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Clinical Trials and Studies

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EVEREST: EVErolimus for Renal Cancer Ensuing Surgical Therapy, A Phase III Study

Description

Brief Summary
RATIONALE: Everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth or by blocking blood flow to the tumor. PURPOSE: This phase III trial is studying everolimus to see how well it works in treating patients with kidney cancer who have undergone surgery.


Detailed Description
OBJECTIVES: Primary - to compare recurrence-free survival in renal carcinoma patients randomly assigned to 54 weeks of everolimus versus 54 weeks of placebo after nephrectomy or partial nephrectomy. Secondary - To compare the overall survival of patients treated with everolimus vs placebo. - To compare qualitative and quantitative toxicity between the two study arms. - To bank tissue and biologic specimens for future study of molecular biomarkers relevant to the AKT/mTOR and other pathways implicated in the pathogenesis of renal carcinoma and to investigate their potential predictive and prognostic value. - To bank blood specimens for the future study of the relationship between steady-state trough levels of everolimus and relevant side effects (lymphopenia, infection, hyperglycemia, hypercholesterolemia, hypertriglyceridemia) in patients treated on this study with everolimus. OUTLINE: This is a multicenter study. Patients are stratified according to pathologic stage (intermediate high-risk vs very high-risk), histologic subtype (clear cell vs non-clear cell), and performance status (0 vs 1). Patients are randomized to 1 of 2 treatment arms. - Arm I: Patients receive oral everolimus once daily on days 1-42. Treatment repeats every 6 weeks for 9 courses in the absence of disease progression or unacceptable toxicity. - Arm II: Patients receive oral placebo once daily on days 1-42. Treatment repeats every 6 weeks for 9 courses in the absence of disease progression or unacceptable toxicity. Archived tumor tissue, plasma, and whole blood samples may be collected periodically for biomarker analysis and other translational studies. After completion of study treatment, patients are followed up every 6 months for 2 years and then annually for 8 years.

Phase

Phase 3 - a treatment has shown activity against a particular disease, where it is either added to existing treatment or compared to the standard treatment.

Inclusion and Exclusion Criteria

  • Histologically or cytologically confirmed renal cell carcinoma
  • Clear cell or non-clear cell allowed
  • No disease of the collecting duct or medullary carcinoma
  • Considered pathologically either intermediate high-risk or very high-risk disease
  • No history of distant metastases
  • Patients with microvascular invasion of the renal vein of any grade or stage (as long as M0) are eligible
  • Have undergone a full surgical resection (radical nephrectomy or partial nephrectomy) including removal of all clinically positive nodes
  • Surgical margins must be negative
  • Patients with positive renal vein margins are eligible unless there is invasion of the renal vein wall at the margin (provided no other margins are positive)
  • Patients must be registered within 84 days after the date of the first surgical resection of the first tumor
  • No evidence of residual or metastatic renal cell cancer on CT scan of the chest, abdomen, and pelvis (all with oral and IV contrast) performed after nephrectomy and within 28 days before registration
  • MRI scans of the abdomen and pelvis with gadolinium and a non-contrast CT scan of the chest may be substituted if the patient is not able to have CT scans with IV contrast PATIENT CHARACTERISTICS:
  • Zubrod performance status 0-1
  • ANC ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Serum creatinine ≤ 2.0 times upper limit of normal (ULN) OR calculated creatinine clearance ≥ 30 mL/min
  • Bilirubin ≤ 1.5 times ULN
  • SGOT and SGPT ≤ 2.5 times ULN
  • Not pregnant or nursing
  • Fertile patients must use effective contraception during and for up to 8 weeks after completion of study treatment
  • Able to take oral medications
  • Patients must not have any of the following:
  • NYHA class III-IV cardiac disease (i.e., patients with cardiac disease resulting in marked limitation of physical activity or resulting in inability to carry on any physical activity without discomfort)
  • Unstable angina pectoris
  • Myocardial infarction within the past 6 months
  • Serious uncontrolled cardiac arrhythmia
  • Patients must NOT have liver disease such as cirrhosis or severe hepatic impairment (Child-Pugh Class C)
  • HBV and HCV testing are required at screening for all patients with a positive medical history based on risk factors and/or confirmation of prior HBV/HCV infection
  • Must be able to take oral medications
  • No impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of everolimus (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection)
  • No known history of HIV seropositivity
  • No known uncontrolled, underlying pulmonary disease (spirometry and DLCO ≤ 50% of predicted OR oxygen saturation ≤ 88% at rest on room air)
  • No uncontrolled hyperlipidemia (fasting serum cholesterol > 300 mg/dL AND fasting triglycerides > 2.5 times ULN) obtained within 28 days prior to registration
  • Optimal lipid control must be achieved before registration and monitored during protocol treatment
  • No uncontrolled diabetes mellitus (defined by fasting serum glucose > 1.5 times ULN) obtained within 28 days prior to registration.
  • Optimal glucose control must be achieved before registration and monitored during protocol treatment
  • No prior malignancies except for any of the following:
  • Adequately treated basal cell or squamous cell skin cancer
  • In situ cervical cancer
  • Adequately treated stage I or stage II cancer from which the patient is currently in complete remission
  • Any other cancer from which the patient has been disease-free for 5 years
  • No known hypersensitivity to everolimus or other rapamycins (sirolimus, temsirolimus) or to their excipients
  • No contraindications to receiving either IV iodine-based contrast or gadolinium PRIOR CONCURRENT THERAPY:
  • See Disease Characteristics
  • Patients must have recovered from any surgery-related complications
  • No prior anticancer therapy for renal cell carcinoma including systemic therapy in the adjuvant or neoadjuvant setting, immunotherapy, investigational therapy, surgical metastasectomy, or radiotherapy
  • More than 14 days since prior and no concurrent strong CYP3A4 inhibitors (i.e., ketoconazole, itraconazole, voriconazole, posaconazole, fluvoxamine, nefazodone, nelfinavir, or ritonavir) or strong CYP3A4 inducers (i.e., phenytoin, rifampin, or rifabutin)
  • More than 7 days since prior and no concurrent live vaccines
  • No other concurrent anticancer agents including investigational agents
  • No concurrent chronic treatment with systemic steroids or another immunosuppressive agent
  • Topical or inhaled corticosteroids are allowed

Sites

  • California

    • Kaiser Permanente Medical Center - Los Angeles, Los Angeles, California, 90027
    • Glendale Memorial Hospital Comprehensive Cancer Center, Glendale, California, 91204
    • Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, Los Angeles, California, 90048
    • Kaiser Foundation Hospital - West Los Angeles, Los Angeles, California, 90034
    • Ruby L. Golleher Cancer Program at Presbyterian Intercommunity Hospital, Whittier, California, 90602
    • Kaiser Permanente Medical Center - Bellflower, Bellflower, California, 90706
    • Kaiser Permanente Medical Center - Baldwin Park, Baldwin Park, California, 91706
    • Kaiser Permanente Medical Group, Panorama City, California, 91402
    • Kaiser Permanente Medical Center - Harbor City, Harbor City, California, 90710
    • Virginia K. Crosson Cancer Center at St. Jude Medical Center, Fullerton, California, 92835
    • Kaiser Permanente Medical Cener - Woodland Hills, Woodland Hills, California, 91367
    • Kaiser Permanente Medical Center - Anaheim/Orange County, Anaheim, California, 92807
    • Kaiser Permanente - Irvine, Irvine, California, 92618
    • Kaiser Permanente Medical Center - Riverside, Riverside, California, 92505
    • Kaiser Permanente Medical Center - Fontana, Fontana, California, 92335
    • Kaiser Permanente Health Care, San Marcos, California, 92078
    • Lucy Curci Cancer Center at Eisenhower Memorial Hospital and Medical Center, Rancho Mirage, California, 92270
    • Kaiser Permanente Medical Center - Kaiser Foundation Hospital - San Diego, San Diego, California, 92120
    • Memorial Medical Center, Modesto, California, 95355
    • El Camino Hospital Cancer Center, Mountain View, California, 94040
    • Valley Medical Oncology, Fremont, California, 94538
    • Washington Township Hospital, Fremont, California, 94538
    • Valley Medical Oncology Consultants - Pleasanton, Pleasanton, California, 94588
    • East Bay Radiation Oncology Center, Castro Valley, California, 94546
    • Valley Medical Oncology Consultants - Castro Valley, Castro Valley, California, 94546
    • Peninsula Medical Center, Burlingame, California, 94010
    • Highland General Hospital, Oakland, California, 94602
    • Epic Care - Oakland, Oakland, California, 94612
    • Tom K Lee, Incorporated, Oakland, California, 94609
    • Alta Bates Summit Medical Center - Summit Campus, Oakland, California, 94609
    • Larry G Strieff MD Medical Corporation, Oakland, California, 94609
    • CCOP - Bay Area Tumor Institute, Oakland, California, 94609
    • Bay Area Breast Surgeons, Incorporated, Oakland, California, 94609
    • Alta Bates Summit Comprehensive Cancer Center, Berkeley, California, 94704
    • California Pacific Medical Center - California Campus, San Francisco, California, 94118
    • Doctors Medical Center - San Pablo Campus, San Pablo, California, 94806
    • Sutter Cancer Center, Sacramento, California, 95816
    • North Bay Cancer Center, Fairfield, California, 94533
    • Sutter Solano Medical Center, Vallejo, California, 94589
    • Sutter Cancer Center at Roseville Medical Center, Roseville, California, 95661
    • Sutter Health - Western Division Cancer Research Group, Novato, California, 94945
    • Tahoe Forest Cancer Center, Truckee, California, 96161
    • Sutter Pacific Medical Foundation, Santa Rosa, California, 95403
    • Tibotec Therapeutics - Division of Ortho Biotech Products, LP, Marysville, California, 95901
  • Nevada

    • University Medical Center of Southern Nevada, Las Vegas, Nevada, 89102
    • Sunrise Hospital and Medical Center, Las Vegas, Nevada, 89109
    • CCOP - Nevada Cancer Research Foundation, Las Vegas, Nevada, 89106
    • Renown Institute for Cancer at Renown Regional Medical Center, Reno, Nevada, 89502
  • Arizona

    • Arizona Cancer Center at UMC Orange Grove, Tucson, Arizona, 85704
    • Arizona Cancer Center at University Medical Center North, Tucson, Arizona, 85719
  • Utah

    • Huntsman Cancer Institute at University of Utah, Salt Lake City, Utah, 84112
  • Oregon

    • Dubs Cancer Center at Rogue Valley Medical Center, Medford, Oregon, 97504
    • Providence Cancer Center at PMCC, Medford, Oregon, 97504
    • Three Rivers Community Hospital, Grants Pass, Oregon, 97527
    • St. Charles Medical Center - Bend, Bend, Oregon, 97701
    • Bay Area Hospital, Coos Bay, Oregon, 97420
    • Legacy Meridian Park Hospital, Tualatin, Oregon, 97062
    • Legacy Mount Hood Medical Center, Gresham, Oregon, 97030
    • Legacy Good Samaritan Hospital & Comprehensive Cancer Center, Portland, Oregon, 97210
    • Kaiser Permanente Health Care - Portland, Portland, Oregon, 97227
  • Colorado

    • St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center, Grand Junction, Colorado, 81502
    • Montrose Memorial Hospital Cancer Center, Montrose, Colorado, 81401
    • Valley View Hospital Cancer Center, Glenwood Springs, Colorado, 81601
    • San Luis Valley Regional Medical Center, Alamosa, Colorado, 81101
    • Shaw Regional Cancer Center, Edwards, Colorado, 81632
    • St. Mary - Corwin Regional Medical Center, Pueblo, Colorado, 81004
    • Memorial Hospital Cancer Center - Colorado Springs, Colorado Springs, Colorado, 80909
    • Exempla Lutheran Medical Center, Wheat Ridge, Colorado, 80033
    • Littleton Adventist Hospital, Littleton, Colorado, 80122
    • St. Anthony Central Hospital, Denver, Colorado, 80204
    • Sky Ridge Medical Center, Lone Tree, Colorado, 80124
    • Presbyterian - St. Luke's Medical Center, Denver, Colorado, 80218
    • St. Joseph Hospital, Denver, Colorado, 80218
    • Rose Medical Center, Denver, Colorado, 80220
    • Aurora Presbyterian Hospital, Aurora, Colorado, 80012
    • Hope Cancer Care Center at Longmont United Hospital, Longmont, Colorado, 80501
    • University of Colorado Cancer Center at UC Health Sciences Center, Aurora, Colorado, 80045
    • Parker Adventist Hospital, Parker, Colorado, 80138
    • Front Range Cancer Specialists, Fort Collins, Colorado, 80528
    • Poudre Valley Hospital, Fort Collins, Colorado, 80524
    • North Colorado Medical Center, Greeley, Colorado, 80631
  • New Mexico

    • Hematology Oncology Associates, PC, Albuquerque, New Mexico, 87106
    • Presbyterian Cancer Treatment Center at Presbyterian Kaseman Hospital, Albuquerque, New Mexico, 87110
  • Washington

    • Legacy Salmon Creek Medical Center, Vancouver, Washington, 98686
    • Columbia Basin Hematology, Kennewick, Washington, 99336
    • North Star Lodge Cancer Center at Yakima Valley Memorial Hospital, Yakima, Washington, 98902
    • Madigan Army Medical Center - Tacoma, Tacoma, Washington, 98431
    • Good Samaritan Cancer Center, Puyallup, Washington, 98372
    • St. Clare Hospital, Tacoma, Washington, 98499
    • MultiCare Regional Cancer Center at Tacoma General Hospital, Tacoma, Washington, 98405
    • CCOP - Northwest, Tacoma, Washington, 98405
    • Allenmore Hospital, Tacoma, Washington, 98405
    • St. Francis Hospital, Federal Way, Washington, 98003
    • Cancer Care Northwest - Spokane South, Spokane, Washington, 99202
    • University Cancer Center at University of Washington Medical Center, Seattle, Washington, 98195
    • Evergreen Hematology and Oncology, PS, Spokane, Washington, 99218
    • Highline Medical Center Cancer Center, Burien, Washington, 98166
    • Swedish Medical Center - Issaquah Campus, Issaquah, Washington, 98029
    • Overlake Cancer Center at Overlake Hospital Medical Center, Bellevue, Washington, 98004
    • Pacific Medical Center, Seattle, Washington, 98104
    • Harborview Medical Center, Seattle, Washington, 98104
    • Polyclinic First Hill, Seattle, Washington, 98122
    • Virginia Mason Medical Center, Seattle, Washington, 98101
    • CCOP - Virginia Mason Research Center, Seattle, Washington, 98101
    • Group Health Central Hospital, Seattle, Washington, 98112
    • Fred Hutchinson Cancer Research Center, Seattle, Washington, 98109
    • Olympic Hematology and Oncology, Bremerton, Washington, 98310
    • Cascade Cancer Center at Evergreen Hospital Medical Center, Kirkland, Washington, 98033
    • Harrison Poulsbo Hematology and Onocology, Poulsbo, Washington, 98370
    • Providence Regional Cancer Partnership, Everett, Washington, 98201
    • Skagit Valley Hospital Cancer Care Center, Mount Vernon, Washington, 98274
    • North Puget Oncology at United General Hospital, Sedro-Woolley, Washington, 98284
    • Island Hospital Cancer Care Center at Island Hospital, Anacortes, Washington, 98221
    • St. Joseph Cancer Center, Bellingham, Washington, 98225
  • Idaho

    • St. Joseph Regional Medical Center, Lewiston, Idaho, 83501
  • Montana

    • St. James Healthcare Cancer Care, Butte, Montana, 59701
    • Bozeman Deaconess Cancer Center, Bozeman, Montana, 59715
    • Montana Cancer Center at St. Patrick Hospital and Health Sciences Center, Missoula, Montana, 59807
    • St. Peter's Hospital, Helena, Montana, 59601
    • Hematology-Oncology Centers of the Northern Rockies - Billings, Billings, Montana, 59102
    • CCOP - Montana Cancer Consortium, Billings, Montana, 59101
    • St. Vincent Healthcare Cancer Care Services, Billings, Montana, 59101
    • Sletten Cancer Institute at Benefis Healthcare, Great Falls, Montana, 59405
    • Great Falls Clinic - Main Facility, Great Falls, Montana, 59405
    • Kalispell Regional Medical Center, Kalispell, Montana, 59901
    • Kalispell Medical Oncology at KRMC, Kalispell, Montana, 59901
    • Glacier Oncology, PLLC, Kalispell, Montana, 59901
  • Wyoming

    • Rocky Mountain Oncology, Casper, Wyoming, 82609
  • Kansas

    • Cancer Center of Kansas, PA - Liberal, Liberal, Kansas, 67901
    • Cancer Center of Kansas, PA - Dodge City, Dodge City, Kansas, 67801
    • Hays Medical Center, Hays, Kansas, 67601
    • Cancer Center of Kansas, PA - Pratt, Pratt, Kansas, 67124
    • St. Rose Ambulatory and Surgery Center, Great Bend, Kansas, 67530
    • Cancer Center of Kansas, PA - Kingman, Kingman, Kansas, 67068
    • Hutchinson Hospital Corporation, Hutchinson, Kansas, 67502
    • Cancer Center of Kansas, PA - McPherson, McPherson, Kansas, 67460
    • Cancer Center of Kansas, PA - Wellington, Wellington, Kansas, 67152
    • Tammy Walker Cancer Center at Salina Regional Health Center, Salina, Kansas, 67401
    • Cancer Center of Kansas, PA - Salina, Salina, Kansas, 67401
    • CCOP - Wichita, Wichita, Kansas, 67214
    • Cancer Center of Kansas, PA - Wichita, Wichita, Kansas, 67214
    • Via Christi Cancer Center at Via Christi Regional Medical Center, Wichita, Kansas, 67214
    • Associates in Womens Health, PA - North Review, Wichita, Kansas, 67208
    • Cancer Center of Kansas, PA - Medical Arts Tower, Wichita, Kansas, 67208
    • Cancer Center of Kansas, PA - Newton, Newton, Kansas, 67114
    • Cancer Center of Kansas, PA - Winfield, Winfield, Kansas, 67156
    • Cancer Center of Kansas, PA - El Dorado, El Dorado, Kansas, 67042
    • Cancer Center of Kansas-Independence, Independence, Kansas, 67301
    • St. Francis Comprehensive Cancer Center, Topeka, Kansas, 66606
    • Cotton-O'Neil Cancer Center, Topeka, Kansas, 66606
    • Cancer Center of Kansas, PA - Chanute, Chanute, Kansas, 66720
    • Cancer Center of Kansas, PA - Parsons, Parsons, Kansas, 67357
    • Lawrence Memorial Hospital, Lawrence, Kansas, 66044
    • Mount Carmel Regional Cancer Center, Pittsburg, Kansas, 66762
    • Cancer Center of Kansas - Fort Scott, Fort Scott, Kansas, 66701
    • Providence Medical Center, Kansas City, Kansas, 66112
    • Kansas City Cancer Centers - West, Kansas City, Kansas, 66112
    • Saint Luke's Hospital - South, Overland Park, Kansas, 66213
    • Kansas City Cancer Centers - Southwest, Overland Park, Kansas, 66210
    • Kansas City Cancer Center - Shawnee Mission, Shawnee Mission, Kansas, 66204
    • Menorah Medical Center, Overland Park, Kansas, 66209
    • CCOP - Kansas City, Prairie Village, Kansas, 66208
  • South Dakota

    • Rapid City Regional Hospital, Rapid City, South Dakota, 57701
    • Oncology Services of Aberdeen, Aberdeen, South Dakota, 57401
    • Avera Cancer Institute, Sioux Falls, South Dakota, 57105
  • Oklahoma

    • Cancer Centers of Southwest Oklahoma, LLC - Lawton, Lawton, Oklahoma, 73505
    • Cancer Care Associates - Mercy Campus, Oklahoma City, Oklahoma, 73120
    • Oklahoma University Cancer Institute, Oklahoma City, Oklahoma, 73104
    • Cancer Care Associates - Norman, Norman, Oklahoma, 73071
    • Natalie Warren Bryant Cancer Center at St. Francis Hospital, Tulsa, Oklahoma, 74136
  • Texas

    • University Hospital - San Antonio, San Antonio, Texas, 78229
    • Cancer Therapy and Research Center, San Antonio, Texas, 78229
    • Veterans Affairs Medical Center - San Antonio (Murphy), San Antonio, Texas, 78209
    • CCOP - Scott and White Hospital, Temple, Texas, 76508
    • Methodist Hospital, Houston, Texas, 77030
    • St. Luke's Texas Cancer Institute at St. Luke's Episcopal Hospital, Houston, Texas, 77030
    • Baylor University Medical Center - Houston, Houston, Texas, 77030
    • Ben Taub General Hospital, Houston, Texas, 77030
  • North Dakota

    • Medcenter One Hospital Cancer Care Center, Bismarck, North Dakota, 58501
    • Mid Dakota Clinic, PC, Bismarck, North Dakota, 58501
    • St. Alexius Medical Center Cancer Center, Bismarck, North Dakota, 58502
    • CCOP - MeritCare Hospital, Fargo, North Dakota, 58122
    • Roger Maris Cancer Center at MeritCare Hospital, Fargo, North Dakota, 58122
    • MeritCare Broadway, Fargo, North Dakota, 58102
    • Altru Cancer Center at Altru Hospital, Grand Forks, North Dakota, 58201
  • Iowa

    • St. Luke's Regional Medical Center, Sioux City, Iowa, 51104
    • Mercy Medical Center - Sioux City, Sioux City, Iowa, 51102
    • Medical Oncology and Hematology Associates - West Des Moines, Clive, Iowa, 50325
    • Mercy Cancer Center - West Lakes, Clive, Iowa, 50325
    • Medical Oncology and Hematology Associates at Mercy Cancer Center, Des Moines, Iowa, 50314
    • Mercy Cancer Center at Mercy Medical Center - Des Moines, Des Moines, Iowa, 50314
    • CCOP - Iowa Oncology Research Association, Des Moines, Iowa, 50309
    • Medical Oncology and Hematology Associates at John Stoddard Cancer Center, Des Moines, Iowa, 50309
    • John Stoddard Cancer Center at Iowa Lutheran Hospital, Des Moines, Iowa, 50316
    • Iowa Blood and Cancer Care, Cedar Rapids, Iowa, 52402
    • St. Luke's Hospital, Cedar Rapids, Iowa, 52402
    • Mercy Regional Cancer Center at Mercy Medical Center, Cedar Rapids, Iowa, 52403
    • Cedar Rapids Oncology Associates, Cedar Rapids, Iowa, 52403
    • Genesis Regional Cancer Center at Genesis Medical Center, Davenport, Iowa, 52803
  • Missouri

    • Freeman Cancer Institute at Freeman Health System, Joplin, Missouri, 64804
    • Saint Joseph Oncology, Incorporated, Saint Joseph, Missouri, 64507
    • Heartland Regional Medical Center, Saint Joseph, Missouri, 64506
    • Kansas City Cancer Centers - North, Kansas City, Missouri, 64154
    • Saint Luke's Cancer Institute at Saint Luke's Hospital, Kansas City, Missouri, 64111
    • Kansas City Cancer Centers - South, Kansas City, Missouri, 64131
    • Truman Medical Center - Hospital Hill, Kansas City, Missouri, 64108
    • Research Medical Center, Kansas City, Missouri, 64132
    • North Kansas City Hospital, Kansas City, Missouri, 64116
    • Heartland Hematology Oncology Associates, Incorporated, Kansas City, Missouri, 64118
    • Parvin Radiation Oncology, Liberty, Missouri, 64068
    • Kansas City Cancer Centers - East, Lee's Summit, Missouri, 64064
    • Saint Luke's East - Lee's Summit, Lee's Summit, Missouri, 64086
    • CCOP - Cancer Research for the Ozarks, Springfield, Missouri, 65802
    • Hulston Cancer Center at Cox Medical Center South, Springfield, Missouri, 65807
    • St. John's Regional Health Center, Springfield, Missouri, 65804
    • Goldschmidt Cancer Center, Jefferson City, Missouri, 65109
    • Phelps County Regional Medical Center, Rolla, Missouri, 65401
    • Mercy Clinic Cancer and Hematology - Rolla, Rolla, Missouri, 65401
    • Saint Luke's Hospital, Chesterfield, Missouri, 63017
    • CCOP - St. Louis-Cape Girardeau, Saint Louis, Missouri, 63141
    • David C. Pratt Cancer Center at St. John's Mercy, Saint Louis, Missouri, 63141
    • Missouri Baptist Cancer Center, Saint Louis, Missouri, 63131
    • Midwest Hematology Oncology Group, Incorporated, Saint Louis, Missouri, 63109
    • Saint Louis University Cancer Center, Saint Louis, Missouri, 63110
    • Saint Francis Medical Center, Cape Girardeau, Missouri, 63703
    • Southeast Cancer Center, Cape Girardeau, Missouri, 63703
  • Louisiana

    • Highland Clinic, Shreveport, Louisiana, 71105
    • Louisiana State University Health Sciences Center - Monroe, Monroe, Louisiana, 71210
    • MBCCOP - LSU Health Sciences Center, New Orleans, Louisiana, 70112
    • Medical Center of Louisiana - New Orleans, New Orleans, Louisiana, 70112
  • Minnesota

    • Willmar Cancer Center at Rice Memorial Hospital, Willmar, Minnesota, 56201
    • New Ulm Medical Center, New Ulm, Minnesota, 56073
    • Hutchinson Area Health Care, Hutchinson, Minnesota, 55350
    • Ridgeview Medical Center, Waconia, Minnesota, 55387
    • Coborn Cancer Center, Saint Cloud, Minnesota, 56303
    • CentraCare Clinic - River Campus, Saint Cloud, Minnesota, 56303
    • St. Francis Cancer Center at St. Francis Medical Center, Shakopee, Minnesota, 55379
    • Fairview Southdale Hospital, Edina, Minnesota, 55435
    • Fairview Ridges Hospital, Burnsville, Minnesota, 55337
    • CCOP - Metro-Minnesota, Saint Louis Park, Minnesota, 55416
    • Park Nicollet Cancer Center, Saint Louis Park, Minnesota, 55416
    • St. Joseph's Medical Center, Brainerd, Minnesota, 56401
    • Virginia Piper Cancer Institute at Abbott - Northwestern Hospital, Minneapolis, Minnesota, 55407
    • Veterans Affairs Medical Center - Minneapolis, Minneapolis, Minnesota, 55417
    • Hennepin County Medical Center - Minneapolis, Minneapolis, Minnesota, 55415
    • Mercy and Unity Cancer Center at Mercy Hospital, Coon Rapids, Minnesota, 55433
    • Mercy and Unity Cancer Center at Unity Hospital, Fridley, Minnesota, 55432
    • MeritCare Bemidji, Bemidji, Minnesota, 56601
    • United Hospital, Saint Paul, Minnesota, 55102
    • Regions Hospital Cancer Care Center, St. Paul, Minnesota, 55101
    • Minnesota Oncology - Maplewood, Maplewood, Minnesota, 55109
    • HealthEast Cancer Care at St. John's Hospital, Maplewood, Minnesota, 55109
    • Minnesota Oncology - Woodbury, Woodbury, Minnesota, 55125
    • Lakeview Hospital, Stillwater, Minnesota, 55082
    • CCOP - Duluth, Duluth, Minnesota, 55805
    • Miller - Dwan Medical Center, Duluth, Minnesota, 55805
  • Arkansas

    • Arkansas Cancer Research Center at University of Arkansas for Medical Sciences, Little Rock, Arkansas, 72205
  • Illinois

    • Illinois CancerCare - Carthage, Carthage, Illinois, 62321
    • Memorial Hospital, Carthage, Illinois, 62321
    • McDonough District Hospital, Macomb, Illinois, 61455
    • Illinois CancerCare - Macomb, Macomb, Illinois, 61455
    • Illinois CancerCare - Monmouth, Monmouth, Illinois, 61462
    • OSF Holy Family Medical Center, Monmouth, Illinois, 61462
    • Illinois CancerCare - Galesburg, Galesburg, Illinois, 61401
    • Galesburg Clinic, PC, Galesburg, Illinois, 61401
    • Mason District Hospital, Havana, Illinois, 62644
    • Illinois CancerCare - Havana, Havana, Illinois, 62644
    • Illinois CancerCare - Canton, Canton, Illinois, 61520
    • Graham Hospital, Canton, Illinois, 61520
    • Illinois CancerCare - Kewanee Clinic, Kewanee, Illinois, 61443
    • Cancer Treatment Center at Pekin Hospital, Pekin, Illinois, 61554
    • Oncology Hematology Associates of Central Illinois, PC - Peoria, Peoria, Illinois, 61615
    • CCOP - Illinois Oncology Research Association, Peoria, Illinois, 61615
    • Methodist Medical Center of Illinois, Peoria, Illinois, 61636
    • OSF St. Francis Medical Center, Peoria, Illinois, 61637
    • Proctor Hospital, Peoria, Illinois, 61614
    • Illinois CancerCare - Pekin, Pekin, Illinois, 61603
    • Perry Memorial Hospital, Princeton, Illinois, 61356
    • Illinois CancerCare - Princeton, Princeton, Illinois, 61356
    • Illinois CancerCare - Eureka, Eureka, Illinois, 61530
    • Eureka Community Hospital, Eureka, Illinois, 61530
    • Good Samaritan Regional Health Center, Mount Vernon, Illinois, 62864
    • Illinois CancerCare - Spring Valley, Spring Valley, Illinois, 61362
    • Decatur Memorial Hospital Cancer Care Institute, Decatur, Illinois, 62526
    • St. Joseph Medical Center, Bloomington, Illinois, 61701
    • Illinois CancerCare - Bloomington, Bloomington%, Illinois, 61701
    • Illinois CancerCare - Peru, Peru, Illinois, 61354
    • Illinois Valley Community Hospital, Peru, Illinois, 61354
    • Mid-Illinois Hematology-Oncology Associates at Community Cancer Center, Normal, Illinois, 61761
    • Illinois CancerCare - Community Cancer Center, Normal, Illinois, 61761
    • BroMenn Regional Medical Center, Normal, Illinois, 61761
    • Community Cancer Center, Normal, Illinois, 61761
    • Community Hospital of Ottawa, Ottawa, Illinois, 61350
    • Oncology Hematology Associates of Central Illinois, PC - Ottawa, Ottawa, Illinois, 61350
    • CCOP - Carle Cancer Center, Urbana, Illinois, 61801
    • Delnor Hospital - Geneva, Geneva, Illinois, 60134
    • Rush-Copley Cancer Care Center, Aurora, Illinois, 60504
    • Central Dupage Cancer Center, Warrenville, Illinois, 60555
    • Edward Hospital Cancer Center, Naperville, Illinois, 60540
    • Provena St. Mary's Regional Cancer Center - Kankakee, Kankakee, Illinois, 60901
    • La Grange Memorial Hospital, La Grange, Illinois, 60525
    • Veterans Affairs Medical Center - Hines, Hines, Illinois, 60141
    • Resurrection Medical Center, Chicago, Illinois, 60631
  • Wisconsin

    • Gundersen Lutheran Center for Cancer and Blood, La Crosse, Wisconsin, 54601
    • Center for Cancer Treatment & Prevention at Sacred Heart Hospital, Eau Claire, Wisconsin, 54701
    • Marshfield Clinic Cancer Care at Regional Cancer Center, Eau Claire, Wisconsin, 54701
    • Marshfield Clinic - Indianhead Center, Rice Lake, Wisconsin, 54868
    • Saint Joseph's Hospital, Marshfield, Wisconsin, 54449
    • Marshfield Clinic - Marshfield Center, Marshfield, Wisconsin, 54449
    • Dean Medical Center - Madison, Madison, Wisconsin, 53717
    • Riverview UW Cancer Center at Riverview Hospital, Wisconsin Rapids, Wisconsin, 54494
    • Marshfield Clinic - Wisconsin Rapids Center, Wisconsin Rapids, Wisconsin, 54494
    • Marshfield Clinic at Saint Michael's Hospital, Stevens Point, Wisconsin, 54481
    • Saint Michael's Hospital Cancer Center, Stevens Point, Wisconsin, 54481
    • University of Wisconcin Cancer Center at Aspirus Wausau Hospital, Wausau, Wisconsin, 54401
    • Marshfield Clinic - Weston Center, Weston, Wisconsin, 54476
    • Diagnostic and Treatment Center, Weston, Wisconsin, 54476
    • UW Cancer Center Johnson Creek, Johnson Creek, Wisconsin, 53038
    • Marshfield Clinic - Lakeland Center, Minocqua, Wisconsin, 54548
    • Aurora Medical Center, Summit, Wisconsin, 53066
    • Ministry Medical Group at Saint Mary's Hospital, Rhinelander, Wisconsin, 54501
    • Langlade Memorial Hospital, Antigo, Wisconsin, 54409
    • Oncology Alliance, SC - Milwaukee - West, Wauwatosa, Wisconsin, 53226
    • Wheaton Franciscan Cancer Care - St. Joseph, Milwaukee, Wisconsin, 53210
    • St. Mary's Hospital Medical Center - Green Bay, Green Bay, Wisconsin, 54303
    • Green Bay Oncology, Limited at St. Mary's Hospital, Green Bay, Wisconsin, 54303
    • Green Bay Oncology, Limited - Oconto Falls, Oconto Falls, Wisconsin, 54154
    • St. Nicholas Hospital, Sheboygan, Wisconsin, 53081
    • Vince Lombardi Cancer Clinic - Sheboygan, Sheboygan, Wisconsin, 53081
    • Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center, Green Bay, Wisconsin, 54311
    • Vince Lombardi Cancer Clinic - Two Rivers, Two Rivers, Wisconsin, 54241
    • Vince Lombardi Cancer Clinic - Marinette, Marinette, Wisconsin, 54143
    • Bay Area Cancer Care Center at Bay Area Medical Center, Marinette, Wisconsin, 54143
    • Green Bay Oncology, Limited - Sturgeon Bay, Sturgeon Bay, Wisconsin, 54235
  • Mississippi

    • University of Mississippi Cancer Clinic, Jackson, Mississippi, 39216
  • Indiana

    • Suniti Medical Corporation, Merrillville, Indiana, 46410
    • Saint Anthony Memorial Health Centers, Michigan City, Indiana, 46360
    • Veterans Affairs Medical Center - Indianapolis, Indianapolis, Indiana, 46202
    • St. Francis Hospital and Health Centers - Beech Grove Campus, Beech Grove, Indiana, 46107
    • Reid Hospital & Health Care Services, Richmond, Indiana, 47374
  • Michigan

    • Dickinson County Healthcare System, Iron Mountain, Michigan, 49801
    • Green Bay Oncology, Limited - Escanaba, Escanaba, Michigan, 49431
    • Mercy General Health Partners, Muskegon, Michigan, 49444
    • Bronson Methodist Hospital, Kalamazoo, Michigan, 49007
    • Borgess Medical Center, Kalamazoo, Michigan, 49001
    • Lacks Cancer Center at Saint Mary's Health Care, Grand Rapids, Michigan, 49503
    • CCOP - Grand Rapids, Grand Rapids, Michigan, 49503
    • Butterworth Hospital at Spectrum Health, Grand Rapids, Michigan, 49503
    • Mecosta County Medical Center, Big Rapids, Michigan, 49307
    • Battle Creek Health System Cancer Care Center, Battle Creek, Michigan, 49017
    • Spectrum Health Reed City Hospital, Reed City, Michigan, 49677
    • Munson Medical Center, Traverse City, Michigan, 49684
    • Foote Memorial Hospital, Jackson, Michigan, 49201
  • Alabama

    • UAB Comprehensive Cancer Center, Birmingham, Alabama, 35294
  • Tennessee

    • Erlanger Cancer Center at Erlanger Hospital - Baroness, Chattanooga, Tennessee, 37403
  • Ohio

    • Wayne Hospital, Greenville, Ohio, 45331
    • Charles M. Barrett Cancer Center at University Hospital, Cincinnati, Ohio, 45267
    • Precision Radiotherapy at University Pointe, West Chester, Ohio, 45069
    • Samaritan North Cancer Care Center, Dayton, Ohio, 45415
    • Good Samaritan Hospital, Dayton, Ohio, 45406
    • Grandview Hospital, Dayton, Ohio, 45405
    • David L. Rike Cancer Center at Miami Valley Hospital, Dayton, Ohio, 45409
    • Charles F. Kettering Memorial Hospital, Kettering, Ohio, 45429
    • Fulton County Health Center, Wauseon, Ohio, 43567
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