Docetaxel With or Without Infliximab in Treating Weight Loss, Loss of Appetite, and Fatigue in Patients With Unresectable Non-Small Cell Lung Cancer (Infliximab Treatment Discontinued Effective 10/05/05)

Sponsor

Alliance for Clinical Trials in Oncology (Other)

Overall Status

Completed

CT.gov ID

NCT00040885

Collaborator

National Cancer Institute (NCI) (NIH)

Enrollment

188

Locations

Arms

Duration (Months)

0.4

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

RATIONALE: Drugs used in chemotherapy, such as docetaxel, work in different ways to stop tumor cells from dividing so they stop growing or die. Infliximab may improve cancer-related weight loss, lack of appetite, and fatigue. It is not yet known whether docetaxel is more effective with or without infliximab in preventing weight loss and fatigue in patients with advanced cancer. (Infliximab treatment discontinued effective 10/05/05)

PURPOSE: Randomized phase III trial to determine the effectiveness of docetaxel with or without infliximab in preventing weight loss, loss of appetite, and fatigue in patients who have unresectable non-small cell lung cancer. (Infliximab treatment discontinued effective 10/05/05)

Condition or Disease	Intervention/Treatment	Phase
Anorexia Cachexia Fatigue Lung Cancer	Biological: infliximab Drug: docetaxel Other: placebo	Phase 3

Detailed Description

OBJECTIVES:

Compare the improvement or stabilization of weight in elderly or poor performance status patients with unresectable non-small cell lung cancer treated with docetaxel with or without infliximab (infliximab treatment discontinued effective 10/05/05).
Compare appetite and functional status in patients treated with these regimens.
Compare the toxicity of these regimens in these patients.
Compare the augmentation or maintenance of lean tissue in patients treated with these regimens.
Compare the response rates and time to disease progression in patients treated with these regimens.
Compare the survival of patients treated with these regimens.
Determine whether the tumor necrosis factor-alpha polymorphisms in the -308 and -238 regions predict which cancer patients will experience loss of appetite and weight and which patients might potentially benefit from infliximab (infliximab treatment discontinued effective 10/05/05).

OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to weight loss within the past 6 months (0% vs more than 0% to less than 5% vs at least 5%), number of prior chemotherapy regimens (0 vs 1 vs more than 1), gender, and GBU prognostic index (good vs bad vs unsure).

Part A (non-randomized, single-center portion of study): Five patients receive infliximab IV (infliximab treatment discontinued effective 10/05/05) over 2 hours once weekly on weeks 1, 3, and 5 of the first course and once weekly on weeks 1 and 5 of all subsequent courses and docetaxel IV over 1 hour (immediately after completion of infliximab infusion [infliximab treatment discontinued effective 10/05/05]) once weekly on weeks 1-6 of each course. Treatment repeats every 8 weeks for 2-3 courses in the absence of disease progression or unacceptable toxicity.

If none of the 5 patients experiences any grade 4 or 5 toxicity directly attributable to infliximab (infliximab treatment discontinued effective 10/05/05), additional patients are accrued for part B of the study.

Part B (randomized, multicenter portion of study): Patients are randomized to 1 of 2 treatment arms.
Arm I (infliximab treatment discontinued effective 10/05/05): Patients receive infliximab and docetaxel as in part A.
Arm II: Patients receive docetaxel as in part A and placebo IV over 2 hours according to the infliximab schedule in part A (infliximab treatment discontinued effective 10/05/05).

Treatment in both arms repeats as in part A.

Quality of life, fatigue, appetite/anorexia, cachexia, and weight are assessed at baseline, weekly on weeks 1-8, and then monthly for the remainder of study treatment.

Patients are followed every 6 months for 5 years.

Study Design

Study Type:

Interventional

Actual Enrollment :

67 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Double (Participant, Investigator)

Primary Purpose:

Supportive Care

Official Title:

Docetaxel And Infliximab/Placebo In Non-Small Cell Lung Cancer (NSCLC) Patients Greater Than Or Equal To 65 Years Of Age Or In NSCLC Patients With Poor Performance Status: A Double-Blind Randomized, Placebo-Controlled Trial To Prevent And Treat Wasting, Anorexia, And Asthenia In Chemotherapy-Naive And Previously-Treated Patients

Study Start Date :

Oct 1, 2002

Actual Primary Completion Date :

Feb 1, 2006

Actual Study Completion Date :

Oct 1, 2008

Arms and Interventions

Arm	Intervention/Treatment
Experimental: infliximab + docetaxel Patients receive infliximab IV over 2 hours once weekly on weeks 1, 3, and 5 of the first course and once weekly on weeks 1 and 5 of all subsequent courses and docetaxel IV over 1 hour (immediately after completion of infliximab infusion once weekly on weeks 1-6 of each course. Treatment repeats every 8 weeks for 2-3 courses in the absence of disease progression or unacceptable toxicity. Quality of life, fatigue, appetite/anorexia, cachexia, and weight are assessed at baseline, weekly on weeks 1-8, and then monthly for the remainder of study treatment. Patients are followed every 6 months for 5 years.	Biological: infliximab Drug: docetaxel
Active Comparator: placebo + docetaxel Patients receive docetaxel IV over 1 hour (immediately after completion of infliximab infusion once weekly on weeks 1-6 of each course. Patients receive placebo IV over 2 hours once weekly on weeks 1, 3, and 5 of the first course and once weekly on weeks 1 and 5 of all subsequent courses. Treatment repeats every 8 weeks for 2-3 courses in the absence of disease progression or unacceptable toxicity. Quality of life, fatigue, appetite/anorexia, cachexia, and weight are assessed at baseline, weekly on weeks 1-8, and then monthly for the remainder of study treatment. Patients are followed every 6 months for 5 years.	Drug: docetaxel Other: placebo

Arm

Intervention/Treatment

Experimental: infliximab + docetaxel

Patients receive infliximab IV over 2 hours once weekly on weeks 1, 3, and 5 of the first course and once weekly on weeks 1 and 5 of all subsequent courses and docetaxel IV over 1 hour (immediately after completion of infliximab infusion once weekly on weeks 1-6 of each course. Treatment repeats every 8 weeks for 2-3 courses in the absence of disease progression or unacceptable toxicity. Quality of life, fatigue, appetite/anorexia, cachexia, and weight are assessed at baseline, weekly on weeks 1-8, and then monthly for the remainder of study treatment. Patients are followed every 6 months for 5 years.

Biological: infliximab

Drug: docetaxel

Active Comparator: placebo + docetaxel

Patients receive docetaxel IV over 1 hour (immediately after completion of infliximab infusion once weekly on weeks 1-6 of each course. Patients receive placebo IV over 2 hours once weekly on weeks 1, 3, and 5 of the first course and once weekly on weeks 1 and 5 of all subsequent courses. Treatment repeats every 8 weeks for 2-3 courses in the absence of disease progression or unacceptable toxicity. Quality of life, fatigue, appetite/anorexia, cachexia, and weight are assessed at baseline, weekly on weeks 1-8, and then monthly for the remainder of study treatment. Patients are followed every 6 months for 5 years.

Drug: docetaxel

Other: placebo

Outcome Measures

Primary Outcome Measures

Assessment of weight [Up to 5 years]
Rate of weight change [Up to 5 years]

Secondary Outcome Measures

Overall survival [Up to 5 years]
Incidence of treatment-related toxicity [Up to 5 years]
Cancer-related fatigue as measured by the Brief Fatigue Inventory [Up to 5 years]
Time-to-weight decline [Up to 5 years]
Appetite [Up to 5 years]
Lean tissue changes [Up to 5 years]
Quality of life [Up to 5 years]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

DISEASE CHARACTERISTICS:

Histologically or cytologically confirmed unresectable non-small cell lung cancer that is considered incurable with other therapies
Chemotherapy naive or previously treated disease
Meets one of the following criteria:
Age 65 and over with ECOG performance status of 0-2
Under age 65 with ECOG performance status of 2
No symptomatic or known untreated brain metastases

PATIENT CHARACTERISTICS:

Age:

See Disease Characteristics
Adult

Performance status:

See Disease Characteristics
ECOG 0-2

Life expectancy:

At least 3 months

Hematopoietic:

Absolute neutrophil count ≥ 1,500/mm^3
Platelet count ≥ 100,000/mm^3

Hepatic:

Bilirubin normal
AST and/or ALT ≤ 2.5 times upper limit of normal (ULN) if alkaline phosphatase less than ULN OR
Alkaline phosphatase ≤ 4 times ULN if ALT less than ULN
No ascites

Renal:

Creatinine ≤ 1.5 times ULN

Cardiovascular:

No prior or concurrent congestive heart failure

Pulmonary:

No prior tuberculosis or positive purified protein derivative skin test (tuberculin test)

Other:

No prior anaphylactic reaction to any taxane
No known mechanical obstruction of the alimentary tract, malabsorption, or intractable vomiting (more than 5 episodes per week)
No infection or chronic debilitating illness that would increase the risk of chemotherapy administration
No grade 2 or greater peripheral neuropathy of any etiology
No edema
No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer
Alert and mentally competent
Able to complete questionnaires alone or with assistance
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

Not specified

Chemotherapy:

See Disease Characteristics
No prior docetaxel for metastatic non-small cell lung cancer

Endocrine therapy:

At least 1 month since prior adrenal steroids, androgens, progestational agents, or appetite stimulants
No concurrent adrenal steroids, androgens, progestational agents, or appetite stimulants unless needed (e.g., steroids for CNS metastases)
Concurrent inhaled, topical, or optical steroids allowed
Concurrent short-term dexamethasone around days of chemotherapy administration allowed for protection against anaphylaxis and emesis

Radiotherapy:

More than 3 weeks since prior radiotherapy
No prior radiotherapy to more than 25% of bone marrow

Surgery:

More than 3 weeks since prior major surgery

Other:

More than 3 weeks since other prior antineoplastic therapy

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	CCOP - Mayo Clinic Scottsdale Oncology Program	Scottsdale	Arizona	United States	85259
2	Aurora Presbyterian Hospital	Aurora	Colorado	United States	80012
3	Boulder Community Hospital	Boulder	Colorado	United States	80301
4	Penrose Cancer Center at Penrose Hospital	Colorado Springs	Colorado	United States	80933
5	Porter Adventist Hospital	Denver	Colorado	United States	80210
6	Presbyterian - St. Luke's Medical Center	Denver	Colorado	United States	80218
7	St. Joseph Hospital	Denver	Colorado	United States	80218
8	Rose Medical Center	Denver	Colorado	United States	80220
9	CCOP - Colorado Cancer Research Program, Incorporated	Denver	Colorado	United States	80224-2522
10	Swedish Medical Center	Englewood	Colorado	United States	80110
11	Sky Ridge Medical Center	Lone Tree	Colorado	United States	80124
12	Hope Cancer Care Center at Longmont United Hospital	Longmont	Colorado	United States	80502
13	St. Mary-Corwin Regional Medical Center	Pueblo	Colorado	United States	81004
14	North Suburban Medical Center	Thorton	Colorado	United States	80229
15	Mayo Clinic - Jacksonville	Jacksonville	Florida	United States	32224-9980
16	Rush-Copley Cancer Care Center	Aurora	Illinois	United States	60507
17	St. Joseph Medical Center	Bloomington	Illinois	United States	61701
18	Graham Hospital	Canton	Illinois	United States	61520
19	Memorial Hospital	Carthage	Illinois	United States	62321
20	Eureka Community Hospital	Eureka	Illinois	United States	61530
21	Galesburg Clinic	Galesburg	Illinois	United States	61401
22	Galesburg Cottage Hospital	Galesburg	Illinois	United States	61401
23	InterCommunity Cancer Center of Western Illinois	Galesburg	Illinois	United States	61401
24	Mason District Hospital	Havana	Illinois	United States	62644
25	Hopedale Medical Complex	Hopedale	Illinois	United States	61747
26	Joliet Oncology Hematology Associates, Limited - West	Joliet	Illinois	United States	60435
27	Kewanee Hospital	Kewanee	Illinois	United States	61443
28	McDonough District Hospital	Macomb	Illinois	United States	61455
29	BroMenn Regional Medical Center	Normal	Illinois	United States	61761
30	Community Cancer Center	Normal	Illinois	United States	61761
31	Community Hospital of Ottawa	Ottawa	Illinois	United States	61350
32	Oncology Hematology Associates of Central Illinois - Ottawa	Ottawa	Illinois	United States	61350
33	Cancer Treatment Center at Pekin Hospital	Pekin	Illinois	United States	61554
34	Methodist Medical Center of Illinois	Peoria	Illinois	United States	61603
35	Proctor Hospital	Peoria	Illinois	United States	61614
36	CCOP - Illinois Oncology Research Association	Peoria	Illinois	United States	61615
37	Oncology/Hematology Associates of Central Illinois, P.C.	Peoria	Illinois	United States	61615
38	OSF St. Francis Medical Center	Peoria	Illinois	United States	61637
39	Illinois Valley Community Hospital	Peru	Illinois	United States	61354
40	Perry Memorial Hospital	Princeton	Illinois	United States	61356
41	St. Margaret's Hospital	Spring Valley	Illinois	United States	61362
42	Valley Cancer Center	Spring Valley	Illinois	United States	61362
43	Carle Cancer Center at Carle Foundation Hospital	Urbana	Illinois	United States	61801
44	CCOP - Carle Cancer Center	Urbana	Illinois	United States	61801
45	St. Francis Hospital and Health Centers	Beech Grove	Indiana	United States	46107
46	Saint Anthony Memorial Health Centers	Michigan City	Indiana	United States	46360
47	Saint Anthony Regional Hospital	Carroll	Iowa	United States	51401
48	St. Luke's Hospital	Cedar Rapids	Iowa	United States	52402
49	Cedar Rapids Oncology Associates	Cedar Rapids	Iowa	United States	52403
50	Mercy Cancer Center at Mercy Medical Center	Cedar Rapids	Iowa	United States	52403
51	Alegent Health Mercy Hospital	Council Bluffs	Iowa	United States	51503
52	Mercy Capitol Hospital	Des Moines	Iowa	United States	50307
53	CCOP - Iowa Oncology Research Association	Des Moines	Iowa	United States	50309
54	John Stoddard Cancer Center at Iowa Methodist Medical Center	Des Moines	Iowa	United States	50309
55	Medical Oncology and Hematology Associates at John Stoddard Cancer Center	Des Moines	Iowa	United States	50309
56	Medical Oncology and Hematology Associates at Mercy Cancer Center	Des Moines	Iowa	United States	50314
57	Mercy Cancer Center at Mercy Medical Center - Des Moines	Des Moines	Iowa	United States	50314
58	John Stoddard Cancer Center at Iowa Lutheran Hospital	Des Moines	Iowa	United States	50316
59	Mercy Cancer Center at Mercy Medical Center - North Iowa	Mason City	Iowa	United States	50401
60	Alegent Health Community Memorial Hospital	Missouri Valley	Iowa	United States	51555
61	Burgess Health Center	Onawa	Iowa	United States	51040
62	Ottumwa Regional Health Center Cancer Center	Ottumwa	Iowa	United States	52501
63	Siouxland Regional Cancer Center	Sioux City	Iowa	United States	51101-1733
64	Siouxland Hematology-Oncology Associates	Sioux City	Iowa	United States	51101
65	Mercy Medical Center - Sioux City	Sioux City	Iowa	United States	51104
66	St. Luke's Regional Medical Center	Sioux City	Iowa	United States	51104
67	Medical Oncology and Hematology Associates - West Des Moines	West Des Moines	Iowa	United States	50266
68	Cancer Center of Kansas - Chanute	Chanute	Kansas	United States	66720
69	Cancer Center of Kansas - Dodge City	Dodge City	Kansas	United States	67801
70	Cancer Center of Kansas, P.A. - El Dorado	El Dorado	Kansas	United States	67042
71	Cancer Center of Kansas - Kingman	Kingman	Kansas	United States	67068
72	Southwest Medical Center	Liberal	Kansas	United States	67901
73	Cancer Center of Kansas - Newton	Newton	Kansas	United States	67114
74	Cancer Center of Kansas, P.A. - Parsons	Parsons	Kansas	United States	67357
75	Pratt Cancer Center of Kansas	Pratt	Kansas	United States	67124
76	Cancer Center of Kansas - Salina	Salina	Kansas	United States	67042
77	Cancer Center of Kansas - Wellington	Wellington	Kansas	United States	67152
78	Associates in Womens Health	Wichita	Kansas	United States	67203
79	Cancer Center of Kansas, P.A.	Wichita	Kansas	United States	67208
80	Cancer Center of Kansas, P.A. - Wichita	Wichita	Kansas	United States	67214
81	CCOP - Wichita	Wichita	Kansas	United States	67214
82	Via Christi Cancer Center at Via Christi Regional Medical Center	Wichita	Kansas	United States	67214
83	Cancer Center of Kansas - Winfield	Winfield	Kansas	United States	67156
84	Hickman Cancer Center at Bixby Medical Center	Adrian	Michigan	United States	49221
85	Green Bay Oncology, Limited - Escanaba	Escanaba	Michigan	United States	49431
86	Green Bay Oncology, Limited - Iron Mountain	Iron Mountain	Michigan	United States	49801
87	Haematology-Oncology Associates of Ohio and Michigan, P.C.	Lambertville	Michigan	United States	48144
88	Community Cancer Center of Monroe	Monroe	Michigan	United States	48162
89	Mercy Memorial Hospital System	Monroe	Michigan	United States	48162
90	MeritCare Clinic - Bemidji	Bemidji	Minnesota	United States	56601
91	Brainerd Medical Center	Brainerd	Minnesota	United States	56401
92	St. Joseph's Medical Center	Brainerd	Minnesota	United States	56401
93	Fairview Ridges Hospital	Burnsville	Minnesota	United States	55337
94	Mercy and Unity Cancer Center at Mercy Hospital	Coon Rapids	Minnesota	United States	55433
95	CCOP - Duluth	Duluth	Minnesota	United States	55805
96	Miller-Dwan Medical Center	Duluth	Minnesota	United States	55805
97	St. Mary's - Duluth Clinic Cancer Center	Duluth	Minnesota	United States	55805
98	Fairview Southdale Hospital	Edina	Minnesota	United States	55435
99	Mercy and Unity Cancer Center at Unity Hospital	Fridley	Minnesota	United States	55432
100	Virginia Piper Cancer Institute at Abbott-Northwestern Hospital	Minneapolis	Minnesota	United States	55403
101	Chippewa County - Montevideo Hospital	Montevideo	Minnesota	United States	56265
102	Hubert H. Humphrey Cancer Center at North Memorial Medical Center	Robbinsdale	Minnesota	United States	55422
103	Mayo Clinic Cancer Center	Rochester	Minnesota	United States	55905
104	St. Cloud Hospital	Saint Cloud	Minnesota	United States	56303
105	CCOP - Metro-Minnesota	Saint Louis Park	Minnesota	United States	55416
106	Adult and Pediatric Urology, P.L.L.P.	St. Cloud	Minnesota	United States	56303
107	CentraCare Clinic - River Campus	St. Cloud	Minnesota	United States	56303
108	Park Nicollet Health Services	St. Louis Park	Minnesota	United States	55416
109	United Hospital	St. Paul	Minnesota	United States	55102
110	Ridgeview Medical Center	Waconia	Minnesota	United States	55387
111	CCOP - Montana Cancer Consortium	Billings	Montana	United States	59101
112	Deaconess Billings Clinic - Downtown	Billings	Montana	United States	59101
113	Northern Rockies Radiation Oncology Center	Billings	Montana	United States	59101
114	St. Vincent Healthcare	Billings	Montana	United States	59101
115	Deaconess Billings Clinic Cancer Center	Billings	Montana	United States	59107
116	Bozeman Deaconess Hospital	Bozeman	Montana	United States	59715
117	St. James Community Hospital	Butte	Montana	United States	59701
118	Great Falls Clinic	Great Falls	Montana	United States	59405
119	Sletten Regional Cancer Institute	Great Falls	Montana	United States	59405
120	St. Peter's Hospital	Helena	Montana	United States	59601
121	Kalispell Regional Medical Center	Kalispell	Montana	United States	59901
122	Eastern Montana Cancer Center	Miles City	Montana	United States	59301
123	Community Medical Center	Missoula	Montana	United States	59801
124	Montana Cancer Center at St. Patrick Hospital and Health Sciences Center	Missoula	Montana	United States	59802
125	Fremont Area Medical Center	Fremont	Nebraska	United States	68025
126	CCOP - Missouri Valley Cancer Consortium	Omaha	Nebraska	United States	68106
127	Immanuel Medical Center	Omaha	Nebraska	United States	68122
128	Bergan Mercy Medical Center	Omaha	Nebraska	United States	68124
129	Creighton University Medical Center	Omaha	Nebraska	United States	68131
130	Midlands Cancer Center at Midlands Community Hospital	Papillion	Nebraska	United States	68046
131	Rutherford Hospital	Rutherfordton	North Carolina	United States	28139
132	Bismarck Cancer Center	Bismarck	North Dakota	United States	58501
133	Cancer Care Center at Medcenter One Hospital	Bismarck	North Dakota	United States	58501
134	Mid Dakota Clinic, P.C.	Bismarck	North Dakota	United States	58501
135	St. Alexius Medical Center	Bismarck	North Dakota	United States	58501
136	CCOP - MeritCare Hospital	Fargo	North Dakota	United States	58122
137	MeritCare Medical Group	Fargo	North Dakota	United States	58122
138	Wood County Oncology Center	Bowling Green	Ohio	United States	43402
139	Grandview Hospital	Dayton	Ohio	United States	45405
140	Good Samaritan Hospital	Dayton	Ohio	United States	45406
141	David L. Rike Cancer Center at Miami Valley Hospital	Dayton	Ohio	United States	45409
142	Samaritan North Cancer Care Center	Dayton	Ohio	United States	45415
143	Veterans Affairs Medical Center - Dayton	Dayton	Ohio	United States	45428
144	CCOP - Dayton	Dayton	Ohio	United States	45429
145	Blanchard Valley Medical Associates	Findlay	Ohio	United States	45840
146	Fremont Memorial Hospital	Fremont	Ohio	United States	43420
147	Kenton Oncology, Incorporated	Kenton	Ohio	United States	43326
148	Charles F. Kettering Memorial Hospital	Kettering	Ohio	United States	45429
149	Lima Memorial Hospital	Lima	Ohio	United States	45804
150	Northwest Ohio Oncology Center	Maumee	Ohio	United States	43537
151	St. Luke's Hospital	Maumee	Ohio	United States	43537
152	Middletown Regional Hospital	Middletown	Ohio	United States	45044
153	St. Charles Mercy Hospital	Oregon	Ohio	United States	43616
154	Toledo Clinic - Oregon	Oregon	Ohio	United States	43616
155	Firelands Regional Medical Center	Sandusky	Ohio	United States	44870
156	North Coast Cancer Care, Incorporated	Sandusky	Ohio	United States	44870
157	Promedica Cancer Center at Flower Hospital	Sylvania	Ohio	United States	43560
158	Mercy Hospital of Tiffin	Tiffin	Ohio	United States	44883
159	Toledo Hospital	Toledo	Ohio	United States	43606
160	St. Vincent Mercy Medical Center	Toledo	Ohio	United States	43608
161	Medical College of Ohio Cancer Institute	Toledo	Ohio	United States	43614
162	CCOP - Toledo Community Hospital	Toledo	Ohio	United States	43623
163	Toledo Clinic, Incorporated	Toledo	Ohio	United States	43623
164	Toledo Surgical Specialists	Toledo	Ohio	United States	43623
165	UVMC Cancer Care Center at Upper Valley Medical Center	Troy	Ohio	United States	45373
166	Fulton County Health Center	Wauseon	Ohio	United States	43567
167	United States Air Force Medical Center Wright-Patterson	Wright-Patterson Afb	Ohio	United States	45433-5529
168	Ruth G. McMillan Cancer Center at Greene Memorial Hospital	Xenia	Ohio	United States	45385
169	Natalie Warren Bryant Cancer Center at St. Francis Hospital	Tulsa	Oklahoma	United States	74136
170	Geisinger Medical Center	Danville	Pennsylvania	United States	17822-2001
171	Geisinger Medical Group	State College	Pennsylvania	United States	16801
172	Geisinger Wyoming Valley Medical Center	Wilkes-Barre	Pennsylvania	United States	18711
173	Rose Ramer Cancer Clinic at Anderson Area Medical Center	Anderson	South Carolina	United States	29621
174	Gibbs Regional Cancer Center at Spartanburg Regional Medical Center	Spartanburg	South Carolina	United States	29303
175	CCOP - Upstate Carolina	Spartanburg	South Carolina	United States	29304
176	Sioux Valley Hospital and University of South Dakota Medical Center	Sioux Falls	South Dakota	United States	57104
177	Avera McKennan Hospital and University Health Center	Sioux Falls	South Dakota	United States	57105
178	Medical X-Ray Center	Sioux Falls	South Dakota	United States	57105
179	Luther Mildelfort Hospital	Eau Claire	Wisconsin	United States	54702
180	Midelfort Clinic - Luther	Eau Claire	Wisconsin	United States	54702
181	Green Bay Oncology, Limited at St. Vincent Hospital	Green Bay	Wisconsin	United States	54301-3526
182	St. Vincent Hospital	Green Bay	Wisconsin	United States	54301
183	Green Bay Oncology, Limited at St. Mary's Hospital	Green Bay	Wisconsin	United States	54303
184	St. Mary's Hospital Medical Center	Green Bay	Wisconsin	United States	54303
185	Franciscan Skemp Healthcare	La Crosse	Wisconsin	United States	54601
186	Green Bay Oncology, Limited - Oconto Falls	Oconto Falls	Wisconsin	United States	54154
187	Green Bay Oncology, Limited - Sturgeon Bay	Sturgeon Bay	Wisconsin	United States	54235
188	Welch Cancer Center	Sheridan	Wyoming	United States	82801