Combination Chemotherapy in Treating Women With Stage I, Stage II, or Stage IIIA (cT1-3, N0-1, M0) Breast Cancer and Positive Axillary Lymph Nodes

Overview[ - collapse ][ - ]

Purpose RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving combination chemotherapy after surgery may kill any tumor cells remaining following surgery. It is not yet known which regimen of combination chemotherapy is more effective in treating breast cancer with positive axillary lymph nodes. PURPOSE: Randomized phase III trial to compare the effectiveness of different regimens of combination chemotherapy in treating women who have undergone surgery for stage I, stage II, or stage IIIA breast cancer with positive axillary lymph nodes.
ConditionBreast Cancer
InterventionDrug: cyclophosphamide
Drug: docetaxel
Drug: doxorubicin
PhasePhase 3
SponsorNational Surgical Adjuvant Breast and Bowel Project (NSABP)
Responsible PartyNational Surgical Adjuvant Breast and Bowel Project (NSABP)
ClinicalTrials.gov IdentifierNCT00003782
First ReceivedNovember 1, 1999
Last UpdatedJanuary 11, 2013
Last verifiedJanuary 2013

Tracking Information[ + expand ][ + ]

First Received DateNovember 1, 1999
Last Updated DateJanuary 11, 2013
Start DateMarch 1999
Estimated Primary Completion DateDecember 2012
Current Primary Outcome Measures
  • Overall Survival [Time Frame: 8 years] [Designated as safety issue: No]
  • Disease Free Survival [Time Frame: time to event: breast cancer recurrence; second primary cancer; death from any cause as a first event] [Designated as safety issue: No]
Current Secondary Outcome Measures
  • Toxicities Among the 3 Regimens [Time Frame: 9 years] [Designated as safety issue: Yes]
  • Quality of Life Among Breast Cancer Patients [Time Frame: baseline, 9 weeks, and 6, 12, 18, and 24 months] [Designated as safety issue: No]
  • Amenorrhea in Premenopausal Women [Time Frame: baseline, 9 weeks, and 6, 12, 18, and 24 months] [Designated as safety issue: No]

Descriptive Information[ + expand ][ + ]

Brief TitleCombination Chemotherapy in Treating Women With Stage I, Stage II, or Stage IIIA (cT1-3, N0-1, M0) Breast Cancer and Positive Axillary Lymph Nodes
Official TitleA Three-Arm Randomized Trial to Compare Adjuvant Adriamycin and Cyclophosphamide Followed by Taxotere (AC-T); Adriamycin and Taxotere (AT); and Adriamycin, Taxotere, and Cyclophosphamide (ATC) in Breast Cancer Patients With Positive Axillary Lymph Nodes
Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Giving combination chemotherapy after surgery may kill any
tumor cells remaining following surgery. It is not yet known which regimen of combination
chemotherapy is more effective in treating breast cancer with positive axillary lymph nodes.

PURPOSE: Randomized phase III trial to compare the effectiveness of different regimens of
combination chemotherapy in treating women who have undergone surgery for stage I, stage II,
or stage IIIA breast cancer with positive axillary lymph nodes.
Detailed Description
OBJECTIVES:

- Compare the efficacy of adjuvant doxorubicin, cyclophosphamide, and docetaxel given
concurrently vs adjuvant doxorubicin and cyclophosphamide followed by docetaxel, in
terms of overall survival and disease-free survival, of women with breast cancer and
positive axillary lymph nodes.

- Compare the efficacy of adjuvant doxorubicin and docetaxel vs regimens containing
cyclophosphamide in these patients.

- Compare the toxic effects of these regimens in these patients.

- Compare the quality of life of patients treated with these regimens. (Quality of life
substudy closed to accrual as of 7/20/01.)

- Compare the differences in amenorrhea in premenopausal women in each treatment arm and
its relationship to symptoms, quality of life (quality of life substudy closed to
accrual as of 7/20/01), disease-free survival, and overall survival.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to
participating center, number of positive nodes (1-3 vs 4-9 vs at least 10), sequential
tamoxifen or anastrozole administration (yes vs no), and type of prior surgery and
radiotherapy plan (mastectomy with no local or regional radiotherapy vs mastectomy with
local and/or regional radiotherapy vs lumpectomy with local radiotherapy vs lumpectomy with
local and regional radiotherapy). Patients are randomized to one of three treatment arms.

- Arm 1: Patients receive doxorubicin IV over 15 minutes and cyclophosphamide IV over 30
minutes every 21 days for 4 courses. Three weeks after the last dose of this
combination, patients receive docetaxel IV over 1 hour every 21 days for 4 courses.

- Arm 2: Patients receive doxorubicin IV over 15 minutes and docetaxel IV over 1 hour
every 21 days for 4 courses.

- Arm 3: Patients receive doxorubicin IV over 15 minutes, cyclophosphamide IV over 30
minutes, and docetaxel IV over 1 hour every 21 days for 4 courses.

Patients in all arms who are estrogen receptor-positive and/or progesterone
receptor-positive receive oral tamoxifen daily for 5 years beginning within 3-12 weeks of
completion of chemotherapy. Patients who are postmenopausal may receive alternative hormonal
therapy at the discretion of the treating physician.

Some patients may receive postmastectomy radiotherapy on SWOG-S9927 or NCIC-MA.20 after
recovery from chemotherapy.

Quality of life and menstrual history are assessed before randomization, on day 1 of course
4, and at 6, 12, 18, and 24 months. (Quality of life substudy closed to accrual as of
7/20/01.)

Patients are followed every 6 months for 5 years and then annually thereafter.

PROJECTED ACCRUAL: A total of 5,300 patients will be accrued for this study within 4-5
years.
Study TypeInterventional
Study PhasePhase 3
Study DesignAllocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
ConditionBreast Cancer
InterventionDrug: cyclophosphamide
Arm 1: 600 mg/m2 IV every 21 days for 4 cycles; Arm 3: 500 mg/m2 IV every 21 days for 4 cycles
Drug: docetaxel
Arm 1: 100 mg/m2 IV every 21 days for 4 cycles; Arms 2 and 3: 75 mg/m2 IV every 21 days for 4 cycles
Other Names:
TaxotereDrug: doxorubicin
Arm 1: 60 mg/m2 IV every 21 days for 4 cycles; Arms 2 and 3: 50 mg/m2 IV every 21 days for 4 cycles
Other Names:
Adriamycin
Study Arm (s)
  • Experimental: Arm 1: Doxorubicin + Cyclophosphamide, then Docetaxel
    Doxorubicin + Cyclophosphamide, then Docetaxel
  • Experimental: Arm 2: Doxorubicin + Docetaxel
    Doxorubicin + Docetaxel
  • Experimental: Arm 3: Doxorubicin + Docetaxel + Cyclophosphamide
    Doxorubicin + Docetaxel + Cyclophosphamide

Recruitment Information[ + expand ][ + ]

Recruitment StatusCompleted
Estimated Enrollment5351
Estimated Completion DateDecember 2012
Estimated Primary Completion DateDecember 2008
Eligibility Criteria
DISEASE CHARACTERISTICS:

- Histologically confirmed invasive adenocarcinoma of the breast

- Confined to the breast and ipsilateral axilla on clinical exam

- Stage I, II, or IIIA (cT1-3, N0-1, M0)

- At least one axillary lymph node with evidence of tumor on histologic exam

- Sentinel node biopsy allowed if followed by axillary dissection

- No suspicious palpable nodes in the contralateral axilla or palpable
supraclavicular or infraclavicular nodes, unless proven on biopsy to not be
involved with tumor

- No bilateral malignancy or mass in the opposite breast, unless mass is histologically
proven to be benign

- Must have undergone either a prior total mastectomy and axillary dissection (modified
radical mastectomy) OR

- Prior lumpectomy and axillary dissection

- Patients must receive radiotherapy after randomization (not before) AND after
chemotherapy

- Margins must be clear

- No ipsilateral lymph nodes that are fixed to one another or to other structures
(N2 disease) and/or any positive nonaxillary lymph nodes (intramammary nodes are
considered axillary nodes)

- No histologically evident invasive tumor or ductal carcinoma in situ

- No diffuse tumors by mammography that would not be surgically amenable to
lumpectomy

- No other dominant mass in the ipsilateral breast remnant unless one of the
following is true:

- Histologically benign

- Surgically removed with clear margins if malignant

- No ulceration, erythema, infiltration of the skin or underlying chest wall (complete
fixation), peau d'orange, or skin edema of any magnitude

- Tethering or dimpling of the skin or nipple inversion allowed

- No metastatic disease

- Skeletal pain allowed if bone scan negative for metastases

- Hormone receptor status:

- Estrogen and progesterone status determined

PATIENT CHARACTERISTICS:

Age:

- greater than or equal to 18 years

Sex:

- Female

Menopausal status:

- Not specified

Performance status:

- Not specified

Life expectancy:

- At least 10 years, excluding diagnosis of cancer

Hematopoietic:

- Absolute neutrophil count at least 1,500/mm^3 (may be less, if in the opinion of the
investigator, this represents an ethnic or racial variation)

- Platelet count at least 100,000/mm^3* NOTE: *If platelet count is above the upper
limit of normal (ULN), significant underlying hematologic disorders must be excluded

Hepatic:

- Bilirubin no greater than ULN

- Alkaline phosphatase less than 2.5 times ULN*

- SGOT less than 1.5 times ULN*

- No nonmalignant systemic hepatic disease that would preclude study participation
NOTE: *Alkaline phosphatase and SGOT cannot both be greater than ULN

Renal:

- Creatinine no greater than normal

- No nonmalignant systemic renal disease that would preclude study participation

Cardiovascular:

- No nonmalignant systemic cardiovascular disease that would preclude study
participation

- LVEF at least lower limit of normal (LLN) by MUGA or echocardiogram

- No active cardiac disease that would preclude use of doxorubicin or docetaxel,
including the following:

- Any prior myocardial infarction

- Angina pectoris requiring anti-anginal medication

- History of congestive heart failure

- Cardiac arrhythmia requiring medication

- Severe conduction abnormality

- Valvular disease with documented cardiac function compromise

- Cardiomegaly on chest x-ray or ventricular hypertrophy on EKG, unless LVEF at
least LLN

- Poorly controlled hypertension (diastolic greater than 100 mm/Hg)

- Hypertension well controlled by medication allowed

Other:

- No grade 2 or greater peripheral neuropathy

- No other prior malignancy within the past 5 years except:

- Effectively treated squamous cell or basal cell skin cancer

- Surgically treated carcinoma in situ of the cervix

- Segmentally resected lobular carcinoma in situ of the ipsilateral or
contralateral breast

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective barrier contraception

- No nonmalignant systemic disease that would preclude study participation

- No diabetes with morning fasting blood glucose of 200 mg/dL or greater

- No psychiatric or addictive disorders that would preclude informed consent

- No contraindication to corticosteroids that would preclude study participation

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- No prior immunotherapy for breast cancer

Chemotherapy:

- No prior chemotherapy for breast cancer

- No prior anthracyclines or taxanes

- No other concurrent investigational chemotherapy

Endocrine therapy:

- No prior hormonal therapy for breast cancer

- No concurrent hormonal birth control methods or other hormonal therapy

- No concurrent raloxifene, including for osteoporosis

- Concurrent low-dose topical estrogen in the form of conjugated estrogen ring or
conjugated estrogen vaginal cream (dose no more than 0.3 mg or 1/8 of an applicator
applied vaginally 3 times a week) allowed

Radiotherapy:

- See Disease Characteristics

- No prior radiotherapy for this malignancy

Surgery:

- See Disease Characteristics

- No more than 84 days since prior surgery for breast cancer (e.g., lumpectomy,
mastectomy, sentinel node biopsy, axillary dissection, or re-excision of lumpectomy
margins)

Other:

- No prior systemic therapy for this malignancy

- No concurrent medications that alter cardiac conduction (e.g., digitalis, beta
blockers, or calcium-channel blockers) for cardiac arrhythmia, angina, or congestive
heart failure (allowed if administered for other reasons [e.g., hypertension])

- Concurrent bisphosphonates allowed
GenderFemale
Ages18 Years
Accepts Healthy VolunteersNo
ContactsNot Provided
Location CountriesUnited States, Canada

Administrative Information[ + expand ][ + ]

NCT Number NCT00003782
Other Study ID NumbersNSABP B-30
Has Data Monitoring CommitteeYes
Information Provided ByNational Surgical Adjuvant Breast and Bowel Project (NSABP)
Study SponsorNational Surgical Adjuvant Breast and Bowel Project (NSABP)
CollaboratorsNational Cancer Institute (NCI)
Investigators Principal Investigator: Norman Wolmark, MD NSABP Foundation, Inc.
Verification DateJanuary 2013

Locations[ + expand ][ + ]

Comprehensive Cancer Institute
Huntsville, Alabama, United States, 35801
Providence Alaska Medical Center
Anchorage, Alaska, United States, 99519-6604
CCOP - Western Regional, Arizona
Phoenix, Arizona, United States, 85006-2726
City of Hope Comprehensive Cancer Center
Duarte, California, United States, 91010-3000
California Cancer Center
Fresno, California, United States, 93720
Sutter Health Western Division Cancer Research Group
Greenbrae, California, United States, 94904
Scripps Cancer Center at Scripps Clinic
La Jolla, California, United States, 92037
Rebecca and John Moores UCSD Cancer Center
La Jolla, California, United States, 92093-0658
Loma Linda University Cancer Institute at Loma Linda University Medical Center
Loma Linda, California, United States, 92354
Pacific Shores Medical Group
Long Beach, California, United States, 90813
CCOP - Bay Area Tumor Institute
Oakland, California, United States, 94609-3305
Chao Family Comprehensive Cancer Center at University of California Irvine Cancer Center
Orange, California, United States, 92868
Comprehensive Cancer Centers of the Desert
Palm Springs, California, United States, 92262
Stanford Cancer Center at Stanford University Medical Center
Palo Alto, California, United States, 94305-5408
Sutter Cancer Center
Sacramento, California, United States, 95816
Kaiser Permanente Medical Center/Kaiser Foundation Hospital - San Diego
San Diego, California, United States, 92120
Catholic Healthcare West - Westbay Region
San Francisco, California, United States, 94107-1728
CCOP - Santa Rosa Memorial Hospital
Santa Rosa, California, United States, 95403
Kaiser Permanente Medical Center - Vallejo
Vallejo, California, United States, 94589
CCOP - Colorado Cancer Research Program, Incorporated
Denver, Colorado, United States, 80209-5031
University of Colorado Cancer Center at University of Colorado Health Sciences Center
Denver, Colorado, United States, 80010
University of Connecticut Cancer Center at University of Connecticut Health Center
Farmington, Connecticut, United States, 06360-7106
Hartford Hospital
Hartford, Connecticut, United States, 06102-5037
CCOP - Christiana Care Health Services
Wilmington, Delaware, United States, 19899
MBCCOP - Howard University Cancer Center
Washington, District of Columbia, United States, 20060
Morton Plant Hospital
Clearwater, Florida, United States, 33756
Halifax Medical Center
Daytona Beach, Florida, United States, 32114
Baptist Regional Cancer Institute - Jacksonville
Jacksonville, Florida, United States, 32207
University of Miami Sylvester Cancer Center
Miami, Florida, United States, 33136
CCOP - Mount Sinai Medical Center
Miami Beach, Florida, United States, 33140
MD Anderson Cancer Center Orlando
Orlando, Florida, United States, 32806
Sarasota Memorial Hospital
Sarasota, Florida, United States, 34239
CCOP - Atlanta Regional
Atlanta, Georgia, United States, 30342-1701
Winship Cancer Institute of Emory University
Atlanta, Georgia, United States, 30322
Medical College of Georgia Comprehensive Cancer Center
Augusta, Georgia, United States, 30912-4000
Dwight David Eisenhower Army Medical Center
Fort Gordon, Georgia, United States, 30905-5650
Cancer Research Center of Hawaii
Honolulu, Hawaii, United States, 96813
North Idaho Cancer Center
Coeur d'Alene, Idaho, United States, 83814
John H. Stroger, Jr. Hospital of Cook County
Chicago, Illinois, United States, 60612-9985
Rush-Presbyterian-St. Luke's Medical Center
Chicago, Illinois, United States, 60612
Creticos Cancer Center at Advocate Illinois Masonic Medical Center
Chicago, Illinois, United States, 60657
CCOP - Central Illinois
Decatur, Illinois, United States, 62526
CCOP - Evanston
Evanston, Illinois, United States, 60201
CCOP - Illinois Oncology Research Association
Peoria, Illinois, United States, 61602
CCOP - Carle Cancer Center
Urbana, Illinois, United States, 61801
St. Vincent Hospital and Health Care Center
Indianapolis, Indiana, United States, 46260
Methodist Cancer Center at Methodist Hospital
Indianapolis, Indiana, United States, 46206-1367
Community Hospital
Munster, Indiana, United States, 46321
Genesis Medical Center
Davenport, Iowa, United States, 52804
CCOP - Iowa Oncology Research Association
Des Moines, Iowa, United States, 50309-1016
Holden Comprehensive Cancer Center at University of Iowa
Iowa City, Iowa, United States, 52242-1009
CCOP - Wichita
Wichita, Kansas, United States, 67214-3882
Markey Cancer Center at University of Kentucky Chandler Medical Center
Lexington, Kentucky, United States, 40536-0093
Consultants in Blood Disorders and Cancer
Louisville, Kentucky, United States, 40207
Norton Healthcare Cancer Center
Louisville, Kentucky, United States, 40202-5070
CCOP - Ochsner
New Orleans, Louisiana, United States, 70121
Stanley S. Scott Cancer Center at Louisiana State University Medical Center - New Orleans
New Orleans, Louisiana, United States, 70112
Tulane University Medical Center
New Orleans, Louisiana, United States, 70112
Eastern Maine Medical Center
Bangor, Maine, United States, 04401
Franklin Square Hospital Center
Baltimore, Maryland, United States, 21237
National Naval Medical Center
Bethesda, Maryland, United States, 20889-5000
Cancer Research Center at Boston Medical Center
Boston, Massachusetts, United States, 02118
Lahey Clinic Medical Center - Burlington
Burlington, Massachusetts, United States, 01805
Berkshire Medical Center
Pittsfield, Massachusetts, United States, 01201
Baystate Medical Center
Springfield, Massachusetts, United States, 01199
CCOP - Michigan Cancer Research Consortium
Ann Arbor, Michigan, United States, 48106
Josephine Ford Cancer Center at Henry Ford Hospital
Detroit, Michigan, United States, 48202
Michigan State University
East Lansing, Michigan, United States, 48824
CCOP - Grand Rapids
Grand Rapids, Michigan, United States, 49503
CCOP - Kalamazoo
Kalamazoo, Michigan, United States, 49007-3731
CCOP - Beaumont
Royal Oak, Michigan, United States, 48073-6769
Providence Cancer Institute at Providence Hospital
Southfield, Michigan, United States, 48075-9975
CCOP - Duluth
Duluth, Minnesota, United States, 55805
Hennepin County Medical Center - Minneapolis
Minneapolis, Minnesota, United States, 55415
CCOP - Metro-Minnesota
Saint Louis Park, Minnesota, United States, 55416
Ellis Fischel Cancer Center at University of Missouri - Columbia
Columbia, Missouri, United States, 65203
CCOP - Kansas City
Kansas City, Missouri, United States, 64131
CCOP - St. Louis-Cape Girardeau
Saint Louis, Missouri, United States, 63141
St. Louis University Hospital Cancer Center
Saint Louis, Missouri, United States, 63110-0250
CCOP - Cancer Research for the Ozarks
Springfield, Missouri, United States, 65807
CCOP - Montana Cancer Consortium
Billings, Montana, United States, 59101
CCOP - Missouri Valley Cancer Consortium
Omaha, Nebraska, United States, 68131
Methodist Hospital Cancer Center at Nebraska Methodist Hospital - Omaha
Omaha, Nebraska, United States, 68114
CCOP - Southern Nevada Cancer Research Foundation
Las Vegas, Nevada, United States, 89106
CCOP - Northern New Jersey
Hackensack, New Jersey, United States, 07601
Cancer Institute of New Jersey
New Brunswick, New Jersey, United States, 08903
Newark Beth Israel Medical Center
Newark, New Jersey, United States, 07112
MBCCOP - University of New Mexico HSC
Albuquerque, New Mexico, United States, 87131
New York Oncology Hematology, P.C. - Albany Regional Cancer Center
Albany, New York, United States, 12208
MBCCOP-Our Lady of Mercy Cancer Center
Bronx, New York, United States, 10466
Lincoln Medical and Mental Health Center
Bronx, New York, United States, 10451
Charles R. Wood Foundation Cancer Center at Glens Falls Hospital
Glens Falls, New York, United States, 12801
Staten Island University Hospital
Staten Island, New York, United States, 10305
CCOP - Syracuse Hematology-Oncology Associates of Central New York, P.C.
Syracuse, New York, United States, 13217
Alamance Cancer Center
Burlington, North Carolina, United States, 27216
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
Chapel Hill, North Carolina, United States, 27599-7295
Leo W. Jenkins Cancer Center of University Health Systems of Eastern Carolina
Greenville, North Carolina, United States, 27858-4354
CCOP - Southeast Cancer Control Consortium
Winston-Salem, North Carolina, United States, 27104-4241
Comprehensive Cancer Center at Wake Forest University
Winston-Salem, North Carolina, United States, 27157-1082
CCOP - Merit Care Hospital
Fargo, North Dakota, United States, 58122
Akron City Hospital
Akron, Ohio, United States, 44309
Aultman Hospital Cancer Center at Aultman Health Foundation
Canton, Ohio, United States, 44710
Jewish Hospital of Cincinnati, Incorporated
Cincinnati, Ohio, United States, 45236
Charles M. Barrett Cancer Center at University Hospital
Cincinnati, Ohio, United States, 45267-0502
CCOP - Columbus
Columbus, Ohio, United States, 43206
Arthur G. James Cancer Hospital - Ohio State University
Columbus, Ohio, United States, 43210-1240
CCOP - Dayton
Kettering, Ohio, United States, 45429
CCOP - Toledo Community Hospital
Toledo, Ohio, United States, 43623-3456
South Pointe Hospital - Cancer Care Center
Warrensville Heights, Ohio, United States, 44122
CCOP - Oklahoma
Tulsa, Oklahoma, United States, 74136
CCOP - Columbia River Oncology Program
Portland, Oregon, United States, 97213
John and Dorothy Morgan Cancer Center at Lehigh Valley Hospital
Allentown, Pennsylvania, United States, 18103
Geisinger Medical Center
Danville, Pennsylvania, United States, 17822-2001
Albert Einstein Cancer Center
Philadelphia, Pennsylvania, United States, 19141
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
Philadelphia, Pennsylvania, United States, 19107-5541
Allegheny General Hospital
Pittsburgh, Pennsylvania, United States, 15212-4772
Hillman Cancer Center at University of Pittsburgh Cancer Institute
Pittsburgh, Pennsylvania, United States, 15213-3489
Reading Hospital and Medical Center
Reading, Pennsylvania, United States, 19612-6052
Mercy Hospital Cancer Center - Scranton
Scranton, Pennsylvania, United States, 18501
CCOP - MainLine Health
Wynnewood, Pennsylvania, United States, 19096
Wellspan Health - York Cancer Center
York, Pennsylvania, United States, 17315
CCOP - Greenville
Greenville, South Carolina, United States, 29615
CCOP - Upstate Carolina
Spartanburg, South Carolina, United States, 29303
Thompson Cancer Survival Center
Knoxville, Tennessee, United States, 37916
Baptist Cancer Institute - Memphis at Baptist Memorial Hospital - Memphis
Memphis, Tennessee, United States, 38146
Simmons Cancer Center at University of Texas Southwestern Medical Center - Dallas
Dallas, Texas, United States, 75235-9154
Medical City Dallas Hospital
Dallas, Texas, United States, 75230
Baylor College of Medicine
Houston, Texas, United States, 77030
Joe Arrington Cancer Research and Treatment Center
Lubbock, Texas, United States, 79410-1894
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States, 78284-7811
CCOP - Scott and White Hospital
Temple, Texas, United States, 76508
Utah Valley Regional Medical Center - Provo
Provo, Utah, United States, 84604
Green Mountain Oncology Group
Bennington, Vermont, United States, 05201
Virginia Oncology Associates - Newport News
Newport News, Virginia, United States, 23606
Eastern Virginia Medical School
Norfolk, Virginia, United States, 23507
MBCCOP - Massey Cancer Center
Richmond, Virginia, United States, 23298-0037
Oncology and Hematology Associates of Southwest Virginia, Inc.
Roanoke, Virginia, United States, 24014
CCOP - Virginia Mason Research Center
Seattle, Washington, United States, 98101
Puget Sound Oncology Consortium
Seattle, Washington, United States, 98109
CCOP - Northwest
Tacoma, Washington, United States, 98405-0986
Charleston Area Medical Center
Charleston, West Virginia, United States, 25304-1297
Camden-Clark Memorial Hospital
Parkersburg, West Virginia, United States, 26102
CCOP - St. Vincent Hospital Cancer Center, Green Bay
Green Bay, Wisconsin, United States, 54301
CCOP - Marshfield Clinic Research Foundation
Marshfield, Wisconsin, United States, 54449
St. Luke's Medical Center
Milwaukee, Wisconsin, United States, 53215
Medical College of Wisconsin Cancer Center
Milwaukee, Wisconsin, United States, 53226
Tom Baker Cancer Center - Calgary
Calgary, Alberta, Canada, T2N 4N2
CancerCare Manitoba
Winnipeg, Manitoba, Canada, R3E 0V9
Credit Valley Hospital
Mississauga, Ontario, Canada, L5M 2N1
Ottawa Regional Cancer Centre
Ottawa, Ontario, Canada, K1H 1C4
St. Michael's Hospital - Toronto
Toronto, Ontario, Canada, M5B 1W8
Royal Victoria Hospital - Montreal
Montreal, Quebec, Canada, H3A 1A1
St. Mary's Hospital Center
Montreal, Quebec, Canada, H3T 1M5
Jewish General Hospital - Montreal
Montreal, Quebec, Canada, H3T 1E2
Montreal General Hospital
Montreal, Quebec, Canada, H3G 1A4
Centre Hospitalier de l'Universite de Montreal
Montreal, Quebec, Canada, H2L-4M1
Hopital du Saint-Sacrement, Quebec
Quebec City, Quebec, Canada, G1S 4L8