Tamoxifen Citrate in Treating Patients With Metastatic or Recurrent Breast Cancer

Phase 2

Completed

Conditions: Breast Cancer
Stage IV Breast Cancer

Interventions: Drug: tamoxifen

Registration Number: NCT01124695

Lead Sponsor: ECOG-ACRIN Cancer Research Group

Brief Summary: RATIONALE: Estrogen can cause the growth of breast cancer cells. Hormone therapy using tamoxifen citrate may fight cancer by blocking the use of estrogen by tumor cells.

PURPOSE: This phase II trial is studying how well tamoxifen citrate works in patients with metastatic or recurrent breast cancer.

Detailed Description: OBJECTIVES:

Primary

* To correlate CYP2D6 (Cytochrome P450 2D6) score (0 vs 1-2) and progression-free survival (PFS)

Secondary

* To correlate CYP2D6 score (0 vs 1 vs 2) and PFS

* To correlate CYP2D6 score (0 vs 1-2) and the proportion of these patients who are progression-free at 6 months.

* To correlate endoxifen concentration with response

* To correlate CYP2D6 with response

* To correlate the presence of candidate estrogen receptor (ESR) 1 and 2 variant alleles, UDP-glucuronosyltransferases (UGT) 7, sulfotransferases (SULT) 1A1, other candidate genes and biomarkers to PFS and other tamoxifen related outcomes

OUTLINE: This is a multicenter study.

Patients receive oral tamoxifen citrate once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicities.

Blood, plasma, and tissue samples are collected periodically for laboratory studies.

After completion of study therapy, patients are followed up every 3-6 months for 5 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 124

Inclusion Criteria

Histologically confirmed adenocarcinoma of the breast
- Stage III (locally advanced), metastatic, or recurrent disease
- Deemed not resectable
Estrogen-receptor and/or progesterone-receptor positive disease
- Receptor status is based on most recent results
Measurable or non-measurable disease
ECOG performance status 0-2
History of central nervous system (CNS) metastasis allowed provided it has been treated (surgery, radiotherapy, or radiosurgery) within the past 4 weeks and does not require medications to control symptoms
Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
Alanine transaminase (ALT) and aspartate transaminase (AST) ≤ 2.5 times ULN (≤ 5 times ULN if liver metastases present)
Negative pregnancy test
Fertile patients must use effective nonhormonal contraception
Disease-free of prior invasive malignancies for ≥ 5 years with the exception of curatively-treated basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix
Prior chemotherapy, trastuzumab, or bevacizumab in the adjuvant setting allowed provided it has been completed ≥ 4 weeks before study therapy; other prior non-hormonal investigational agents in the adjuvant setting must have been completed at least 4 weeks prior to study registration and should be discussed with the study PI
Prior tamoxifen as adjuvant treatment is allowed as long as the patient did not have disease relapse or progression while on adjuvant tamoxifen or within 4 weeks of last dose
Treatment in the advanced setting must have been completed at least 2 weeks prior to study initiation
Prior aromatase inhibitors (e.g., anastrozole, letrozole, exemestane, aminoglutethamide) are allowed in the adjuvant or metastatic setting
At least 2 weeks since prior and no concurrent medications that are strong to moderate inhibitors of CYP2D6 and may alter tamoxifen citrate metabolism including, but not limited to, any of the following:
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Bupropion (Wellbutrin)
- Quinidine (Cardioquin)
Concurrent radiotherapy to painful sites of bone disease or areas of impending fractures allowed provided the following criteria are met:
- Radiotherapy was initiated before study entry
- Sites of measurable or non-measurable disease are outside the radiotherapy port
- Recovered from prior radiotherapy

Exclusion Criteria

Pregnant or nursing
Concurrent chemotherapy
Leptomeningeal disease
Non-protocol concurrent hormonal therapy
Medical or psychiatric conditions that would interfere with protocol compliance, the ability to provide informed consent, assessment of response, or anticipated toxicities
Prior tamoxifen for advanced disease
More than 2 lines of non-hormonal treatment in the locally advanced or metastatic setting, including trastuzumab (Herceptin), bevacizumab, or other biologics
Starting bisphosphonate therapy while receiving treatment on this study
- Patients who have begun receiving bisphosphonate therapy prior to registration may continue at the same intervals used prior to study registration

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Tamoxifen	tamoxifen	Patients receive oral tamoxifen citrate once daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicities.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival by CYP2D6 Status in 2 Categories	Assessed every 3 months for 2 years, then every 6 months up to 5 years	Progression-free survival is defined as the time from registration to progression or death, whichever occurs first. Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) was used to evaluate progression. Progression is defined as appearance of one or more new lesions or unequivocal progression of existing non-target lesions or at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.

Secondary Outcome Measures

Name	Time	Method
Progression-free Survival by CYP2D6 Status in 3 Categories	Assessed every 3 months for 2 years, then every 6 months up to 5 years	Progression-free survival is defined as the time from registration to progression or death, whichever occurs first. Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) was used to evaluate progression. Progression is defined as appearance of one or more new lesions or unequivocal progression of existing non-target lesions or at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.
Proportion of Patients With Response	Assessed every 3 months for 2 years, then every 6 months up to 5 years	Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) was used to evaluate response. Either complete response (CR) or partial response (PR) is considered as response. CR is defined as disappearance of all lesions. PR is defined as at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Progression-free Survival From 3 Months Post Registration	Assessed every 3 months for 2 years, then every 6 months up to 5 years	This is a landmark progression-free survival analysis at 3 months post registration. Only patients who were progression-free and alive at 3 months were included. Progression-free survival in this analysis is defined as the time from 3 months post registration to progression or death, whichever occurs first. Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) was used to evaluate progression. Progression is defined as appearance of one or more new lesions or unequivocal progression of existing non-target lesions or at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.
Proportion of Patients Progression-free at 6 Months	Assessed every 3 months for 6 months	Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) was used to evaluate progression. Progression is defined as appearance of one or more new lesions or unequivocal progression of existing non-target lesions or at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm.
Endoxifen Concentration by Response	Endoxifen was assessed at cycle 3; response was assessed every 3 months for 2 years, then every 6 months up to 5 years	Endoxifen (ng/ml) was assessed at cycle 3. Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) was used to evaluate response. Either complete response (CR) or partial response (PR) is considered as response. CR is defined as disappearance of all lesions. PR is defined as at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.

Trial Locations

Locations (294): Greenebaum Cancer Center at University of Maryland Medical Center
🇺🇸
Baltimore, Maryland, United States
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
🇺🇸
Baltimore, Maryland, United States
Cleveland Clinic Cancer Center at Fairview Hospital
🇺🇸
Cleveland, Ohio, United States
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus
🇺🇸
Seattle, Washington, United States
University Cancer Center at University of Washington Medical Center
🇺🇸
Seattle, Washington, United States
CCOP - Nevada Cancer Research Foundation
🇺🇸
Las Vegas, Nevada, United States
Hennepin County Medical Center - Minneapolis
🇺🇸
Minneapolis, Minnesota, United States
Kapiolani Medical Center at Pali Momi
🇺🇸
'Aiea, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸
Honolulu, Hawaii, United States
Kauai Medical Clinic
🇺🇸
Lihue, Hawaii, United States
Cancer Research Center of Hawaii
🇺🇸
Honolulu, Hawaii, United States
Pacific Cancer Institute - Maui
🇺🇸
Wailuku, Hawaii, United States
St. Alexius Medical Center Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Straub Clinic and Hospital, Incorporated
🇺🇸
Honolulu, Hawaii, United States
Maui Memorial Medical Center
🇺🇸
Wailuku, Hawaii, United States
Cancer Center of Kansas, PA - Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Mid Dakota Clinic, PC
🇺🇸
Bismarck, North Dakota, United States
Hawaii Medical Center - East
🇺🇸
Honolulu, Hawaii, United States
Cancer Center of Kansas, PA - El Dorado
🇺🇸
El Dorado, Kansas, United States
Presbyterian - St. Luke's Medical Center
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Josephine Ford Cancer Center at Henry Ford Hospital
🇺🇸
Detroit, Michigan, United States
OnCare Hawaii, Incorporated - Kuakini
🇺🇸
Honolulu, Hawaii, United States
UVMC Cancer Care Center at Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Medical University of Ohio Cancer Center
🇺🇸
Toledo, Ohio, United States
Flower Hospital Cancer Center
🇺🇸
Sylvania, Ohio, United States
Center for Cancer Therapy at LaPorte Hospital and Health Services
🇺🇸
La Porte, Indiana, United States
Elmhurst Memorial Hospital
🇺🇸
Elmhurst, Illinois, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
Toledo Hospital
🇺🇸
Toledo, Ohio, United States
CCOP - Toledo Community Hospital
🇺🇸
Toledo, Ohio, United States
St. Anne Mercy Hospital
🇺🇸
Toledo, Ohio, United States
Toledo Clinic, Incorporated - Main Clinic
🇺🇸
Toledo, Ohio, United States
Michiana Hematology Oncology PC - Plymouth
🇺🇸
Plymouth, Indiana, United States
Cancer Center of Kansas, PA - McPherson
🇺🇸
McPherson, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas, PA - Liberal
🇺🇸
Liberal, Kansas, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
Cancer Care Associates - Norman
🇺🇸
Norman, Oklahoma, United States
Cleveland Clinic - Wooster
🇺🇸
Wooster, Ohio, United States
United States Air Force Medical Center - Wright-Patterson
🇺🇸
Wright-Patterson Air Force Base, Ohio, United States
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
🇺🇸
Philadelphia, Pennsylvania, United States
Lancaster General Hospital
🇺🇸
Lancaster, Pennsylvania, United States
Ruth G. McMillan Cancer Center at Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Cancer Center of Kansas, PA - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas, PA - Pratt
🇺🇸
Pratt, Kansas, United States
Penn State Hershey Cancer Institute at Milton S. Hershey Medical Center
🇺🇸
Hershey, Pennsylvania, United States
Sanford Cancer Center at Sanford USD Medical Center
🇺🇸
Sioux Falls, South Dakota, United States
Pottstown Memorial Regional Cancer Center
🇺🇸
Pottstown, Pennsylvania, United States
Doylestown Hospital Cancer Center
🇺🇸
Doylestown, Pennsylvania, United States
St. Mary Regional Cancer Center
🇺🇸
Langhorne, Pennsylvania, United States
Cancer Center of Kansas, PA - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas, PA - Wellington
🇺🇸
Wellington, Kansas, United States
CCOP - Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Winfield
🇺🇸
Winfield, Kansas, United States
Associates in Womens Health, PA - North Review
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Wichita
🇺🇸
Wichita, Kansas, United States
Via Christi Cancer Center at Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Barbara Ann Karmanos Cancer Institute
🇺🇸
Detroit, Michigan, United States
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
🇺🇸
Dallas, Texas, United States
Fredericksburg Oncology, Incorporated
🇺🇸
Fredericksburg, Virginia, United States
Hickman Cancer Center at Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Lakeside Cancer Specialists, PLLC
🇺🇸
Saint Joseph, Michigan, United States
Community Cancer Center of Monroe
🇺🇸
Monroe, Michigan, United States
MeritCare Bemidji
🇺🇸
Bemidji, Minnesota, United States
Borgess Medical Center
🇺🇸
Kalamazoo, Michigan, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Bronson Methodist Hospital
🇺🇸
Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Dickinson County Healthcare System
🇺🇸
Iron Mountain, Michigan, United States
Olympic Hematology and Oncology
🇺🇸
Bremerton, Washington, United States
Harrison Poulsbo Hematology and Onocology
🇺🇸
Poulsbo, Washington, United States
Mercy Memorial Hospital - Monroe
🇺🇸
Monroe, Michigan, United States
Highline Medical Center Cancer Center
🇺🇸
Burien, Washington, United States
Columbia Basin Hematology
🇺🇸
Kennewick, Washington, United States
St. Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Swedish Medical Center - Issaquah Campus
🇺🇸
Issaquah, Washington, United States
Miller - Dwan Medical Center
🇺🇸
Duluth, Minnesota, United States
Minor and James Medical, PLLC
🇺🇸
Seattle, Washington, United States
CCOP - Duluth
🇺🇸
Duluth, Minnesota, United States
Polyclinic First Hill
🇺🇸
Seattle, Washington, United States
Minnesota Oncology - Maplewood
🇺🇸
Maplewood, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸
Fridley, Minnesota, United States
HealthEast Cancer Care at St. John's Hospital
🇺🇸
Maplewood, Minnesota, United States
Immanuel St. Joseph's
🇺🇸
Mankato, Minnesota, United States
Group Health Central Hospital
🇺🇸
Seattle, Washington, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Humphrey Cancer Center at North Memorial Outpatient Center
🇺🇸
Robbinsdale, Minnesota, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
CCOP - Metro-Minnesota
🇺🇸
Saint Louis Park, Minnesota, United States
Central Care Cancer Center at Carrie J. Babb Cancer Center
🇺🇸
Bolivar, Missouri, United States
St. Francis Cancer Center at St. Francis Medical Center
🇺🇸
Shakopee, Minnesota, United States
Skaggs Cancer Center at Skaggs Regional Medical Center
🇺🇸
Branson, Missouri, United States
Evergreen Hematology and Oncology, PS
🇺🇸
Spokane, Washington, United States
Park Nicollet Cancer Center
🇺🇸
Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
St. Vincent Healthcare Cancer Care Services
🇺🇸
Billings, Montana, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Regions Hospital Cancer Care Center
🇺🇸
Saint Paul, Minnesota, United States
Wenatchee Valley Medical Center
🇺🇸
Wenatchee, Washington, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Big Sky Oncology
🇺🇸
Great Falls, Montana, United States
University of Mississippi Cancer Clinic
🇺🇸
Jackson, Mississippi, United States
Langlade Memorial Hospital
🇺🇸
Antigo, Wisconsin, United States
Goldschmidt Cancer Center
🇺🇸
Jefferson City, Missouri, United States
Mercy Clinic Cancer and Hematology - Rolla
🇺🇸
Rolla, Missouri, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Hematology-Oncology Centers of the Northern Rockies - Billings
🇺🇸
Billings, Montana, United States
St. John's Regional Health Center
🇺🇸
Springfield, Missouri, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
CCOP - Montana Cancer Consortium
🇺🇸
Billings, Montana, United States
Hulston Cancer Center at Cox Medical Center South
🇺🇸
Springfield, Missouri, United States
Green Bay Oncology, Limited at St. Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
St. Peter's Hospital
🇺🇸
Helena, Montana, United States
Gundersen Lutheran Center for Cancer and Blood
🇺🇸
La Crosse, Wisconsin, United States
Vince Lombardi Cancer Clinic - Marinette
🇺🇸
Marinette, Wisconsin, United States
Holy Family Memorial Medical Center Cancer Care Center
🇺🇸
Manitowoc, Wisconsin, United States
Cancer Resource Center - Lincoln
🇺🇸
Lincoln, Nebraska, United States
Somerset Medical Center
🇺🇸
Somerville, New Jersey, United States
Charles R. Wood Cancer Center at Glens Falls Hospital
🇺🇸
Glens Falls, New York, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Cancer Institute of New Jersey at Cooper - Voorhees
🇺🇸
Voorhees, New Jersey, United States
Lovelace Medical Center - Downtown
🇺🇸
Albuquerque, New Mexico, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Medcenter One Hospital Cancer Care Center
🇺🇸
Bismarck, North Dakota, United States
Albert Einstein Cancer Center at Albert Einstein College of Medicine
🇺🇸
Bronx, New York, United States
Fox Chase Virtua Health Cancer Program at Virtua West Jersey
🇺🇸
Voorhees, New Jersey, United States
Beth Israel Medical Center - Petrie Division
🇺🇸
New York, New York, United States
St. Luke's - Roosevelt Hospital Center - St.Luke's Division
🇺🇸
New York, New York, United States
MeritCare Broadway
🇺🇸
Fargo, North Dakota, United States
Wayne Memorial Hospital, Incorporated
🇺🇸
Goldsboro, North Carolina, United States
Kinston Medical Specialists
🇺🇸
Kinston, North Carolina, United States
D.N. Greenwald Center
🇺🇸
Mukwonago, Wisconsin, United States
CCOP - MeritCare Hospital
🇺🇸
Fargo, North Dakota, United States
Wood County Oncology Center
🇺🇸
Bowling Green, Ohio, United States
Roger Maris Cancer Center at MeritCare Hospital
🇺🇸
Fargo, North Dakota, United States
McDowell Cancer Center at Akron General Medical Center
🇺🇸
Akron, Ohio, United States
Green Bay Oncology, Limited - Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
University of South Alabama Mitchell Cancer Institute
🇺🇸
Mobile, Alabama, United States
Valley Medical Oncology Consultants - Pleasanton
🇺🇸
Pleasanton, California, United States
Aultman Cancer Center at Aultman Hospital
🇺🇸
Canton, Ohio, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸
Oshkosh, Wisconsin, United States
Case Comprehensive Cancer Center
🇺🇸
Cleveland, 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
Good Samaritan Hospital
🇺🇸
Dayton, Ohio, United States
Community Cancer Center
🇺🇸
Elyria, Ohio, United States
Camino Medical Group - Treatment Center
🇺🇸
Mountain View, California, United States
Blanchard Valley Medical Associates
🇺🇸
Findlay, Ohio, United States
CCOP - Colorado Cancer Research Program
🇺🇸
Denver, Colorado, United States
Waukesha Memorial Hospital Regional Cancer Center
🇺🇸
Waukesha, Wisconsin, United States
Charles F. Kettering Memorial Hospital
🇺🇸
Kettering, Ohio, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Cleveland Clinic Cancer Center
🇺🇸
Independence, Ohio, United States
Northwest Ohio Oncology Center
🇺🇸
Maumee, Ohio, United States
North Coast Cancer Care, Incorporated
🇺🇸
Sandusky, Ohio, United States
Riverview UW Cancer Center at Riverview Hospital
🇺🇸
Wisconsin Rapids, Wisconsin, United States
Instituto Nacional de Enfermedades Neoplasicas
🇵🇪
Lima, Peru
British Columbia Cancer Agency - Vancouver Cancer Centre
🇨🇦
Vancouver, British Columbia, Canada
Parma Community General Hospital
🇺🇸
Parma, Ohio, United States
Cleveland Clinic Foundation - Strongsville
🇺🇸
Strongsville, Ohio, United States
Cancer Care Associates - Mercy Campus
🇺🇸
Oklahoma City, Oklahoma, United States
Toledo Clinic - Oregon
🇺🇸
Oregon, Ohio, United States
OnCare Hawaii, Incorporated - Lusitana
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Institute at Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
Missouri Baptist Cancer Center
🇺🇸
Saint Louis, Missouri, United States
CCOP - Cancer Research for the Ozarks
🇺🇸
Springfield, Missouri, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Duluth Clinic Cancer Center - Duluth
🇺🇸
Duluth, Minnesota, United States
Palo Alto Medical Foundation
🇺🇸
Palo Alto, California, United States
Michiana Hematology-Oncology, PC - South Bend
🇺🇸
Mishawaka, Indiana, United States
Cleveland Clinic Taussig Cancer Center
🇺🇸
Cleveland, Ohio, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
CCOP - Dayton
🇺🇸
Dayton, Ohio, United States
Hematology Oncology Center
🇺🇸
Elyria, Ohio, United States
Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Hillcrest Cancer Center at Hillcrest Hospital
🇺🇸
Mayfield Heights, Ohio, United States
St. Charles Mercy Hospital
🇺🇸
Oregon, Ohio, United States
St. Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Island Hospital Cancer Care Center at Island Hospital
🇺🇸
Anacortes, Washington, United States
St. Joseph Cancer Center
🇺🇸
Bellingham, Washington, United States
Skagit Valley Hospital Cancer Care Center
🇺🇸
Mount Vernon, Washington, United States
Harborview Medical Center
🇺🇸
Seattle, Washington, United States
Fred Hutchinson Cancer Research Center
🇺🇸
Seattle, Washington, United States
North Puget Oncology at United General Hospital
🇺🇸
Sedro-Woolley, Washington, United States
St. Mary's Hospital Medical Center - Green Bay
🇺🇸
Green Bay, Wisconsin, United States
St. Nicholas Hospital
🇺🇸
Sheboygan, Wisconsin, United States
Green Bay Oncology, Limited - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
University of Wisconcin Cancer Center at Aspirus Wausau Hospital
🇺🇸
Wausau, Wisconsin, United States
Vince Lombardi Cancer Clinic - Two Rivers
🇺🇸
Two Rivers, Wisconsin, United States
St. James Healthcare Cancer Care
🇺🇸
Butte, Montana, United States
University of Michigan Comprehensive Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
Mayo Clinic Cancer Center
🇺🇸
Rochester, Minnesota, United States
CCOP - Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Alegant Health Cancer Center at Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Lakeside Hospital
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Green Bay Oncology, Limited - Escanaba
🇺🇸
Escanaba, Michigan, United States
Lakeland Regional Cancer Care Center - St. Joseph
🇺🇸
Saint Joseph, Michigan, United States
Willmar Cancer Center at Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Minnesota Oncology - Woodbury
🇺🇸
Woodbury, Minnesota, United States
Aurora Medical Center
🇺🇸
Summit, Wisconsin, United States
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler
🇺🇸
Savannah, Georgia, United States
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
🇺🇸
Missoula, Montana, United States
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center
🇺🇸
Green Bay, Wisconsin, United States
UAB Comprehensive Cancer Center
🇺🇸
Birmingham, Alabama, United States
Hembree Mercy Cancer Center at St. Edward Mercy Medical Center
🇺🇸
Fort Smith, Arkansas, United States
Tibotec Therapeutics - Division of Ortho Biotech Products, LP
🇺🇸
Marysville, California, United States
Mercy Cancer Center at Mercy Medical Center
🇺🇸
Merced, California, United States
St. Joseph Hospital Regional Cancer Center - Orange
🇺🇸
Orange, California, United States
University of California Davis Cancer Center
🇺🇸
Sacramento, California, United States
Aurora Presbyterian Hospital
🇺🇸
Aurora, Colorado, United States
Tahoe Forest Cancer Center
🇺🇸
Truckee, California, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Penrose Cancer Center at Penrose Hospital
🇺🇸
Colorado Springs, Colorado, United States
St. Anthony Central Hospital
🇺🇸
Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
St. Joseph Hospital
🇺🇸
Denver, Colorado, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Littleton Adventist Hospital
🇺🇸
Littleton, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center
🇺🇸
Grand Junction, Colorado, United States
Hope Cancer Care Center at Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
St. Mary - Corwin Regional Medical Center
🇺🇸
Pueblo, Colorado, United States
Parker Adventist Hospital
🇺🇸
Parker, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Yale Cancer Center
🇺🇸
New Haven, Connecticut, United States
Exempla Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
Tunnell Cancer Center at Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Middlesex Hospital Cancer Center
🇺🇸
Middletown, Connecticut, United States
CCOP - Christiana Care Health Services
🇺🇸
Newark, Delaware, United States
Lombardi Comprehensive Cancer Center at Georgetown University Medical Center
🇺🇸
Washington, District of Columbia, United States
Broward General Medical Center Cancer Center
🇺🇸
Fort Lauderdale, Florida, United States
Washington Cancer Institute at Washington Hospital Center
🇺🇸
Washington, District of Columbia, United States
Louis A. Weiss Memorial Hospital
🇺🇸
Chicago, Illinois, United States
Decatur Memorial Hospital Cancer Care Institute
🇺🇸
Decatur, Illinois, United States
La Grange Memorial Hospital
🇺🇸
La Grange, Illinois, United States
Elkhart Clinic, LLC
🇺🇸
Elkhart, Indiana, United States
St. Francis Hospital and Health Centers - Beech Grove Campus
🇺🇸
Beech Grove, Indiana, United States
West Suburban Center for Cancer Care
🇺🇸
River Forest, Illinois, United States
William N. Wishard Memorial Hospital
🇺🇸
Indianapolis, Indiana, United States
Michiana Hematology-Oncology, PC - Elkhart
🇺🇸
Elkhart, Indiana, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
Howard Community Hospital
🇺🇸
Kokomo, Indiana, United States
Cancer Center at Ball Memorial Hospital
🇺🇸
Muncie, Indiana, United States
Saint Joseph Regional Medical Center
🇺🇸
Mishawaka, Indiana, United States
Reid Hospital & Health Care Services
🇺🇸
Richmond, Indiana, United States
CCOP - Northern Indiana CR Consortium
🇺🇸
South Bend, Indiana, United States
McFarland Clinic, PC
🇺🇸
Ames, Iowa, United States
Michiana Hematology Oncology PC - La Porte
🇺🇸
Westville, Indiana, United States
Medical Oncology and Hematology Associates - West Des Moines
🇺🇸
Clive, Iowa, United States
CCOP - Iowa Oncology Research Association
🇺🇸
Des Moines, Iowa, United States
Mercy Cancer Center - West Lakes
🇺🇸
Clive, Iowa, United States
Medical Oncology and Hematology Associates at John Stoddard Cancer Center
🇺🇸
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 Mercy Cancer Center
🇺🇸
Des Moines, Iowa, United States
Mercy Cancer Center at Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Siouxland Hematology-Oncology Associates, LLP
🇺🇸
Sioux City, Iowa, United States
Mercy Medical Center - Sioux City
🇺🇸
Sioux City, Iowa, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
St. Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Cancer Center of Kansas, PA - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas, PA - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas, PA - Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas, PA - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Care Northwest - Spokane South
🇺🇸
Spokane, Washington, United States
West Virginia University Health Sciences Center - Charleston
🇺🇸
Charleston, West Virginia, United States
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Montana Cancer Specialists at Montana Cancer Center
🇺🇸
Missoula, Montana, United States
Sletten Cancer Institute at Benefis Healthcare
🇺🇸
Great Falls, Montana, United States
Kalispell Medical Oncology at KRMC
🇺🇸
Kalispell, Montana, United States
Good Samaritan Cancer Center at Good Samaritan Hospital
🇺🇸
Kearney, Nebraska, United States
Union Hospital of Cecil County
🇺🇸
Elkton, Maryland, United States
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton
🇺🇸
Marlton, New Jersey, United States
St. Joseph's Hospital and Medical Center
🇺🇸
Paterson, New Jersey, United States
John Stoddard Cancer Center at Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Billings Clinic - Downtown
🇺🇸
Billings, Montana, United States
Southeast Cancer Center
🇺🇸
Cape Girardeau, Missouri, United States
J. Phillip Citta Regional Cancer Center at Community Medical Center
🇺🇸
Toms River, New Jersey, United States
Vince Lombardi Cancer Clinic - Sheboygan
🇺🇸
Sheboygan, Wisconsin, United States
Cleveland Clinic Beachwood Family Health and Surgery Center
🇺🇸
Beachwood, Ohio, United States
Regional Cancer Center at Oconomowoc Memorial Hospital
🇺🇸
Oconomowoc, Wisconsin, United States
University of New Mexico Cancer Center - South
🇺🇸
Las Cruces, New Mexico, United States