Combination Chemotherapy Before or After Surgery in Treating Patients With Colorectal Cancer With Liver Metastases That Could Be Removed By Surgery

Last updated: May 8, 2013
Sponsor: NSABP Foundation Inc
Overall Status: Terminated

Phase

3

Condition

Metastatic Cancer

Colorectal Cancer

Rectal Cancer

Treatment

N/A

Clinical Study ID

NCT01189227
NSABP C-11
NSABP-C-11
  • Ages > 18
  • All Genders

Study Summary

RATIONALE: Drugs used in chemotherapy work in different ways to kill tumor cells or stop them from growing. Giving combination chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving combination chemotherapy after surgery may kill any remaining tumor cells. It is not yet known whether giving combination chemotherapy before and after surgery is more effective than giving combination chemotherapy after surgery.

PURPOSE: This randomized phase III trial is studying giving combination chemotherapy before and after surgery to see how well it works compared to giving combination chemotherapy after surgery in treating patients with colorectal cancer with liver metastases that could be removed by surgery.

Eligibility Criteria

Inclusion

DISEASE CHARACTERISTICS:

  • Histologically confirmed colorectal adenocarcinoma

  • Hepatic metastasis (no histologic confirmation required) and no evidence of extrahepatic metastatic disease within the past 4 weeks by one of the following imaging studies*:

  • PET/CT scan with contrast

  • PET scan AND CT scan with contrast

  • PET scan AND MRI with contrast

  • PET/CT scan without contrast AND MRI with contrast NOTE: *If findings noted in imaging study reports are equivocal, the determination of whether or not the findings represent extrahepatic disease will be at the investigator's discretion.

  • No history of or concurrent evidence of extrahepatic metastases

  • Patients with regional nodes that are suspicious on imaging and are associated with the primary colorectal tumor are eligible provided the nodes will be resected with the primary tumor after randomization

  • No radiographic evidence of metastases to portal lymph nodes (node > 1 cm in diameter) unless the node(s) are proven by biopsy to be negative

  • No anal, small bowel, or appendiceal carcinoma

  • No sarcoma, lymphoma, or carcinoid colorectal malignant diseases

  • Within 4 weeks before randomization, the liver metastases must be determined by a hepatic surgeon to be resectable based on meeting both of the following criteria:

  • A complete resection can be performed in a single operation

  • There are ≥ 2 uninvolved contiguous segments of the liver

  • Meets one of the following criteria:

  • Primary tumor and regional nodes resected with clear surgical margins and no evidence of extrahepatic disease

  • Unresected primary tumor with plans to resect the primary tumor before randomization

  • Unresected primary tumor with plans to resect the primary tumor and the liver metastases in a single surgical procedure performed after randomization

  • No unresected primary tumor in the colon or rectum with significant symptoms related to obstruction or that will require radiotherapy

PATIENT CHARACTERISTICS:

  • Eastern Cooperative Oncology Group (ECOG) performance status 0-1

  • Life expectancy ≥ 5 years (excluding the diagnosis of metastatic CRC)

  • absolute neutrophil count (ANC) ≥ 1,200/mm^3

  • Platelet count ≥ 100,000/mm^3

  • Hemoglobin ≥ 10 g/dL

  • Total bilirubin ≤ upper limit of normal (ULN)

  • aspartate aminotransferase (AST) ≤ 5.0 times ULN

  • Alkaline phosphatase ≤ 5.0 times ULN

  • Serum creatinine ≤ ULN OR calculated creatinine clearance ≥ 30 mL/min

  • Not pregnant or nursing

  • Negative pregnancy test

  • Fertile patients must use effective contraception during and for ≥ 180 days after completion of study treatment

  • Considered a potential candidate for a major hepatic surgical procedure

  • No grade 3 or 4 anorexia, grade 3 nausea, or vomiting ≥ grade 2 (per CTCAE v4.0) related to metastatic disease

  • No paresthesias, peripheral sensory neuropathy, or peripheral motor neuropathy ≥ grade 2 per Common Toxicity Criteria for Adverse Effects (CTCAE) v4.0 (patients with grade 2 neuropathy who will receive FOLFIRI are eligible)

  • No uncontrolled high BP defined as systolic BP ≥ 160 mm Hg OR diastolic BP ≥ 100 mm Hg, with or without antihypertensive medication (patients with initial BP elevations are eligible provided initiation or adjustment of BP medication lowers pressure to meet this criteria)

  • Documented history of congestive heart failure requiring chronic medical therapy

  • No active inflammatory bowel disease

  • No active infection or chronic infection requiring chronic suppressive antibiotics

  • No known bleeding diathesis or coagulopathy

  • No symptomatic interstitial pneumonitis OR definitive evidence of interstitial pneumonitis described on CT scan, MRI, or chest x-ray in asymptomatic patients

  • No other malignancies unless the patient is considered to be disease-free and has completed therapy for the malignancy ≥ 1 year ago

  • Patients with carcinoma in situ of the cervix, CRC in situ, melanoma in situ, or basal cell or squamous cell carcinoma of the skin diagnosed and treated at any time before study treatment are eligible

  • No known Gilbert syndrome

  • Not known to be homozygous for the UGT1A1 allele (for patients who will receive FOLFIRI chemotherapy)

  • No prior serious hypersensitivity reaction to any of the agents administered as part of study treatment (determination of "serious" is at the investigator's discretion)

  • No other serious concurrent medical condition that, in the opinion of the investigator, would compromise the safety of the patient or compromise the patient's ability to participate in the study, or cause a delay in the initiation of therapy (surgery or chemotherapy) longer than 4 weeks following randomization

  • No psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude the patient from meeting the study requirements

  • No pre-existing chronic hepatic disease (e.g., chronic active hepatitis, cirrhosis) that, in the opinion of the investigator and hepatic surgeon, would limit the patient's ability to undergo hepatic metastasectomy

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics

  • No previous hepatic-directed therapy, including hepatic resection and/or ablation, hepatic arterial infusion therapy, or hepatic radiotherapy

  • Patients who have only had an incision or excisional biopsy are eligible

  • No previous chemotherapy or any other systemic therapy for metastatic colorectal cancer (CRC)

  • No prior or concurrent portal vein embolization or other hepatic preconditioning techniques

  • At least 30 days since prior investigational products

  • No intent to use ablation to treat any hepatic lesion

  • No concurrent therapeutic doses of coumadin or equivalent

Study Design

Total Participants: 9
Study Start date:
August 01, 2010
Estimated Completion Date:
December 31, 2011

Study Description

OBJECTIVES:

Primary

  • To evaluate the difference in recurrence-free survival (RFS) of patients with potentially resectable hepatic colorectal metastases receiving perioperative (preoperative plus postoperative) adjuvant chemotherapy vs only postoperative adjuvant chemotherapy following liver resection for colorectal metastases.

Secondary

  • To compare the proportion of patients between study arms who are R0 or R1 resected, alive, and free of recurrence at 6 months.

  • To compare RFS between study arms in the cohort of patients event-free at 6 months.

  • To compare overall survival between study arms.

  • To evaluate the difference in R0 and combined R0 + R1 resection rates in patients receiving neoadjuvant therapy and those undergoing initial surgical resection.

  • To compare the postoperative morbidity profile between study arms.

  • To evaluate the safety and toxicity profile of postoperative and perioperative administration of chemotherapy and bevacizumab.

Tertiary

  • To evaluate the relationship of baseline circulating tumor cells (CTC) to RFS.

  • To evaluate the relationship of baseline CTC to R0 resection.

  • To evaluate the relationship of pre-resection CTC in the preoperative therapy group only with RFS and R0 resection.

OUTLINE: This is a multicenter study. Patients are stratified by number of liver metastases (1-3 vs 4+), chemotherapy regimen* (mFOLFOX6 vs FOLFIRI), and synchronous** primary colorectal cancer (yes vs no). Patients are randomized to 1 of 2 treatment arms.

NOTE: *Patients who have not received previous oxaliplatin receive mFOLFOX6 chemotherapy comprising oxaliplatin IV over 2 hours, leucovorin calcium IV over 2 hours, and fluorouracil IV over 46 hours on day 1. Patients who have received previous oxaliplatin receive FOLFIRI chemotherapy comprising irinotecan hydrochloride IV over 2 hours, leucovorin calcium IV over 2 hours, and fluorouracil IV over 46 hours on day 1.

NOTE: **Synchronous is defined as the detection (by imaging) of suspicious liver metastases within 90 days before or after the date of histologic diagnosis of the primary colon or rectal cancer.

  • Arm 1 (postoperative): Patients undergo hepatic resection. Beginning 31-56 days after surgery, patients receive mFOLFOX6 or FOLFIRI chemotherapy IV on day 1 over 3 hours. Patients receive an additional dose of fluorouracil over 46 hours using a portable pump. Treatment repeats every 2 weeks for 12 courses.

  • Arm 2 (perioperative): Patients receive mFOLFOX6 or FOLFIRI chemotherapy IV over 3 hours on day 1. Patients receive an additional dose of fluorouracil over 46 hours using a portable pump. Treatment repeats for every 2 weeks for 6 courses. Patients then undergo hepatic resection. Beginning 31-56 days after surgery, patients receive an additional 6 courses of mFOLFOX6 or FOLFIRI chemotherapy.

Blood and tumor tissue samples may be collected periodically for correlative studies.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Connect with a study center

  • Kaiser Permanente - Deer Valley

    Antioch, California 94531
    United States

    Site Not Available

  • City of Hope Comprehensive Cancer Center

    Duarte, California 91010-3000
    United States

    Site Not Available

  • Kaiser Permanente - Fremont

    Fremont, California 94538
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Hayward

    Hayward, California 94545
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Oakland

    Oakland, California 94611
    United States

    Site Not Available

  • St. Joseph Hospital Regional Cancer Center - Orange

    Orange, California 92868
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Redwood City

    Redwood City, California 94063
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Richmond

    Richmond, California 94801
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Roseville

    Roseville, California 95661
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Sacramento

    Sacramento, California 95825
    United States

    Site Not Available

  • South Sacramento Kaiser-Permanente Medical Center

    Sacramento, California 95823
    United States

    Site Not Available

  • Kaiser Permanente Medical Office -Vandever Medical Office

    San Diego, California 92120
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - San Francisco Geary Campus

    San Francisco, California 94115
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Santa Teresa

    San Jose, California 95119
    United States

    Site Not Available

  • Kaiser Foundation Hospital - San Rafael

    San Rafael, California 94903
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Santa Clara Kiely Campus

    Santa Clara, California 95051
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Santa Rosa

    Santa Rosa, California 95403
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - South San Francisco

    South San Francisco, California 94080
    United States

    Site Not Available

  • Kaiser Permanente Medical Facility - Stockton

    Stockton, California 95210
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Vacaville

    Vacaville, California 95688
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Vallejo

    Vallejo, California 94589
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Walnut Creek

    Walnut Creek, California 94596
    United States

    Site Not Available

  • University of Colorado Cancer Center at UC Health Sciences Center

    Aurora, Colorado 80045
    United States

    Site Not Available

  • Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center

    Hartford, Connecticut 06105
    United States

    Site Not Available

  • Manchester Memorial Hospital

    Manchester, Connecticut 06040
    United States

    Site Not Available

  • Tunnell Cancer Center at Beebe Medical Center

    Lewes, Delaware 19958
    United States

    Site Not Available

  • CCOP - Christiana Care Health Services

    Newark, Delaware 19713
    United States

    Site Not Available

  • Washington Cancer Institute at Washington Hospital Center

    Washington, District of Columbia 20010
    United States

    Site Not Available

  • Baptist Cancer Institute - Jacksonville

    Jacksonville, Florida 32207
    United States

    Site Not Available

  • Lakeland Regional Cancer Center at Lakeland Regional Medical Center

    Lakeland, Florida 33805
    United States

    Site Not Available

  • Florida Hospital Cancer Institute at Florida Hospital Orlando

    Orlando, Florida 32803-1273
    United States

    Site Not Available

  • Veterans Affairs Medical Center - Atlanta (Decatur)

    Decatur, Georgia 30033
    United States

    Site Not Available

  • Kaiser Permanente - Moanalua Medical Center and Clinic

    Honolulu, Hawaii 96819
    United States

    Site Not Available

  • Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center

    Boise, Idaho 83706
    United States

    Site Not Available

  • St. Joseph Medical Center

    Bloomington, Illinois 61701
    United States

    Site Not Available

  • Graham Hospital

    Canton, Illinois 61520
    United States

    Site Not Available

  • Memorial Hospital

    Carthage, Illinois 62321
    United States

    Site Not Available

  • Decatur Memorial Hospital Cancer Care Institute

    Decatur, Illinois 62526
    United States

    Site Not Available

  • Eureka Community Hospital

    Eureka, Illinois 61530
    United States

    Site Not Available

  • Galesburg Clinic, PC

    Galesburg, Illinois 61401
    United States

    Site Not Available

  • Mason District Hospital

    Havana, Illinois 62644
    United States

    Site Not Available

  • Hinsdale Hematology Oncology Associates

    Hinsdale, Illinois 60521
    United States

    Site Not Available

  • McDonough District Hospital

    Macomb, Illinois 61455
    United States

    Site Not Available

  • BroMenn Regional Medical Center

    Normal, Illinois 61761
    United States

    Site Not Available

  • Community Cancer Center

    Normal, Illinois 61761
    United States

    Site Not Available

  • Advocate Christ Medical Center

    Oak Lawn, Illinois 60453-2699
    United States

    Site Not Available

  • Community Hospital of Ottawa

    Ottawa, Illinois 61350
    United States

    Site Not Available

  • Cancer Treatment Center at Pekin Hospital

    Pekin, Illinois 61554
    United States

    Site Not Available

  • CCOP - Illinois Oncology Research Association

    Peoria, Illinois 61615
    United States

    Site Not Available

  • Methodist Medical Center of Illinois

    Peoria, Illinois 61636
    United States

    Site Not Available

  • OSF St. Francis Medical Center

    Peoria, Illinois 61637
    United States

    Site Not Available

  • Oncology Hematology Associates of Central Illinois, PC - Peoria

    Peoria, Illinois 61615
    United States

    Site Not Available

  • Proctor Hospital

    Peoria, Illinois 61614
    United States

    Site Not Available

  • Illinois Valley Community Hospital

    Peru, Illinois 61354
    United States

    Site Not Available

  • Perry Memorial Hospital

    Princeton, Illinois 61356
    United States

    Site Not Available

  • Regional Cancer Center at Memorial Medical Center

    Springfield, Illinois 62781-0001
    United States

    Site Not Available

  • St. Francis Hospital and Health Centers - Beech Grove Campus

    Beech Grove, Indiana 46107
    United States

    Site Not Available

  • Elkhart Clinic, LLC

    Elkhart, Indiana 46514-2098
    United States

    Site Not Available

  • Howard Community Hospital

    Kokomo, Indiana 46904
    United States

    Site Not Available

  • Reid Hospital & Health Care Services

    Richmond, Indiana 47374
    United States

    Site Not Available

  • CCOP - Northern Indiana CR Consortium

    South Bend, Indiana 46601
    United States

    Site Not Available

  • Michiana Hematology-Oncology, PC - South Bend

    South Bend, Indiana 46601
    United States

    Site Not Available

  • McFarland Clinic, PC

    Ames, Iowa 50010
    United States

    Site Not Available

  • Medical Oncology and Hematology Associates - West Des Moines

    Clive, Iowa 50325
    United States

    Site Not Available

  • Mercy Cancer Center - West Lakes

    Clive, Iowa 50325
    United States

    Site Not Available

  • CCOP - Iowa Oncology Research Association

    Des Moines, Iowa 50309
    United States

    Site Not Available

  • John Stoddard Cancer Center at Iowa Lutheran Hospital

    Des Moines, Iowa 50316
    United States

    Site Not Available

  • John Stoddard Cancer Center at Iowa Methodist Medical Center

    Des Moines, Iowa 50309
    United States

    Site Not Available

  • Medical Oncology and Hematology Associates at John Stoddard Cancer Center

    Des Moines, Iowa 50309
    United States

    Site Not Available

  • Medical Oncology and Hematology Associates at Mercy Cancer Center

    Des Moines, Iowa 50314
    United States

    Site Not Available

  • Mercy Cancer Center at Mercy Medical Center - Des Moines

    Des Moines, Iowa 50314
    United States

    Site Not Available

  • Holden Comprehensive Cancer Center at University of Iowa

    Iowa City, Iowa 52242-1002
    United States

    Site Not Available

  • McCreery Cancer Center at Ottumwa Regional

    Ottumwa, Iowa 52501
    United States

    Site Not Available

  • Mercy Medical Center - Sioux City

    Sioux City, Iowa 51102
    United States

    Site Not Available

  • Siouxland Hematology-Oncology Associates, LLP

    Sioux City, Iowa 51101
    United States

    Site Not Available

  • St. Luke's Regional Medical Center

    Sioux City, Iowa 51104
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Chanute

    Chanute, Kansas 66720
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Dodge City

    Dodge City, Kansas 67801
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - El Dorado

    El Dorado, Kansas 67042
    United States

    Site Not Available

  • Cancer Center of Kansas - Fort Scott

    Fort Scott, Kansas 66701
    United States

    Site Not Available

  • Cancer Center of Kansas-Independence

    Independence, Kansas 67301
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Kingman

    Kingman, Kansas 67068
    United States

    Site Not Available

  • Lawrence Memorial Hospital

    Lawrence, Kansas 66044
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Liberal

    Liberal, Kansas 67901
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Newton

    Newton, Kansas 67114
    United States

    Site Not Available

  • Menorah Medical Center

    Overland Park, Kansas 66209
    United States

    Site Not Available

  • Saint Luke's Hospital - South

    Overland Park, Kansas 66213
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Parsons

    Parsons, Kansas 67357
    United States

    Site Not Available

  • CCOP - Kansas City

    Prairie Village, Kansas 66208
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Pratt

    Pratt, Kansas 67124
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Salina

    Salina, Kansas 67401
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Wellington

    Wellington, Kansas 67152
    United States

    Site Not Available

  • Associates in Womens Health, PA - North Review

    Wichita, Kansas 67208
    United States

    Site Not Available

  • CCOP - Wichita

    Wichita, Kansas 67214
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Medical Arts Tower

    Wichita, Kansas 67208
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Wichita

    Wichita, Kansas 67214
    United States

    Site Not Available

  • Via Christi Cancer Center at Via Christi Regional Medical Center

    Wichita, Kansas 67214
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Winfield

    Winfield, Kansas 67156
    United States

    Site Not Available

  • Central Baptist Hospital

    Lexington, Kentucky 40503-9985
    United States

    Site Not Available

  • Lucille P. Markey Cancer Center at University of Kentucky

    Lexington, Kentucky 40536-0093
    United States

    Site Not Available

  • Ochsner Health Center - Bluebonnet

    Baton Rouge, Louisiana 70809
    United States

    Site Not Available

  • Ochsner Health Center - Covington

    Covington, Louisiana 70433
    United States

    Site Not Available

  • CCOP - Ochsner

    New Orleans, Louisiana 70121
    United States

    Site Not Available

  • Harry and Jeanette Weinberg Cancer Institute at Franklin Square Hospital Center

    Baltimore, Maryland 21237
    United States

    Site Not Available

  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

    Baltimore, Maryland 21231-2410
    United States

    Site Not Available

  • Union Hospital of Cecil County

    Elkton MD, Maryland 21921
    United States

    Site Not Available

  • Peninsula Regional Medical Center

    Salisbury, Maryland 21801
    United States

    Site Not Available

  • Berkshire Hematology Oncology, PC

    Pittsfield, Massachusetts 01201
    United States

    Site Not Available

  • Hickman Cancer Center at Bixby Medical Center

    Adrian, Michigan 49221
    United States

    Site Not Available

  • CCOP - Michigan Cancer Research Consortium

    Ann Arbor, Michigan 48106
    United States

    Site Not Available

  • Saint Joseph Mercy Cancer Center

    Ann Arbor, Michigan 48106-0995
    United States

    Site Not Available

  • Oakwood Cancer Center at Oakwood Hospital and Medical Center

    Dearborn, Michigan 48123-2500
    United States

    Site Not Available

  • Genesys Hurley Cancer Institute

    Flint, Michigan 48503
    United States

    Site Not Available

  • Hurley Medical Center

    Flint, Michigan 48503
    United States

    Site Not Available

  • Van Elslander Cancer Center at St. John Hospital and Medical Center

    Grosse Pointe Woods, Michigan 48236
    United States

    Site Not Available

  • Foote Memorial Hospital

    Jackson, Michigan 49201
    United States

    Site Not Available

  • Borgess Medical Center

    Kalamazoo, Michigan 49001
    United States

    Site Not Available

  • Bronson Methodist Hospital

    Kalamazoo, Michigan 49007
    United States

    Site Not Available

  • West Michigan Cancer Center

    Kalamazoo, Michigan 49007-3731
    United States

    Site Not Available

  • Breslin Cancer Center at Ingham Regional Medical Center

    Lansing, Michigan 48910
    United States

    Site Not Available

  • Sparrow Regional Cancer Center

    Lansing, Michigan 48912-1811
    United States

    Site Not Available

  • St. Mary Mercy Hospital

    Livonia, Michigan 48154
    United States

    Site Not Available

  • Mercy Memorial Hospital - Monroe

    Monroe, Michigan 48162
    United States

    Site Not Available

  • St. Joseph Mercy Oakland

    Pontiac, Michigan 48341-2985
    United States

    Site Not Available

  • Mercy Regional Cancer Center at Mercy Hospital

    Port Huron, Michigan 48060
    United States

    Site Not Available

  • Seton Cancer Institute at Saint Mary's - Saginaw

    Saginaw, Michigan 48601
    United States

    Site Not Available

  • Lakeside Cancer Specialists, PLLC

    Saint Joseph, Michigan 49085
    United States

    Site Not Available

  • Providence Cancer Institute at Providence Hospital - Southfield Campus

    Southfield, Michigan 48075
    United States

    Site Not Available

  • St. John Macomb Hospital

    Warren, Michigan 48093
    United States

    Site Not Available

  • St. Joseph's Medical Center

    Brainerd, Minnesota 56401
    United States

    Site Not Available

  • Fairview Ridges Hospital

    Burnsville, Minnesota 55337
    United States

    Site Not Available

  • Mercy and Unity Cancer Center at Mercy Hospital

    Coon Rapids, Minnesota 55433
    United States

    Site Not Available

  • CCOP - Duluth

    Duluth, Minnesota 55805
    United States

    Site Not Available

  • St. Luke's Hospital Cancer Care Center

    Duluth, Minnesota 55805
    United States

    Site Not Available

  • Fairview Southdale Hospital

    Edina, Minnesota 55435
    United States

    Site Not Available

  • Fergus Falls Medical Group, PA

    Fergus Falls, Minnesota 56537
    United States

    Site Not Available

  • Mercy and Unity Cancer Center at Unity Hospital

    Fridley, Minnesota 55432
    United States

    Site Not Available

  • Hutchinson Area Health Care

    Hutchinson, Minnesota 55350
    United States

    Site Not Available

  • HealthEast Cancer Care at St. John's Hospital

    Maplewood, Minnesota 55109
    United States

    Site Not Available

  • Minnesota Oncology Hematology, PA - Maplewood

    Maplewood, Minnesota 55109
    United States

    Site Not Available

  • Hennepin County Medical Center - Minneapolis

    Minneapolis, Minnesota 55415
    United States

    Site Not Available

  • Virginia Piper Cancer Institute at Abbott - Northwestern Hospital

    Minneapolis, Minnesota 55407
    United States

    Site Not Available

  • Humphrey Cancer Center at North Memorial Outpatient Center

    Robbinsdale, Minnesota 55422-2900
    United States

    Site Not Available

  • CCOP - Metro-Minnesota

    Saint Louis Park, Minnesota 55416
    United States

    Site Not Available

  • Park Nicollet Cancer Center

    Saint Louis Park, Minnesota 55416
    United States

    Site Not Available

  • United Hospital

    Saint Paul, Minnesota 55102
    United States

    Site Not Available

  • St. Francis Cancer Center at St. Francis Medical Center

    Shakopee, Minnesota 55379
    United States

    Site Not Available

  • Regions Hospital Cancer Care Center

    St. Paul, Minnesota 55101
    United States

    Site Not Available

  • Lakeview Hospital

    Stillwater, Minnesota 55082
    United States

    Site Not Available

  • Ridgeview Medical Center

    Waconia, Minnesota 55387
    United States

    Site Not Available

  • Willmar Cancer Center at Rice Memorial Hospital

    Willmar, Minnesota 56201
    United States

    Site Not Available

  • Minnesota Oncology Hematology, PA - Woodbury

    Woodbury, Minnesota 55125
    United States

    Site Not Available

  • Goldschmidt Cancer Center

    Jefferson City, Missouri 65109
    United States

    Site Not Available

  • Heartland Hematology Oncology Associates, Incorporated

    Kansas City, Missouri 64118
    United States

    Site Not Available

  • North Kansas City Hospital

    Kansas City, Missouri 64116
    United States

    Site Not Available

  • Parvin Radiation Oncology

    Kansas City, Missouri 64116
    United States

    Site Not Available

  • Research Medical Center

    Kansas City, Missouri 64132
    United States

    Site Not Available

  • Saint Luke's Cancer Institute at Saint Luke's Hospital

    Kansas City, Missouri 64111
    United States

    Site Not Available

  • St. Joseph Medical Center

    Kansas City, Missouri 64114
    United States

    Site Not Available

  • Saint Luke's East - Lee's Summit

    Lee's Summit, Missouri 64086
    United States

    Site Not Available

  • Liberty Hospital

    Liberty, Missouri 64068
    United States

    Site Not Available

  • Heartland Regional Medical Center

    Saint Joseph, Missouri 64506
    United States

    Site Not Available

  • Comprehensive Cancer Care, PC

    Saint Louis, Missouri 63141
    United States

    Site Not Available

  • Missouri Baptist Cancer Center

    Saint Louis, Missouri 63131
    United States

    Site Not Available

  • Saint Louis University Cancer Center

    Saint Louis, Missouri 63110
    United States

    Site Not Available

  • Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis

    Saint Louis, Missouri 63110
    United States

    Site Not Available

  • CCOP - Cancer Research for the Ozarks

    Springfield, Missouri 65802
    United States

    Site Not Available

  • Hulston Cancer Center at Cox Medical Center South

    Springfield, Missouri 65807
    United States

    Site Not Available

  • Billings Clinic - Downtown

    Billings, Montana 59107-7000
    United States

    Site Not Available

  • CCOP - Montana Cancer Consortium

    Billings, Montana 59101
    United States

    Site Not Available

  • Hematology-Oncology Centers of the Northern Rockies - Billings

    Billings, Montana 59102
    United States

    Site Not Available

  • St. Vincent Healthcare Cancer Care Services

    Billings, Montana 59101
    United States

    Site Not Available

  • Bozeman Deaconess Cancer Center

    Bozeman, Montana 59715
    United States

    Site Not Available

  • St. James Healthcare Cancer Care

    Butte, Montana 59701
    United States

    Site Not Available

  • Great Falls Clinic - Main Facility

    Great Falls, Montana 59405
    United States

    Site Not Available

  • Sletten Cancer Institute at Benefis Healthcare

    Great Falls, Montana 59405
    United States

    Site Not Available

  • St. Peter's Hospital

    Helena, Montana 59601
    United States

    Site Not Available

  • Glacier Oncology, PLLC

    Kalispell, Montana 59901
    United States

    Site Not Available

  • Kalispell Medical Oncology at KRMC

    Kalispell, Montana 59901
    United States

    Site Not Available

  • Kalispell Regional Medical Center

    Kalispell, Montana 59901
    United States

    Site Not Available

  • Montana Cancer Center at St. Patrick Hospital and Health Sciences Center

    Missoula, Montana 59807
    United States

    Site Not Available

  • Cancer Resource Center - Lincoln

    Lincoln, Nebraska 68510
    United States

    Site Not Available

  • Alegant Health Cancer Center at Bergan Mercy Medical Center

    Omaha, Nebraska 68124
    United States

    Site Not Available

  • CCOP - Missouri Valley Cancer Consortium

    Omaha, Nebraska 68106
    United States

    Site Not Available

  • Creighton University Medical Center

    Omaha, Nebraska 68131-2197
    United States

    Site Not Available

  • Immanuel Medical Center

    Omaha, Nebraska 68122
    United States

    Site Not Available

  • Newark Beth Israel Medical Center

    Newark, New Jersey 07112
    United States

    Site Not Available

  • Cancer Institute of New Jersey at Cooper - Voorhees

    Voorhees, New Jersey 08043
    United States

    Site Not Available

  • University of New Mexico Cancer Center

    Albuquerque, New Mexico 87131-5636
    United States

    Site Not Available

  • Roswell Park Cancer Institute

    Buffalo, New York 14263-0001
    United States

    Site Not Available

  • Charles R. Wood Cancer Center at Glens Falls Hospital

    Glens Falls, New York 12801
    United States

    Site Not Available

  • NYU Cancer Institute at New York University Medical Center

    New York, New York 10016
    United States

    Site Not Available

  • Nalitt Cancer Institute at Staten Island University Hospital

    Staten Island, New York 10305
    United States

    Site Not Available

  • Presbyterian Cancer Center at Presbyterian Hospital

    Charlotte, North Carolina 28233-3549
    United States

    Site Not Available

  • Leo W. Jenkins Cancer Center at ECU Medical School

    Greenville, North Carolina 27834
    United States

    Site Not Available

  • Kinston Medical Specialists

    Kinston, North Carolina 28501
    United States

    Site Not Available

  • Iredell Memorial Hospital

    Statesville, North Carolina 28677
    United States

    Site Not Available

  • Forsyth Regional Cancer Center at Forsyth Medical Center

    Winston-Salem, North Carolina 27103
    United States

    Site Not Available

  • Wake Forest University Comprehensive Cancer Center

    Winston-Salem, North Carolina 27157-1096
    United States

    Site Not Available

  • CCOP - MeritCare Hospital

    Fargo, North Dakota 58122
    United States

    Site Not Available

  • Mary Rutan Hospital

    Bellefontaine, Ohio 43311
    United States

    Site Not Available

  • Adena Regional Medical Center

    Chillicothe, Ohio 45601
    United States

    Site Not Available

  • Case Comprehensive Cancer Center

    Cleveland, Ohio 44106-5065
    United States

    Site Not Available

  • CCOP - Columbus

    Columbus, Ohio 43215
    United States

    Site Not Available

  • Doctors Hospital at Ohio Health

    Columbus, Ohio 43228
    United States

    Site Not Available

  • Grant Medical Center Cancer Care

    Columbus, Ohio 43215
    United States

    Site Not Available

  • Mount Carmel Health - West Hospital

    Columbus, Ohio 43222
    United States

    Site Not Available

  • Riverside Methodist Hospital Cancer Care

    Columbus, Ohio 43214-3998
    United States

    Site Not Available

  • CCOP - Dayton

    Dayton, Ohio 45420
    United States

    Site Not Available

  • David L. Rike Cancer Center at Miami Valley Hospital

    Dayton, Ohio 45409
    United States

    Site Not Available

  • Good Samaritan Hospital

    Dayton, Ohio 45406
    United States

    Site Not Available

  • Grandview Hospital

    Dayton, Ohio 45405
    United States

    Site Not Available

  • Grady Memorial Hospital

    Delaware, Ohio 43015
    United States

    Site Not Available

  • Community Cancer Center

    Elyria, Ohio 44035
    United States

    Site Not Available

  • Hematology Oncology Center

    Elyria, Ohio 44035
    United States

    Site Not Available

  • Blanchard Valley Medical Associates

    Findlay, Ohio 45840
    United States

    Site Not Available

  • Middletown Regional Hospital

    Franklin, Ohio 45005-1066
    United States

    Site Not Available

  • Wayne Hospital

    Greenville, Ohio 45331
    United States

    Site Not Available

  • Charles F. Kettering Memorial Hospital

    Kettering, Ohio 45429
    United States

    Site Not Available

  • Fairfield Medical Center

    Lancaster, Ohio 43130
    United States

    Site Not Available

  • Lima Memorial Hospital

    Lima, Ohio 45804
    United States

    Site Not Available

  • Strecker Cancer Center at Marietta Memorial Hospital

    Marietta, Ohio 45750
    United States

    Site Not Available

  • St. Luke's Hospital

    Maumee, Ohio 43537
    United States

    Site Not Available

  • Knox Community Hospital

    Mount Vernon, Ohio 43050
    United States

    Site Not Available

  • Licking Memorial Cancer Care Program at Licking Memorial Hospital

    Newark, Ohio 43055
    United States

    Site Not Available

  • Fisher-Titus Medical Center

    Norwalk, Ohio 44857
    United States

    Site Not Available

  • St. Charles Mercy Hospital

    Oregon, Ohio 43616
    United States

    Site Not Available

  • North Coast Cancer Care, Incorporated

    Sandusky, Ohio 44870
    United States

    Site Not Available

  • Community Hospital of Springfield and Clark County

    Springfield, Ohio 45505
    United States

    Site Not Available

  • Flower Hospital Cancer Center

    Sylvania, Ohio 43560
    United States

    Site Not Available

  • Mercy Hospital of Tiffin

    Tiffin, Ohio 44883
    United States

    Site Not Available

  • CCOP - Toledo Community Hospital

    Toledo, Ohio 43617
    United States

    Site Not Available

  • Medical University of Ohio Cancer Center

    Toledo, Ohio 43614
    United States

    Site Not Available

  • St. Anne Mercy Hospital

    Toledo, Ohio 43623
    United States

    Site Not Available

  • St. Vincent Mercy Medical Center

    Toledo, Ohio 43608
    United States

    Site Not Available

  • Toledo Clinic, Incorporated - Main Clinic

    Toledo, Ohio 43623
    United States

    Site Not Available

  • Toledo Hospital

    Toledo, Ohio 43606
    United States

    Site Not Available

  • UVMC Cancer Care Center at Upper Valley Medical Center

    Troy, Ohio 45373-1300
    United States

    Site Not Available

  • Fulton County Health Center

    Wauseon, Ohio 43567
    United States

    Site Not Available

  • Mount Carmel St. Ann's Cancer Center

    Westerville, Ohio 43081
    United States

    Site Not Available

  • Ruth G. McMillan Cancer Center at Greene Memorial Hospital

    Xenia, Ohio 45385
    United States

    Site Not Available

  • Genesis - Good Samaritan Hospital

    Zanesville, Ohio 43701
    United States

    Site Not Available

  • Oklahoma University Cancer Institute

    Oklahoma City, Oklahoma 73104
    United States

    Site Not Available

  • Natalie Warren Bryant Cancer Center at St. Francis Hospital

    Tulsa, Oklahoma 74136
    United States

    Site Not Available

  • Butler Memorial Hospital

    Butler, Pennsylvania 16001
    United States

    Site Not Available

  • Riddle Memorial Hospital Cancer Center

    Media, Pennsylvania 19063
    United States

    Site Not Available

  • Kimmel Cancer Center at Thomas Jefferson University - Philadelphia

    Philadelphia, Pennsylvania 19107-5541
    United States

    Site Not Available

  • Allegheny Cancer Center at Allegheny General Hospital

    Pittsburgh, Pennsylvania 15212
    United States

    Site Not Available

  • UPMC Cancer Centers

    Pittsburgh, Pennsylvania 15232
    United States

    Site Not Available

  • McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center

    Reading, Pennsylvania 19612-6052
    United States

    Site Not Available

  • Associates in Hematology-Oncology, PC at Crozer Regional Cancer Center

    Upland, Pennsylvania 19013
    United States

    Site Not Available

  • Bon Secours St. Francis Health System

    Greenville, South Carolina 29601
    United States

    Site Not Available

  • CCOP - Greenville

    Greenville, South Carolina 29615
    United States

    Site Not Available

  • Self Regional Cancer Center at Self Regional Medical Center

    Greenwood, South Carolina 29646
    United States

    Site Not Available

  • Medical X-Ray Center, PC

    Sioux Falls, South Dakota 57105
    United States

    Site Not Available

  • Sanford Cancer Center at Sanford USD Medical Center

    Sioux Falls, South Dakota 57117-5039
    United States

    Site Not Available

  • Thompson Cancer Survival Center

    Knoxville, Tennessee 37916
    United States

    Site Not Available

  • Parkland Memorial Hospital

    Dallas, Texas 75235
    United States

    Site Not Available

  • Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas

    Dallas, Texas 75390
    United States

    Site Not Available

  • Joe Arrington Cancer Research and Treatment Center

    Lubbock, Texas 79410-1894
    United States

    Site Not Available

  • Sandra L. Maxwell Cancer Center

    Cedar City, Utah 84720
    United States

    Site Not Available

  • Logan Regional Hospital

    Logan, Utah 84321
    United States

    Site Not Available

  • Val and Ann Browning Cancer Center at McKay-Dee Hospital Center

    Ogden, Utah 84403
    United States

    Site Not Available

  • Utah Valley Regional Medical Center - Provo

    Provo, Utah 84604
    United States

    Site Not Available

  • Dixie Regional Medical Center - East Campus

    Saint George, Utah 84770
    United States

    Site Not Available

  • LDS Hospital

    Salt Lake City, Utah 84143
    United States

    Site Not Available

  • Danville Regional Medical Center

    Danville, Virginia 24541
    United States

    Site Not Available

  • Fredericksburg Oncology, Incorporated

    Fredericksburg, Virginia 22401
    United States

    Site Not Available

  • Overlake Cancer Center at Overlake Hospital Medical Center

    Bellevue, Washington 98004
    United States

    Site Not Available

  • Fred Hutchinson Cancer Research Center

    Seattle, Washington 98109
    United States

    Site Not Available

  • Group Health Central Hospital

    Seattle, Washington 98112
    United States

    Site Not Available

  • Swedish Cancer Institute at Swedish Medical Center - First Hill Campus

    Seattle, Washington 98122-4307
    United States

    Site Not Available

  • Community Comprehensive Cancer Center at Camden-Clark Memorial Hospital

    Parkersburg, West Virginia 26102
    United States

    Site Not Available

  • Marshfield Clinic - Chippewa Center

    Chippewa Falls, Wisconsin 54729
    United States

    Site Not Available

  • Marshfield Clinic Cancer Care at Regional Cancer Center

    Eau Claire, Wisconsin 54701
    United States

    Site Not Available

  • Marshfield Clinic - Marshfield Center

    Marshfield, Wisconsin 54449
    United States

    Site Not Available

  • Medical College of Wisconsin Cancer Center

    Milwaukee, Wisconsin 53226
    United States

    Site Not Available

  • Marshfield Clinic - Lakeland Center

    Minocqua, Wisconsin 54548
    United States

    Site Not Available

  • Ministry Medical Group at Saint Mary's Hospital

    Rhinelander, Wisconsin 54501
    United States

    Site Not Available

  • Marshfield Clinic - Indianhead Center

    Rice Lake, Wisconsin 54868
    United States

    Site Not Available

  • Marshfield Clinic at Saint Michael's Hospital

    Stevens Point, Wisconsin 54481
    United States

    Site Not Available

  • Marshfield Clinic - Weston Center

    Weston, Wisconsin 54476
    United States

    Site Not Available

  • Marshfield Clinic - Wisconsin Rapids Center

    Wisconsin Rapids, Wisconsin 54494
    United States

    Site Not Available

  • Welch Cancer Center at Sheridan Memorial Hospital

    Sheridan, Wyoming 82801
    United States

    Site Not Available

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