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A Phase III, Randomized Clinical Trial of Standard Adjuvant Endocrine Therapy +/- Chemotherapy in Patients With 1-3 Positive Nodes, Hormone Receptor-Positive and HER2-Negative Breast Cancer With Recurrence Score (RS) of 25 or Less. RxPONDER: A Clinical Trial Rx for Positive Node, Endocrine Responsive Breast Cancer

Description

Brief Summary
This randomized phase III clinical trial studies how well tamoxifen citrate, anastrozole, letrozole, or exemestane with or without chemotherapy work in treating patients with breast cancer that has spread from where it began in the breast to surrounding normal tissue (invasive). Estrogen can cause the growth of breast cancer cells. Hormone therapy, using tamoxifen citrate, may fight breast cancer by blocking the use of estrogen by the tumor cells. Aromatase inhibitors, such as anastrozole, letrozole, and exemestane, may fight breast cancer by lowering the amount of estrogen the body makes. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving tamoxifen citrate, anastrozole, letrozole, or exemestane is more effective with combination chemotherapy in treating patients with breast cancer.


Detailed Description
PRIMARY OBJECTIVE: I. To determine the effect of chemotherapy in patients with node positive breast cancer who do not have high recurrence scores (RS) by Oncotype DX. SECONDARY OBJECTIVES: I. To compare overall survival (OS), distant disease-free survival (DDFS) and local disease-free interval (LDFI) by receipt of chemotherapy or not and its interaction with RS. II. To compare the toxicity across the treatment arms. III. To perform other molecular assays or test other signatures that measure prognosis and potential benefit of chemotherapy and compare them to Oncotype DX. IV. To determine the impact of management with Oncotype DX on patient-reported anxiety (co-primary Health-Related Quality of Life [HRQL] outcome) prior to screening, after disclosure of test results, and during the randomized trial. V. To determine the impact of Oncotype DX on the initial management cost of node-positive, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. VI. To compare patient-reported utilities (e.g., quality of life [QOL]) for those randomized to chemotherapy versus no chemotherapy. VII. Using modeling and DFS information from the trial, to estimate the cost-effectiveness of management with Oncotype DX vs usual care. VIII. To determine the role of other assays as predictors of DFS, DDFS, and LDFI for patients randomized to chemotherapy versus no chemotherapy. IX. To determine the impact of treatment with chemotherapy versus no chemotherapy on patient-reported fatigue and cognitive concerns (secondary HRQL outcomes). X. To determine the impact of management with Oncotype DX on patient-reported decision conflict, perceptions regarding Oncotype DX testing, and survivor concerns prior to screening, after disclosure of test results, and during the randomized trial (secondary HRQL outcomes). XI. The presence of circulating tumor cells (CTC+) using two CTC platforms will be assessed at up to two time points to assess late recurrence in those still at risk for the primary outcome. XII. To compare clinically reported menopausal status with status categorized by serum hormone levels determined from baseline serum in women under age 55 years and to assess subsequent association with outcomes. BANKING OBJECTIVE: I. To bank specimens for future correlative studies. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM I: Patients receive a protocol-approved chemotherapy regimen based on the patient and/or physician preference. Patients then receive a protocol-approved adjuvant endocrine therapy comprising tamoxifen citrate, an aromatase inhibitor (anastrozole, letrozole, or exemestane), or both for 5-10 years in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive a protocol-approved endocrine therapy comprising tamoxifen citrate, an aromatase inhibitor (anastrozole, letrozole, or exemestane), or both for 5-10 years in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 1 year, every 6 months for 4 years, and then yearly for 15 years.

Phase

N/A

Inclusion and Exclusion Criteria

  • Patients must have a histologically confirmed diagnosis of node positive (1-3 nodes) invasive breast carcinoma with positive estrogen and/or progesterone receptor status, and negative HER-2 status; estrogen and progesterone receptor positivity must be assessed according to American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines as either estrogen receptor (ER) or progesterone receptor (PR) >= 1% positive nuclear staining; HER-2 test result negativity must be assessed as per ASCO/CAP 2013 guidelines using immunohistochemistry (IHC), in situ hybridization (ISH) or both; HER-2 is negative if a single test (or all tests) performed in a tumor specimen show: a) IHC negative (0 or 1+) or b) ISH negative using single probe or dual probe (average HER-2 copy number < 4.0 signals per cell by single probe or HER-2/CEP ration < 2.0 with an average copy number < 4.0 signals per cell by dual probe); if HER-2 IHC is 2+, evaluation for gene amplification (ISH) must be performed and the ISH must be negative; ISH is not required if IHC is 0 or 1+; HER-2 equivocal is not eligible
  • Patients with multifocal, multicentric and synchronous bilateral breast cancers are allowed
  • Multifocal disease is defined as more than one invasive cancer < 2 cm from the largest lesion within the same breast quadrant; (NOTE: the Oncotype DX testing must be completed on the largest lesion)
  • Multicentric disease is defined as more than one invasive cancer >= 2 cm from the largest lesion within the same breast quadrant or more than one lesion in different quadrants (NOTE: Oncotype DX testing should be completed on all tumors and the determination for eligibility should be made on the highest recurrence score)
  • Synchronous bilateral disease is defined as invasive breast cancer with positive lymph nodes (axillary or intramammary) in at least one breast, diagnosed within 30 days of each other; (NOTE: the Oncotype DX testing should be completed on both tumors and the tumor with the highest recurrence score should be used)
  • Patients will have undergone axillary staging by sentinel node biopsy or axillary lymph nodes dissection (ALND); patients must have at least one, but no more than three known positive lymph nodes (pN1a, pN1b or pN1c); patients with micrometastases as the only nodal involvement (pN1mi) are not eligible; patients with positive sentinel node are not required to undergo full axillary lymph node dissection; this is at the discretion of the treating physician; axillary node evaluation is to be performed per the standard of care at each institution
  • Patients with a prior diagnosis of contralateral ductal carcinoma in situ (DCIS) are eligible if they underwent a mastectomy or lumpectomy with whole breast radiation; prior partial breast irradiation, including brachytherapy, is not allowed; patients with a prior diagnosis of ipsilateral DCIS or invasive breast cancer who received radiation to that breast are not eligible
  • Patients must have had either breast-conserving surgery with planned radiation therapy or total mastectomy (with or without planned postmastectomy radiation); patients must have clear margins from both invasive breast cancer and DCIS (as per local institutional guidelines); lobular carcinoma in situ (LCIS) at the margins is allowed
  • Registration of patients who have not yet undergone Oncotype DX screening must occur no later than 56 days after definitive surgery; (for all patients, Step 2 Registration must occur within 84 days after definitive surgery); if the Oncotype DX Breast Cancer Assay has not been performed, patients must be willing to submit tissue samples for testing to determine the Recurrence Score value; a representative block or unstained sections from the representative block are sent directly to Genomic Health for Oncotype DX Breast Cancer Assay which will be performed according to the standard commercial process
  • If the Oncotype DX Recurrence Score is already known and is 25 or less, the patient must be registered to Step 2 immediately following Step 1 registration; if the Oncotype DX Recurrence Score is already known and is greater than 25, the patient is ineligible
  • Patients must be females >= 18 years of age. As the Oncotype DX recurrence score has not been validated in men with breast cancer, men are not eligible for this study
  • Patients must have a complete history and physical examination within 28 days prior to registration
  • Patients must have a performance status of 0-2 by Zubrod criteria
  • Patients must be able to receive taxane and/or anthracycline based chemotherapy
  • Patients must not have received an aromatase inhibitor (AI) or a selective estrogen receptor modulator (SERM) such as tamoxifen or raloxifene within 5 years prior to registration
  • No other prior malignancy is allowed except for adequately treated basal cell (or squamous cell) skin cancer, in situ cervical cancer, or other cancer for which the patient has been disease-free for 5 years
  • The Quality of Life and Economic Substudy is permanently closed to accrual effective 12/1/12; patients who consented to QOL prior to 12/1/12 should continue to complete QOL forms per their expectation report; patients who are able to complete a questionnaire in English must be offered the opportunity to participate in the Quality of Life and Economic Substudy; (The Quality of Life and Economic Substudy is available to U.S. INSTITUTIONS ONLY); patients who are not able to complete a questionnaire in English are registered to S1007 without participating in the Quality of Life and Economic Substudy
  • Patients who consent to participate in the Quality of Life and Economic Substudy and who do not yet know the results of their Oncotype DX screening must agree to complete the S1007 Health-Related Quality of Life Questionnaire: Enrollment between 14 days prior to and 7 days after Step 1 Registration
  • Patients who consent to participate in the Quality of Life and Economic Substudy and who do already know their Oncotype DX Recurrence Score (and it is 25 or less) will proceed to Step 2 Registration without completing the S1007 Health-Related Quality of Life Questionnaire Enrollment Form (but will complete the S1007 Health-Related Quality of Life Questionnaire: Randomized Study Form)
  • Patients or their legally authorized representative must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines; for Step 1 registration of patients who have not yet submitted specimens for the Oncotype DX Breast Cancer Assay, the appropriate consent form is the Step 1 Consent Form; for both Step 1 and Step 2 registration of patients whose Recurrence Score is already known and is 25 or less, the appropriate consent form is the Step 2 Consent Form
  • As a part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system
  • STEP 2 REGISTRATION
  • Recurrence score (RS) by Oncotype DX must be =< 25
  • Step 2 Registration must take place within 84 days after definitive surgery; patients must not have begun chemotherapy or endocrine therapy for their breast cancer prior to randomization
  • Patients randomized to either arm may also co-enroll in phase III trials that compare local therapies, or compare systemic therapies (such as chemotherapy, if randomized to Arm I of S1007)
  • The Quality of Life and Economic Substudy is permanently closed to accrual effective 12/1/12; patients at U.S. INSTITUTIONS who consent to participate in the Quality of Life and Economic Substudy must agree to complete the S1007 Health-Related Quality of Life Questionnaire: Randomized Study Form after Recurrence Score results and randomized treatment status are known but before treatment has been initiated
  • Patients or their legally authorized representative must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines; for all patients the appropriate consent form for this registration is the Step 2 Consent
  • STEP 3 REGISTRATION CBALR TM Substudy
  • Patients must be disease-free, with no prior invasive recurrence at time of registration to Step 3
  • Patients must be registered to Step 3 no more than 8 years after randomization (Step 2 Registration) and must agree to have samples drawn within 28 days after registration to Step 3
  • Patients must agree to have blood samples collected at up to 3 timepoints: 1) within 28 days after registration to Step 3, 2) 2-3 years after time of registration to Step 3, and 3) At time of invasive recurrence (if applicable). Patients must also agree to have tissue submitted at time of invasive recurrence (if applicable) from the invasive recurrence biopsy (where tissue is available)

  • Patients must not have inflammatory breast cancer and must not have metastatic disease
  • Patients must not have begun chemotherapy or endocrine therapy for their breast cancer prior to registration
  • Patients must not require chronic treatment with systemic steroids (inhaled steroids are allowed) or other immunosuppressive agents
  • Patients must not be pregnant or nursing; women of reproductive potential must have agreed to use an effective contraceptive method; a woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months; in addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation; however, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures

Sites

  • California

    • USC / Norris Comprehensive Cancer Center, Los Angeles, California, 90033
    • Los Angeles County-USC Medical Center, Los Angeles, California, 90033
    • Kaiser Permanente, Los Angeles, California, 90027
    • Keck Medical Center of USC Pasadena, Pasadena, California, 91105
    • Cedars-Sinai Medical Center, Los Angeles, California, 90048
    • Presbyterian Intercommunity Hospital, Whittier, California, 90602
    • City of Hope Comprehensive Cancer Center, Duarte, California, 91010
    • Northridge Hospital Medical Center, Northridge, California, 91325
    • Olive View-University of California Los Angeles Medical Center, Sylmar, California, 91342
    • Saint Joseph Hospital - Orange, Orange, California, 92868
    • Desert Regional Medical Center, Palm Springs, California, 92262
    • Sharp Memorial Hospital, San Diego, California, 92123
    • UC San Diego Moores Cancer Center, La Jolla, California, 92093
    • Kaiser Permanente-Mission, San Diego, California, 92108
    • California Cancer Center - North Fresno, Fresno, California, 93720
    • Mercy UC Davis Cancer Center, Merced, California, 95340
    • Salinas Valley Memorial, Salinas, California, 93901
    • Memorial Medical Center, Modesto, California, 95355
    • Palo Alto Medical Foundation-Camino Division, Mountain View, California, 94040
    • Palo Alto Medical Foundation-Gynecologic Oncology, Mountain View, California, 94040
    • Washington Hospital, Fremont, California, 94538
    • Stanford University Hospitals and Clinics, Stanford, California, 94305
    • Epic Care-Dublin, Dublin, California, 94568
    • East Bay Medical Oncology Hematology Medical Associates-Antioch, Antioch, California, 94531
    • East Bay Medical Oncology Hematology Associates Inc, San Leandro, California, 94578
    • Mills - Peninsula Hospitals, Burlingame, California, 94010
    • John Muir Medical Center, Walnut Creek, California, 94598
    • Diablo Valley Oncology and Hematology Medical Group-Pleasant Hill, Pleasant Hill, California, 94523
    • John Muir Medical Center-Concord Campus, Concord, California, 94520
    • Alta Bates Summit Medical Center-Herrick Campus, Berkeley, California, 94704
    • University of California Davis Comprehensive Cancer Center, Sacramento, California, 95817
    • Sutter General Hospital, Sacramento, California, 95816
    • Northbay Cancer Center, Fairfield, California, 94533
    • Sutter Roseville Medical Center, Roseville, California, 95661
    • Sutter Davis Hospital, Davis, California, 95616
    • Sutter Cancer Research Consortium, Novato, California, 94945
    • Sutter Auburn Faith Hospital, Auburn, California, 95602
    • Sutter Pacific Medical Foundation, Santa Rosa, California, 95403
    • Fremont - Rideout Cancer Center, Marysville, California, 95901
  • Nevada

    • Children's Specialty Center of Nevada II, Las Vegas, Nevada, 89109
  • Utah

    • Dixie Medical Center Regional Cancer Center, Saint George, Utah, 84770
    • Sandra L Maxwell Cancer Center, Cedar City, Utah, 84720
    • Utah Valley Regional Medical Center, Provo, Utah, 84604
    • American Fork Hospital, American Fork, Utah, 84003
    • American Fork Hospital / Huntsman Intermountain Cancer Center, American Fork, Utah, 84003
    • Intermountain Medical Center, Murray, Utah, 84157
    • Utah Cancer Specialists-Salt Lake City, Salt Lake City, Utah, 84106
    • LDS Hospital, Salt Lake City, Utah, 84143
    • Huntsman Cancer Institute/University of Utah, Salt Lake City, Utah, 84112
    • McKay-Dee Hospital Center, Ogden, Utah, 84403
    • Logan Regional Hospital, Logan, Utah, 84321
  • Arizona

    • Pinnacle Oncology Hematology, Scottsdale, Arizona, 85258
  • Idaho

    • Saint Luke's Mountain States Tumor Institute-Twin Falls, Twin Falls, Idaho, 83301
    • Saint Luke's Mountain States Tumor Institute - Nampa, Nampa, Idaho, 83686
    • Saint Luke's Mountain States Tumor Institute - Meridian, Meridian, Idaho, 83642
    • Saint Luke's Mountain States Tumor Institute, Boise, Idaho, 83712
    • Saint Luke's Mountain States Tumor Institute - Fruitland, Fruitland, Idaho, 83619
  • Oregon

    • Rogue Valley Medical Center, Medford, Oregon, 97504
    • Providence Medford Medical Center, Medford, Oregon, 97504
    • Three Rivers Community Hospital, Grants Pass, Oregon, 97527
    • Saint Charles Medical Center-Bend, Bend, Oregon, 97701
    • Good Samaritan Hospital, Corvallis, Oregon, 97330
    • Legacy Meridian Park Hospital, Tualatin, Oregon, 97062
    • Legacy Mount Hood Medical Center, Gresham, Oregon, 97030
    • Oregon Health and Science University, Portland, Oregon, 97239
    • SWOG, Portland, Oregon, 97239
    • Legacy Good Samaritan Hospital and Medical Center, Portland, Oregon, 97210
  • Colorado

    • Montrose Memorial Hospital, Montrose, Colorado, 81401
    • San Luis Valley Regional Medical Center, Alamosa, Colorado, 81101
    • The Shaw Regional Cancer Center, Edwards, Colorado, 81632
    • Denver Veterans Administration Medical Center, Denver, Colorado, 80220
    • University of Colorado Cancer Center - Anschutz Cancer Pavilion, Aurora, Colorado, 80045
  • New Mexico

    • University of New Mexico at Lovelace Medical Center, Albuquerque, New Mexico, 87102
    • University of New Mexico, Albuquerque, New Mexico, 87106
    • Presbyterian Kaseman Hospital, Albuquerque, New Mexico, 87110
    • Memorial Medical Center - Las Cruces, Las Cruces, New Mexico, 88011
    • New Mexico Cancer Care Associates, Santa Fe, New Mexico, 87505
  • Texas

    • Texas Technology University, El Paso, Texas, 79905
    • Covenant Medical Center-Lakeside, Lubbock, Texas, 79410
    • Texas Tech University Health Sciences Center, Lubbock, Texas, 79430
    • Cancer Therapy and Research Center at The UT Health Science Center at San Antonio, San Antonio, Texas, 78229
    • University Hospital, San Antonio, Texas, 78229
    • University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78229
    • Audie L Murphy Veterans Affairs Hospital, San Antonio, Texas, 78209
    • Baylor All Saints Medical Center at Fort Worth, Fort Worth, Texas, 76104
    • Scott and White Memorial Hospital, Temple, Texas, 76508
    • Baylor Medical Center at Irving, Irving, Texas, 75061
    • Parkland Memorial Hospital, Dallas, Texas, 75235
    • Dallas VA Medical Center, Dallas, Texas, 75216
    • University of Texas Southwestern Medical Center, Dallas, Texas, 75390
    • Saint Joseph Regional Cancer Center, Bryan, Texas, 77802
    • Blood and Cancer Center of East Texas, Tyler, Texas, 75701
    • Methodist Hospital, Houston, Texas, 77030
    • Baylor College of Medicine, Houston, Texas, 77030
    • M D Anderson Cancer Center, Houston, Texas, 77030
  • Washington

    • Providence Saint Mary Regional Cancer Center, Walla Walla, Washington, 99362
    • Compass Oncology Vancouver, Vancouver, Washington, 98684
    • Legacy Salmon Creek Hospital, Vancouver, Washington, 98686
    • Kadlec Clinic Hematology and Oncology, Kennewick, Washington, 99336
    • North Star Lodge Cancer Center at Yakima Valley Memorial Hospital, Yakima, Washington, 98902
    • Madigan Army Medical Center, Tacoma, Washington, 98431
    • Saint Elizabeth Hospital, Enumclaw, Washington, 98022
    • MultiCare Good Samaritan Hospital, Puyallup, Washington, 98372
    • Saint Clare Hospital, Lakewood, Washington, 98499
    • Northwest Medical Specialties PLLC, Tacoma, Washington, 98405
    • Franciscan Research Center-Northwest Medical Plaza, Tacoma, Washington, 98405
    • Saint Francis Hospital, Federal Way, Washington, 98003
    • Highline Medical Center-Main Campus, Burien, Washington, 98166
    • Pacific Medical Center-First Hill, Seattle, Washington, 98104
    • Virginia Mason Medical Center, Seattle, Washington, 98101
    • Group Health, Seattle, Washington, 98109
    • EvergreenHealth Medical Center, Kirkland, Washington, 98033
  • Nebraska

    • Regional West Medical Center, Scottsbluff, Nebraska, 69361
    • Great Plains Regional Medical Center, North Platte, Nebraska, 69103
    • Heartland Hematology and Oncology, Kearney, Nebraska, 68845
    • Saint Francis Medical Center, Grand Island, Nebraska, 68803
    • Faith Regional Medical Offices West, Norfolk, Nebraska, 68701
    • Southeast Nebraska Hematology and Oncology Consultants, P.C, Lincoln, Nebraska, 68510
    • Nebraska Cancer Research Center, Lincoln, Nebraska, 68510
    • Saint Elizabeth Regional Medical Center, Lincoln, Nebraska, 68510
    • Alegent Health Lakeside Hospital, Omaha, Nebraska, 68130
    • University of Nebraska Medical Center, Omaha, Nebraska, 68198
    • Midlands Community Hospital, Papillion, Nebraska, 68046
    • Alegent Health Bergan Mercy Medical Center, Omaha, Nebraska, 68124
    • Alegent Health Immanuel Medical Center, Omaha, Nebraska, 68122
    • Hemotology and Oncology Consultants PC, Omaha, Nebraska, 68122
    • Missouri Valley Cancer Consortium, Omaha, Nebraska, 68106
  • Montana

    • Northern Montana Hospital, Havre, Montana, 59501
  • Oklahoma

    • Cancer Care Associates-Norman, Norman, Oklahoma, 73071
    • Mercy Clinic Oncology and Hematology-Ardmore, Ardmore, Oklahoma, 73401
  • Kansas

    • Via Christi Regional Medical Center, Wichita, Kansas, 67214
    • Olathe Medical Center, Olathe, Kansas, 66061
    • Kansas City Cancer Center-Shawnee Mission, Shawnee Mission, Kansas, 66204
  • South Dakota

    • Conklin Regional Cancer Center, Aberdeen, South Dakota, 57401
    • Sanford Cancer Center-Oncology Clinic, Sioux Falls, South Dakota, 57104
  • North Dakota

    • Trinity Cancer Care Center, Minot, North Dakota, 58701
  • Iowa

    • Heartland Oncology and Hematology LLP, Council Bluffs, Iowa, 51503
    • Alegent Health Mercy Hospital, Council Bluffs, Iowa, 51503
    • Mercy Medical Center-West Lakes, West Des Moines, Iowa, 50266
    • Medical Oncology and Hematology Associates-West Des Moines, Clive, Iowa, 50325
    • Medical Oncology and Hematology Associates-Laurel, Des Moines, Iowa, 50314
    • Iowa Oncology Research Association CCOP, Des Moines, Iowa, 50309
    • Medical Oncology and Hematology Associates-Des Moines, Des Moines, Iowa, 50309
    • Iowa Lutheran Hospital, Des Moines, Iowa, 50316
  • Missouri

    • North Kansas City Hospital, Kansas City, Missouri, 64116
    • University of Missouri - Ellis Fischel, Columbia, Missouri, 65212
    • Washington University School of Medicine, Saint Louis, Missouri, 63110
    • Saint Louis University Hospital, Saint Louis, Missouri, 63110
    • Southeast Cancer Center, Cape Girardeau, Missouri, 63703
  • Louisiana

    • Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, 71103
    • Christus Saint Frances Cabrini Hospital, Alexandria, Louisiana, 71301
    • Baton Rouge General Medical Center, Baton Rouge, Louisiana, 70806
    • Hematology/Oncology Clinic LLP, Baton Rouge, Louisiana, 70809
    • West Jefferson Medical Center, Marrero, Louisiana, 70072
  • Minnesota

    • New Ulm Medical Center, New Ulm, Minnesota, 56073
    • Medini, Eitan MD (UIA Investigator), Alexandria, Minnesota, 56308
    • Mayo Clinic Health Systems-Mankato, Mankato, Minnesota, 56001
    • Mayo Clinic, Rochester, Minnesota, 55905
  • Arkansas

    • NEA Baptist Memorial Hospital, Jonesboro, Arkansas, 72401
    • Fowler Family Center for Cancer Care, Jonesboro, Arkansas, 72401
  • Wisconsin

    • Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, 54601
    • Marshfield Clinic Cancer Center at Sacred Heart, Eau Claire, Wisconsin, 54701
    • Marshfield Clinic-Rice Lake Center, Rice Lake, Wisconsin, 54868
    • Marshfield Clinic-Chippewa Center, Chippewa Falls, Wisconsin, 54729
    • Marshfield Clinic, Marshfield, Wisconsin, 54449
    • University of Wisconsin Hospital and Clinics, Madison, Wisconsin, 53792
    • Marshfield Clinic - Wisconsin Rapids Center, Wisconsin Rapids, Wisconsin, 54494
    • Marshfield Clinic Cancer Care at Saint Michael's Hospital, Stevens Point, Wisconsin, 54481
    • Marshfield Clinic-Wausau Center, Wausau, Wisconsin, 54401
    • Marshfield Clinic - Weston Center, Weston, Wisconsin, 54476
    • UW Cancer Center Johnson Creek, Johnson Creek, Wisconsin, 53038
    • Marshfield Clinic-Minocqua Center, Minocqua, Wisconsin, 54548
    • Marshfield Clinic at James Beck Cancer Center, Rhinelander, Wisconsin, 54501
    • Fox Valley Hematology and Oncology, Appleton, Wisconsin, 54911
    • Wheaton Franciscan Healthcare - Saint Joseph, Milwaukee, Wisconsin, 53210
    • Columbia Saint Mary's Hospital - Ozaukee, Mequon, Wisconsin, 53097
    • Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, 53215
    • Wheaton Franciscan Cancer Care - All Saints, Racine, Wisconsin, 53405
    • Columbia Saint Mary's Water Tower Medical Commons, Milwaukee, Wisconsin, 53211
  • Illinois

    • Western Illinois Cancer Treatment Center, Galesburg, Illinois, 61401
    • Central Illinois Hematology Oncology Center, Springfield, Illinois, 62702
    • FHN Leonard C. Ferguson Cancer Center, Freeport, Illinois, 61032
    • Central Illinois CCOP, Decatur, Illinois, 62526
    • Valley Radiation Oncology, Peru, Illinois, 61354
    • Advocate Sherman Hospital, Elgin, Illinois, 60123
    • Hematology Oncology Consultants Limited, Naperville, Illinois, 60540
    • Edward Hospital/Cancer Center, Naperville, Illinois, 60540
    • UC Comprehensive Cancer Center at Silver Cross, New Lennox, Illinois, 60451
    • Presence Saint Mary's Hospital, Kankakee, Illinois, 60901
    • Hinsdale Hematology Oncology Associates Incorporated, Hinsdale, Illinois, 60521
    • North Shore Hematology Oncology, Libertyville, Illinois, 60048
    • Advocate Lutheran General Hospital., Park Ridge, Illinois, 60068
    • Resurrection Healthcare, Chicago, Illinois, 60631
    • Illinois Cancer Specialists-Niles, Niles, Illinois, 60714
    • Hematology Oncology Associates of Illinois-Highland Park, Highland Park, Illinois, 60035
    • Ingalls Memorial Hospital, Harvey, Illinois, 60426
    • Hematology Oncology Associates of Illinois - Skokie, Skokie, Illinois, 60076
    • University of Illinois, Chicago, Illinois, 60612
    • Mount Sinai Hospital Medical Center, Chicago, Illinois, 60608
    • University of Chicago Comprehensive Cancer Center, Chicago, Illinois, 60637
    • Northwestern University, Chicago, Illinois, 60611
  • Tennessee

    • University of Tennessee Health Science Center, Memphis, Tennessee, 38163
    • Nashville Breast Center, Nashville, Tennessee, 37203
    • Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, 37232
    • Vanderbilt Breast Center at One Hundred Oaks, Nashville, Tennessee, 37204
    • Vanderbilt-Ingram Cancer Center Cool Springs, Franklin, Tennessee, 37067
    • Cookeville Regional Medical Center, Cookeville, Tennessee, 38501
    • Erlanger Medical Center, Chattanooga, Tennessee, 37403
    • Memorial Hospital, Chattanooga, Tennessee, 37404
    • Pulmonary Medicine Center of Chattanooga-Hixson, Hixson, Tennessee, 37343
    • Memorial GYN Plus, Ooltewah, Tennessee, 37363
  • Mississippi

    • University of Mississippi Medical Center, Jackson, Mississippi, 39216
  • Kentucky

    • Baptist Health Madisonville/Merle Mahr Cancer Center, Madisonville, Kentucky, 42431
    • Owensboro Health Mitchell Memorial Cancer Center, Owensboro, Kentucky, 42303
    • Hardin Memorial Hospital, Elizabethtown, Kentucky, 42701
    • Saints Mary and Elizabeth Hospital, Louisville, Kentucky, 40215
    • The James Graham Brown Cancer Center at University of Louisville, Louisville, Kentucky, 40202
    • Jewish Hospital, Louisville, Kentucky, 40202
    • Jewish Hospital Medical Center South, Shepherdsville, Kentucky, 40165
    • Jewish Hospital Medical Center Northeast, Louisville, Kentucky, 40245
    • Flaget Memorial Hospital, Bardstown, Kentucky, 40004
    • Saint Elizabeth Medical Center South, Edgewood, Kentucky, 41017
    • Saint Joseph Radiation Oncology Resource Center, Lexington, Kentucky, 40504
    • Baptist Health Lexington, Lexington, Kentucky, 40503
    • University of Kentucky/Markey Cancer Center, Lexington, Kentucky, 40536
    • Saint Luke Hospital, Fort Thomas, Kentucky, 41075
    • Saint Joseph Hospital East, Lexington, Kentucky, 40509
  • Alabama

    • University of South Alabama Mitchell Cancer Institute, Mobile, Alabama, 36688
    • Gulf Coast MBCCOP, Mobile, Alabama, 36604
    • University of Alabama at Birmingham, Birmingham, Alabama, 35233
    • Northeast Alabama Regional Medical Center, Anniston, Alabama, 36202
  • Indiana

    • Porter Memorial Hospital, Valparaiso, Indiana, 46383
    • IU Health Arnett Cancer Care, Lafayette, Indiana, 47904
    • Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, 46202
    • IU Health Central Indiana Cancer Centers-East, Indianapolis, Indiana, 46219
    • Saint Joseph Regional Medical Center-Mishawaka, Mishawaka, Indiana, 46545
    • IU Health Ball Memorial Hospital, Muncie, Indiana, 47303
    • Fort Wayne Medical Oncology and Hematology Inc-Parkview, Fort Wayne, Indiana, 46845
  • Michigan

    • Michiana Hematology Oncology PC-Niles, Niles, Michigan, 49120
    • McLaren-Central Michigan, Mount Pleasant, Michigan, 48858
  • Florida

    • Sacred Heart Medical Oncology Group - Davis Highway, Pensacola, Florida, 32514
    • Sacred Heart Hospital, Pensacola, Florida, 32504
  • Ohio

    • TriHealth Cancer Institute-Westside, Cincinnati, Ohio, 45247
    • Good Samaritan Hospital - Cincinnati, Cincinnati, Ohio, 45220
    • The Christ Hospital, Cincinnati, Ohio, 45219
    • Bethesda North Hospital, Cincinnati, Ohio, 45242
    • TriHealth Cancer Institute-Anderson, Cincinnati, Ohio, 45255
  • Georgia

    • Saint Joseph's Hospital of Atlanta, Atlanta, Georgia, 30342
    • Piedmont Hospital, Atlanta, Georgia, 30309
    • Grady Health System, Atlanta, Georgia, 30303
    • Emory University/Winship Cancer Institute, Atlanta, Georgia, 30322
  • Spain

    • Hospital Clinico Universitario Lozano Blesa, Zaragoza, 50009
    • Hospital Universitario Miguel Servet, Zaragoza, 50009
    • Hospital Virgen de la Salud, Toledo, 45004
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