Bevacizumab and Temozolomide or Bevacizumab and Paclitaxel Albumin-Stabilized Nanoparticle Formulation and Carboplatin in Treating Patients With Stage IV Malignant Melanoma That Cannot Be Removed by Surgery

Phase 2

Completed

Conditions: Melanoma (Skin)

Interventions: Biological: bevacizumab
Drug: temozolomide
Drug: carboplatin
Drug: paclitaxel albumin-stabilized nanoparticle formulation

Registration Number: NCT00626405

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: RATIONALE: Drugs used in chemotherapy, such as temozolomide, paclitaxel albumin-stabilized nanoparticle formulation, and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. 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. It is not yet known whether bevacizumab is more effective when given together with temozolomide or paclitaxel albumin-stabilized nanoparticle formulation and carboplatin in killing malignant melanoma cells.

PURPOSE: This randomized phase II trial is studying the side effects of giving temozolomide together with bevacizumab and to see how well it works compared with giving bevacizumab together with paclitaxel albumin-stabilized nanoparticle formulation and carboplatin in treating patients with stage IV malignant melanoma that cannot be removed by surgery.

Detailed Description: OBJECTIVES:

Primary

* To assess the anti-tumor activity, in terms of the percentage of patients who are treated with these regimens and who are progression-free at 6 months.

* To assess the safety profile of each treatment regimen.

Secondary

* To estimate the response rate in patients treated with these regimens.

* To estimate the distribution of progression-free survival time and overall survival time of patients treated with these regimens.

Tertiary

* To examine the impact of therapy on angiogenesis and immune homeostasis.

OUTLINE: Patients are stratified according to ECOG performance status (0 vs 1) and location of metastatic disease (M1a \[skin or subcutaneous tissue or lymph node only\] vs M1b \[lung\] vs M1c \[other visceral sites\]) and randomized to 1 of 2 treatment arms.

* Arm I: Patients receive oral temozolomide on days 1-5 and bevacizumab IV over 30-90 minutes on days 1 and 15. (closed to accrual 8/21/09)

* Arm II: Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15, paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15, and carboplatin IV over 30 minutes on day 1.

In both arms, treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

Patients undergo blood sample collection periodically for VEGF plasma levels and analysis of changes in immune homeostasis.

Beginning at study entry, patients are followed up every 3 months for 2 years and then every 6 months for up to 3 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 95

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I	bevacizumab	Patients receive oral temozolomide on days 1-5 and bevacizumab IV over 30-90 minutes on days 1 and 15.
Arm II	bevacizumab	Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15, paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15, and carboplatin IV over 30 minutes on day 1.
Arm II	paclitaxel albumin-stabilized nanoparticle formulation	Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15, paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15, and carboplatin IV over 30 minutes on day 1.
Arm I	temozolomide	Patients receive oral temozolomide on days 1-5 and bevacizumab IV over 30-90 minutes on days 1 and 15.
Arm II	carboplatin	Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15, paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes on days 1, 8, and 15, and carboplatin IV over 30 minutes on day 1.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival at 6 Months	at 6 months	The primary endpoint is the 6 month post registration Progression-free survival (PFS) rate. Progression-free survival time is defined as the time from registration to documentation of disease progression using the RECIST criteria. Patients who died without documentation of disease progression will be considered to have progressed at death unless there is sufficient documented evidence to conclude no progression occurred prior to death. All patients, who meet the eligibility criteria, sign a consent form, and start treatment will be included in the evaluation of the 6 month PFS rate.

Secondary Outcome Measures

Name	Time	Method
Tumor Response Rate, Calculated as a Percentage Along With it's 95% Confidence Interval	Up to 5 years	A confirmed tumor response is defined to be a Complete Response or Partial Response noted \> as the objective status on 2 consecutive evaluations at least 8 \> weeks apart. The proportion of tumor responses will be \> estimated by the number of confirmed tumor responses divided \> by the total number of evaluable patients. \> Complete Response (CR): Disappearance of all target lesions \> Partial Response (PR): At least a 30% decrease in the sum of the LD of target lesions taking as reference the baseline sum LD. \> Progression (PD): At least a 20% increase in the sum of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. \> Stable Disease (SD): Neither sufficient shrinkage to Qualify for PR nor sufficient increase to Qualify for PD taking as reference the smallest sum LD. responses will be calculated assuming that the number of \> confirmed tumor responses follows a binomial distribution.
Overall Survival	Up to 5 years	Overall survival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier.

Trial Locations

Locations (255): Swedish Medical Center
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Englewood, Colorado, United States
Perry Memorial Hospital
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Princeton, Illinois, United States
St. James Healthcare Cancer Care
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Butte, Montana, United States
Penrose Cancer Center at Penrose Hospital
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Colorado Springs, Colorado, United States
OSF St. Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Boulder Community Hospital
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Boulder, Colorado, United States
Cancer Treatment Center at Pekin Hospital
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Pekin, Illinois, United States
Hope Cancer Care Center at Longmont United Hospital
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Longmont, Colorado, United States
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center
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Grand Junction, Colorado, United States
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus
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Moline, Illinois, United States
Illinois CancerCare - Eureka
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Eureka, Illinois, United States
Galesburg Cottage Hospital
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Galesburg, Illinois, United States
Mayo Clinic - Jacksonville
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Jacksonville, Florida, United States
Sky Ridge Medical Center
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Lone Tree, Colorado, United States
Illinois CancerCare - Kewanee Clinic
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Kewanee, Illinois, United States
St. Mary - Corwin Regional Medical Center
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Pueblo, Colorado, United States
Eureka Community Hospital
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Eureka, Illinois, United States
McDonough District Hospital
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Macomb, Illinois, United States
Community Cancer Center
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Normal, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Ottawa
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Ottawa, Illinois, United States
Galesburg Clinic, PC
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Galesburg, Illinois, United States
Illinois CancerCare - Havana
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Havana, Illinois, United States
Mason District Hospital
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Havana, Illinois, United States
Rose Medical Center
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Denver, Colorado, United States
McFarland Clinic, PC
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Ames, Iowa, United States
North Colorado Medical Center
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Greeley, Colorado, United States
Illinois CancerCare - Monmouth
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Monmouth, Illinois, United States
Elkhart General Hospital
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Elkhart, Indiana, United States
Memorial Hospital of South Bend
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South Bend, Indiana, United States
CCOP - Illinois Oncology Research Association
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Peoria, Illinois, United States
Mercy Regional Cancer Center at Mercy Medical Center
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Cedar Rapids, Iowa, United States
Medical Oncology and Hematology Associates - West Des Moines
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Clive, Iowa, United States
Howard Community Hospital
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Kokomo, Indiana, United States
Mercy Medical Center - Sioux City
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Sioux City, Iowa, United States
Methodist Medical Center of Illinois
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Peoria, Illinois, United States
Lacks Cancer Center at Saint Mary's Health Care
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Grand Rapids, Michigan, United States
Battle Creek Health System Cancer Care Center
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Battle Creek, Michigan, United States
McCreery Cancer Center at Ottumwa Regional
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Ottumwa, Iowa, United States
Green Bay Oncology, Limited - Escanaba
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Escanaba, Michigan, United States
CCOP - Northern Indiana CR Consortium
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South Bend, Indiana, United States
St. Luke's Regional Medical Center
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Sioux City, Iowa, United States
Seton Cancer Institute at Saint Mary's - Saginaw
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Saginaw, Michigan, United States
Cedar Rapids Oncology Associates
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Cedar Rapids, Iowa, United States
Hickman Cancer Center at Bixby Medical Center
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Adrian, Michigan, United States
Foote Memorial Hospital
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Jackson, Michigan, United States
Siouxland Hematology-Oncology Associates, LLP
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Sioux City, Iowa, United States
St. John Macomb Hospital
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Warren, Michigan, United States
St. Mary Mercy Hospital
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Livonia, Michigan, United States
Mecosta County Medical Center
🇺🇸
Big Rapids, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Mercy Regional Cancer Center at Mercy Hospital
🇺🇸
Port Huron, Michigan, United States
Butterworth Hospital at Spectrum Health
🇺🇸
Grand Rapids, Michigan, United States
Lakeland Regional Cancer Care Center - St. Joseph
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Saint Joseph, Michigan, United States
Fairview Southdale Hospital
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Edina, Minnesota, United States
MeritCare Bemidji
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Bemidji, Minnesota, United States
Oakwood Cancer Center at Oakwood Hospital and Medical Center
🇺🇸
Dearborn, Michigan, United States
CCOP - Grand Rapids
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Grand Rapids, Michigan, United States
MeritCare Broadway
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Fargo, North Dakota, United States
Dickinson County Healthcare System
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Iron Mountain, Michigan, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
CCOP - Duluth
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Duluth, Minnesota, United States
HealthEast Cancer Care at St. John's Hospital
🇺🇸
Maplewood, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
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Fridley, Minnesota, United States
Metro Health Hospital
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Wyoming, Michigan, United States
Hutchinson Area Health Care
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Hutchinson, Minnesota, United States
Duluth Clinic Cancer Center - Duluth
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Duluth, Minnesota, United States
CCOP - Cancer Research for the Ozarks
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Springfield, Missouri, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
Northwest Ohio Oncology Center
🇺🇸
Maumee, Ohio, United States
St. Luke's Hospital
🇺🇸
Maumee, Ohio, United States
CCOP - Metro-Minnesota
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Saint Louis Park, Minnesota, United States
Montana Cancer Specialists at Montana Cancer Center
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Missoula, Montana, United States
St. Anne Mercy Hospital
🇺🇸
Toledo, Ohio, United States
Strecker Cancer Center at Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Toledo Clinic - Oregon
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Oregon, Ohio, United States
Geisinger Medical Group - Scenery Park
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State College, Pennsylvania, United States
Toledo Hospital
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Toledo, Ohio, United States
St. Charles Mercy Hospital
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Oregon, Ohio, United States
Mount Carmel St. Ann's Cancer Center
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Westerville, Ohio, United States
Mary Rutan Hospital
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Bellefontaine, Ohio, United States
Clinton Memorial Hospital
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Wilmington, Ohio, United States
Licking Memorial Cancer Care Program at Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
North Coast Cancer Care, Incorporated
🇺🇸
Sandusky, Ohio, United States
St. Mary's Hospital Medical Center - Green Bay
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Green Bay, Wisconsin, United States
Fredericksburg Oncology, Incorporated
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Fredericksburg, Virginia, United States
Fulton County Health Center
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Wauseon, Ohio, United States
St. Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
Flower Hospital Cancer Center
🇺🇸
Sylvania, Ohio, United States
Ruth G. McMillan Cancer Center at Greene Memorial Hospital
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Xenia, Ohio, United States
Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest
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Allentown, Pennsylvania, United States
Genesis - Good Samaritan Hospital
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Zanesville, Ohio, United States
CCOP - Toledo Community Hospital
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Toledo, Ohio, United States
St. Vincent Hospital Regional Cancer Center
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Green Bay, Wisconsin, United States
UVMC Cancer Care Center at Upper Valley Medical Center
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Troy, Ohio, United States
Geisinger Cancer Institute at Geisinger Health
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Danville, Pennsylvania, United States
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
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Green Bay, Wisconsin, United States
Green Bay Oncology, Limited - Oconto Falls
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Oconto Falls, Wisconsin, United States
Green Bay Oncology, Limited - Sturgeon Bay
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Sturgeon Bay, Wisconsin, United States
CCOP - Columbus
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Columbus, Ohio, United States
Front Range Cancer Specialists
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Fort Collins, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Illinois CancerCare - Canton
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Canton, Illinois, United States
St. Joseph Medical Center
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Bloomington, Illinois, United States
Illinois CancerCare - Carthage
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Carthage, Illinois, United States
Illinois CancerCare - Macomb
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Macomb, Illinois, United States
BroMenn Regional Medical Center
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Normal, Illinois, United States
Community Hospital of Ottawa
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Ottawa, Illinois, United States
Illinois Valley Community Hospital
🇺🇸
Peru, Illinois, United States
St. Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
St. Francis Hospital and Health Centers - Beech Grove Campus
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Beech Grove, Indiana, United States
Reid Hospital & Health Care Services
🇺🇸
Richmond, Indiana, United States
Saint Joseph Regional Medical Center
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South Bend, Indiana, United States
Mercy Cancer Center at Mercy Medical Center - North Iowa
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Mason City, Iowa, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Van Elslander Cancer Center at St. John Hospital and Medical Center
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Grosse Pointe Woods, Michigan, United States
Haematology-Oncology Associates of Ohio and Michigan, PC
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Lambertville, Michigan, United States
Community Cancer Center of Monroe
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Monroe, Michigan, United States
Mercy Memorial Hospital - Monroe
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Monroe, Michigan, United States
Mercy General Health Partners
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Muskegon, Michigan, United States
St. Joseph Mercy Oakland
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Pontiac, Michigan, United States
Munson Medical Center
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Traverse City, Michigan, United States
Fairview Ridges Hospital
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Burnsville, Minnesota, United States
Miller - Dwan Medical Center
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Duluth, Minnesota, United States
Minnesota Oncology Hematology, PA - Maplewood
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Maplewood, Minnesota, United States
Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center
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Robbinsdale, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
St. Francis Cancer Center at St. Francis Medical Center
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Shakopee, Minnesota, United States
Minnesota Oncology Hematology, PA - Woodbury
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Woodbury, Minnesota, United States
Missouri Baptist Cancer Center
🇺🇸
Saint Louis, Missouri, United States
Arch Medical Services, Incorporated at Center for Cancer Care and Research
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Saint Louis, Missouri, United States
St. John's Regional Health Center
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Springfield, Missouri, United States
Hulston Cancer Center at Cox Medical Center South
🇺🇸
Springfield, Missouri, United States
CCOP - Montana Cancer Consortium
🇺🇸
Billings, Montana, United States
Hematology-Oncology Centers of the Northern Rockies - Billings
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Billings, Montana, United States
Billings Clinic - Downtown
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Billings, Montana, United States
Bozeman Deaconess Cancer Center
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Bozeman, Montana, United States
Great Falls Clinic - Main Facility
🇺🇸
Great Falls, 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
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
🇺🇸
Missoula, Montana, United States
Cancer Resource Center - Lincoln
🇺🇸
Lincoln, Nebraska, United States
Rutherford Hospital
🇺🇸
Rutherfordton, North Carolina, United States
Bismarck Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Medcenter One Hospital Cancer Care Center
🇺🇸
Bismarck, North Dakota, United States
Wood County Oncology Center
🇺🇸
Bowling Green, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
North Coast Cancer Care - Clyde
🇺🇸
Clyde, Ohio, United States
Riverside Methodist Hospital Cancer Care
🇺🇸
Columbus, Ohio, United States
Grant Medical Center Cancer Care
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health - West Hospital
🇺🇸
Columbus, Ohio, United States
Doctors Hospital at Ohio Health
🇺🇸
Columbus, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Hematology Oncology Center
🇺🇸
Elyria, Ohio, United States
Blanchard Valley Medical Associates
🇺🇸
Findlay, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Charles F. Kettering Memorial Hospital
🇺🇸
Kettering, Ohio, United States
Medical University of Ohio Cancer Center
🇺🇸
Toledo, Ohio, United States
Geisinger Hazleton Cancer Center
🇺🇸
Hazleton, Pennsylvania, United States
Green Bay Oncology, Limited at St. Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center - Minneapolis
🇺🇸
Minneapolis, Minnesota, United States
Cancer Center of Kansas, PA - El Dorado
🇺🇸
El Dorado, Kansas, United States
Altru Cancer Center at Altru Hospital
🇺🇸
Grand Forks, North Dakota, United States
Cancer Center of Kansas, PA - Kingman
🇺🇸
Kingman, Kansas, United States
St. Alexius Medical Center Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Southwest Medical Center
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas, PA - Newton
🇺🇸
Newton, Kansas, United States
Hospital District Sixth of Harper County
🇺🇸
Anthony, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas, PA - Chanute
🇺🇸
Chanute, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas, PA - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Mid Dakota Clinic, PC
🇺🇸
Bismarck, North Dakota, United States
Cancer Center of Kansas, PA - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas, PA - Parsons
🇺🇸
Parsons, Kansas, United States
CCOP - MeritCare Hospital
🇺🇸
Fargo, North Dakota, United States
Cancer Center of Kansas, PA - Winfield
🇺🇸
Winfield, Kansas, United States
Welch Cancer Center at Sheridan Memorial Hospital
🇺🇸
Sheridan, Wyoming, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Graham Hospital
🇺🇸
Canton, Illinois, United States
Presbyterian - St. Luke's Medical Center
🇺🇸
Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
St. Joseph Hospital
🇺🇸
Denver, Colorado, United States
CCOP - Colorado Cancer Research Program
🇺🇸
Denver, Colorado, United States
St. Anthony Central Hospital
🇺🇸
Denver, Colorado, United States
CentraCare Clinic - River Campus
🇺🇸
Saint Cloud, Minnesota, United States
Coborn Cancer Center
🇺🇸
Saint Cloud, Minnesota, United States
Park Nicollet Cancer Center
🇺🇸
Saint Louis Park, Minnesota, United States
Regions Hospital Cancer Care Center
🇺🇸
Saint Paul, Minnesota, United States
Exempla Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
OSF Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Illinois CancerCare - Community Cancer Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare - Peru
🇺🇸
Peru, Illinois, United States
Illinois CancerCare - Pekin
🇺🇸
Pekin, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Peoria
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare - Spring Valley
🇺🇸
Spring Valley, Illinois, United States
South Bend Clinic
🇺🇸
South Bend, Indiana, United States
Sparrow Regional Cancer Center
🇺🇸
Lansing, Michigan, United States
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Aurora Presbyterian Hospital
🇺🇸
Aurora, Colorado, 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 - 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
Illinois CancerCare - Princeton
🇺🇸
Princeton, Illinois, United States
Center for Cancer Therapy at LaPorte Hospital and Health Services
🇺🇸
La Porte, Indiana, United States
Community Medical Center
🇺🇸
Missoula, Montana, United States
Providence Cancer Center
🇺🇸
Anchorage, Alaska, United States
CCOP - Upstate Carolina
🇺🇸
Spartanburg, South Carolina, United States
St. Vincent Healthcare Cancer Care Services
🇺🇸
Billings, Montana, United States
Sanford Cancer Center at Sanford USD Medical Center
🇺🇸
Sioux Falls, South Dakota, United States
Rapid City Regional Hospital
🇺🇸
Rapid City, South Dakota, United States
Kalispell Medical Oncology at KRMC
🇺🇸
Kalispell, Montana, United States
Medical X-Ray Center, PC
🇺🇸
Sioux Falls, South Dakota, United States
Mayo Clinic Scottsdale
🇺🇸
Scottsdale, Arizona, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
AnMed Cancer Center
🇺🇸
Anderson, South Carolina, United States
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Mercy Cancer Center at Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, 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
John Stoddard Cancer Center at Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Associates in Womens Health, PA - North Review
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Wichita
🇺🇸
Wichita, Kansas, United States
CCOP - Wichita
🇺🇸
Wichita, Kansas, United States
Via Christi Cancer Center at Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Good Samaritan Hospital
🇺🇸
Dayton, 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
CCOP - Dayton
🇺🇸
Dayton, Ohio, United States
Toledo Clinic, Incorporated - Main Clinic
🇺🇸
Toledo, Ohio, United States
Illinois CancerCare - Bloomington
🇺🇸
Bloomington, Illinois, United States
Cancer Center of Kansas, PA - Salina
🇺🇸
Salina, Kansas, United States
Mercy Medical Center
🇺🇸
Springfield, Ohio, United States
Community Hospital of Springfield and Clark County
🇺🇸
Springfield, Ohio, United States
Cancer Center of Kansas, PA - Wellington
🇺🇸
Wellington, Kansas, United States