Pyridoxine and Topical Urea/Lactic Acid-Based Cream in Preventing Hand-Foot Syndrome in Patients Receiving Capecitabine for Breast Cancer or Other Cancer

Phase 3

Completed

Conditions: Breast Cancer
Drug/Agent Toxicity by Tissue/Organ
Unspecified Adult Solid Tumor, Protocol Specific

Interventions: Dietary Supplement: pyridoxine hydrochloride
Drug: urea/lactic acid-based topical cream
Other: placebo

Registration Number: NCT00296036

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: RATIONALE: Pyridoxine (vitamin B6) and topical urea/lactic acid-based cream may prevent or lessen hand-foot syndrome caused by chemotherapy. It is not yet known whether giving pyridoxine with or without topical urea/lactic acid-based cream is more effective than topical urea/lactic acid-based cream alone or a placebo in preventing hand-foot syndrome.

PURPOSE: This randomized phase III trial is studying pyridoxine and topical urea/lactic acid-based cream to see how well they work compared with giving pyridoxine together with a placebo, giving topical urea/lactic acid-based cream together with a placebo, or giving two placebos in preventing hand-foot syndrome in patients who are receiving capecitabine for breast cancer or other cancer.

Detailed Description: OBJECTIVES:

* Determine whether the prophylactic use of a topical urea/lactic acid cream can decrease the incidence/severity of capecitabine-caused palmar-plantar erythrodysesthesia in patients receiving capecitabine for breast and/or other cancer.

* Evaluate the potential toxicity of this cream.

* Determine whether the prophylactic use of vitamin B6 can decrease the incidence and/or severity of capecitabine-caused palmar-plantar erythrodysesthesia.

* Evaluate the potential toxicity of vitamin B6.

* Determine whether the prophylactic use of a topical urea/lactic acid cream in combination with vitamin B6 can decrease the incidence and/or severity of capecitabine caused palmar-plantar erythrodysesthesia.

OUTLINE: This is a randomized, double-blind, placebo-controlled study. Patients are stratified according to age (\< 50 years old vs 50-60 years old vs \> 60 years old), sex, capecitabine dose level (2000 mg/day vs 2500 mg/day), cancer type (breast vs other), and mode of therapy (adjuvant \[including neo-adjuvant\] therapy vs metastatic disease). Patients are randomized to 1 of 6 treatment arms (treatment arms I-IV closed to accrual as of 10/24/007).

* Arm I (closed to accrual as of 10/24/2007): Patients receive topical urea/lactic acid-based cream applied to palms and soles twice daily and oral pyridoxine once daily on days 1-21.

* Arm II (closed to accrual as of 10/24/2007): Patients receive topical urea/lactic acid-based cream as in arm I (closed to accrual as of 10/24/2007) and oral placebo once daily on days 1-21.

* Arm III (closed to accrual as of 10/24/2007): Patients receive placebo cream applied to palms and soles twice daily and pyridoxine as in arm I (closed to accrual as of 10/24/2007).

* Arm IV (closed to accrual as of 10/24/2007):Patients receive placebo cream as in arm III and oral placebo as in arm II (closed to accrual as of 10/24/2007).

* Arm V: Patients receive topical urea/lactic acid-based cream applied to palms and soles twice daily on days 1-21.

* Arm VI: Patients receive placebo cream applied to palms and soles twice daily on days 1-21.

In all arms, treatment repeats every 21 days for up to 4 courses in the absence of disease progression or unacceptable toxicity.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 137

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (closed to accrual as of 10/24/2007)	pyridoxine hydrochloride	Patients receive topical urea/lactic acid-based cream applied to palms and soles twice daily and oral pyridoxine once daily on days 1-21.
Arm I (closed to accrual as of 10/24/2007)	urea/lactic acid-based topical cream	Patients receive topical urea/lactic acid-based cream applied to palms and soles twice daily and oral pyridoxine once daily on days 1-21.
Arm II (closed to accrual as of 10/24/2007)	urea/lactic acid-based topical cream	Patients receive topical urea/lactic acid-based cream as in arm I (closed to accrual as of 10/24/2007) and oral placebo once daily on days 1-21.
Arm II (closed to accrual as of 10/24/2007)	placebo	Patients receive topical urea/lactic acid-based cream as in arm I (closed to accrual as of 10/24/2007) and oral placebo once daily on days 1-21.
Arm III (closed to accrual as of 10/24/2007)	pyridoxine hydrochloride	Patients receive placebo cream applied to palms and soles twice daily and pyridoxine as in arm I (closed to accrual as of 10/24/2007).
Arm III (closed to accrual as of 10/24/2007)	placebo	Patients receive placebo cream applied to palms and soles twice daily and pyridoxine as in arm I (closed to accrual as of 10/24/2007).
Arm IV (closed to accrual as of 10/24/2007)	placebo	Patients receive placebo cream as in arm III and oral placebo as in arm II (closed to accrual as of 10/24/2007).
Arm V	urea/lactic acid-based topical cream	Patients receive topical urea/lactic acid-based cream applied to palms and soles twice daily on days 1-21.
Arm VI	placebo	Patients receive placebo cream applied to palms and soles twice daily on days 1-21.

Primary Outcome Measures

Name	Time	Method
To Determine Whether the Prophylactic Use of a Topical Urea/Lactic Acid Cream Can Decrease the Incidence/Severity of Capecitabine-caused Palmar-plantar Erythrodysesthesia	First 3 weeks of treatment	A patient self-reported hand-foot syndrome (HFSD), also known as palmar-plantar erythrodysesthesia, was completed daily while applying the cream. Patients rated skin severity symptoms individually in their hands and in their feet. Definitions of symptoms, which were based on Common Terminology Criteria for Adverse Events (CTCAE) v3.0, were provided to patients. The number of patients reporting moderate to severe symptoms in either hands or feet were tabulated and percentages are reported.

Secondary Outcome Measures

Name	Time	Method
To Evaluate the Potential Toxicity of Urea/Lactic Acid Cream	Up to 4, 21-day cycles	Frequency and severity of adverse events reported by patients in weekly diary and evaluated through clinical assessment by NCI CTCAE v3.0. The number of patients reporting grade 3 or higher events are reported in this outcome measure. For a full list of all events, please refer to the Adverse Events section of this report.
Determine Whether the Prophylactic Use of Vitamin B6 Can Decrease the Incidence and/or Severity of Capecitabine-caused Palmar-plantar Erythrodysesthesia (HFSD).	First 3 weeks of treatment	A patient self-reported hand-foot syndrome diary (HFSD) was completed daily while applying the cream. Patients rated skin severity symptoms individually in their hands and in their feet. Definitions of symptoms, which were based on Common Terminology Criteria for Adverse Events (CTCAE) v3.0, were provided to patients. The number of patients reporting moderate to severe symptoms were tabulated and percentages are reported.
Evaluate the Potential Toxicity of Vitamin B6.	up to 4, 21-day cycles	Frequency and severity of adverse events reported by patients in weekly diary and evaluated through clinical assessment by NCI CTCAE v3.0. The number of patients reporting grade 3 or higher events are reported in this outcome measure. For a full list of all events, please refer to the Adverse Events section of this report.
Determine Whether the Prophylactic Use of a Topical Urea/Lactic Acid Cream in Combination With Vitamin B6 Can Decrease the Incidence and/or Severity of Capecitabine Caused Palmar-plantar Erythrodysesthesia.	First 3 weeks of treatment	A patient self-reported hand-foot syndrome diary (HFSD) was completed daily while applying the cream. Patients rated skin severity symptoms individually in their hands and in their feet. Definitions of symptoms, which were based on Common Terminology Criteria for Adverse Events (CTCAE) v3.0, were provided to patients. The number of patients reporting moderate to severe symptoms were tabulated.

Trial Locations

Locations (226): Fredericksburg Oncology, Incorporated
🇺🇸
Fredericksburg, Virginia, United States
Mayo Clinic Scottsdale
🇺🇸
Scottsdale, Arizona, United States
Galesburg Clinic, PC
🇺🇸
Galesburg, Illinois, United States
BroMenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Cancer Treatment Center at Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Mercy Memorial Hospital - Monroe
🇺🇸
Monroe, Michigan, United States
Southwest Medical Center
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas, PA - Winfield
🇺🇸
Winfield, Kansas, United States
Siouxland Hematology-Oncology Associates, LLP
🇺🇸
Sioux City, Iowa, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
McDonough District Hospital
🇺🇸
Macomb, Illinois, United States
Hopedale Medical Complex
🇺🇸
Hopedale, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
OSF St. Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Joliet Oncology-Hematology Associates, Limited - West
🇺🇸
Joliet, Illinois, United States
St. Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
Graham Hospital
🇺🇸
Canton, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Saint Joseph Regional Medical Center
🇺🇸
South Bend, Indiana, United States
Penrose Cancer Center at Penrose Hospital
🇺🇸
Colorado Springs, Colorado, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
Eureka Community Hospital
🇺🇸
Eureka, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Community Cancer Center
🇺🇸
Normal, Illinois, United States
Cedar Rapids Oncology Associates
🇺🇸
Cedar Rapids, Iowa, United States
Cancer Center of Kansas, PA - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas, PA - Kingman
🇺🇸
Kingman, Kansas, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Albert Lea Cancer Center at Albert Lea Medical Center
🇺🇸
Albert Lea, Minnesota, United States
Cancer Center of Kansas, PA - Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Community Cancer Center of Monroe
🇺🇸
Monroe, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Cancer Center of Kansas, PA - Wellington
🇺🇸
Wellington, Kansas, United States
Howard Community Hospital
🇺🇸
Kokomo, Indiana, United States
Cancer Center of Kansas, PA - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas, PA - Parsons
🇺🇸
Parsons, Kansas, United States
Mid Dakota Clinic, PC
🇺🇸
Bismarck, North Dakota, United States
St. Alexius Medical Center Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Associates in Womens Health, PA - North Review
🇺🇸
Wichita, Kansas, United States
McCreery Cancer Center at Ottumwa Regional
🇺🇸
Ottumwa, Iowa, United States
Cancer Center of Kansas, PA - Newton
🇺🇸
Newton, Kansas, United States
South Bend Clinic
🇺🇸
South Bend, Indiana, United States
Seton Cancer Institute at Saint Mary's - Saginaw
🇺🇸
Saginaw, Michigan, United States
St. Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Cancer Center of Kansas, PA - Dodge City
🇺🇸
Dodge City, Kansas, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Green Bay Oncology, Limited - Escanaba
🇺🇸
Escanaba, Michigan, United States
Medcenter One Hospital Cancer Care Center
🇺🇸
Bismarck, North Dakota, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Altru Cancer Center at Altru Hospital
🇺🇸
Grand Forks, North Dakota, United States
St. Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
CCOP - MeritCare Hospital
🇺🇸
Fargo, North Dakota, United States
HealthEast Cancer Care at St. Joseph's Hospital
🇺🇸
Saint Paul, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Van Elslander Cancer Center at St. John Hospital and Medical Center
🇺🇸
Grosse Pointe Woods, Michigan, United States
MeritCare Bemidji
🇺🇸
Bemidji, Minnesota, United States
Sparrow Regional Cancer Center
🇺🇸
Lansing, Michigan, United States
Duluth Clinic Cancer Center - Duluth
🇺🇸
Duluth, Minnesota, United States
St. John Macomb Hospital
🇺🇸
Warren, Michigan, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Northwest Ohio Oncology Center
🇺🇸
Maumee, Ohio, United States
Good Samaritan Hospital
🇺🇸
Dayton, Ohio, United States
Mercy Regional Cancer Center at Mercy Hospital
🇺🇸
Port Huron, Michigan, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Hematology Oncology Center
🇺🇸
Elyria, Ohio, United States
Bismarck Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Wood County Oncology Center
🇺🇸
Bowling Green, Ohio, United States
Green Bay Oncology, Limited at St. Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Medical University of Ohio Cancer Center
🇺🇸
Toledo, Ohio, United States
Rapid City Regional Hospital
🇺🇸
Rapid City, South Dakota, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, United States
Blanchard Valley Medical Associates
🇺🇸
Findlay, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Natalie Warren Bryant Cancer Center at St. Francis Hospital
🇺🇸
Tulsa, Oklahoma, United States
Toledo Clinic, Incorporated - Main Clinic
🇺🇸
Toledo, Ohio, United States
Green Bay Oncology, Limited - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
Flower Hospital Cancer Center
🇺🇸
Sylvania, Ohio, United States
Charles F. Kettering Memorial Hospital
🇺🇸
Kettering, Ohio, United States
Green Bay Oncology, Limited - Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Mount Carmel St. Ann's Cancer Center
🇺🇸
Westerville, Ohio, United States
Medical X-Ray Center, PC
🇺🇸
Sioux Falls, South Dakota, United States
Licking Memorial Cancer Care Program at Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
UVMC Cancer Care Center at Upper Valley Medical Center
🇺🇸
Troy, Ohio, 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
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Ruth G. McMillan Cancer Center at Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
CCOP - Toledo Community Hospital
🇺🇸
Toledo, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Genesis - Good Samaritan Hospital
🇺🇸
Zanesville, Ohio, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Clinton Memorial Hospital
🇺🇸
Wilmington, Ohio, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
Riverside Methodist Hospital Cancer Care
🇺🇸
Columbus, Ohio, United States
CCOP - Columbus
🇺🇸
Columbus, Ohio, United States
Grant Medical Center Cancer Care
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health - West Hospital
🇺🇸
Columbus, Ohio, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center - Minneapolis
🇺🇸
Minneapolis, Minnesota, United States
Hematology-Oncology Centers of the Northern Rockies - Billings
🇺🇸
Billings, Montana, United States
Great Falls Clinic - Main Facility
🇺🇸
Great Falls, Montana, United States
Glacier Oncology, PLLC
🇺🇸
Kalispell, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Hope Cancer Care Center at Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
CCOP - Duluth
🇺🇸
Duluth, Minnesota, United States
CentraCare Clinic - River Campus
🇺🇸
Saint Cloud, Minnesota, United States
Minnesota Oncology Hematology, PA - Maplewood
🇺🇸
Maplewood, Minnesota, United States
Coborn Cancer Center
🇺🇸
Saint Cloud, Minnesota, United States
Minnesota Oncology Hematology, PA - Woodbury
🇺🇸
Woodbury, Minnesota, United States
Park Nicollet Cancer Center
🇺🇸
Saint Louis Park, Minnesota, United States
Cancer Center of Kansas, PA - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas, PA - Wichita
🇺🇸
Wichita, Kansas, United States
Community Hospital of Ottawa
🇺🇸
Ottawa, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Peoria
🇺🇸
Peoria, Illinois, United States
St. Luke's Hospital
🇺🇸
Maumee, Ohio, United States
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus
🇺🇸
Moline, Illinois, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center
🇺🇸
Grand Junction, Colorado, United States
St. Mary - Corwin Regional Medical Center
🇺🇸
Pueblo, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Exempla Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Mayo Clinic - Jacksonville
🇺🇸
Jacksonville, Florida, United States
Memorial Cancer Institute at Memorial Regional Hospital
🇺🇸
Hollywood, Florida, United States
Rush-Copley Cancer Care Center
🇺🇸
Aurora, Illinois, United States
St. Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
CCOP - Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Ottawa
🇺🇸
Ottawa, Illinois, United States
CCOP - Illinois Oncology Research Association
🇺🇸
Peoria, Illinois, United States
Illinois Valley Community Hospital
🇺🇸
Peru, Illinois, United States
St. Francis Hospital and Health Centers - Beech Grove Campus
🇺🇸
Beech Grove, Indiana, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
Carle Cancer Center at Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Reid Hospital & Health Care Services
🇺🇸
Richmond, Indiana, United States
Saint Anthony Memorial Health Centers
🇺🇸
Michigan City, Indiana, United States
CCOP - Northern Indiana CR Consortium
🇺🇸
South Bend, Indiana, United States
Mercy Regional Cancer Center at Mercy Medical Center
🇺🇸
Cedar Rapids, Iowa, United States
McFarland Clinic, PC
🇺🇸
Ames, Iowa, United States
Mercy Medical Center - Sioux City
🇺🇸
Sioux City, Iowa, United States
St. Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Cancer Center of Kansas, PA - Pratt
🇺🇸
Pratt, Kansas, United States
CCOP - Wichita
🇺🇸
Wichita, Kansas, United States
Via Christi Cancer Center at Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Oakwood Cancer Center at Oakwood Hospital and Medical Center
🇺🇸
Dearborn, Michigan, United States
Hickman Cancer Center at Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Foote Memorial Hospital
🇺🇸
Jackson, Michigan, United States
Dickinson County Healthcare System
🇺🇸
Iron Mountain, Michigan, United States
Haematology-Oncology Associates of Ohio and Michigan, PC
🇺🇸
Lambertville, Michigan, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Lakeland Regional Cancer Care Center - St. Joseph
🇺🇸
St. Joseph, Michigan, United States
Miller - Dwan Medical Center
🇺🇸
Duluth, Minnesota, United States
Meeker County Memorial Hospital
🇺🇸
Lichfield, Minnesota, United States
Immanuel St. Joseph's
🇺🇸
Mankato, Minnesota, United States
HealthEast Cancer Care at St. John's Hospital
🇺🇸
Maplewood, Minnesota, United States
Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center
🇺🇸
Robbinsdale, Minnesota, United States
CCOP - Metro-Minnesota
🇺🇸
Saint Louis Park, Minnesota, United States
St. Francis Cancer Center at St. Francis Medical Center
🇺🇸
Shakopee, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Missouri Baptist Cancer Center
🇺🇸
Saint Louis, Missouri, United States
Regions Hospital Cancer Care Center
🇺🇸
St. Paul, Minnesota, United States
HealthEast Cancer Care at Woodwinds Health Campus
🇺🇸
Woodbury, Minnesota, United States
CCOP - Montana Cancer Consortium
🇺🇸
Billings, Montana, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Arch Medical Services, Incorporated at Center for Cancer Care and Research
🇺🇸
Saint Louis, Missouri, United States
St. Vincent Healthcare Cancer Care Services
🇺🇸
Billings, Montana, United States
Billings Clinic - Downtown
🇺🇸
Billings, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
St. James Healthcare Cancer Care
🇺🇸
Butte, Montana, United States
Sletten Cancer Institute at Benefis Healthcare
🇺🇸
Great Falls, Montana, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Big Sky Oncology
🇺🇸
Great Falls, Montana, United States
Kalispell Medical Oncology at KRMC
🇺🇸
Kalispell, Montana, United States
Cancer Resource Center - Lincoln
🇺🇸
Lincoln, Nebraska, United States
Montana Cancer Specialists at Montana Cancer Center
🇺🇸
Missoula, Montana, United States
Rutherford Hospital
🇺🇸
Rutherfordton, North Carolina, United States
MeritCare Broadway
🇺🇸
Fargo, North Dakota, United States
Mary Rutan Hospital
🇺🇸
Bellefontaine, Ohio, United States
Doctors Hospital at Ohio Health
🇺🇸
Columbus, Ohio, United States
CCOP - Dayton
🇺🇸
Dayton, Ohio, United States
Samaritan North Cancer Care Center
🇺🇸
Dayton, Ohio, United States
David L. Rike Cancer Center at Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Toledo Clinic - Oregon
🇺🇸
Oregon, Ohio, United States
Strecker Cancer Center at Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
St. Charles Mercy Hospital
🇺🇸
Oregon, Ohio, United States
Mercy Medical Center
🇺🇸
Springfield, Ohio, United States
North Coast Cancer Care, Incorporated
🇺🇸
Sandusky, Ohio, United States
Community Hospital of Springfield and Clark County
🇺🇸
Springfield, Ohio, United States
Toledo Hospital
🇺🇸
Toledo, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
St. Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
St. Anne Mercy Hospital
🇺🇸
Toledo, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
CCOP - Upstate Carolina
🇺🇸
Spartanburg, South Carolina, United States
Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
AnMed Cancer Center
🇺🇸
Anderson, South Carolina, United States
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Sanford Cancer Center at Sanford USD Medical Center
🇺🇸
Sioux Falls, South Dakota, United States
Aurora Presbyterian Hospital
🇺🇸
Aurora, Colorado, United States
St. Anthony Central Hospital
🇺🇸
Denver, Colorado, 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
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Saint Joseph Mercy Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
CCOP - Colorado Cancer Research Program
🇺🇸
Denver, Colorado, United States
CCOP - Michigan Cancer Research Consortium
🇺🇸
Ann Arbor, Michigan, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Mayo Clinic Cancer Center
🇺🇸
Rochester, Minnesota, United States
CCOP - Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Community Medical Center
🇺🇸
Missoula, Montana, United States
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
🇺🇸
Missoula, 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
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Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Lutheran Hospital
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Des Moines, Iowa, United States