a single dose at bedtime. The dose is then increased by 100 mg every week as tolerated up to a total dose of 1000 mg.
Arm B (Paclitaxel + Carboplatin + RT+ Thalidomide)paclitaxelpaclitaxel, carboplatin, and radiotherapy are same as those in Arm A. thalidomide: Induction chemotherapy dosing, oral daily, starting Day 1 for 24 months or until disease progression. Concurrent chemotherapy / radiotherapy dosing, oral daily, begin with 200 mg thalidomide as a single dose at bedtime. The dose is then increased by 100 mg every week as tolerated up to a total dose of 1000 mg.
Arm B (Paclitaxel + Carboplatin + RT+ Thalidomide)thalidomidepaclitaxel, carboplatin, and radiotherapy are same as those in Arm A. thalidomide: Induction chemotherapy dosing, oral daily, starting Day 1 for 24 months or until disease progression. Concurrent chemotherapy / radiotherapy dosing, oral daily, begin with 200 mg thalidomide as a single dose at bedtime. The dose is then increased by 100 mg every week as tolerated up to a total dose of 1000 mg.
Primary Outcome Measures
NameTimeMethod
Overall Survival Timeevery other month until 24 months from study entry, then every 3 months for year 3, every 4 months for year 4 and every 6 months for year 5

Survival time is defined as time from study entry to death from any cause

Secondary Outcome Measures
NameTimeMethod
Time to Disease Progressionevery other month until 24 months from study entry, every 3 months for year 3, every 4 months for the 4th year and every 6 months for the 5th year

Time to disease progression is defined as the time from randomization to documented disease progression or to death without progression. Patients without documented progression or death reported were censored at the time of the last documented disease evaluation. Progression is defined, using the Response Evaluation Criteria In Solid Tumors (RECIST), as a measurable increase in the smallest dimension of any target or non-target lesion, or the appearance of new lesions, since baseline.

Response Rate at Best Response to Treatmentevery other month until 24 months from study entry, every 3 months for year 3, every 4 months for the 4th year and every 6 months for the 5th year

Proportion of patients with complete or partial response using the Response Evaluation Criteria In Solid Tumors (RECIST) v1.0. Complete response is defined as the complete disappearance of all clinically detectable malignant disease for at least 4 weeks. Partial response is defined as greater than or equal to 50% decrease in tumor size for at least 4 weeks without increase in size of any area of known malignant disease of greater than 25%, or appearance of new areas of malignant disease.

Trial Locations

Locations (233)

Sletten Regional Cancer Institute at Benefis Healthcare

🇺🇸

Great Falls, Montana, United States

Doctors Hospital at Ohio Health

🇺🇸

Columbus, Ohio, United States

Swedish Covenant Hospital

🇺🇸

Chicago, Illinois, United States

Tufts-NEMC Cancer Center

🇺🇸

Boston, Massachusetts, United States

Boulder Community Hospital

🇺🇸

Boulder, Colorado, United States

William W. Backus Hospital

🇺🇸

Norwich, Connecticut, United States

Praxair Cancer Center at Danbury Hospital

🇺🇸

Danbury, Connecticut, United States

Mercy Hospital and Medical Center

🇺🇸

Chicago, Illinois, United States

Memorial Medical Center Cancer Services

🇺🇸

Modesto, California, United States

St. Mary-Corwin Regional Medical Center

🇺🇸

Pueblo, Colorado, United States

Elkhart General Hospital

🇺🇸

Elkhart, Indiana, United States

Stanford Comprehensive Cancer Center at Stanford University Medical Center

🇺🇸

Stanford, California, United States

Sky Ridge Medical Center

🇺🇸

Lone Tree, Colorado, United States

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

🇺🇸

Savannah, Georgia, United States

Trinity Medical Center - East

🇺🇸

Moline, Illinois, United States

North Suburban Medical Center

🇺🇸

Thornton, Colorado, United States

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

🇺🇸

Grand Junction, Colorado, United States

Memorial Hospital

🇺🇸

Colorado Springs, Colorado, United States

Penrose Cancer Center at Penrose Hospital

🇺🇸

Colorado Springs, Colorado, United States

Hope Cancer Care Center at Longmont United Hospital

🇺🇸

Longmont, Colorado, United States

Hembree Mercy Cancer Center at St. Edward Mercy Medical Center

🇺🇸

Ft. Smith, Arkansas, United States

Robert H. Lurie Comprehensive Cancer Center at Northwestern University

🇺🇸

Chicago, Illinois, United States

West Michigan Cancer Center

🇺🇸

Kalamazoo, Michigan, United States

Veterans Affairs Medical Center - Augusta

🇺🇸

Augusta, Georgia, United States

Cedar Rapids Oncology Associates

🇺🇸

Cedar Rapids, Iowa, United States

Salinas Valley Memorial Hospital

🇺🇸

Salinas, California, United States

Midwest Center for Hematology/Oncology

🇺🇸

Joliet, Illinois, United States

Hematology/Oncology of the North Shore at Gross Point Medical Center

🇺🇸

Skokie, Illinois, United States

St. Luke's Hospital

🇺🇸

Maumee, Ohio, United States

Baptist Cancer Institute - Jacksonville

🇺🇸

Jacksonville, Florida, United States

Fairview Ridges Hospital

🇺🇸

Burnsville, Minnesota, United States

DeCesaris Cancer Institute at Anne Arundel Medical Center

🇺🇸

Annapolis, Maryland, United States

MBCCOP - Medical College of Georgia Cancer Center

🇺🇸

Augusta, Georgia, United States

St. Luke's Regional Medical Center

🇺🇸

Sioux City, Iowa, United States

Medical Center of Central Georgia

🇺🇸

Macon, Georgia, United States

Mercy Medical Center - Sioux City

🇺🇸

Sioux City, Iowa, United States

Halifax Medical Center - Daytona Beach

🇺🇸

Daytona Beach, Florida, United States

Howard Community Hospital at Howard Regional Health System

🇺🇸

Kokomo, Indiana, United States

Reid Hospital & Health Care Services, Incorporated

🇺🇸

Richmond, Indiana, United States

Green Bay Oncology, Limited - Escanaba

🇺🇸

Escanaba, Michigan, United States

Morton Hospital & Medical Center

🇺🇸

Taunton, Massachusetts, United States

Saint Joseph Regional Medical Center

🇺🇸

South Bend, Indiana, United States

Swedish-American Regional Cancer Center

🇺🇸

Rockford, Illinois, United States

Miller-Dwan Medical Center

🇺🇸

Duluth, Minnesota, United States

Oakwood Cancer Center at Oakwood Hospital and Medical Center

🇺🇸

Dearborn, Michigan, United States

Siouxland Hematology-Oncology Associates, LLP

🇺🇸

Sioux City, Iowa, United States

Hickman Cancer Center at Bixby Medical Center

🇺🇸

Adrian, Michigan, United States

Newton-Wellesley Hospital

🇺🇸

Newton, Massachusetts, United States

Merle M. Mahr Cancer Center at Regional Medical Center of Hopkins County

🇺🇸

Madisonville, Kentucky, United States

Medical Oncology and Hematology Associates - West Des Moines

🇺🇸

West Des Moines, Iowa, United States

St. John Macomb Hospital

🇺🇸

Warren, Michigan, United States

Baystate Regional Cancer Program at D'Amour Center for Cancer Care

🇺🇸

Springfield, Massachusetts, United States

Seton Cancer Institute - Saginaw

🇺🇸

Saginaw, Michigan, United States

Mercy and Unity Cancer Center at Unity Hospital

🇺🇸

Fridley, Minnesota, United States

St. Mary's - Duluth Clinic Cancer Center

🇺🇸

Duluth, Minnesota, United States

CCOP - Duluth

🇺🇸

Duluth, Minnesota, United States

Deaconess Billings Clinic - Downtown

🇺🇸

Billings, Montana, United States

Meeker County Memorial Hospital

🇺🇸

Lichfield, Minnesota, United States

Hutchinson Area Health Care

🇺🇸

Hutchinson, Minnesota, United States

Bronson Methodist Hospital

🇺🇸

Kalamazoo, Michigan, United States

Sparrow Regional Cancer Center

🇺🇸

Lansing, Michigan, United States

Hulston Cancer Center at Cox Medical Center South

🇺🇸

Springfield, Missouri, United States

Veterans Affairs Medical Center - Buffalo

🇺🇸

Buffalo, New York, United States

United Hospital

🇺🇸

St. Paul, Minnesota, United States

Northern Rockies Radiation Oncology Center

🇺🇸

Billings, Montana, United States

Adena Regional Medical Center

🇺🇸

Chillicothe, Ohio, United States

Wayne Memorial Hospital, Incorporated

🇺🇸

Goldsboro, North Carolina, United States

Overlook Hospital

🇺🇸

Summit, New Jersey, United States

Missouri Baptist Cancer Center

🇺🇸

St. Louis, Missouri, United States

Ridgeview Medical Center

🇺🇸

Waconia, Minnesota, United States

Hunterdon Regional Cancer Center at Hunterdon Medical Center

🇺🇸

Flemington, New Jersey, United States

Woodwinds Health Campus

🇺🇸

Woodbury, Minnesota, United States

Warren Hospital

🇺🇸

Phillipsburg, New Jersey, United States

Carol G. Simon Cancer Center at Morristown Memorial Hospital

🇺🇸

Morristown, New Jersey, United States

Wilson Medical Center

🇺🇸

Wilson, North Carolina, United States

Cancer Resource Center - Lincoln

🇺🇸

Lincoln, Nebraska, United States

Fox Chase Virtua Health Cancer Program at Virtua West Jersey

🇺🇸

Voorhees, New Jersey, United States

Lipson Cancer and Blood Center at Rochester General Hospital

🇺🇸

Rochester, New York, United States

Park Nicollet Health Services

🇺🇸

St. Louis Park, Minnesota, United States

Cancer Institute of New Jersey at Hamilton

🇺🇸

Hamilton, New Jersey, United States

Cancer Care Center at Medcenter One Hospital

🇺🇸

Bismarck, North Dakota, United States

Mountainside Hospital Cancer Center

🇺🇸

Montclair, New Jersey, United States

CCOP - Columbus

🇺🇸

Columbus, Ohio, United States

Toledo Clinic, Incorporated - Main Clinic

🇺🇸

Toledo, Ohio, United States

Joan Karnell Cancer Center at Pennsylvania Hospital

🇺🇸

Philadelphia, Pennsylvania, United States

Penn State Cancer Institute at Milton S. Hershey Medical Center

🇺🇸

Hershey, Pennsylvania, United States

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

🇺🇸

Wilkes-Barre, Pennsylvania, United States

Avera Cancer Institute

🇺🇸

Sioux Falls, South Dakota, United States

St. Vincent Mercy Medical Center

🇺🇸

Toledo, Ohio, United States

Medical University of Ohio Cancer Center

🇺🇸

Toledo, Ohio, United States

CCOP - Toledo Community Hospital

🇺🇸

Toledo, Ohio, United States

UVMC Cancer Care Center at Upper Valley Medical Center

🇺🇸

Troy, Ohio, United States

Geisinger Medical Center

🇺🇸

Danville, Pennsylvania, United States

PinnacleHealth Regional Cancer Center at Polyclinic Hospital

🇺🇸

Harrisburg, Pennsylvania, United States

Green Bay Oncology, Limited - Oconto Falls

🇺🇸

Oconto Falls, Wisconsin, United States

All Saints Cancer Center at All Saints Healthcare

🇺🇸

Racine, Wisconsin, United States

Virginia Piper Cancer Institute at Abbott-Northwestern Hospital

🇺🇸

Minneapolis, Minnesota, United States

Hennepin County Medical Center - Minneapolis

🇺🇸

Minneapolis, Minnesota, United States

Big Sky Oncology

🇺🇸

Great Falls, Montana, United States

Porter Adventist Hospital

🇺🇸

Denver, Colorado, United States

Presbyterian - St. Luke's Medical Center

🇺🇸

Denver, Colorado, United States

St. Joseph Hospital

🇺🇸

Denver, Colorado, United States

Rose Medical Center

🇺🇸

Denver, Colorado, United States

CCOP - Colorado Cancer Research Program, Incorporated

🇺🇸

Denver, Colorado, United States

CCOP - Missouri Valley Cancer Consortium

🇺🇸

Omaha, Nebraska, United States

Immanuel Medical Center

🇺🇸

Omaha, Nebraska, United States

Creighton University Medical Center

🇺🇸

Omaha, Nebraska, United States

Pretoria Academic Hospital

🇿🇦

Pretoria, South Africa

Regions Hospital Cancer Care Center

🇺🇸

St. Paul, Minnesota, United States

Swedish Medical Center

🇺🇸

Englewood, Colorado, United States

Green Bay Oncology, Limited - Iron Mountain

🇺🇸

Iron Mountain, Michigan, United States

Haematology-Oncology Associates of Ohio and Michigan, PC

🇺🇸

Lambertville, Michigan, United States

Mercy Memorial Hospital System

🇺🇸

Monroe, Michigan, United States

Aurora Presbyterian Hospital

🇺🇸

Aurora, Colorado, United States

Veterans Affairs Medical Center - Atlanta (Decatur)

🇺🇸

Decatur, Georgia, United States

Pearlman Comprehensive Cancer Center at South Georgia Medical Center

🇺🇸

Valdosta, Georgia, United States

Center for Cancer Therapy at LaPorte Hospital and Health Services

🇺🇸

La Porte, Indiana, United States

CCOP - Northern Indiana CR Consortium

🇺🇸

South Bend, Indiana, United States

Memorial Hospital of South Bend

🇺🇸

South Bend, Indiana, United States

Mercy Regional Cancer Center at Mercy Medical Center

🇺🇸

Cedar Rapids, Iowa, United States

Hematology Oncology Associates of the Quad Cities

🇺🇸

Bettendorf, Iowa, United States

Genesis Regional Cancer Center at Genesis Medical Center

🇺🇸

Davenport, Iowa, United States

Hurley Medical Center

🇺🇸

Flint, Michigan, United States

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

🇺🇸

Grosse Pointe Woods, Michigan, United States

Genesys Hurley Cancer Institute

🇺🇸

Flint, Michigan, United States

Borgess Medical Center

🇺🇸

Kalamazooaa, Michigan, United States

Foote Hospital

🇺🇸

Jackson, Michigan, United States

Lakeland Cancer Care Center at Lakeland Hospital - St. Joseph

🇺🇸

St. Joseph, Michigan, United States

Fairview Southdale Hospital

🇺🇸

Edina, Minnesota, United States

Hubert H. Humphrey Cancer Center at North Memorial Medical Center

🇺🇸

Robbinsdale, Minnesota, United States

Saint Francis Cancer Center

🇺🇸

Shakopee, Minnesota, United States

CCOP - Metro-Minnesota

🇺🇸

Saint Louis Park, Minnesota, United States

St. Joseph's Hospital

🇺🇸

St Paul, Minnesota, United States

CentraCare Clinic - River Campus

🇺🇸

St. Cloud, Minnesota, United States

St. John's Regional Health Center

🇺🇸

Springfield, Missouri, United States

Alegant Health Cancer Center at Bergan Mercy Medical Center

🇺🇸

Omaha, Nebraska, United States

CCOP - Nevada Cancer Research Foundation

🇺🇸

Las Vegas, Nevada, United States

Veterans Affairs Medical Center - East Orange

🇺🇸

East Orange, New Jersey, United States

Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton

🇺🇸

Marlton, New Jersey, United States

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

🇺🇸

New Brunswick, New Jersey, United States

Booker Cancer Center at Riverview Medical Center

🇺🇸

Red Bank, New Jersey, United States

Shore Memorial Hospital - Somers Point

🇺🇸

Somers Point, New Jersey, United States

CCOP - Hematology-Oncology Associates of Central New York

🇺🇸

Syracuse, New York, United States

Bismarck Cancer Center

🇺🇸

Bismarck, North Dakota, United States

Mid Dakota Clinic, P. C.

🇺🇸

Bismarck, North Dakota, United States

St. Alexius Medical Center

🇺🇸

Bismarck, North Dakota, United States

Aultman Hospital Cancer Center at Aultman Health Foundation

🇺🇸

Canton, Ohio, United States

Mount Carmel Health - West Hospital

🇺🇸

Columbus, Ohio, United States

MetroHealth's Cancer Care Center at MetroHealth Medical Center

🇺🇸

Cleveland, Ohio, United States

Akron City Hospital

🇺🇸

Akron, Ohio, United States

Riverside Methodist Hospital Cancer Care

🇺🇸

Columbus, Ohio, United States

Grant Riverside Cancer Services

🇺🇸

Columbus, Ohio, United States

David L. Rike Cancer Center at Miami Valley Hospital

🇺🇸

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

Fairfield Medical Center

🇺🇸

Lancaster, Ohio, United States

Fremont Memorial Hospital

🇺🇸

Fremont, Ohio, United States

Charles F. Kettering Memorial Hospital

🇺🇸

Kettering, Ohio, United States

St. Rita's Medical Center

🇺🇸

Lima, Ohio, United States

Lima Memorial Hospital

🇺🇸

Lima, Ohio, United States

MedCentral - Mansfield Hospital

🇺🇸

Mansfield, Ohio, United States

Strecker Cancer Center at Marietta Memorial Hospital

🇺🇸

Marietta, Ohio, United States

Northwest Ohio Oncology Center

🇺🇸

Maumee, Ohio, United States

Licking Memorial Cancer Care Program at Licking Memorial Hospital

🇺🇸

Newark, Ohio, United States

Mercy Medical Center

🇺🇸

Springfield, Ohio, United States

St. Charles Mercy Hospital

🇺🇸

Oregon, Ohio, United States

Firelands Regional Medical Center

🇺🇸

Sandusky, Ohio, United States

Community Hospital of Springfield and Clark County

🇺🇸

Springfield, Ohio, United States

Flower Hospital Cancer Center

🇺🇸

Sylvania, Ohio, United States

Mercy Hospital of Tiffin

🇺🇸

Tiffin, Ohio, United States

Toledo Hospital

🇺🇸

Toledo, Ohio, United States

Bryn Mawr Hospital

🇺🇸

Bryn Mawr, Pennsylvania, United States

Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest

🇺🇸

Allentown, Pennsylvania, United States

Fulton County Health Center

🇺🇸

Wauseon, Ohio, United States

Oncology Hematology Associates of Northern Pennsylvania, PC at Hahne Regional Cancer Center

🇺🇸

Dubois, Pennsylvania, United States

Easton Regional Cancer Center at Easton Hospital

🇺🇸

Easton, Pennsylvania, United States

Lancaster General Hospital

🇺🇸

Lancaster, Pennsylvania, United States

Lewistown Hospital

🇺🇸

Lewistown, Pennsylvania, United States

Cancer Center at Phoenixville Hospital

🇺🇸

Phoenixville, Pennsylvania, United States

Paoli Memorial Hospital

🇺🇸

Paoli, Pennsylvania, United States

Pottstown Memorial Regional Cancer Center

🇺🇸

Pottstown, Pennsylvania, United States

Mount Nittany Medical Center

🇺🇸

State College, Pennsylvania, United States

Grand View Hospital

🇺🇸

Sellersville, Pennsylvania, United States

Reading Hospital and Medical Center

🇺🇸

Reading, Pennsylvania, United States

Mercy Hospital Cancer Center - Scranton

🇺🇸

Scranton, Pennsylvania, United States

Jennersville Regional Hospital

🇺🇸

West Grove, Pennsylvania, United States

Cancer Care Institute of Carolina at Aiken Regional Medical Centers

🇺🇸

Aiken, South Carolina, United States

CCOP - MainLine Health

🇺🇸

Wynnewood, Pennsylvania, United States

CCOP - Greenville

🇺🇸

Greenville, South Carolina, United States

Medical X-Ray Center, PC

🇺🇸

Sioux Falls, South Dakota, United States

Sioux Valley Hospital and University of South Dakota Medical Center

🇺🇸

Sioux Falls, South Dakota, United States

Lankenau Cancer Center at Lankenau Hospital

🇺🇸

Wynnewood, Pennsylvania, United States

Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical Center

🇺🇸

Kingsport, Tennessee, United States

MBCCOP - Meharry Medical College - Nashville

🇺🇸

Nashville, Tennessee, United States

University of Virginia Cancer Center at UV Health System

🇺🇸

Charlottesville, Virginia, United States

Southwest Virginia Regional Cancer Center

🇺🇸

Norton, Virginia, United States

Danville Regional Medical Center

🇺🇸

Danville, Virginia, United States

West Virginia University - Robert C. Byrd Health Sciences Center - Charleston Division

🇺🇸

Charleston, West Virginia, United States

Marshall University Medical Center

🇺🇸

Huntington, West Virginia, United States

Green Bay Oncology, Limited at St. Vincent Hospital

🇺🇸

Green Bay, Wisconsin, United States

Green Bay Oncology, Limited at St. Mary's Hospital

🇺🇸

Green Bay, Wisconsin, United States

St. Mary's Hospital Medical Center - Green Bay

🇺🇸

Green Bay, Wisconsin, United States

St. Vincent Hospital Regional Cancer Center

🇺🇸

Green Bay, Wisconsin, United States

Bay Area Cancer Care Center at Bay Area Medical Center

🇺🇸

Marinette, Wisconsin, United States

Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center

🇺🇸

La Crosse, Wisconsin, United States

Green Bay Oncology, Limited - Sturgeon Bay

🇺🇸

Sturgeon Bay, Wisconsin, United States

Marshfield Clinic - Marshfield Center

🇺🇸

Marshfield, Wisconsin, United States

Mercy and Unity Cancer Center at Mercy Hospital

🇺🇸

Coon Rapids, Minnesota, United States

HealthEast Cancer Care at St. John's Hospital

🇺🇸

Maplewood, Minnesota, United States

Veterans Affairs Medical Center - Dayton

🇺🇸

Dayton, Ohio, United States

Allegheny Cancer Center at Allegheny General Hospital

🇺🇸

Pittsburgh, Pennsylvania, United States

Hillman Cancer Center at University of Pittsburgh Cancer Institute

🇺🇸

Pittsburgh, Pennsylvania, United States

Hematology and Oncology Associates

🇺🇸

Scranton, Pennsylvania, United States

CCOP - Scott and White Hospital

🇺🇸

Temple, Texas, United States

St. Joseph Mercy Cancer Center at St. Joseph Mercy Hospital

🇺🇸

Ann Arbor, Michigan, United States

CCOP - Michigan Cancer Research Consortium

🇺🇸

Ann Arbor, Michigan, United States

Great Falls Clinic

🇺🇸

Great Falls, Montana, United States

CCOP - Montana Cancer Consortium

🇺🇸

Billings, Montana, United States

Mercy Capitol Hospital

🇺🇸

Des Moines, Iowa, 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

CCOP - Kansas City

🇺🇸

Kansas City, Missouri, United States

Albert Einstein Cancer Center at Albert Einstein College of Medicine

🇺🇸

Bronx, New York, United States

Our Lady of Mercy Medical Center Comprehensive Cancer Center

🇺🇸

Bronx, New York, United States

Virginia Commonwealth University Massey Cancer Center

🇺🇸

Richmond, Virginia, United States

Dean Medical Center - Madison

🇺🇸

Madison, Wisconsin, United States

University of Wisconsin Comprehensive Cancer Center

🇺🇸

Madison, Wisconsin, United States

Hinsdale Hematology Oncology Associates

🇺🇸

Hinsdale, Illinois, United States

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