Combination Chemotherapy in Treating Patients With Bladder Cancer

Sponsor

Alliance for Clinical Trials in Oncology (Other)

Overall Status

Completed

CT.gov ID

NCT00014534

Collaborator

National Cancer Institute (NCI) (NIH)

Enrollment

285

Locations

Arms

Duration (Months)

0.1

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells.

PURPOSE: Randomized phase III trial to compare different combination chemotherapy regimens in treating patients who have advanced bladder cancer.

Condition or Disease	Intervention/Treatment	Phase
Bladder Cancer	Biological: filgrastim Drug: cisplatin Drug: doxorubicin hydrochloride Drug: gemcitabine hydrochloride	Phase 3

Detailed Description

OBJECTIVES:

Primary

Compare the survival of patients with completely resected locally advanced transitional cell carcinoma of the bladder treated with adjuvant doxorubicin and gemcitabine followed by paclitaxel and cisplatin vs adjuvant cisplatin and gemcitabine.

Secondary

Compare the toxicity profiles of these regimens in these patients.

OUTLINE: This is a randomized study. Patients are stratified according to primary tumor status (<T4 vs T4), number of positive lymph nodes (0 or unknown vs 1-5 vs >5), and number of dissected nodes (0-10 or unknown vs > 10). Patients are randomized to one of two treatment arms.

Arm I: Patients receive adjuvant gemcitabine IV over 30 minutes on days 1, 8, and 15 and cisplatin IV over 30-60 minutes on day 1. Treatment repeats every 4 weeks for up to 4 courses in the absence of disease progression or unacceptable toxicity.
Arm II: Patients receive adjuvant doxorubicin IV over 45 minutes followed by gemcitabine IV over 2 hours on day 1. Patients also receive filgrastim (G-CSF) subcutaneously (SC) daily on days 3-10. Treatment repeats every 14 days for up to 4 courses in the absence of disease progression or unacceptable toxicity. Beginning 14 days after the completion of doxorubicin and gemcitabine, patients receive paclitaxel IV over 3 hours and cisplatin IV over 20-30 minutes on day 1. Patients also receive G-CSF SC daily on days 3-10 or 4-11. Treatment repeats every 14 days for up to 4 courses in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 18 months, every 6 months for 18 months, and then annually thereafter.

Study Design

Study Type:

Interventional

Actual Enrollment :

42 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Phase III Study Comparing Sequential Chemotherapy (AG-ITP) To Cisplatin And Gemcitabine As Adjuvant Treatment After Cystectomy For Transitional Cell Carcinoma Of The Bladder

Study Start Date :

Mar 1, 2004

Actual Primary Completion Date :

Jul 1, 2005

Actual Study Completion Date :

Apr 1, 2009

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Gemcitabine + cisplatin	Drug: cisplatin 60 mg/sq m IV Drug: gemcitabine hydrochloride 1000 mg/ sq m IV for Gem + cis arm and 2000 mg/sq m IV for gem + dox + peg arm
Active Comparator: Gemcitabine + Doxorubicin + Pegfilgrastim	Biological: filgrastim 6 mg sub Q Drug: doxorubicin hydrochloride 50 mg/ sq m IV Drug: gemcitabine hydrochloride 1000 mg/ sq m IV for Gem + cis arm and 2000 mg/sq m IV for gem + dox + peg arm

Arm

Intervention/Treatment

Active Comparator: Gemcitabine + cisplatin

Drug: cisplatin

60 mg/sq m IV

Drug: gemcitabine hydrochloride

1000 mg/ sq m IV for Gem + cis arm and 2000 mg/sq m IV for gem + dox + peg arm

Active Comparator: Gemcitabine + Doxorubicin + Pegfilgrastim

Biological: filgrastim

6 mg sub Q

Drug: doxorubicin hydrochloride

50 mg/ sq m IV

Drug: gemcitabine hydrochloride

1000 mg/ sq m IV for Gem + cis arm and 2000 mg/sq m IV for gem + dox + peg arm

Outcome Measures

Primary Outcome Measures

Overall survival [4 years]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

DISEASE CHARACTERISTICS:

Histologically confirmed transitional cell carcinoma of the bladder
Any T, N+, M0 OR
T3a-4a, N0, M0
At least 6 weeks but no more than 3 months since prior complete resection of bladder
Cystoprostatectomy plus pelvic lymph node dissection in males
Cystectomy/total abdominal hysterectomy/bilateral salpingo-oophorectomy plus pelvic lymph node dissection in females
Negative surgical margins
Carcinoma in situ allowed
No partial cystectomy or transurethral bladder tumor resection as definitive loco-regional therapy
Prostate cancer detected in resected specimen allowed if post-operative PSA is no more than 0.05 mg/dL
No metastatic or recurrent disease by post-operative chest x-ray and CT scan of abdomen and pelvis

PATIENT CHARACTERISTICS:

Age:

18 and over

Performance status:

ECOG 0-1

Hematopoietic:

Absolute neutrophil count ≥ 1,500/mm^3
Platelet count ≥ 150,000/mm^3

Hepatic:

Bilirubin ≤ 1.5 times upper limit of normal (ULN)
Alkaline phosphatase ≤ 2 times ULN
AST ≤ 2 times ULN

Renal:

Creatinine ≤ 1.5 mg/dL OR
Creatinine clearance ≥ 60 mL/min

Cardiovascular:

Normal cardiac function by history, physical exam, or chest radiograph
Left ventricular ejection fraction at least 50% by radionuclide ventriculogram or echocardiogram, for prior cardiac disease
No New York Heart Association class III or IV heart disease
No serious cardiac arrhythmias including first-, second-, and third-degree heart block

Other:

Negative pregnancy test
No uncontrolled infection
No other active cancer within the past 5 years except non-melanoma skin cancer or curatively treated carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

Biologic therapy:

Not specified

Chemotherapy:

No prior systemic chemotherapy

Endocrine therapy:

Not specified

Radiotherapy:

No prior radiotherapy to bladder

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	CCOP - Mayo Clinic Scottsdale Oncology Program	Scottsdale	Arizona	United States	85259
2	Arkansas Cancer Research Center at University of Arkansas for Medical Sciences	Little Rock	Arkansas	United States	72205
3	Arroyo Grande Community Hospital	Arroyo Grande	California	United States	93420
4	Rebecca and John Moores UCSD Cancer Center	San Diego	California	United States	92103
5	Kaiser Permanente Medical Office -Vandever Medical Office	San Diego	California	United States	92120
6	Veterans Affairs Medical Center - San Diego	San Diego	California	United States	92161
7	UCSF Comprehensive Cancer Center	San Francisco	California	United States	94115
8	Veterans Affairs Medical Center - San Francisco	San Francisco	California	United States	94121
9	Aurora Presbyterian Hospital	Aurora	Colorado	United States	80012
10	Boulder Community Hospital	Boulder	Colorado	United States	80301
11	Penrose Cancer Center at Penrose Hospital	Colorado Springs	Colorado	United States	80933
12	Porter Adventist Hospital	Denver	Colorado	United States	80210
13	Presbyterian - St. Luke's Medical Center	Denver	Colorado	United States	80218
14	St. Joseph Hospital	Denver	Colorado	United States	80218
15	Rose Medical Center	Denver	Colorado	United States	80220
16	CCOP - Colorado Cancer Research Program, Incorporated	Denver	Colorado	United States	80224-2522
17	Swedish Medical Center	Englewood	Colorado	United States	80110
18	Front Range Cancer Specialists	Fort Collins	Colorado	United States	80524
19	Poudre Valley Hospital	Fort Collins	Colorado	United States	80524
20	Sky Ridge Medical Center	Lone Tree	Colorado	United States	80124
21	Hope Cancer Care Center at Longmont United Hospital	Longmont	Colorado	United States	80502
22	St. Mary-Corwin Regional Medical Center	Pueblo	Colorado	United States	81004
23	North Suburban Medical Center	Thorton	Colorado	United States	80229
24	Beebe Medical Center	Lewes	Delaware	United States	19958
25	CCOP - Christiana Care Health Services	Newark	Delaware	United States	19718
26	St. Francis Hospital	Wilmington	Delaware	United States	19805
27	Lombardi Cancer Center at Georgetown University Medical Center	Washington	District of Columbia	United States	20007
28	Walter Reed Army Medical Center	Washington	District of Columbia	United States	20307
29	Lynn Regional Cancer Center of Boca Raton Community Hospital	Boca Raton	Florida	United States	33486
30	Michael & Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital	Fort Lauderdale	Florida	United States	33308
31	Memorial Cancer Institute at Memorial Regional Hospital	Hollywood	Florida	United States	33021
32	Mayo Clinic - Jacksonville	Jacksonville	Florida	United States	32224-9980
33	Ella Milbank Foshay Cancer Center at Jupiter Medical Center	Jupiter	Florida	United States	33458
34	Watson Clinic	Lakeland	Florida	United States	33805
35	CCOP - Mount Sinai Medical Center	Miami Beach	Florida	United States	33140
36	Phoebe Cancer Center at Phoebe Putney Memorial Hospital	Albany	Georgia	United States	31703
37	Emory University Hospital - Atlanta	Altanta	Georgia	United States	30322
38	Hematology and Oncology of Northeast Georgia	Athens	Georgia	United States	30607
39	MBCCOP-Medical College of Georgia Cancer Center	Augusta	Georgia	United States	30912
40	John B. Amos Community Cancer Center	Columbus	Georgia	United States	31902
41	Curtis & Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center	Savannah	Georgia	United States	31403
42	Rush-Copley Cancer Care Center	Aurora	Illinois	United States	60507
43	St. Joseph Medical Center	Bloomington	Illinois	United States	61701
44	Graham Hospital	Canton	Illinois	United States	61520
45	Memorial Hospital	Carthage	Illinois	United States	62321
46	University of Chicago Cancer Research Center	Chicago	Illinois	United States	60637-1470
47	Louis A. Weiss Memorial Hospital	Chicago	Illinois	United States	60640
48	Eureka Hospital	Eureka	Illinois	United States	61530
49	Galesburg Clinic	Galesburg	Illinois	United States	61401
50	Galesburg Cottage Hospital	Galesburg	Illinois	United States	61401
51	InterCommunity Cancer Center of Western Illinois	Galesburg	Illinois	United States	61401
52	Mason District Hospital	Havana	Illinois	United States	62644
53	Hopedale Medical Complex	Hopedale	Illinois	United States	61747
54	Joliet Oncology Hematology Associates, Limited - West	Joliet	Illinois	United States	60435
55	Provena St. Mary's Wasser Regional Cancer Center - Kankakee	Kankakee	Illinois	United States	60901
56	Kewanee Hospital	Kewanee	Illinois	United States	61443
57	McDonough District Hospital	Macomb	Illinois	United States	61455
58	Cardinal Bernardin Cancer Center at Loyola University Medical Center	Maywood	Illinois	United States	60153
59	BroMenn Regional Medical Center	Normal	Illinois	United States	61761
60	Community Cancer Center	Normal	Illinois	United States	61761
61	Community Hospital of Ottawa	Ottawa	Illinois	United States	61350
62	Oncology Hematology Associates of Central Illinois - Ottawa	Ottawa	Illinois	United States	61350
63	Cancer Treatment Center at Pekin Hospital	Pekin	Illinois	United States	61554
64	Methodist Medical Center of Illinois	Peoria	Illinois	United States	61603
65	Proctor Hospital	Peoria	Illinois	United States	61614
66	CCOP - Illinois Oncology Research Association	Peoria	Illinois	United States	61615
67	Oncology/Hematology Associates of Central Illinois, P.C.	Peoria	Illinois	United States	61615
68	OSF St. Francis Medical Center	Peoria	Illinois	United States	61637
69	Illinois Valley Community Hospital	Peru	Illinois	United States	61354
70	Perry Memorial Hospital	Princeton	Illinois	United States	61356
71	St. Margaret's Hospital	Spring Valley	Illinois	United States	61362
72	Valley Cancer Center	Spring Valley	Illinois	United States	61362
73	Regional Cancer Center at Memorial Medical Center	Springfield	Illinois	United States	62781-0001
74	Carle Cancer Center at Carle Foundation Hospital	Urbana	Illinois	United States	61801
75	CCOP - Carle Cancer Center	Urbana	Illinois	United States	61801
76	St. Francis Hospital and Health Centers	Beech Grove	Indiana	United States	46107
77	Elkhart General Hospital	Elkhart	Indiana	United States	46515
78	Indiana University Cancer Center	Indianapolis	Indiana	United States	46202
79	William N. Wishard Memorial Hospital	Indianapolis	Indiana	United States	46202
80	Center for Cancer Therapy at LaPorte Hospital and Health Services	La Porte	Indiana	United States	46350
81	Saint Anthony Memorial Health Centers	Michigan City	Indiana	United States	46360
82	Saint Joseph Regional Medical Center - Plymouth Campus	Plymouth	Indiana	United States	46544
83	CCOP - Northern Indiana CR Consortium	South Bend	Indiana	United States	46601
84	Memorial Hospital of South Bend	South Bend	Indiana	United States	46601
85	McFarland Clinic, P.C.	Ames	Iowa	United States	50010
86	St. Luke's Hospital	Cedar Rapids	Iowa	United States	52402
87	Cedar Rapids Oncology Associates	Cedar Rapids	Iowa	United States	52403
88	Mercy Cancer Center at Mercy Medical Center	Cedar Rapids	Iowa	United States	52403
89	Genesis Regional Cancer Center at Genesis Medical Center	Davenport	Iowa	United States	52803
90	Genesis Medical Center - West Campus	Davenport	Iowa	United States	52804
91	Mercy Capitol Hospital	Des Moines	Iowa	United States	50307
92	CCOP - Iowa Oncology Research Association	Des Moines	Iowa	United States	50309
93	John Stoddard Cancer Center at Iowa Methodist Medical Center	Des Moines	Iowa	United States	50309
94	Medical Oncology and Hematology Associates at John Stoddard Cancer Center	Des Moines	Iowa	United States	50309
95	Medical Oncology and Hematology Associates at Mercy Cancer Center	Des Moines	Iowa	United States	50314
96	Mercy Cancer Center at Mercy Medical Center - Des Moines	Des Moines	Iowa	United States	50314
97	John Stoddard Cancer Center at Iowa Lutheran Hospital	Des Moines	Iowa	United States	50316
98	Wendt Regional Cancer Center at Finley Hospital	Dubuque	Iowa	United States	52001
99	Holden Comprehensive Cancer Center at University of Iowa	Iowa City	Iowa	United States	52242
100	Siouxland Regional Cancer Center	Sioux City	Iowa	United States	51101-1733
101	Siouxland Hematology-Oncology Associates	Sioux City	Iowa	United States	51101
102	Mercy Medical Center - Sioux City	Sioux City	Iowa	United States	51104
103	St. Luke's Regional Medical Center	Sioux City	Iowa	United States	51104
104	Medical Oncology and Hematology Associates - West Des Moines	West Des Moines	Iowa	United States	50266
105	Cancer Center of Kansas - Chanute	Chanute	Kansas	United States	66720
106	Cancer Center of Kansas - Dodge City	Dodge City	Kansas	United States	67801
107	Cancer Center of Kansas, P.A. - El Dorado	El Dorado	Kansas	United States	67042
108	Cancer Center of Kansas - Kingman	Kingman	Kansas	United States	67068
109	Southwest Medical Center	Liberal	Kansas	United States	67901
110	Cancer Center of Kansas - Newton	Newton	Kansas	United States	67114
111	Cancer Center of Kansas, P.A. - Parsons	Parsons	Kansas	United States	67357
112	Pratt Cancer Center of Kansas	Pratt	Kansas	United States	67124
113	Cancer Center of Kansas - Salina	Salina	Kansas	United States	67042
114	Cancer Center of Kansas - Wellington	Wellington	Kansas	United States	67152
115	Associates in Womens Health	Wichita	Kansas	United States	67203
116	Cancer Center of Kansas, P.A.	Wichita	Kansas	United States	67208
117	Cancer Center of Kansas, P.A. - Wichita	Wichita	Kansas	United States	67214
118	CCOP - Wichita	Wichita	Kansas	United States	67214
119	Via Christi Cancer Center at Via Christi Regional Medical Center	Wichita	Kansas	United States	67214
120	Cancer Center of Kansas - Winfield	Winfield	Kansas	United States	67156
121	Central Maine Medical Center	Lewiston	Maine	United States	04240
122	Maine Center for Cancer Medicine and Blood Disorders - Scarborough	Scarborough	Maine	United States	04074
123	Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins	Baltimore	Maryland	United States	21287-8936
124	Union Hospital Cancer Center at Union Hospital	Elkton MD	Maryland	United States	21921
125	Lawrence Memorial Hospital of Medford	Medford	Massachusetts	United States	02155
126	CCOP - Michigan Cancer Research Consortium	Ann Arbor	Michigan	United States	48100
127	Borgess Medical Center	Kalamazooaa	Michigan	United States	49001
128	Bronson Methodist Hospital	Kalamazoo	Michigan	United States	49007
129	West Michigan Cancer Center	Kalamazoo	Michigan	United States	49007
130	William Beaumont Hospital - Royal Oak Campus	Royal Oak	Michigan	United States	48073
131	Fairview Ridges Hospital	Burnsville	Minnesota	United States	55337
132	Mercy Hospital	Coon Rapids	Minnesota	United States	55433
133	Fairview Southdale Hospital	Edina	Minnesota	United States	55435
134	Mercy and Unity Cancer Center at Mercy and Unity Hospitals	Fridley	Minnesota	United States	55432
135	Hutchinson Area Health Care	Hutchinson	Minnesota	United States	55350
136	Meeker County Memorial Hospital	Litchfield	Minnesota	United States	55355
137	St. John's Hospital	Maplewood	Minnesota	United States	55109
138	Virginia Piper Cancer Institute at Abbott-Northwestern Hospital	Minneapolis	Minnesota	United States	55407
139	Hennepin County Medical Center - Minneapolis	Minneapolis	Minnesota	United States	55415
140	Veterans Affairs Medical Center - Minneapolis	Minneapolis	Minnesota	United States	55417
141	Hubert H. Humphrey Cancer Center at North Memorial Medical Center	Robbinsdale	Minnesota	United States	55422
142	Mayo Clinic Cancer Center	Rochester	Minnesota	United States	55905
143	CCOP - Metro-Minnesota	Saint Louis Park	Minnesota	United States	55416
144	Cancer Care Center at Regions Hospital	Saint Paul	Minnesota	United States	55101
145	Saint Francis Cancer Center	Shakopee	Minnesota	United States	55379
146	St. Joseph's Hospital	St Paul	Minnesota	United States	55102
147	Park Nicollet Clinic	St. Louis Park	Minnesota	United States	55416
148	United Hospital	St. Paul	Minnesota	United States	55102
149	Ridgeview Medical Center	Waconia	Minnesota	United States	55387
150	Woodwinds Hospital	Woodbury	Minnesota	United States	55125
151	Missouri Cancer Associates	Columbia	Missouri	United States	65201
152	CCOP - Kansas City	Kansas City	Missouri	United States	64131
153	St. John's Regional Health Center	Springfield	Missouri	United States	65804
154	Hulston Cancer Center at Cox Medical Center South	Springfield	Missouri	United States	65807
155	St. Anthony's Cancer Center	St. Louis	Missouri	United States	63128
156	CCOP - Montana Cancer Consortium	Billings	Montana	United States	59101
157	Deaconess Billings Clinic - Downtown	Billings	Montana	United States	59101
158	Northern Rockies Radiation Oncology Center	Billings	Montana	United States	59101
159	St. Vincent Healthcare	Billings	Montana	United States	59101
160	Deaconess Billings Clinic Cancer Center	Billings	Montana	United States	59107
161	Bozeman Deaconess Hospital	Bozeman	Montana	United States	59715
162	St. James Community Hospital	Butte	Montana	United States	59701
163	Great Falls Clinic	Great Falls	Montana	United States	59405
164	Sletten Regional Cancer Institute	Great Falls	Montana	United States	59405
165	St. Peter's Hospital	Helena	Montana	United States	59601
166	Kalispell Regional Medical Center	Kalispell	Montana	United States	59901
167	Eastern Montana Cancer Center	Miles City	Montana	United States	59301
168	Community Medical Center	Missoula	Montana	United States	59801
169	Montana Cancer Center at St. Patrick Hospital and Health Sciences Center	Missoula	Montana	United States	59802
170	University Medical Center of Southern Nevada	Las Vegas	Nevada	United States	89102
171	CCOP - Southern Nevada Cancer Research Foundation	Las Vegas	Nevada	United States	89106
172	Cancer Institute of New Jersey at the Cooper University Hospital	Camden	New Jersey	United States	08103
173	Veterans Affairs Medical Center - East Orange	East Orange	New Jersey	United States	07018-1095
174	CCOP - Northern New Jersey	Hackensack	New Jersey	United States	07601
175	Cancer Institute of New Jersey at Hamilton	Hamilton	New Jersey	United States	08690
176	Fox Chase Virtua Health Cancer Program - Marlton	Marlton	New Jersey	United States	08053
177	Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School	New Brunswick	New Jersey	United States	08903
178	Fox Chase Virtua Health Cancer Program at Virtua West Jersey	Voorhees	New Jersey	United States	08043
179	Roswell Park Cancer Institute	Buffalo	New York	United States	14263
180	Charles R. Wood Cancer Center at Glens Falls Hospital	Glens Falls	New York	United States	12801
181	Lipson Cancer and Blood Center at Rochester General Hospital	Rochester	New York	United States	14621
182	James P. Wilmot Cancer Center at University of Rochester Medical Center	Rochester	New York	United States	14642
183	Long Island Cancer Center at Stony Brook University Hospital	Stony Brook	New York	United States	11794
184	CCOP - Syracuse Hematology-Oncology Associates of Central New York, P.C.	Syracuse	New York	United States	13057
185	Veterans Affairs Medical Center - Syracuse	Syracuse	New York	United States	13210
186	Community General Hospital of Greater Syracuse	Syracuse	New York	United States	13215
187	Randolph Hospital	Asheboro	North Carolina	United States	27203
188	Batte Cancer Center at Northeast Medical Center	Concord	North Carolina	United States	28025
189	Duke Comprehensive Cancer Center	Durham	North Carolina	United States	27710
190	John Smith, Jr./Dalton McMichael Cancer Center at Morehead Memorial Hospital	Eden	North Carolina	United States	27288
191	Wayne Memorial Hospital, Incorporated	Goldsboro	North Carolina	United States	27534
192	Moses Cone Regional Cancer Center at Wesley Long Community Hospital	Greensboro	North Carolina	United States	27401
193	Lenoir Memorial Cancer Center	Kinston	North Carolina	United States	28501
194	Annie Penn Cancer Center	Reidsville	North Carolina	United States	27320
195	Rutherford Hospital	Rutherfordton	North Carolina	United States	28139
196	Wilson Medical Center	Wilson	North Carolina	United States	27893
197	Comprehensive Cancer Center at Wake Forest University	Winston-Salem	North Carolina	United States	27157
198	Bismarck Cancer Center	Bismarck	North Dakota	United States	58501
199	Medcenter One Health System	Bismarck	North Dakota	United States	58501
200	Mid Dakota Clinic, P.C.	Bismarck	North Dakota	United States	58501
201	St. Alexius Medical Center	Bismarck	North Dakota	United States	58501
202	Akron City Hospital at Summa Health System	Akron	Ohio	United States	44304
203	St. Elizabeth Boardman Cancer Center	Boardman	Ohio	United States	44512
204	Adena Regional Medical Center	Chillicothe	Ohio	United States	54601
205	Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University	Cleveland	Ohio	United States	44106
206	Cleveland Clinic Taussig Cancer Center	Cleveland	Ohio	United States	44195
207	Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University	Columbus	Ohio	United States	43210
208	Riverside Methodist Hospital Cancer Care	Columbus	Ohio	United States	43214
209	CCOP - Columbus	Columbus	Ohio	United States	43215
210	Grant Riverside Cancer Services	Columbus	Ohio	United States	43215
211	Mount Carmel West Hospital	Columbus	Ohio	United States	43222
212	Doctors Hospital at Ohio Health	Columbus	Ohio	United States	43228
213	Grandview Hospital	Dayton	Ohio	United States	45405
214	Good Samaritan Hospital	Dayton	Ohio	United States	45406
215	Miami Valley Hospital	Dayton	Ohio	United States	45409
216	Samaritan North Cancer Care Center	Dayton	Ohio	United States	45415
217	Veterans Affairs Medical Center - Dayton	Dayton	Ohio	United States	45428
218	CCOP - Dayton	Dayton	Ohio	United States	45429
219	Grady Memorial Hospital	Delaware	Ohio	United States	43015
220	Community Oncology Group - Independence	Independence	Ohio	United States	44131
221	Charles F. Kettering Memorial Hospital	Kettering	Ohio	United States	45429
222	Fairfield Medical Center	Lancaster	Ohio	United States	43130
223	Strecker Cancer Center at Marietta Memorial Hospital	Marietta	Ohio	United States	45750
224	Middletown Regional Hospital	Middletown	Ohio	United States	45044
225	Licking Memorial Cancer Care Program at Licking Memorial Hospital	Newark	Ohio	United States	43055
226	Mercy Medical Center Oncology Unit	Springfield	Ohio	United States	45504
227	Community Hospital of Springfield and Clark County	Springfield	Ohio	United States	45505
228	UVMC Cancer Care Center at Upper Valley Medical Center	Troy	Ohio	United States	45373
229	St. Joseph Health Care Center	Warren	Ohio	United States	44484
230	Mount Carmel Cancer Services at Mount Carmel St. Ann's Hospital	Westerville	Ohio	United States	43081
231	Cleveland Clinic - Wooster	Wooster	Ohio	United States	44691
232	Ruth G. McMillan Cancer Center at Greene Memorial Hospital	Xenia	Ohio	United States	45385
233	St. Elizabeth Cancer Center at St. Elizabeth Health Center - Youngstown	Youngstown	Ohio	United States	44510
234	Genesis - Good Samaritan Hospital	Zanesville	Ohio	United States	43701
235	Oklahoma University Medical Center	Oklahoma City	Oklahoma	United States	73104
236	Legacy Mount Hood Medical Center	Glesham	Oregon	United States	97030
237	Cancer Treatment Center at Merle West Medical Center	Klamath Falls	Oregon	United States	97601
238	Providence Milwaukie Hospital	Milwaukie	Oregon	United States	97222
239	Comprehensive Cancer Center at Legacy Good Samaritan Hospital & Medical Center	Portland	Oregon	United States	97210
240	Providence Cancer Center at Providence Portland Medical Center	Portland	Oregon	United States	97213
241	CCOP - Columbia River Oncology Program	Portland	Oregon	United States	97225
242	Providence St. Vincent Medical Center	Portland	Oregon	United States	97225
243	Institute of Oncology at Vilnius University	Portland	Oregon	United States	97227
244	Legacy Meridian Park Hospital	Tualatin	Oregon	United States	97062
245	Geisinger Medical Center	Danville	Pennsylvania	United States	17822-2001
246	Penn State Cancer Institute at Milton S. Hershey Medical Center	Hershey	Pennsylvania	United States	17033-0850
247	Central Pennsylvania Hematology and Medical Oncology Associates, PC	Lemoyne	Pennsylvania	United States	17043
248	Lewistown Hospital	Lewistown	Pennsylvania	United States	17044
249	Riddle Memorial Hospital	Media	Pennsylvania	United States	19063
250	Abramson Cancer Center of the University of Pennsylvania	Philadelphia	Pennsylvania	United States	19104
251	Joan Karnell Cancer Center at Pennsylvania Hospital	Philadelphia	Pennsylvania	United States	19107
252	Kimmel Cancer Center at Thomas Jefferson University - Philadelphia	Philadelphia	Pennsylvania	United States	19107
253	Hillman Cancer Center at University of Pittsburgh Cancer Institute	Pittsburg	Pennsylvania	United States	15213
254	Pottstown Memorial Regional Cancer Center	Pottstown	Pennsylvania	United States	19464
255	Geisinger Medical Group	State College	Pennsylvania	United States	16801
256	Mount Nittany Medical Center	State College	Pennsylvania	United States	16803
257	Geisinger Wyoming Valley Medical Center	Wilkes-Barre	Pennsylvania	United States	18711
258	Rhode Island Hospital	Providence	Rhode Island	United States	02903
259	Miriam Hospital at Lifespan	Providence	Rhode Island	United States	02906
260	Rose Ramer Cancer Clinic at Anderson Area Medical Center	Anderson	South Carolina	United States	29621
261	Roper St. Francis Healthcare - Roper Hospital	Charleston	South Carolina	United States	29401
262	Bon Secours St. Francis Health System	Greenville	South Carolina	United States	29601
263	Greenville Hospital System Cancer Center	Greenville	South Carolina	United States	29605
264	CCOP - Greenville	Greenville	South Carolina	United States	29615
265	Gibbs Regional Cancer Center at Spartanburg Regional Medical Center	Spartanburg	South Carolina	United States	29303
266	CCOP - Upstate Carolina	Spartanburg	South Carolina	United States	29304
267	Sioux Valley Hospital and University of South Dakota Medical Center	Sioux Falls	South Dakota	United States	57104
268	Avera McKennan Hospital and University Health Center	Sioux Falls	South Dakota	United States	57105
269	Medical X-Ray Center	Sioux Falls	South Dakota	United States	57105
270	Vanderbilt-Ingram Cancer Center at Vanderbilt Medical Center	Nashville	Tennessee	United States	37232
271	Danville Regional Medical Center	Danville	Virginia	United States	24541
272	Providence Cancer Center at Sacred Heart Medical Center	Spokane	Washington	United States	99204
273	Providence Cancer Center at Holy Family Hospital	Spokane	Washington	United States	99207
274	Cancer Center at Southwest Washington Medical Center	Vancouver	Washington	United States	98668
275	West Virginia University - Robert C. Byrd Health Sciences Center - Charleston Division	Charleston	West Virginia	United States	25304
276	St. Mary's Medical Center	Huntington	West Virginia	United States	25702
277	Mary Babb Randolph Cancer Center at West Virginia University Hospitals	Morgantown	West Virginia	United States	26506
278	Fox Valley Hematology and Oncology	Appleton	Wisconsin	United States	54911-3496
279	Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center	La Crosse	Wisconsin	United States	54601
280	UW Health Oncology	Madison	Wisconsin	United States	53715
281	University of Wisconsin Comprehensive Cancer Center	Madison	Wisconsin	United States	53792
282	Marshfield Clinic - Marshfield Center	Marshfield	Wisconsin	United States	54449
283	Medical College of Wisconsin Cancer Center	Milwaukee	Wisconsin	United States	53226
284	University of Wisconsin Cancer Center at Aspirus Wausau Hospital	Wausau	Wisconsin	United States	54401
285	Welch Cancer Center	Sheridan	Wyoming	United States	82801