S0500 Treatment Decision Making Based on Blood Levels of Tumor Cells for Metastatic Breast Cancer Treated With Chemo
- Conditions
- Breast Cancer
- Interventions
- Drug: chemotherapy
- Registration Number
- NCT00382018
- Lead Sponsor
- SWOG Cancer Research Network
- 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. Measuring blood levels of tumor cells may help in learning how well chemotherapy works to kill metastatic breast cancer cells and allow doctors to plan better treatment. When blood levels of tumor cells are high while receiving chemotherapy, it is not yet known whether it is more effective to change chemotherapy regimens at that time or wait until disease progression.
PURPOSE: This randomized phase III trial is studying treatment decision making based on blood levels of tumor cells in women with metastatic breast cancer receiving chemotherapy.
- Detailed Description
OBJECTIVES:
Primary
* Determine whether women with metastatic breast cancer and elevated circulating tumor cells (CTCs) (≥ 5 per 7.5 mL of whole blood) after 3 weeks of first-line chemotherapy derive increased overall survival from changing to an alternative chemotherapy regimen at the next course rather than waiting for clinical evidence of progressive disease before changing to an alternative chemotherapy regimen.
* Determine whether these patients derive increased progression-free survival (PFS) from changing to an alternative chemotherapy regimen at the next course rather than waiting for clinical evidence of progressive disease before changing to an alternative chemotherapy regimen.
* Confirm previous findings that patients with \< 5 CTCs per 7.5 mL of whole blood on initial screening have longer median OS and PFS than patients with ≥ 5 CTCs per 7.5 mL of whole blood.
* Determine the prognostic value of sequentially collected CTC values in these patients.
* Compare toxicity between patients with and without elevated CTCs after 3 weeks of first-line chemotherapy AND between the two randomized treatment arms.
Secondary
* Compare the prognostic and predictive value of CTC number vs breast cancer tumor markers, including CA 15-3 and carcinoembryonic antigen.
* Create a serum specimen bank for future biologic investigation.
OUTLINE: This is a partially blinded, partially randomized, multicenter study. Patients are assigned to 1 of 3 groups based on circulating tumor cells (CTCs) after 1 course of chemotherapy.
All patients undergo blood collection before their first dose of first-line chemotherapy\* to determine baseline CTC count. Patients with \< 5 CTCs at baseline are assigned to group I. Patients with ≥ 5 CTCs at baseline undergo a second blood draw on day 22 (after completion of 1 course of chemotherapy). Patients with \< 5 CTCs after completing 1 course of chemotherapy are assigned to group 2. Patients with ≥ 5 CTCs after completion of 1 course of chemotherapy are assigned to group 3.
NOTE: \*Chemotherapy may be initiated while waiting for the baseline CTC result.
* Group 1 (low risk of early progression): Patients continue to receive regular treatment without change at the discretion of the physician. Patients are eligible for other first-line chemotherapy trials. No further blood is collected.
* Group 2 (moderate risk of early progression): Patients continue to receive their current chemotherapy regimen without change.
* Group 3 (high risk of early progression): Patients are stratified according to HER-2 status (positive vs negative) and disease type (bone-only vs measurable disease). Patients are randomized to 1 of 2 treatment arms.
* Arm I: Patients continue with their current chemotherapy regimen without change.
* Arm II: Patients switch to a different chemotherapy regimen. Selection of a new chemotherapy regimen is made by the patient's doctor.
Patients receiving hormonal therapy or biologic therapy and chemotherapy continue to receive the hormonal or biologic therapy unchanged regardless of CTC level.
In groups 2 and 3, blood is collected periodically during chemotherapy and then at the completion of chemotherapy. Samples are examined for CTCs via the CellSearch™ blood test. Blood is also tested for CA 15-3 and carcinoembryonic antigen (CEA).
After completion of study therapy, patients are followed for up to 5 years.
PROJECTED ACCRUAL: A total of 500 patients will be accrued for this study.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 624
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Group 1 chemotherapy Patients continue to receive regular treatment without change at the discretion of the physician. Patients are eligible for other first-line chemotherapy trials. No further blood is collected. Group 3, Arm I chemotherapy Patients continue with their current chemotherapy regimen without change. Group 3, Arm II chemotherapy Patients switch to a different chemotherapy regimen. Selection of a new chemotherapy regimen is made by the patient's doctor. Group 2 chemotherapy Patients continue to receive their current chemotherapy regimen without change.
- Primary Outcome Measures
Name Time Method Overall Survival Every 3 months until progression then every 6 months for 5 years or until death From date of registration to date of death due to any cause. Patients last known to be alive are censored at date of last contact.
Progression-free Survival every 3 months until progression. From date of registration to date of first documentation of progressive disease, death due to any cause or symptomatic deterioration, whichever occurs first, assessed up to five years. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions
Progression Free Survival every 3 months until progression From date of registration to date of first documentation of progressive disease, death due to any cause or symptomatic deterioration, whichever occurs first. Patients last known to be alive and progression-free are censored at date of last contact.
- Secondary Outcome Measures
Name Time Method Number of Patients With Adverse Events That Are Related to Study Drugs Toxicity assessment was evaluated after 3 weeks, 6 weeks, and every 6 weeks thereafter until progression Adverse Events (AEs) are reported by CTCAE Version 3.0. Only adverse events that are possibly, probably or definitely related to study drug are reported.
Trial Locations
- Locations (295)
NEA Medical Center - Stadium Boulevard
🇺🇸Jonesboro, Arkansas, United States
Hematology-Oncology Centers of the Northern Rockies - Billings
🇺🇸Billings, Montana, United States
Big Sky Oncology
🇺🇸Great Falls, Montana, United States
M. D. Anderson Cancer Center at University of Texas
🇺🇸Houston, Texas, United States
University Cancer Center at University of Washington Medical Center
🇺🇸Seattle, Washington, United States
Harborview Medical Center
🇺🇸Seattle, Washington, United States
Fred Hutchinson Cancer Research Center
🇺🇸Seattle, Washington, United States
Group Health Central Hospital
🇺🇸Seattle, Washington, United States
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus
🇺🇸Seattle, Washington, United States
Utah Cancer Specialists at UCS Cancer Center
🇺🇸Salt Lake City, Utah, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
Alaska Regional Hospital Cancer Center
🇺🇸Anchorage, Alaska, United States
Regional Medical Center
🇺🇸Anniston, Alabama, United States
Glendale Memorial Hospital Comprehensive Cancer Center
🇺🇸Glendale, California, United States
Loma Linda University Cancer Institute at Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
USC/Norris Comprehensive Cancer Center and Hospital
🇺🇸Los Angeles, California, United States
San Luis Valley Regional Medical Center
🇺🇸Alamosa, Colorado, United States
California Cancer Care, Incorporated - Greenbrae
🇺🇸Greenbrae, California, United States
Palo Alto Medical Foundation
🇺🇸Palo Alto, California, United States
Camino Medical Group - Treatment Center
🇺🇸Mountain View, California, United States
Pearlman Comprehensive Cancer Center at South Georgia Medical Center
🇺🇸Valdosta, Georgia, United States
Kapiolani Medical Center at Pali Momi
🇺🇸'Aiea, Hawaii, United States
Rush-Copley Cancer Care Center
🇺🇸Aurora, Illinois, United States
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center
🇺🇸Boise, Idaho, United States
Resurrection Medical Center
🇺🇸Chicago, Illinois, United States
Louis A. Weiss Memorial Hospital
🇺🇸Chicago, Illinois, United States
Elmhurst Memorial Hospital
🇺🇸Elmhurst, Illinois, United States
CCOP - Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Swedish-American Regional Cancer Center
🇺🇸Rockford, Illinois, United States
Michiana Hematology-Oncology, PC - Elkhart
🇺🇸Elkhart, Indiana, United States
Elkhart Clinic, LLC
🇺🇸Elkhart, Indiana, United States
Community Regional Cancer Care at Community Hospital North
🇺🇸Indianapolis, Indiana, United States
St. Vincent Indianapolis Hospital
🇺🇸Indianapolis, Indiana, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Howard Community Hospital
🇺🇸Kokomo, Indiana, United States
Center for Cancer Therapy at LaPorte Hospital and Health Services
🇺🇸La Porte, Indiana, United States
Saint Anthony Memorial Health Centers
🇺🇸Michigan City, Indiana, United States
Saint Joseph Regional Medical Center
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC - La Porte
🇺🇸Westville, Indiana, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
CCOP - Northern Indiana CR Consortium
🇺🇸South Bend, Indiana, United States
Michiana Hematology-Oncology, PC - South Bend
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC - Plymouth
🇺🇸Plymouth, Indiana, United States
Siouxland Hematology-Oncology Associates, LLP
🇺🇸Sioux City, Iowa, United States
Foote Memorial Hospital
🇺🇸Jackson, Michigan, United States
Lakeside Cancer Specialists, PLLC
🇺🇸Saint Joseph, Michigan, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
St. John Macomb Hospital
🇺🇸Warren, Michigan, United States
CCOP - Metro-Minnesota
🇺🇸Saint Louis Park, Minnesota, United States
Park Nicollet Cancer Center
🇺🇸Saint Louis Park, 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
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Willmar Cancer Center at Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Cleveland Clinic Beachwood Family Health and Surgery Center
🇺🇸Beachwood, Ohio, United States
Wood County Oncology Center
🇺🇸Bowling Green, Ohio, United States
Cleveland Clinic Cancer Center at Fairview Hospital
🇺🇸Cleveland, Ohio, United States
St. Rita's Medical Center
🇺🇸Lima, Ohio, United States
Hillcrest Cancer Center at Hillcrest Hospital
🇺🇸Mayfield Heights, Ohio, United States
Fisher-Titus Medical Center
🇺🇸Norwalk, Ohio, United States
Three Rivers Community Hospital
🇺🇸Grants Pass, Oregon, United States
Providence Newberg Medical Center
🇺🇸Newberg, Oregon, United States
Providence Milwaukie Hospital
🇺🇸Milwaukie, Oregon, United States
Dubs Cancer Center at Rogue Valley Medical Center
🇺🇸Medford, Oregon, United States
Willamette Falls Hospital
🇺🇸Oregon City, Oregon, United States
Cancer Centers of the Carolinas - Easley
🇺🇸Easley, South Carolina, United States
Cancer Centers of the Carolinas - Grove Commons
🇺🇸Greenville, South Carolina, United States
Cancer Centers of the Carolinas - Faris Road
🇺🇸Greenville, South Carolina, United States
Greenville Hospital Cancer Center
🇺🇸Greenville, South Carolina, United States
Cancer Centers of the Carolinas - Seneca
🇺🇸Seneca, South Carolina, United States
CCOP - Greenville
🇺🇸Greenville, South Carolina, United States
Cancer Centers of the Carolinas - Greer Medical Oncology
🇺🇸Greer, South Carolina, United States
West Tennessee Cancer Center at Jackson-Madison County General Hospital
🇺🇸Jackson, Tennessee, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
Cancer Centers of the Carolinas - Spartanburg
🇺🇸Spartanburg, South Carolina, United States
CCOP - Scott and White Hospital
🇺🇸Temple, Texas, United States
University Hospital - San Antonio
🇺🇸San Antonio, Texas, United States
Sandra L. Maxwell Cancer Center
🇺🇸Cedar City, Utah, United States
Logan Regional Hospital
🇺🇸Logan, Utah, United States
St. Francis Hospital
🇺🇸Federal Way, Washington, United States
Columbia Basin Hematology
🇺🇸Kennewick, Washington, United States
Harrison Poulsbo Hematology and Onocology
🇺🇸Poulsbo, Washington, United States
Cancer Care Northwest - Spokane South
🇺🇸Spokane, Washington, United States
Wenatchee Valley Medical Center
🇺🇸Wenatchee, Washington, United States
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
🇺🇸Green Bay, Wisconsin, United States
Green Bay Oncology, Limited at St. Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Cotton-O'Neil Cancer Center
🇺🇸Topeka, Kansas, United States
Maui Memorial Medical Center
🇺🇸Wailuku, Hawaii, United States
Pacific Cancer Institute - Maui
🇺🇸Wailuku, Hawaii, United States
Veterans Affairs Medical Center - Denver
🇺🇸Denver, Colorado, United States
CCOP - Columbia River Oncology Program
🇺🇸Portland, Oregon, United States
Providence St. Vincent Medical Center
🇺🇸Portland, Oregon, United States
CentraCare Clinic - River Campus
🇺🇸Saint Cloud, Minnesota, United States
Shaw Regional Cancer Center
🇺🇸Edwards, Colorado, United States
Providence Cancer Center
🇺🇸Anchorage, Alaska, United States
Valley View Hospital Cancer Center
🇺🇸Glenwood Springs, Colorado, United States
Montrose Memorial Hospital Cancer Center
🇺🇸Montrose, Colorado, United States
Ingalls Cancer Care Center at Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Alvin and Lois Lapidus Cancer Institute at Sinai Hospital
🇺🇸Baltimore, Maryland, United States
Mercy Hospital
🇺🇸Portland, Maine, United States
Tammy Walker Cancer Center at Salina Regional Health Center
🇺🇸Salina, Kansas, United States
Barbara Ann Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Butterworth Hospital at Spectrum Health
🇺🇸Grand Rapids, Michigan, United States
CCOP - Grand Rapids
🇺🇸Grand Rapids, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
St. Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
HealthEast Cancer Care at St. John's Hospital
🇺🇸Maplewood, Minnesota, United States
Humphrey Cancer Center at North Memorial Outpatient Center
🇺🇸Robbinsdale, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Minnesota Oncology Hematology, PA - Maplewood
🇺🇸Maplewood, Minnesota, United States
William Beaumont Hospital - Royal Oak Campus
🇺🇸Royal Oak, Michigan, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸Fridley, Minnesota, United States
Coborn Cancer Center
🇺🇸Saint Cloud, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Regional Cancer Center at Singing River Hospital
🇺🇸Pascagoula, Mississippi, United States
University of Mississippi Cancer Clinic
🇺🇸Jackson, Mississippi, United States
Central Care Cancer Center at Carrie J. Babb Cancer Center
🇺🇸Bolivar, Missouri, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Minnesota Oncology Hematology, PA - Woodbury
🇺🇸Woodbury, Minnesota, United States
Presbyterian Cancer Treatment Center at Presbyterian Kaseman Hospital
🇺🇸Albuquerque, New Mexico, United States
St. Joseph's Hospital and Medical Center
🇺🇸Paterson, New Jersey, United States
Goldschmidt Cancer Center
🇺🇸Jefferson City, Missouri, United States
Southeast Cancer Center
🇺🇸Cape Girardeau, Missouri, United States
St. Peter's Hospital
🇺🇸Helena, Montana, United States
Cleveland Clinic Foundation - Strongsville
🇺🇸Strongsville, Ohio, United States
Cleveland Clinic Taussig Cancer Center
🇺🇸Cleveland, Ohio, United States
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
🇺🇸Missoula, Montana, United States
Great Falls Clinic - Main Facility
🇺🇸Great Falls, Montana, United States
St. James Healthcare Cancer Care
🇺🇸Butte, Montana, United States
Northern Montana Hospital
🇺🇸Havre, Montana, United States
Missouri Baptist Cancer Center
🇺🇸Saint Louis, Missouri, United States
Comprehensive Cancer Care, PC
🇺🇸Saint Louis, Missouri, United States
St. Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Medical University of Ohio Cancer Center
🇺🇸Toledo, Ohio, United States
Natalie Warren Bryant Cancer Center at St. Francis Hospital
🇺🇸Tulsa, Oklahoma, United States
Toledo Hospital
🇺🇸Toledo, Ohio, United States
CCOP - Toledo Community Hospital
🇺🇸Toledo, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸Tiffin, Ohio, United States
CCOP - Cancer Research for the Ozarks
🇺🇸Springfield, Missouri, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
CCOP - Montana Cancer Consortium
🇺🇸Billings, Montana, United States
St. Vincent Healthcare Cancer Care Services
🇺🇸Billings, Montana, United States
St. John's Regional Health Center
🇺🇸Springfield, Missouri, United States
Duke Health Raleigh Hospital
🇺🇸Raleigh, North Carolina, United States
Lovelace Medical Center - Downtown
🇺🇸Albuquerque, New Mexico, United States
Montana Cancer Specialists at Montana Cancer Center
🇺🇸Missoula, Montana, United States
Hematology Oncology Associates, PC
🇺🇸Albuquerque, New Mexico, United States
Dickstein Cancer Treatment Center at White Plains Hospital Center
🇺🇸White Plains, New York, United States
Glacier Oncology, PLLC
🇺🇸Kalispell, Montana, United States
Newark Beth Israel Medical Center
🇺🇸Newark, New Jersey, United States
Medcenter One Hospital Cancer Care Center
🇺🇸Bismarck, North Dakota, United States
Hulston Cancer Center at Cox Medical Center South
🇺🇸Springfield, Missouri, United States
Southeastern Regional Medical Center
🇺🇸Lumberton, North Carolina, United States
Kinston Medical Specialists
🇺🇸Kinston, North Carolina, United States
Altru Cancer Center at Altru Hospital
🇺🇸Grand Forks, North Dakota, United States
Wayne Memorial Hospital, Incorporated
🇺🇸Goldsboro, North Carolina, United States
Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Granville Medical Center
🇺🇸Oxford, North Carolina, United States
CCOP - Hematology-Oncology Associates of Central New York
🇺🇸East Syracuse, New York, United States
Bismarck Cancer Center
🇺🇸Bismarck, North Dakota, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
UMDNJ University Hospital
🇺🇸Newark, New Jersey, United States
Duke Cancer Institute
🇺🇸Durham, North Carolina, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Albert Einstein Cancer Center at Albert Einstein College of Medicine
🇺🇸The Bronx, New York, United States
Faxton Regional Cancer Center
🇺🇸Utica, New York, United States
Fox Chase Cancer Center - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
St. Charles Mercy Hospital
🇺🇸Oregon, Ohio, United States
Toledo Clinic - Oregon
🇺🇸Oregon, Ohio, United States
Ephrata Cancer Center at Ephrata Community Hospital
🇺🇸Ephrata, Pennsylvania, United States
Billings Clinic - Downtown
🇺🇸Billings, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸Bozeman, Montana, United States
Providence Cancer Center at Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center
🇺🇸Reading, Pennsylvania, United States
Evergreen Hematology and Oncology, PS
🇺🇸Spokane, Washington, United States
Franciscan Cancer Center at St. Joseph Medical Center
🇺🇸Tacoma, Washington, United States
Allenmore Hospital
🇺🇸Tacoma, Washington, United States
North Puget Oncology at United General Hospital
🇺🇸Sedro-Woolley, Washington, United States
Southwest Washington Medical Center Cancer Center
🇺🇸Vancouver, Washington, United States
Val and Ann Browning Cancer Center at McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Cancer Therapy and Research Center
🇺🇸San Antonio, Texas, United States
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center
🇺🇸Murray, Utah, United States
American Fork Hospital
🇺🇸American Fork, Utah, United States
Gundersen Lutheran Center for Cancer and Blood
🇺🇸La Crosse, Wisconsin, United States
Holy Family Memorial Medical Center Cancer Care Center
🇺🇸Manitowoc, Wisconsin, United States
Green Bay Oncology, Limited - Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Oncology Alliance, SC - Milwaukee - West
🇺🇸Wauwatosa, Wisconsin, United States
Welch Cancer Center at Sheridan Memorial Hospital
🇺🇸Sheridan, Wyoming, United States
Utah Valley Regional Medical Center - Provo
🇺🇸Provo, Utah, United States
Dixie Regional Medical Center - East Campus
🇺🇸Saint George, Utah, United States
Highline Medical Center Cancer Center
🇺🇸Burien, Washington, United States
Skagit Valley Hospital Cancer Care Center
🇺🇸Mount Vernon, Washington, United States
Providence St. Peter Hospital Regional Cancer Center
🇺🇸Olympia, Washington, United States
Providence Centralia Hospital
🇺🇸Centralia, Washington, United States
Good Samaritan Cancer Center
🇺🇸Puyallup, Washington, United States
Stanford Cancer Center
🇺🇸Stanford, California, United States
Cancer Center at Ball Memorial Hospital
🇺🇸Muncie, Indiana, United States
McFarland Clinic, PC
🇺🇸Ames, Iowa, United States
Saint Vincent Hospital at Worcester Medical Center
🇺🇸Worcester, Massachusetts, United States
Mercy Medical Center - Sioux City
🇺🇸Sioux City, Iowa, United States
Covenant Cancer Treatment Center
🇺🇸Waterloo, Iowa, United States
St. Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Battle Creek Health System Cancer Care Center
🇺🇸Battle Creek, Michigan, United States
Saint Joseph Mercy Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Bay Regional Medical Center
🇺🇸Bay City, Michigan, United States
Mecosta County Medical Center
🇺🇸Big Rapids, Michigan, United States
Oakwood Cancer Center at Oakwood Hospital and Medical Center
🇺🇸Dearborn, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Josephine Ford Cancer Center at Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Green Bay Oncology, Limited - Escanaba
🇺🇸Escanaba, Michigan, United States
Lacks Cancer Center at Saint Mary's Health Care
🇺🇸Grand Rapids, Michigan, United States
Dickinson County Healthcare System
🇺🇸Iron Mountain, 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
Community Cancer Center of Monroe
🇺🇸Monroe, Michigan, United States
Clemens Regional Medical Center
🇺🇸Mount Clemens, Michigan, United States
Mercy Memorial Hospital - Monroe
🇺🇸Monroe, Michigan, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, 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
St. Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Lakeland Regional Cancer Care Center - St. Joseph
🇺🇸Saint Joseph, Michigan, United States
Mercy General Health Partners
🇺🇸Muskegon, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
University of New Mexico Cancer Center - South
🇺🇸Las Cruces, New Mexico, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Person Memorial Hospital
🇺🇸Roxboro, North Carolina, United States
Community Cancer Center
🇺🇸Elyria, Ohio, United States
Northwest Ohio Oncology Center
🇺🇸Maumee, Ohio, United States
Lima Memorial Hospital
🇺🇸Lima, Ohio, United States
Parma Community General Hospital
🇺🇸Parma, Ohio, United States
St. Anne Mercy Hospital
🇺🇸Toledo, Ohio, United States
North Coast Cancer Care, Incorporated
🇺🇸Sandusky, Ohio, United States
Flower Hospital Cancer Center
🇺🇸Sylvania, Ohio, United States
Toledo Clinic, Incorporated - Main Clinic
🇺🇸Toledo, Ohio, United States
Fulton County Health Center
🇺🇸Wauseon, Ohio, United States
Providence Cancer Center at PMCC
🇺🇸Medford, Oregon, United States
UPMC Cancer Centers
🇺🇸Pittsburgh, Pennsylvania, United States
Cleveland Clinic - Wooster
🇺🇸Wooster, Ohio, United States
St. Charles Medical Center - Bend
🇺🇸Bend, Oregon, United States
Bay Area Hospital
🇺🇸Coos Bay, Oregon, United States
Guthrie Cancer Center at Guthrie Clinic Sayre
🇺🇸Sayre, Pennsylvania, United States
Danville Regional Medical Center
🇺🇸Danville, Virginia, United States
Fredericksburg Oncology, Incorporated
🇺🇸Fredericksburg, Virginia, United States
St. Joseph Cancer Center
🇺🇸Bellingham, Washington, United States
St. Mary's Hospital Medical Center - Green Bay
🇺🇸Green Bay, Wisconsin, United States
Minor and James Medical, PLLC
🇺🇸Seattle, Washington, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸Green Bay, Wisconsin, United States
St. Clare Hospital
🇺🇸Tacoma, Washington, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
St. Nicholas Hospital
🇺🇸Sheboygan, Wisconsin, United States
University of Colorado Cancer Center at UC Health Sciences Center
🇺🇸Aurora, Colorado, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
CCOP - Michigan Cancer Research Consortium
🇺🇸Ann Arbor, Michigan, United States
Mid Dakota Clinic, PC
🇺🇸Bismarck, North Dakota, United States
St. Alexius Medical Center Cancer Center
🇺🇸Bismarck, North Dakota, United States
Hennepin County Medical Center - Minneapolis
🇺🇸Minneapolis, Minnesota, United States
Veterans Affairs Medical Center - San Antonio (Murphy)
🇺🇸San Antonio, Texas, United States
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center
🇺🇸Grand Junction, Colorado, United States
Providence Cancer Institute at Providence Hospital - Southfield Campus
🇺🇸Southfield, Michigan, United States
Van Elslander Cancer Center at St. John Hospital and Medical Center
🇺🇸Grosse Pointe Woods, Michigan, United States
Island Hospital Cancer Care Center at Island Hospital
🇺🇸Anacortes, Washington, United States
Green Bay Oncology, Limited - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Hematology and Oncology Associates of Northeastern Pennsylvania
🇺🇸Scranton, Pennsylvania, United States
Kalispell Medical Oncology at KRMC
🇺🇸Kalispell, Montana, United States
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center
🇺🇸Hartford, Connecticut, United States
Saint Peter's University Hospital
🇺🇸New Brunswick, New Jersey, United States
Sletten Cancer Institute at Benefis Healthcare
🇺🇸Great Falls, Montana, United States
Good Samaritan Cancer Center at Good Samaritan Hospital
🇺🇸Kearney, Nebraska, United States
Cancer Research Center of Hawaii
🇺🇸Honolulu, Hawaii, United States
OnCare Hawaii, Incorporated - Lusitana
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Institute at Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Yale Cancer Center
🇺🇸New Haven, Connecticut, United States
Florida Hospital Cancer Institute at Florida Hospital Orlando
🇺🇸Orlando, Florida, United States
Hawaii Medical Center - East
🇺🇸Honolulu, Hawaii, United States
OnCare Hawaii, Incorporated - Kuakini
🇺🇸Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸Honolulu, Hawaii, United States
Tripler Army Medical Center
🇺🇸Honolulu, Hawaii, United States
Straub Clinic and Hospital, Incorporated
🇺🇸Honolulu, Hawaii, United States
Roper St. Francis Cancer Center at Roper Hospital
🇺🇸Charleston, South Carolina, United States
Virginia Cancer Institute - West End
🇺🇸Richmond, Virginia, United States
CCOP - Northwest
🇺🇸Tacoma, Washington, United States
MultiCare Regional Cancer Center at Tacoma General Hospital
🇺🇸Tacoma, Washington, United States
Hickman Cancer Center at Bixby Medical Center
🇺🇸Adrian, Michigan, United States
Hematology Oncology Center
🇺🇸Elyria, Ohio, United States
Cleveland Clinic Cancer Center
🇺🇸Independence, Ohio, United States
Cancer Center at Phoenixville Hospital
🇺🇸Phoenixville, Pennsylvania, United States
Olympic Hematology and Oncology
🇺🇸Bremerton, Washington, United States