Letrozole in Treating Postmenopausal Women Who Have Received Hormone Therapy for Hormone Receptor-Positive Breast Cancer

• Sponsor: NSABP Foundation Inc (Other)
• Overall Status: Active, not recruiting
• CT.gov ID: NCT00382070
• Collaborator: National Cancer Institute (NCI) (NIH), Novartis (Industry)
• Enrollment: 3,966
• Locations: 806
• Arms: 2
• Duration (Months): 196
• Patients Per Site: 4.9
• Patients Per Site Per Month: 0

Study Details

Study Description

Brief Summary

RATIONALE: Estrogen can cause the growth of breast cancer cells. Hormone therapy using letrozole may fight breast cancer by lowering the amount of estrogen the body makes. It is not yet known whether letrozole is more effective than a placebo in treating patients with hormone receptor-positive breast cancer.

PURPOSE: This randomized phase III trial is studying letrozole to see how well it works compared with a placebo in treating postmenopausal women who have received hormone therapy for hormone receptor-positive breast cancer.

Condition or Disease	Intervention/Treatment	Phase
Breast Cancer	Drug: Letrozole; Other: Placebo	Phase 3

Detailed Description

OBJECTIVES:

Primary

• Determine whether or not prolonged adjuvant hormonal therapy comprising letrozole vs placebo will improve disease-free survival of postmenopausal women with estrogen receptor-positive and/or progesterone receptor-positive breast cancer who have completed 5 years of hormonal therapy with 5 years of an aromatase inhibitor (AI) or 5 years of a combination of up to 3 years of tamoxifen citrate followed by an AI.

• Compare the disease-free survival of patients treated with these regimens.

Secondary

• Compare overall survival of patients treated with these regimens.

• Compare breast cancer-free interval of patients treated with these regimens.

• Compare distant recurrence in patients treated with these regimens.

• Compare the incidence of osteoporotic-related fractures (e.g., Colles', hip, and spine) in these patients treated with these regimens.

• Compare the incidence of arterial thrombotic events in patients treated with these regimens.

OUTLINE: This is a double-blind, multicenter, placebo-controlled, randomized study. Patients are stratified according to pathologic nodal status (negative vs positive), adjuvant tamoxifen citrate therapy (yes vs no), and lowest bone mineral density T score for lumbosacral spine, total hip, or femoral neck (> -2.0 vs ≤ -2.0 standard deviation). Patients are randomized to 1 of 2 treatment arms.

• Group I: Patients receive oral placebo once daily.

• Group II: Patients receive oral letrozole once daily.

In both arms, treatment continues for up to 5 years in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed annually.

PROJECTED ACCRUAL: A total of 3,840 patients will be accrued for this study.

Study Design

• Study Type: Interventional
• Actual Enrollment: 3966 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Investigator)
• Primary Purpose: Treatment
• Official Title: A Clinical Trial to Determine the Efficacy of Five Years of Letrozole Compared to Placebo in Patients Completing Five Years of Hormonal Therapy Consisting of an Aromatase Inhibitor (AI) or Tamoxifen Followed by an AI in Prolonging Disease-Free Survival in Postmenopausal Women With Hormone Receptor Positive Breast Cancer
• Study Start Date: Aug 1, 2006
• Actual Primary Completion Date: Jan 1, 2016
• Anticipated Study Completion Date: Dec 1, 2022

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Group 2 Letrozole Patients receive oral letrozole once daily for up to 5 years.	Drug: Letrozole; Letrozole 2.5 mg taken orally once daily for 5 years
Placebo Comparator: Group 1 Placebo Patients receive oral placebo once daily for up to 5 years.	Other: Placebo; Placebo tablet taken orally once daily for 5 years

Outcome Measures

Primary Outcome Measures

1. Disease-free Survival [7 years.]

   Percentage of patients free from DFS events. DFS events include local, regional, or distant recurrence, second primary cancer or death from any cause prior to recurrence or second primary cancer.

Secondary Outcome Measures

1. Overall Survival [7 years]

   Percentage of patients alive

2. Breast Cancer-free Interval [7 years]

   Cumulative incidence of breast-cancer-free interval events. BCFI events include local-regional recurrence, distant recurrence or contralateral breast cancer as a first event.

3. Distant Recurrence [7 years]

   Cumulative incidence of distant recurrences.

4. Osteoporotic-related Fractures [7 years]

   Cumulative incidence of osteoporotic-related fractures defined as Colles', hip or spinal fractures

5. Arterial Thrombotic Events [7 years]

   Cumulative incidence of arterial thrombotic events, as defined by CTCAE version 4.0 (grade ≥1 stroke or transient ischaemic attack; grade ≥2 acute coronary syndrome or cerebrovascular ischaemia; grade ≥3 myocardial infarction, peripheral ischaemia, or visceral arterial ischaemia; and grade ≥4 selected thromboembolic events [cerebrovascular event, arterial insufficiency]).

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years to 120 Years
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: No

Eligibility Criteria

• Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 (0 = fully active, able to carry on all pre-disease performance without restriction; 1 = restricted in physically strenuous activity but ambulatory).

• Patients must be postmenopausal at the time of randomization. (Note: Premenopausal or perimenopausal women requiring therapy with luteinizing hormone-releasing hormone [LHRH] analogs to suppress ovarian function are not eligible.) For study purposes, postmenopausal is defined as: age 56 or older with no spontaneous menses for at least 12 months prior to study entry, or age 55 or younger with no spontaneous menses for at least 12 months prior to study entry (e.g., spontaneous or secondary to hysterectomy) AND with a documented estradiol level in the postmenopausal range according to local institutional/laboratory standards, or a prior documented bilateral oophorectomy.

• The patient must have remained disease-free from the time of initial breast cancer diagnosis until the time of randomization.

• The patient must have had histologically-confirmed invasive carcinoma of the breast by diagnostic core needle biopsy or by final pathologic evaluation of the surgical specimen.

• Patients who received neoadjuvant chemotherapy must have been clinical Stage I, II, or IIIA. For patients who received adjuvant chemotherapy, the primary tumor must have been T1-3 on pathologic evaluation and ipsilateral nodes must have been pN0, pN1 (pN1mi, pN1a, pN1b, pN1c), pN2a, pN3a, or pN3b.

• The primary tumor must have been estrogen receptor (ER)-positive and/or progesterone receptor (PgR)-positive. (Patients who had a tumor that was considered to be borderline for hormone receptor positivity and who were treated with tamoxifen and/or an aromatases inhibitor (AI) are eligible for this study.)

• Patients must have undergone either a lumpectomy with axillary nodal staging followed by breast radiotherapy or a total mastectomy with axillary nodal staging. (Acceptable axillary nodal staging procedures include sentinel node biopsy alone, if sentinel nodes were negative on hematoxylin and eosin (H&E) staining.)

• The duration of the patient's hormonal therapy following breast cancer diagnosis must have been 57-63 months from the first dose regardless of the number of missed doses. Hormonal therapy must have consisted of an AI or a combination of up to 3 years of tamoxifen followed by an AI. Tamoxifen may not have been given during years 4 and 5 of the 5 years of adjuvant hormonal therapy. (Note: Patients must discontinue their adjuvant AI therapy at the time of randomization.)

• Optional Letrozole Registration Program for patients who have not yet completed 5 years of hormonal therapy. (Note: As of September 5, 2008, the optional NSABP B-42 Registration Program closed to patient enrollment. Accrual and data collection for the NSABP B-42 randomized treatment trial continues as planned.) In order to have a predominantly letrozole-treated population for B-42 study entry, patients who have had a minimum of 2 years of hormonal therapy and who are currently on tamoxifen (for up to 3 years) or an AI may be offered letrozole at no cost until they complete 5 total years of initial adjuvant hormonal therapy.

• B-42 randomization must be within 6 months following completion of 5 years (57-63 months) of initial adjuvant hormonal therapy.

• At the time of randomization, the patient must have had the following: history and physical exam within 3 months demonstrating no findings suggestive of recurrent breast cancer; bilateral mammogram within 1 year (unilateral if patient had a mastectomy); mammogram not required if patient had a prophylactic contralateral mastectomy; bone mineral density (BMD) testing within 1 year; and fasting lipid profile (total cholesterol, LDL-C, HDL-C, and triglycerides) with a total cholesterol value less than or equal to grade 1 (according to CTCAE v3.0), with or without cholesterol-lowering therapy.

• within 1 year if the patient has a history of hypercholesterolemia controlled with cholesterol-lowering therapy and/or therapeutic lifestyle changes or if the patient has a history of one or more of the following risk factors for future cardiovascular events: diabetes, hypertension, obesity, tobacco use, hypertriglyceridemia, documented coronary artery disease, or family history of premature coronary heart disease.

• within 2 years for all other patients.

Ineligibility Criteria

• Patients with one or more of the following conditions will be ineligible for this study:

• History of non-traumatic osteoporotic fracture of wrist, hip, or spine.

• Diagnosis of bilateral breast cancer including ductal carcinoma in situ (DCIS)[(synchronous or metachronous].

• Other malignancies unless the patient is considered to be disease-free for 5 or more years prior to randomization, and is deemed by their physician to be at low risk for recurrence. Patients with the following cancers are eligible if diagnosed and treated within the past 5 years: carcinoma in situ of the cervix, colon carcinoma in situ, melanoma in situ, and basal cell and squamous cell carcinoma of the skin.

• Sex hormonal therapy, e.g., estrogen- or progesterone-replacement therapy or oral contraceptives. These patients are eligible only if this therapy is discontinued prior to randomization.

• Therapy with any hormonal agent such as raloxifene for management of osteoporosis. Patients are eligible only if these medications are discontinued prior to study entry.

• Administration of any investigational agent within 30 days before study entry.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Regional Medical Center	Anniston	Alabama	United States	36202
2	Providence Cancer Center at Providence Hospital	Mobile	Alabama	United States	36608
3	Providence Cancer Center	Anchorage	Alaska	United States	99508
4	Fairbanks Cancer Treatment Center at Fairbanks Memorial Hospital	Fairbanks	Alaska	United States	99701
5	Arkansas Cancer Research Center at University of Arkansas for Medical Sciences	Little Rock	Arkansas	United States	72205
6	Alta Bates Summit Comprehensive Cancer Center	Berkeley	California	United States	94704
7	Providence Saint Joseph Medical Center - Burbank	Burbank	California	United States	91505
8	Peninsula Medical Center	Burlingame	California	United States	94010
9	East Bay Radiation Oncology Center	Castro Valley	California	United States	94546
10	Eden Medical Center	Castro Valley	California	United States	94546
11	Valley Medical Oncology Consultants - Castro Valley	Castro Valley	California	United States	94546
12	Cancer Care Center at John Muir Health - Concord Campus	Concord	California	United States	94524-4110
13	City of Hope Comprehensive Cancer Center	Duarte	California	United States	91010-3000
14	North Bay Cancer Center	Fairfield	California	United States	94533
15	Kaiser Permanente - Fremont	Fremont	California	United States	94538
16	Valley Medical Oncology	Fremont	California	United States	94538
17	Cancer Care Associates	Fresno	California	United States	93720
18	Virginia K. Crosson Cancer Center at St. Jude Medical Center	Fullerton	California	United States	92835
19	Glendale Memorial Hospital Comprehensive Cancer Center	Glendale	California	United States	91204
20	Marin Cancer Institute at Marin General Hospital	Greenbrae	California	United States	94904
21	Sutter Health - Western Division Cancer Research Group	Greenbrae	California	United States	94904
22	Kaiser Permanente Medical Center - Hayward	Hayward	California	United States	94545
23	Scripps Cancer Center - San Diego	La Jolla	California	United States	92037
24	Rebecca and John Moores UCSD Cancer Center	La Jolla	California	United States	92093-0658
25	Loma Linda University Cancer Institute at Loma Linda University Medical Center	Loma Linda	California	United States	92354
26	Breastlink Medical Group, Incorporated at Long Beach Memorial Medical Center	Long Beach	California	United States	90806
27	Pacific Shores Medical Group - Long Beach	Long Beach	California	United States	90813
28	USC/Norris Comprehensive Cancer Center and Hospital	Los Angeles	California	United States	90089-9181
29	Jonsson Comprehensive Cancer Center at UCLA	Los Angeles	California	United States	90095-1781
30	Contra Costa Regional Medical Center	Martinez	California	United States	94553-3156
31	El Camino Hospital Cancer Center	Mountain View	California	United States	94040
32	Highland General Hospital	Oakland	California	United States	94602
33	Alta Bates Summit Medical Center - Summit Campus	Oakland	California	United States	94609
34	Bay Area Breast Surgeons, Incorporated	Oakland	California	United States	94609
35	CCOP - Bay Area Tumor Institute	Oakland	California	United States	94609
36	Larry G Strieff MD Medical Corporation	Oakland	California	United States	94609
37	Tom K Lee, Incorporated	Oakland	California	United States	94609
38	Kaiser Permanente Medical Center - Oakland	Oakland	California	United States	94611
39	Chao Family Comprehensive Cancer Center at University of California Irvine Medical Center	Orange	California	United States	92868
40	St. Joseph Hospital Regional Cancer Center - Orange	Orange	California	United States	92868
41	Desert Regional Medical Center Comprehensive Cancer Center	Palm Springs	California	United States	92262
42	Valley Care Medical Center	Pleasanton	California	United States	94588
43	Valley Medical Oncology Consultants - Pleasanton	Pleasanton	California	United States	94588
44	Robert and Beverly Lewis Family Cancer Care Center at Pomona Valley Hospital Medical Center	Pomona	California	United States	91767
45	Lucy Curci Cancer Center at Eisenhower Memorial Hospital and Medical Center	Rancho Mirage	California	United States	92270
46	North Valley Breast Clinic	Redding	California	United States	96001
47	Kaiser Permanente Medical Center - Redwood City	Redwood City	California	United States	94063
48	Kaiser Permanente Medical Center - Richmond	Richmond	California	United States	94801
49	Kaiser Permanente Medical Center - Roseville	Roseville	California	United States	95661
50	Sutter Cancer Center at Roseville Medical Center	Roseville	California	United States	95661
51	Sutter Cancer Center	Sacramento	California	United States	95816
52	South Sacramento Kaiser-Permanente Medical Center	Sacramento	California	United States	95823
53	Kaiser Permanente Medical Center - Sacramento	Sacramento	California	United States	95825
54	Salinas Valley Memorial Hospital	Salinas	California	United States	93901
55	Kaiser Permanente Medical Office -Vandever Medical Office	San Diego	California	United States	92120
56	San Francisco General Hospital Medical Center	San Francisco	California	United States	94110
57	Kaiser Permanente Medical Center - San Francisco Geary Campus	San Francisco	California	United States	94115
58	California Pacific Medical Center - California Campus	San Francisco	California	United States	94118
59	Kaiser Permanente Medical Center - Santa Teresa	San Jose	California	United States	95119
60	Doctors Medical Center - San Pablo Campus	San Pablo	California	United States	94806
61	Kaiser Foundation Hospital - San Rafael	San Rafael	California	United States	94903
62	Kaiser Permanente Medical Center - Santa Clara Kiely Campus	Santa Clara	California	United States	95051
63	Kaiser Permanente Medical Center - Santa Rosa	Santa Rosa	California	United States	95403
64	Kaiser Permanente Medical Center - South San Francisco	South San Francisco	California	United States	94080
65	Stanford Cancer Center	Stanford	California	United States	94305-5824
66	Kaiser Permanente Medical Facility - Stockton	Stockton	California	United States	95210
67	Kaiser Permanente Medical Center - Vallejo	Vallejo	California	United States	94589
68	Sutter Solano Medical Center	Vallejo	California	United States	94589
69	Kaiser Permanente Medical Center - Walnut Creek	Walnut Creek	California	United States	94596
70	John Muir/Mt. Diablo Comprehensive Cancer Center	Walnut Creek	California	United States	94598
71	Aurora Presbyterian Hospital	Aurora	Colorado	United States	80012
72	University of Colorado Cancer Center at UC Health Sciences Center	Aurora	Colorado	United States	80045
73	Boulder Community Hospital	Boulder	Colorado	United States	80301-9019
74	Memorial Hospital Cancer Center - Colorado Springs	Colorado Springs	Colorado	United States	80909
75	Penrose Cancer Center at Penrose Hospital	Colorado Springs	Colorado	United States	80933
76	Denver Health Medical Center	Denver	Colorado	United States	80204
77	St. Anthony Central Hospital	Denver	Colorado	United States	80204
78	Porter Adventist Hospital	Denver	Colorado	United States	80210
79	Presbyterian - St. Luke's Medical Center	Denver	Colorado	United States	80218
80	St. Joseph Hospital	Denver	Colorado	United States	80218
81	Rose Medical Center	Denver	Colorado	United States	80220
82	Veterans Affairs Medical Center - Denver	Denver	Colorado	United States	80220
83	CCOP - Colorado Cancer Research Program	Denver	Colorado	United States	80224-2522
84	Shaw Regional Cancer Center	Edwards	Colorado	United States	81632
85	Swedish Medical Center	Englewood	Colorado	United States	80110
86	Poudre Valley Hospital	Fort Collins	Colorado	United States	80524
87	Front Range Cancer Specialists	Fort Collins	Colorado	United States	80528
88	St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center	Grand Junction	Colorado	United States	81502
89	North Colorado Medical Center	Greeley	Colorado	United States	80631
90	Sky Ridge Medical Center	Lone Tree	Colorado	United States	80124
91	Hope Cancer Care Center at Longmont United Hospital	Longmont	Colorado	United States	80501
92	McKee Medical Center	Loveland	Colorado	United States	80539
93	St. Mary - Corwin Regional Medical Center	Pueblo	Colorado	United States	81004
94	North Suburban Medical Center	Thornton	Colorado	United States	80229
95	Exempla Lutheran Medical Center	Wheat Ridge	Colorado	United States	80033
96	Bridgeport Hospital	Bridgeport	Connecticut	United States	06610
97	Bristol Hospital	Bristol	Connecticut	United States	06011-0977
98	Praxair Cancer Center at Danbury Hospital	Danbury	Connecticut	United States	06810
99	Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center	Farmington	Connecticut	United States	06360-2875
100	Helen and Harry Gray Cancer Center at Hartford Hospital	Hartford	Connecticut	United States	06102-5037
101	Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center	Hartford	Connecticut	United States	06105
102	Middlesex Hospital Cancer Center	Middletown	Connecticut	United States	06457
103	Norwalk Hospital	Norwalk	Connecticut	United States	06856
104	Eastern Connecticut Hematology and Oncology Associates	Norwich	Connecticut	United States	06360
105	Carl and Dorothy Bennett Cancer Center at Stamford Hospital	Stamford	Connecticut	United States	06904
106	Connecticut Oncology & Hematology - Torrington	Torrington	Connecticut	United States	06790
107	Harold Leever Regional Cancer Center	Waterbury	Connecticut	United States	06708
108	Tunnell Cancer Center at Beebe Medical Center	Lewes	Delaware	United States	19958
109	CCOP - Christiana Care Health Services	Newark	Delaware	United States	19713
110	Lombardi Comprehensive Cancer Center at Georgetown University Medical Center	Washington	District of Columbia	United States	20007
111	Washington Cancer Institute at Washington Hospital Center	Washington	District of Columbia	United States	20010
112	Sibley Memorial Hospital	Washington	District of Columbia	United States	20016
113	Walter Reed Army Medical Center	Washington	District of Columbia	United States	20307-5001
114	Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Community Hospital - West	Boca Raton	Florida	United States	33428
115	Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Community Hospital - Main Campus	Boca Raton	Florida	United States	33486
116	Morton Plant Hospital	Clearwater	Florida	United States	33756
117	Herbert D. Kerman Regional Oncology Center - Daytona Beach	Daytona Beach	Florida	United States	32114
118	North Broward Medical Center	Deerfield Beach	Florida	United States	33064-3596
119	Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital	Fort Lauderdale	Florida	United States	33308
120	University of Florida Shands Cancer Center	Gainesville	Florida	United States	32610-0232
121	Memorial Cancer Institute at Memorial Regional Hospital	Hollywood	Florida	United States	33021
122	Baptist Cancer Institute - Jacksonville	Jacksonville	Florida	United States	32207
123	Center for Cancer Care and Research at Watson Clinic, LLP	Lakeland	Florida	United States	33805
124	CCOP - Mount Sinai Medical Center	Miami Beach	Florida	United States	33140
125	Integrated Community Oncology Network - Orange Park	Orange Park	Florida	United States	32073
126	M.D. Anderson Cancer Center at Orlando	Orlando	Florida	United States	32806
127	Florida Cancer Specialists - Sarasota Downtown	Sarasota	Florida	United States	34236
128	Cleveland Clinic Florida - Weston	Weston	Florida	United States	33331
129	Phoebe Cancer Center at Phoebe Putney Memorial Hospital	Albany	Georgia	United States	31701
130	Northeast Georgia Cancer Care, LLC - Medical Oncology	Athens	Georgia	United States	30607
131	Georgia Cancer Center for Excellence at Grady Memorial Hospital	Atlanta	Georgia	United States	30303
132	Emory Crawford Long Hospital	Atlanta	Georgia	United States	30308
133	Piedmont Hospital	Atlanta	Georgia	United States	30309
134	Winship Cancer Institute of Emory University	Atlanta	Georgia	United States	30322
135	Northside Hospital Cancer Center	Atlanta	Georgia	United States	30342-1611
136	Saint Joseph's Hospital of Atlanta	Atlanta	Georgia	United States	30342-1701
137	CCOP - Atlanta Regional	Atlanta	Georgia	United States	30342
138	Augusta Oncology Associates - Walton Way	Augusta	Georgia	United States	30901
139	MBCCOP - Medical College of Georgia Cancer Center	Augusta	Georgia	United States	30912
140	WellStar Cobb Hospital	Austell	Georgia	United States	30106
141	John B. Amos Cancer Center	Columbus	Georgia	United States	31904
142	Charles B. Eberhart Cancer Center at DeKalb Medical Center	Decatur	Georgia	United States	30033
143	Northeast Georgia Medical Center	Gainesville	Georgia	United States	30501
144	Gwinnett Medical Center	Lawrenceville	Georgia	United States	30045
145	Kennestone Cancer Center at Wellstar Kennestone Hospital	Marietta	Georgia	United States	30060
146	Harbin Clinic Cancer Center - Medical Oncology	Rome	Georgia	United States	30165
147	Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center	Savannah	Georgia	United States	31403-3089
148	Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler	Savannah	Georgia	United States	31405
149	Kapiolani Medical Center at Pali Momi	'Aiea	Hawaii	United States	96701
150	Cancer Research Center of Hawaii	Honolulu	Hawaii	United States	96813
151	OnCare Hawaii, Incorporated - Lusitana	Honolulu	Hawaii	United States	96813
152	Queen's Cancer Institute at Queen's Medical Center	Honolulu	Hawaii	United States	96813
153	Straub Clinic and Hospital, Incorporated	Honolulu	Hawaii	United States	96813
154	Hawaii Medical Center - East	Honolulu	Hawaii	United States	96817
155	OnCare Hawaii, Incorporated - Kuakini	Honolulu	Hawaii	United States	96817
156	Kapiolani Medical Center for Women and Children	Honolulu	Hawaii	United States	96826
157	Maui Memorial Medical Center	Wailuku	Hawaii	United States	96793
158	Pacific Cancer Institute - Maui	Wailuku	Hawaii	United States	96793
159	Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center	Boise	Idaho	United States	83706
160	Mountain States Tumor Institute at St. Luke's Regional Medical Center	Boise	Idaho	United States	83712
161	Kootenai Cancer Center - Coeur d'Alene	Coeur d'Alene	Idaho	United States	83814
162	Saint Anthony's Hospital at Saint Anthony's Health Center	Alton	Illinois	United States	62002
163	St. Joseph Medical Center	Bloomington	Illinois	United States	61701
164	Graham Hospital	Canton	Illinois	United States	61520
165	Rush University Medical Center	Chicago	Illinois	United States	60612
166	Resurrection Medical Center	Chicago	Illinois	United States	60631
167	University of Chicago Cancer Research Center	Chicago	Illinois	United States	60637-1470
168	Louis A. Weiss Memorial Hospital	Chicago	Illinois	United States	60640
169	Creticos Cancer Center at Advocate Illinois Masonic Medical Center	Chicago	Illinois	United States	60657
170	Decatur Memorial Hospital Cancer Care Institute	Decatur	Illinois	United States	62526
171	Sherman Hospital	Elgin	Illinois	United States	60120
172	Alexian Brothers Radiation Oncology	Elk Grove Village	Illinois	United States	60007
173	Elmhurst Memorial Hospital	Elmhurst	Illinois	United States	60126
174	Eureka Community Hospital	Eureka	Illinois	United States	61530
175	Evanston Hospital	Evanston	Illinois	United States	60201-1781
176	Galesburg Clinic, PC	Galesburg	Illinois	United States	61401
177	Galesburg Cottage Hospital	Galesburg	Illinois	United States	61401
178	Mason District Hospital	Havana	Illinois	United States	62644
179	Hinsdale Hematology Oncology Associates	Hinsdale	Illinois	United States	60521
180	Provena St. Mary's Regional Cancer Center - Kankakee	Kankakee	Illinois	United States	60901
181	La Grange Memorial Hospital	La Grange	Illinois	United States	60525
182	McDonough District Hospital	Macomb	Illinois	United States	61455
183	Cardinal Bernardin Cancer Center at Loyola University Medical Center	Maywood	Illinois	United States	60153
184	Trinity Cancer Center at Trinity Medical Center - 7th Street Campus	Moline	Illinois	United States	61265
185		Moline	Illinois	United States	61265
186	OSF Holy Family Medical Center	Monmouth	Illinois	United States	61462
187	Good Samaritan Regional Health Center	Mount Vernon	Illinois	United States	62864
188	Edward Hospital Cancer Center	Naperville	Illinois	United States	60540
189	Hematology Oncology Consultants - Naperville	Naperville	Illinois	United States	60540
190	BroMenn Regional Medical Center	Normal	Illinois	United States	61761
191	Community Cancer Center	Normal	Illinois	United States	61761
192	Advocate Christ Medical Center	Oak Lawn	Illinois	United States	60453-2699
193	Community Hospital of Ottawa	Ottawa	Illinois	United States	61350
194	Oncology Hematology Associates of Central Illinois, PC - Ottawa	Ottawa	Illinois	United States	61350
195	Advocate Lutheran General Cancer Care Center	Park Ridge	Illinois	United States	60068-1174
196	Cancer Treatment Center at Pekin Hospital	Pekin	Illinois	United States	61554
197	Proctor Hospital	Peoria	Illinois	United States	61614
198	CCOP - Illinois Oncology Research Association	Peoria	Illinois	United States	61615
199	Oncology Hematology Associates of Central Illinois, PC - Peoria	Peoria	Illinois	United States	61615
200	Methodist Medical Center of Illinois	Peoria	Illinois	United States	61636
201	OSF St. Francis Medical Center	Peoria	Illinois	United States	61637
202	Illinois Valley Community Hospital	Peru	Illinois	United States	61354
203	Perry Memorial Hospital	Princeton	Illinois	United States	61356
204	Swedish-American Regional Cancer Center	Rockford	Illinois	United States	61104-2315
205	Center for Cancer Care at OSF Saint Anthony Medical Center	Rockford	Illinois	United States	61108
206	St. Margaret's Hospital	Spring Valley	Illinois	United States	61362
207	Regional Cancer Center at Memorial Medical Center	Springfield	Illinois	United States	62781-0001
208	Central Dupage Cancer Center	Winfield	Illinois	United States	60190
209	St. Francis Hospital and Health Centers - Beech Grove Campus	Beech Grove	Indiana	United States	46107
210	Elkhart General Hospital	Elkhart	Indiana	United States	46515
211	Center for Cancer Care at Goshen General Hospital	Goshen	Indiana	United States	46526
212	Community Regional Cancer Care at Community Hospital East	Indianapolis	Indiana	United States	46219
213	Community Regional Cancer Care at Community Hospital North	Indianapolis	Indiana	United States	46256
214	St. Vincent Indianapolis Hospital	Indianapolis	Indiana	United States	46260
215	Howard Community Hospital	Kokomo	Indiana	United States	46904
216	Center for Cancer Therapy at LaPorte Hospital and Health Services	La Porte	Indiana	United States	46350
217	Horizon Oncology Center	Lafayette	Indiana	United States	47905
218	Community Hospital	Munster	Indiana	United States	46321
219	Reid Hospital & Health Care Services	Richmond	Indiana	United States	47374
220	CCOP - Northern Indiana CR Consortium	South Bend	Indiana	United States	46601
221	Memorial Hospital of South Bend	South Bend	Indiana	United States	46601
222	Saint Joseph Regional Medical Center	South Bend	Indiana	United States	46617
223	South Bend Clinic	South Bend	Indiana	United States	46617
224	McFarland Clinic, PC	Ames	Iowa	United States	50010
225	Hematology Oncology Associates of the Quad Cities	Bettendorf	Iowa	United States	52722
226		Bettendorf	Iowa	United States	52722
227	Iowa Blood and Cancer Care	Cedar Rapids	Iowa	United States	52402
228	St. Luke's Hospital	Cedar Rapids	Iowa	United States	52402
229	Cedar Rapids Oncology Associates	Cedar Rapids	Iowa	United States	52403
230	Mercy Regional Cancer Center at Mercy Medical Center	Cedar Rapids	Iowa	United States	52403
231	Heartland Oncology and Hematology	Council Bluffs	Iowa	United States	51503
232	Genesis Regional Cancer Center at Genesis Medical Center	Davenport	Iowa	United States	52803
233	Genesis Medical Center - West Campus	Davenport	Iowa	United States	52804
234	Mercy Capitol Hospital	Des Moines	Iowa	United States	50307
235	CCOP - Iowa Oncology Research Association	Des Moines	Iowa	United States	50309
236	John Stoddard Cancer Center at Iowa Methodist Medical Center	Des Moines	Iowa	United States	50309
237	Medical Oncology and Hematology Associates at Mercy Cancer Center	Des Moines	Iowa	United States	50314
238	Mercy Cancer Center at Mercy Medical Center - Des Moines	Des Moines	Iowa	United States	50314
239	John Stoddard Cancer Center at Iowa Lutheran Hospital	Des Moines	Iowa	United States	50316
240	Holden Comprehensive Cancer Center at University of Iowa	Iowa City	Iowa	United States	52242-1002
241	McCreery Cancer Center at Ottumwa Regional	Ottumwa	Iowa	United States	52501
242	Siouxland Hematology-Oncology Associates, LLP	Sioux City	Iowa	United States	51101
243	Mercy Medical Center - Sioux City	Sioux City	Iowa	United States	51104
244	St. Luke's Regional Medical Center	Sioux City	Iowa	United States	51104
245	Cedar Valley Medical Specialists, PC - West Ridgeway Avenue	Waterloo	Iowa	United States	50701
246	Covenant Cancer Treatment Center	Waterloo	Iowa	United States	50702
247	Hospital District Sixth of Harper County	Anthony	Kansas	United States	67003
248	Cancer Center of Kansas, PA - Chanute	Chanute	Kansas	United States	66720
249	Cancer Center of Kansas, PA - Dodge City	Dodge City	Kansas	United States	67801
250	Cancer Center of Kansas, PA - El Dorado	El Dorado	Kansas	United States	67042
251	Cancer Center of Kansas - Fort Scott	Fort Scott	Kansas	United States	66701
252	Cancer Center of Kansas-Independence	Independence	Kansas	United States	67301
253	Cancer Center of Kansas, PA - Kingman	Kingman	Kansas	United States	67068
254	Lawrence Memorial Hospital	Lawrence	Kansas	United States	66044
255	Southwest Medical Center	Liberal	Kansas	United States	67901
256	Cancer Center of Kansas, PA - Newton	Newton	Kansas	United States	67114
257	Cancer Center of Kansas, PA - Parsons	Parsons	Kansas	United States	67357
258	Mount Carmel Regional Cancer Center	Pittsburg	Kansas	United States	66762
259	Cancer Center of Kansas, PA - Pratt	Pratt	Kansas	United States	67124
260	Cancer Center of Kansas, PA - Salina	Salina	Kansas	United States	67042
261	Cotton-O'Neil Cancer Center	Topeka	Kansas	United States	66606
262	Cancer Center of Kansas, PA - Wellington	Wellington	Kansas	United States	67152
263	Associates in Womens Health, PA - North Review	Wichita	Kansas	United States	67208
264	Cancer Center of Kansas, PA - Medical Arts Tower	Wichita	Kansas	United States	67208
265	Cancer Center of Kansas, PA - Wichita	Wichita	Kansas	United States	67214
266	CCOP - Wichita	Wichita	Kansas	United States	67214
267	Via Christi Cancer Center at Via Christi Regional Medical Center	Wichita	Kansas	United States	67214
268	Cancer Center of Kansas, PA - Winfield	Winfield	Kansas	United States	67156
269	Cancer Resource Center at King's Daughters Medical Center	Ashland	Kentucky	United States	41101-0151
270	Cancer Care at Our Lady of Bellefonte Hospital	Ashland	Kentucky	United States	41101
271	Central Baptist Hospital	Lexington	Kentucky	United States	40503-9985
272	Lucille P. Markey Cancer Center at University of Kentucky	Lexington	Kentucky	United States	40536-0093
273	Louisville Oncology at Norton Cancer Institute - Louisville	Louisville	Kentucky	United States	40202
274	Consultants in Blood Disorders and Cancer	Louisville	Kentucky	United States	40207
275	Drs. Carrol, Sheth, Raghavan	Louisville	Kentucky	United States	40215
276	Pennington Cancer Center at Baton Rouge General	Baton Rouge	Louisiana	United States	70806
277	Mary Bird Perkins Cancer Center - Baton Rouge	Baton Rouge	Louisiana	United States	70809
278	Ochsner Health Center - Bluebonnet	Baton Rouge	Louisiana	United States	70809
279	Terrebonne General Medical Center	Houma	Louisiana	United States	70360
280	Drs Gurtler Brinz and Russo APMC-Metairie Oncologists	Metairie	Louisiana	United States	70006
281	MBCCOP - LSU Health Sciences Center	New Orleans	Louisiana	United States	70112
282	Medical Center of Louisiana - New Orleans	New Orleans	Louisiana	United States	70112
283	CCOP - Ochsner	New Orleans	Louisiana	United States	70121
284	Ochsner Cancer Institute at Ochsner Clinic Foundation	New Orleans	Louisiana	United States	70121
285	Christus Schumpert Cancer Treatment Center	Shreveport	Louisiana	United States	71101
286	CancerCare of Maine at Eastern Maine Medical Center	Bangor	Maine	United States	04401
287	Central Maine Comprehensive Cancer Center at Central Maine Medical Center	Lewiston	Maine	United States	04240
288	Mercy Hospital	Portland	Maine	United States	04101
289	York Hospital's Oncology Treatment Center	York	Maine	United States	03909
290	Mercy Medical Center	Baltimore	Maryland	United States	21202
291	Greater Baltimore Medical Center Cancer Center	Baltimore	Maryland	United States	21204
292	St. Agnes Hospital Cancer Center	Baltimore	Maryland	United States	21229
293	Harry & Jeanette Weinberg Cancer Institute at Franklin Square Hospital Center	Baltimore	Maryland	United States	21237
294	Suburban Hospital	Bethesda	Maryland	United States	20814
295	Shore Regional Cancer Center at Memorial Hospital - Easton	Easton	Maryland	United States	21601
296	Union Hospital Cancer Program at Union Hospital	Elkton	Maryland	United States	21921
297	Frederick Memorial Hospital Regional Cancer Therapy Center	Frederick	Maryland	United States	21701
298	St. Mary's Hospital	Leonardtown	Maryland	United States	20650
299	Peninsula Regional Medical Center	Salisbury	Maryland	United States	21801
300	Sturdy Memorial Hospital	Attleboro	Massachusetts	United States	02703
301	Tufts-NEMC Cancer Center	Boston	Massachusetts	United States	02111
302	Boston University Cancer Research Center	Boston	Massachusetts	United States	02118
303	Lahey Clinic Medical Center - Burlington	Burlington	Massachusetts	United States	01805
304	Commonwealth Hematology-Oncology, PC - Concord	Concord	Massachusetts	United States	01742
305	Commonwealth Hematology Oncology PC - Dorchester	Dorchester	Massachusetts	United States	02124
306	Hudner Oncology Center at Saint Anne's Hospital - Fall River	Fall River	Massachusetts	United States	02721
307	Simonds-Sinon Regional Cancer Center at HealthAlliance Hospital - Burbank Campus	Fitchburg	Massachusetts	United States	01420
308	Addison Gilbert Hospital	Gloucester	Massachusetts	United States	01930
309	Commonwealth Hematology-Oncology, PC - Lawrence	Lawrence	Massachusetts	United States	01842
310	Commonwealth Hematology Oncology PC - Leominster	Leominster	Massachusetts	United States	01453
311	Caritas Holy Family Hospital	Methuen	Massachusetts	United States	01844
312	NSMC Cancer Center - Peabody	Peabody	Massachusetts	United States	01960
313	Berkshire Hematology Oncology, PC	Pittsfield	Massachusetts	United States	01201
314	Jordan Hospital Club Cancer Center	Plymouth	Massachusetts	United States	02360
315	Commonwealth Hematology-Oncology, PC - Quincy	Quincy	Massachusetts	United States	02169
316	Baystate Regional Cancer Program at D'Amour Center for Cancer Care	Springfield	Massachusetts	United States	01199
317	Commonwealth Hematology-Oncology, PC - Stoneham	Stoneham	Massachusetts	United States	02180
318	Commonwealth Hematology-Oncology, PC - Weymouth	Weymouth	Massachusetts	United States	02190
319	Commonwealth Hematology-Oncology, PC - Worcester	Worcester	Massachusetts	United States	01605
320	UMASS Memorial Cancer Center - University Campus	Worcester	Massachusetts	United States	01655
321	Hickman Cancer Center at Bixby Medical Center	Adrian	Michigan	United States	49221
322	Saint Joseph Mercy Cancer Center	Ann Arbor	Michigan	United States	48106-0995
323	CCOP - Michigan Cancer Research Consortium	Ann Arbor	Michigan	United States	48106
324	Battle Creek Health System Cancer Care Center	Battle Creek	Michigan	United States	49017
325	Bay Regional Medical Center	Bay City	Michigan	United States	48708
326	Mecosta County Medical Center	Big Rapids	Michigan	United States	49307
327	Oakwood Cancer Center at Oakwood Hospital and Medical Center	Dearborn	Michigan	United States	48123-2500
328	Barbara Ann Karmanos Cancer Institute	Detroit	Michigan	United States	48201-1379
329	Josephine Ford Cancer Center at Henry Ford Hospital	Detroit	Michigan	United States	48202
330	Green Bay Oncology, Limited - Escanaba	Escanaba	Michigan	United States	49431
331	Genesys Hurley Cancer Institute	Flint	Michigan	United States	48503
332	Hurley Medical Center	Flint	Michigan	United States	48503
333	Great Lakes Cancer Institute at McLaren Regional Medical Center	Flint	Michigan	United States	48532
334	Butterworth Hospital at Spectrum Health	Grand Rapids	Michigan	United States	49503
335	CCOP - Grand Rapids	Grand Rapids	Michigan	United States	49503
336	Lacks Cancer Center at Saint Mary's Health Care	Grand Rapids	Michigan	United States	49503
337	Van Elslander Cancer Center at St. John Hospital and Medical Center	Grosse Pointe Woods	Michigan	United States	48236
338	Dickinson County Healthcare System	Iron Mountain	Michigan	United States	49801
339	Foote Memorial Hospital	Jackson	Michigan	United States	49201
340	Borgess Medical Center	Kalamazoo	Michigan	United States	49001
341	West Michigan Cancer Center	Kalamazoo	Michigan	United States	49007-3731
342	Bronson Methodist Hospital	Kalamazoo	Michigan	United States	49007
343	Haematology-Oncology Associates of Ohio and Michigan, PC	Lambertville	Michigan	United States	48144
344	Breslin Cancer Center at Ingham Regional Medical Center	Lansing	Michigan	United States	48910
345	Sparrow Regional Cancer Center	Lansing	Michigan	United States	48912-1811
346	Lapeer Regional Hospital	Lapeer	Michigan	United States	48446
347	St. Mary Mercy Hospital	Livonia	Michigan	United States	48154
348	Upper Michigan Cancer Center at Marquette General Hospital	Marquette	Michigan	United States	49855
349	MidMichigan Medical Center - Midland	Midland	Michigan	United States	48670
350	Community Cancer Center of Monroe	Monroe	Michigan	United States	48162
351	Mercy Memorial Hospital - Monroe	Monroe	Michigan	United States	48162
352	Clemens Regional Medical Center	Mount Clemens	Michigan	United States	48043
353	Mercy General Health Partners	Muskegon	Michigan	United States	49443
354	St. Joseph Mercy Oakland	Pontiac	Michigan	United States	48341-2985
355	Mercy Regional Cancer Center at Mercy Hospital	Port Huron	Michigan	United States	48060
356	William Beaumont Hospital - Royal Oak Campus	Royal Oak	Michigan	United States	48073
357	Seton Cancer Institute at Saint Mary's - Saginaw	Saginaw	Michigan	United States	48601
358	Lakeland Regional Cancer Care Center - St. Joseph	Saint Joseph	Michigan	United States	49085
359	Providence Cancer Institute at Providence Hospital - Southfield Campus	Southfield	Michigan	United States	48075
360	Munson Medical Center	Traverse City	Michigan	United States	49684
361	St. John Macomb Hospital	Warren	Michigan	United States	48093
362	Metro Health Hospital	Wyoming	Michigan	United States	49519
363	MeritCare Bemidji	Bemidji	Minnesota	United States	56601
364	Fairview Ridges Hospital	Burnsville	Minnesota	United States	55337
365	Mercy and Unity Cancer Center at Mercy Hospital	Coon Rapids	Minnesota	United States	55433
366	Duluth Clinic Cancer Center - Duluth	Duluth	Minnesota	United States	55805-1983
367	CCOP - Duluth	Duluth	Minnesota	United States	55805
368	Miller - Dwan Medical Center	Duluth	Minnesota	United States	55805
369	St. Luke's Hospital Cancer Care Center	Duluth	Minnesota	United States	55805
370	Fairview Southdale Hospital	Edina	Minnesota	United States	55435
371	Mercy and Unity Cancer Center at Unity Hospital	Fridley	Minnesota	United States	55432
372	Hutchinson Area Health Care	Hutchinson	Minnesota	United States	55350
373	Immanuel St. Joseph's	Mankato	Minnesota	United States	56002
374	HealthEast Cancer Care at St. John's Hospital	Maplewood	Minnesota	United States	55109
375	Minnesota Oncology Hematology, PA - Maplewood	Maplewood	Minnesota	United States	55109
376	Virginia Piper Cancer Institute at Abbott - Northwestern Hospital	Minneapolis	Minnesota	United States	55407
377	Hennepin County Medical Center - Minneapolis	Minneapolis	Minnesota	United States	55415
378	Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center	Robbinsdale	Minnesota	United States	55422-2900
379	CCOP - Metro-Minnesota	Saint Louis Park	Minnesota	United States	55416
380	Park Nicollet Cancer Center	Saint Louis Park	Minnesota	United States	55416
381	Regions Hospital Cancer Care Center	Saint Paul	Minnesota	United States	55101
382	United Hospital	Saint Paul	Minnesota	United States	55102
383	St. Francis Cancer Center at St. Francis Medical Center	Shakopee	Minnesota	United States	55379
384	Ridgeview Medical Center	Waconia	Minnesota	United States	55387
385	Minnesota Oncology Hematology, PA - Woodbury	Woodbury	Minnesota	United States	55125
386	Hattiesburg Clinic, PA at Forrest General	Hattiesburg	Mississippi	United States	39401
387	Keesler Air Force Base Medical Center	Keesler Air Force Base	Mississippi	United States	39534
388	Regional Cancer Center at Singing River Hospital	Pascagoula	Mississippi	United States	39581
389	Saint Francis Medical Center	Cape Girardeau	Missouri	United States	63703
390	Saint Luke's Hospital	Chesterfield	Missouri	United States	63017
391	Ellis Fischel Cancer Center at University of Missouri - Columbia	Columbia	Missouri	United States	65203
392	Freeman Cancer Institute at Freeman Health System	Joplin	Missouri	United States	64804
393	St. John's Regional Medical Center	Joplin	Missouri	United States	64804
394	Midwest Hematology Oncology Group, Incorporated	Saint Louis	Missouri	United States	63109
395	Saint Louis University Cancer Center	Saint Louis	Missouri	United States	63110
396	Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis	Saint Louis	Missouri	United States	63110
397	St. Anthony's Cancer Center	Saint Louis	Missouri	United States	63128
398	Missouri Baptist Cancer Center	Saint Louis	Missouri	United States	63131
399	Arch Medical Services, Incorporated at Center for Cancer Care and Research	Saint Louis	Missouri	United States	63141
400	CCOP - St. Louis-Cape Girardeau	Saint Louis	Missouri	United States	63141
401	David C. Pratt Cancer Center at St. John's Mercy	Saint Louis	Missouri	United States	63141
402	CCOP - Cancer Research for the Ozarks	Springfield	Missouri	United States	65802
403	St. John's Regional Health Center	Springfield	Missouri	United States	65804
404	Hulston Cancer Center at Cox Medical Center South	Springfield	Missouri	United States	65807
405	CCOP - Montana Cancer Consortium	Billings	Montana	United States	59101
406	Hematology-Oncology Centers of the Northern Rockies - Billings	Billings	Montana	United States	59101
407	Northern Rockies Radiation Oncology Center	Billings	Montana	United States	59101
408	St. Vincent Healthcare Cancer Care Services	Billings	Montana	United States	59101
409	Billings Clinic - Downtown	Billings	Montana	United States	59107-7000
410	Bozeman Deaconess Cancer Center	Bozeman	Montana	United States	59715
411	St. James Healthcare Cancer Care	Butte	Montana	United States	59701
412	Big Sky Oncology	Great Falls	Montana	United States	59405-5309
413	Sletten Cancer Institute at Benefis Healthcare	Great Falls	Montana	United States	59405
414		Great Falls	Montana	United States	59405
415	Northern Montana Hospital	Havre	Montana	United States	59501
416	St. Peter's Hospital	Helena	Montana	United States	59601
417	Glacier Oncology, PLLC	Kalispell	Montana	United States	59901
418	Kalispell Medical Oncology at KRMC	Kalispell	Montana	United States	59901
419	Kalispell Regional Medical Center	Kalispell	Montana	United States	59901
420	Community Medical Center	Missoula	Montana	United States	59801
421	Guardian Oncology and Center for Wellness	Missoula	Montana	United States	59804
422	Montana Cancer Specialists at Montana Cancer Center	Missoula	Montana	United States	59807-7877
423	Montana Cancer Center at St. Patrick Hospital and Health Sciences Center	Missoula	Montana	United States	59807
424	Saint Francis Cancer Treatment Center at Saint Francis Memorial Health Center	Grand Island	Nebraska	United States	68803
425	Good Samaritan Cancer Center at Good Samaritan Hospital	Kearney	Nebraska	United States	68848-1990
426	Cancer Resource Center - Lincoln	Lincoln	Nebraska	United States	68510
427	Callahan Cancer Center at Great Plains Regional Medical Center	North Platte	Nebraska	United States	69103
428	CCOP - Missouri Valley Cancer Consortium	Omaha	Nebraska	United States	68106
429	Methodist Estabrook Cancer Center	Omaha	Nebraska	United States	68114
430	Immanuel Medical Center	Omaha	Nebraska	United States	68122
431	Alegant Health Cancer Center at Bergan Mercy Medical Center	Omaha	Nebraska	United States	68124
432	Creighton University Medical Center	Omaha	Nebraska	United States	68131-2197
433	UNMC Eppley Cancer Center at the University of Nebraska Medical Center	Omaha	Nebraska	United States	68198-6805
434	University Medical Center of Southern Nevada	Las Vegas	Nevada	United States	89102
435	CCOP - Nevada Cancer Research Foundation	Las Vegas	Nevada	United States	89106
436	New Hampshire Oncology - Hematology, PA at Payson Center for Cancer Care	Concord	New Hampshire	United States	03301
437	Seacoast Cancer Center at Wentworth - Douglass Hospital	Dover	New Hampshire	United States	03820
438	Center for Cancer Care at Exeter Hospital	Exeter	New Hampshire	United States	03833
439	New Hampshire Oncology - Hematology, PA - Hooksett	Hooksett	New Hampshire	United States	03106
440	Lakes Region General Hospital	Laconia	New Hampshire	United States	03246
441	Portsmouth Regional Hospital	Portsmouth	New Hampshire	United States	03802
442	Ocean Medical Center at Meridian Health	Brick	New Jersey	United States	08724
443	Dizzy Gillespie Cancer Institute at Englewood Hospital and Medical Center	Englewood	New Jersey	United States	07631
444	Hunterdon Regional Cancer Center at Hunterdon Medical Center	Flemington	New Jersey	United States	08822
445	CentraState Medical Center	Freehold	New Jersey	United States	07728
446	Cancer Institute of New Jersey at Hamilton	Hamilton	New Jersey	United States	08690
447	St. Barnabas Medical Center Cancer Center	Livingston	New Jersey	United States	07039
448	Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton	Marlton	New Jersey	United States	08053
449	Saint Peter's University Hospital	New Brunswick	New Jersey	United States	08901
450	Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School	New Brunswick	New Jersey	United States	08903
451	Newark Beth Israel Medical Center	Newark	New Jersey	United States	07112
452	AtlantiCare Cancer Care Institute at AtlantiCare Regional Medical Center - Mainland Campus	Pomona	New Jersey	United States	08240
453	University Medical Center at Princeton	Princeton	New Jersey	United States	08540-3298
454	Booker Cancer Center at Riverview Medical Center	Red Bank	New Jersey	United States	07701
455	Valley Hospital - Ridgewood	Ridgewood	New Jersey	United States	07450
456	Somerset Medical Center	Somerville	New Jersey	United States	08876
457	Frederick R. and Betty M. Smith Cancer Treatment Center	Sparta	New Jersey	United States	07871
458	Capital Health Regional Cancer Center	Trenton	New Jersey	United States	08618
459	St. Francis Regional Cancer Center	Trenton	New Jersey	United States	08629
460	Franklin & Edith Scarpa Regional Cancer Center at South Jersey Healthcare	Vineland	New Jersey	United States	08360
461	Cancer Institute of New Jersey at Cooper - Voorhees	Voorhees	New Jersey	United States	08043
462	Fox Chase Virtua Health Cancer Program at Virtua West Jersey	Voorhees	New Jersey	United States	08043
463	Lovelace Medical Center - Downtown	Albuquerque	New Mexico	United States	87102
464	Hematology Oncology Associates, PC	Albuquerque	New Mexico	United States	87106
465	New Mexico Cancer Center	Albuquerque	New Mexico	United States	87109
466	University of New Mexico Cancer Center	Albuquerque	New Mexico	United States	87131-5636
467	New York Oncology Hematology, PC at Albany Regional Cancer Care	Albany	New York	United States	12206
468	New York Oncology Hematology, PC at Albany Medical Center	Albany	New York	United States	12208
469	Amsterdam Community Cancer Program	Amsterdam	New York	United States	12010
470	Albert Einstein Cancer Center at Albert Einstein College of Medicine	Bronx	New York	United States	10461
471	Coney Island Hospital	Brooklyn	New York	United States	11235
472	Roswell Park Cancer Institute	Buffalo	New York	United States	14263-0001
473	CCOP - Hematology-Oncology Associates of Central New York	East Syracuse	New York	United States	13057
474	Adirondack Cancer Care - Glens Falls	Glens Falls	New York	United States	12801
475	Charles R. Wood Cancer Center at Glens Falls Hospital	Glens Falls	New York	United States	12801
476	New York Oncology Hematology, PC - Hudson	Hudson	New York	United States	12534
477	Monter Cancer Center of the North Shore-LIJ Health System	Lake Success	New York	United States	11042
478	New York Oncology Hematology, PC - Latham	Latham	New York	United States	12110
479	CCOP - North Shore University Hospital	Manhasset	New York	United States	11030
480	Don Monti Comprehensive Cancer Center at North Shore University Hospital	Manhasset	New York	United States	11030
481	Northern Westchester Hospital	Mount Kisco	New York	United States	10549
482	Long Island Jewish Medical Center	New Hyde Park	New York	United States	11040
483	Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center	New York	New York	United States	10032
484	Dyson Center for Cancer Care at Vassar Brothers Medical Center	Poughkeepsie	New York	United States	12601-3990
485	Cancer Center of Poughkeepsie	Poughkeepsie	New York	United States	12601
486	Hudson Valley Oncology Associates	Poughkeepsie	New York	United States	12601
487	Saint Francis Hospital Cancer Center	Poughkeepsie	New York	United States	12601
488	Riverview Cancer Care Medical Associates, PC	Rexford	New York	United States	12148
489	Lipson Cancer and Blood Center at Rochester General Hospital	Rochester	New York	United States	14621
490	Interlakes Oncology/Hematology PC	Rochester	New York	United States	14623
491	James P. Wilmot Cancer Center at University of Rochester Medical Center	Rochester	New York	United States	14642
492	Nalitt Cancer Institute at Staten Island University Hospital	Staten Island	New York	United States	10305
493	Stony Brook University Cancer Center	Stony Brook	New York	United States	11794-9446
494	SUNY Upstate Medical University Hospital	Syracuse	New York	United States	13210
495	Samaritan Hospital at Northeast Health	Troy	New York	United States	12180
496	Dickstein Cancer Treatment Center at White Plains Hospital Center	White Plains	New York	United States	10601
497	Randolph Hospital	Asheboro	North Carolina	United States	27203-5400
498	Hope A Women's Cancer Center	Asheville	North Carolina	United States	28801
499	Mission Hospitals - Memorial Campus	Asheville	North Carolina	United States	28801
500	Alamance Cancer Center at Alamance Regional Medical Center	Burlington	North Carolina	United States	27216
501	Waverly Hematology Oncology	Cary	North Carolina	United States	27511
502	Blumenthal Cancer Center at Carolinas Medical Center	Charlotte	North Carolina	United States	28232-2861
503	Presbyterian Cancer Center at Presbyterian Hospital	Charlotte	North Carolina	United States	28233-3549
504	Batte Cancer Center at Northeast Medical Center	Concord	North Carolina	United States	28025
505	CaroMont Cancer Center at Gaston Memorial Hospital	Gastonia	North Carolina	United States	28053
506	Wayne Memorial Hospital, Incorporated	Goldsboro	North Carolina	United States	27534
507	Moses Cone Regional Cancer Center at Wesley Long Community Hospital	Greensboro	North Carolina	United States	27403-1198
508	Leo W. Jenkins Cancer Center at ECU Medical School	Greenville	North Carolina	United States	27834
509	Pardee Memorial Hospital	Hendersonville	North Carolina	United States	28791
510	High Point Regional Hospital	High Point	North Carolina	United States	27261
511	Kinston Medical Specialists	Kinston	North Carolina	United States	28501
512	Annie Penn Cancer Center	Reidsville	North Carolina	United States	27320
513	Rutherford Hospital	Rutherfordton	North Carolina	United States	28139
514	Iredell Memorial Hospital	Statesville	North Carolina	United States	28677
515	Marion L. Shepard Cancer Center at Beaufort County Hospital	Washington	North Carolina	United States	27889
516	Forsyth Regional Cancer Center at Forsyth Medical Center	Winston-Salem	North Carolina	United States	27103
517	Wake Forest University Comprehensive Cancer Center	Winston-Salem	North Carolina	United States	27157-1096
518	Bismarck Cancer Center	Bismarck	North Dakota	United States	58501
519	Medcenter One Hospital Cancer Care Center	Bismarck	North Dakota	United States	58501
520	Mid Dakota Clinic, PC	Bismarck	North Dakota	United States	58501
521	St. Alexius Medical Center Cancer Center	Bismarck	North Dakota	United States	58502
522	Dakota Cancer Institute at Dakota Clinic - South University	Fargo	North Dakota	United States	58103
523	CCOP - MeritCare Hospital	Fargo	North Dakota	United States	58122
524	MeritCare Broadway	Fargo	North Dakota	United States	58122
525	Altru Cancer Center at Altru Hospital	Grand Forks	North Dakota	United States	58201
526	McDowell Cancer Center at Akron General Medical Center	Akron	Ohio	United States	44307
527	Summa Center for Cancer Care at Akron City Hospital	Akron	Ohio	United States	44309-2090
528	Barberton Citizens Hospital	Barberton	Ohio	United States	44203
529	Cleveland Clinic Beachwood Family Health and Surgery Center	Beachwood	Ohio	United States	44122
530	Mary Rutan Hospital	Bellefontaine	Ohio	United States	43311
531	Wood County Oncology Center	Bowling Green	Ohio	United States	43402
532	Mercy Cancer Center at Mercy Medical Center	Canton	Ohio	United States	44708
533	Aultman Cancer Center at Aultman Hospital	Canton	Ohio	United States	44710-1799
534	Adena Regional Medical Center	Chillicothe	Ohio	United States	45601
535	Christ Hospital Cancer Center	Cincinnati	Ohio	United States	45219
536	Oncology Hematology Care, Incorporated - Blue Ash	Cincinnati	Ohio	United States	45242
537	Case Comprehensive Cancer Center	Cleveland	Ohio	United States	44106-5065
538	MetroHealth Cancer Care Center at MetroHealth Medical Center	Cleveland	Ohio	United States	44109
539	Cleveland Clinic Cancer Center at Fairview Hospital	Cleveland	Ohio	United States	44111
540	Cleveland Clinic Taussig Cancer Center	Cleveland	Ohio	United States	44195
541	North Coast Cancer Care - Clyde	Clyde	Ohio	United States	43410
542	Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center	Columbus	Ohio	United States	43210-1240
543	Riverside Methodist Hospital Cancer Care	Columbus	Ohio	United States	43214-3998
544	CCOP - Columbus	Columbus	Ohio	United States	43215
545	Grant Medical Center Cancer Care	Columbus	Ohio	United States	43215
546	Mount Carmel Health - West Hospital	Columbus	Ohio	United States	43222
547	Doctors Hospital at Ohio Health	Columbus	Ohio	United States	43228
548	Grandview Hospital	Dayton	Ohio	United States	45405
549	Good Samaritan Hospital	Dayton	Ohio	United States	45406
550	David L. Rike Cancer Center at Miami Valley Hospital	Dayton	Ohio	United States	45409
551	Samaritan North Cancer Care Center	Dayton	Ohio	United States	45415
552	CCOP - Dayton	Dayton	Ohio	United States	45420
553	Grady Memorial Hospital	Delaware	Ohio	United States	43015
554	Hematology Oncology Center	Elyria	Ohio	United States	44035
555	Blanchard Valley Medical Associates	Findlay	Ohio	United States	45840
556	Middletown Regional Hospital	Franklin	Ohio	United States	45005-1066
557	Wayne Hospital	Greenville	Ohio	United States	45331
558	Cleveland Clinic Cancer Center	Independence	Ohio	United States	44131
559	Charles F. Kettering Memorial Hospital	Kettering	Ohio	United States	45429
560	Fairfield Medical Center	Lancaster	Ohio	United States	43130
561	St. Rita's Medical Center	Lima	Ohio	United States	45801
562	Lima Memorial Hospital	Lima	Ohio	United States	45804
563	MedCentral - Mansfield Hospital	Mansfield	Ohio	United States	44903
564	Strecker Cancer Center at Marietta Memorial Hospital	Marietta	Ohio	United States	45750
565	Northwest Ohio Oncology Center	Maumee	Ohio	United States	43537-1839
566	St. Luke's Hospital	Maumee	Ohio	United States	43537
567	Hillcrest Cancer Center at Hillcrest Hospital	Mayfield Heights	Ohio	United States	44124
568	Licking Memorial Cancer Care Program at Licking Memorial Hospital	Newark	Ohio	United States	43055
569	St. Charles Mercy Hospital	Oregon	Ohio	United States	43616
570	Toledo Clinic - Oregon	Oregon	Ohio	United States	43616
571	Cancer Care Center, Incorporated	Salem	Ohio	United States	44460
572	North Coast Cancer Care, Incorporated	Sandusky	Ohio	United States	44870
573	Mercy Medical Center	Springfield	Ohio	United States	45504
574	Community Hospital of Springfield and Clark County	Springfield	Ohio	United States	45505
575	Flower Hospital Cancer Center	Sylvania	Ohio	United States	43560
576	Mercy Hospital of Tiffin	Tiffin	Ohio	United States	44883
577	Toledo Hospital	Toledo	Ohio	United States	43606
578	St. Vincent Mercy Medical Center	Toledo	Ohio	United States	43608
579	Medical University of Ohio Cancer Center	Toledo	Ohio	United States	43614
580	CCOP - Toledo Community Hospital	Toledo	Ohio	United States	43617
581	St. Anne Mercy Hospital	Toledo	Ohio	United States	43623
582	Toledo Clinic, Incorporated - Main Clinic	Toledo	Ohio	United States	43623
583	UVMC Cancer Care Center at Upper Valley Medical Center	Troy	Ohio	United States	45373-1300
584	Fulton County Health Center	Wauseon	Ohio	United States	43567
585	Mount Carmel St. Ann's Cancer Center	Westerville	Ohio	United States	43081
586	Clinton Memorial Hospital	Wilmington	Ohio	United States	45177
587	Cancer Treatment Center	Wooster	Ohio	United States	44691
588	Cleveland Clinic - Wooster	Wooster	Ohio	United States	44691
589	United States Air Force Medical Center - Wright-Patterson	Wright-Patterson Air Force Base	Ohio	United States	45433-5529
590	Ruth G. McMillan Cancer Center at Greene Memorial Hospital	Xenia	Ohio	United States	45385
591	Genesis - Good Samaritan Hospital	Zanesville	Ohio	United States	43701
592	Cleo Craig Cancer Research Clinic	Lawton	Oklahoma	United States	73505
593	Natalie Warren Bryant Cancer Center at St. Francis Hospital	Tulsa	Oklahoma	United States	74136
594	St. Charles Medical Center - Bend	Bend	Oregon	United States	97701
595	Bay Area Hospital	Coos Bay	Oregon	United States	97420
596	Three Rivers Community Hospital	Grants Pass	Oregon	United States	97527
597	Legacy Mount Hood Medical Center	Gresham	Oregon	United States	97030
598	Dubs Cancer Center at Rogue Valley Medical Center	Medford	Oregon	United States	97504
599	Providence Cancer Center at PMCC	Medford	Oregon	United States	97504
600	Providence Milwaukie Hospital	Milwaukie	Oregon	United States	97222
601	Legacy Good Samaritan Hospital & Comprehensive Cancer Center	Portland	Oregon	United States	97210
602	Providence Cancer Center at Providence Portland Medical Center	Portland	Oregon	United States	97213-2967
603	CCOP - Columbia River Oncology Program	Portland	Oregon	United States	97225
604	Providence St. Vincent Medical Center	Portland	Oregon	United States	97225
605	Legacy Emanuel Hospital and Health Center and Children's Hospital	Portland	Oregon	United States	97227
606	Northwest Cancer Specialists at Rose Quarter Cancer Center	Portland	Oregon	United States	97227
607	Kaiser Permanente Health Care - Portland	Portland	Oregon	United States	97232
608	Knight Cancer Institute at Oregon Health and Science University	Portland	Oregon	United States	97239-3098
609	Salem Hospital Regional Cancer Care Services	Salem	Oregon	United States	97309-5014
610	Legacy Meridian Park Hospital	Tualatin	Oregon	United States	97062
611	Sacred Heart Hospital	Allentown	Pennsylvania	United States	18102
612	Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest	Allentown	Pennsylvania	United States	18105
613	St. Luke's Cancer Network at St. Luke's Hospital	Bethlehem	Pennsylvania	United States	18015
614	Bryn Mawr Hospital	Bryn Mawr	Pennsylvania	United States	19010
615	Geisinger Cancer Institute at Geisinger Health	Danville	Pennsylvania	United States	17822-0001
616	Mercy Fitzgerald Hospital	Darby	Pennsylvania	United States	19023
617	Oncology Hematology Associates of Northern Pennsylvania, PC at Hahne Regional Cancer Center	DuBois	Pennsylvania	United States	15801
618	Dale and Frances Hughes Cancer Center at Pocono Medical Center	East Stroudsburg	Pennsylvania	United States	18301
619	Geisinger Hazleton Cancer Center	Hazleton	Pennsylvania	United States	18201
620	Penn State Cancer Institute at Milton S. Hershey Medical Center	Hershey	Pennsylvania	United States	17033-0850
621	Lancaster General Hospital	Lancaster	Pennsylvania	United States	17604
622	St. Mary Regional Cancer Center	Langhorne	Pennsylvania	United States	19047
623	Charles A. & Betty Bott Cancer Center at Holy Redeemer Hospital	Meadowbrook	Pennsylvania	United States	19046
624	Riddle Memorial Hospital Cancer Center	Media	Pennsylvania	United States	19063
625	Cancer Center of Paoli Memorial Hospital	Paoli	Pennsylvania	United States	19301-1792
626	Abramson Cancer Center of the University of Pennsylvania	Philadelphia	Pennsylvania	United States	19104-4283
627	Kimmel Cancer Center at Thomas Jefferson University - Philadelphia	Philadelphia	Pennsylvania	United States	19107-5541
628	Frankford Hospital Cancer Center - Torresdale Campus	Philadelphia	Pennsylvania	United States	19114
629	Albert Einstein Cancer Center	Philadelphia	Pennsylvania	United States	19141
630	Cancer Center at Phoenixville Hospital	Phoenixville	Pennsylvania	United States	19460
631	Allegheny Cancer Center at Allegheny General Hospital	Pittsburgh	Pennsylvania	United States	15212
632	Western Pennsylvania Cancer Institute at Western Pennsylvania Hospital	Pittsburgh	Pennsylvania	United States	15224-1791
633	UPMC Cancer Centers	Pittsburgh	Pennsylvania	United States	15232
634	St. Joseph Medical Center	Reading	Pennsylvania	United States	19605
635	McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center	Reading	Pennsylvania	United States	19612-6052
636	Mercy Hospital Cancer Center - Scranton	Scranton	Pennsylvania	United States	18501
637	Hematology and Oncology Associates of Northeastern Pennsylvania	Scranton	Pennsylvania	United States	18510
638	Geisinger Medical Group - Scenery Park	State College	Pennsylvania	United States	16801
639	Associates in Hematology-Oncology, PC at Crozer Regional Cancer Center	Upland	Pennsylvania	United States	19013
640	Chester County Hospital	West Chester	Pennsylvania	United States	19380
641	Jennersville Regional Hospital	West Grove	Pennsylvania	United States	19390-9499
642	Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center	Wilkes-Barre	Pennsylvania	United States	18711
643	CCOP - Main Line Health	Wynnewood	Pennsylvania	United States	19096
644	Lankenau Cancer Center at Lankenau Hospital	Wynnewood	Pennsylvania	United States	19096
645	York Cancer Center at Apple Hill Medical Center	York	Pennsylvania	United States	17405
646	Rhode Island Hospital Comprehensive Cancer Center	Providence	Rhode Island	United States	02903
647	Women and Infants Hospital of Rhode Island	Providence	Rhode Island	United States	02905
648	Miriam Hospital	Providence	Rhode Island	United States	02906
649	AnMed Cancer Center	Anderson	South Carolina	United States	29621
650	Roper St. Francis Cancer Center at Roper Hospital	Charleston	South Carolina	United States	29401
651	Hollings Cancer Center at Medical University of South Carolina	Charleston	South Carolina	United States	29425
652	McLeod Regional Medical Center	Florence	South Carolina	United States	29501
653	Georgetown Memorial Hospital	Georgetown	South Carolina	United States	29440
654	CCOP - Greenville	Greenville	South Carolina	United States	29615
655	Carolina Blood and Cancer Care Associates, PA	Lancaster	South Carolina	United States	29720
656	Carolina Blood and Cancer Care	Rock Hill	South Carolina	United States	29732
657	CCOP - Upstate Carolina	Spartanburg	South Carolina	United States	29303
658	Gibbs Regional Cancer Center at Spartanburg Regional Medical Center	Spartanburg	South Carolina	United States	29303
659	Lexington Medical Center	West Columbia	South Carolina	United States	29169
660	Rapid City Regional Hospital	Rapid City	South Dakota	United States	57701
661	Avera Cancer Institute	Sioux Falls	South Dakota	United States	57105
662	Medical X-Ray Center, PC	Sioux Falls	South Dakota	United States	57105
663	Sanford Cancer Center at Sanford USD Medical Center	Sioux Falls	South Dakota	United States	57117-5039
664	Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical Center	Kingsport	Tennessee	United States	37662
665	Thompson Cancer Survival Center	Knoxville	Tennessee	United States	37916
666	U.T. Medical Center Cancer Institute	Knoxville	Tennessee	United States	37920-6999
667	University of Tennessee Cancer Institute - Memphis	Memphis	Tennessee	United States	38104
668	Southwest Regional Cancer Center - Central	Austin	Texas	United States	78705
669	Texas Oncology, PA at Texas Oncology Cancer Center - Central	Austin	Texas	United States	78731
670	Texas Oncology, PA - Austin Northwest	Austin	Texas	United States	78759
671	Texas Oncology, PA - Austin North	Austin	Texas	United States	78759
672	St. Joseph Regional Cancer Center	Bryan	Texas	United States	77802
673	Texas Oncology, PA - Cedar Park	Cedar Park	Texas	United States	78613
674	Medical City Dallas Hospital	Dallas	Texas	United States	75230
675	Presbyterian Hospital of Dallas	Dallas	Texas	United States	75231
676	M. D. Anderson Cancer Center at University of Texas	Houston	Texas	United States	77030-4009
677	Baylor University Medical Center - Houston	Houston	Texas	United States	77030
678	Joe Arrington Cancer Research and Treatment Center	Lubbock	Texas	United States	79410-1894
679	UMC Southwest Cancer and Research Center	Lubbock	Texas	United States	79415-3364
680	Texas Oncology, PA - Seton Williamson	Round Rock	Texas	United States	78665
681	Texas Oncology, PA at Texas Cancer Center Round Rock	Round Rock	Texas	United States	78681
682	University of Texas Health Science Center at San Antonio	San Antonio	Texas	United States	78229-3900
683	Texas Oncology, PA - San Marcos	San Marcos	Texas	United States	78666
684	American Fork Hospital	American Fork	Utah	United States	84003
685	Sandra L. Maxwell Cancer Center	Cedar City	Utah	United States	84720
686	Logan Regional Hospital	Logan	Utah	United States	84321
687	Jon and Karen Huntsman Cancer Center at Intermountain Medical Center	Murray	Utah	United States	84157
688	Val and Ann Browning Cancer Center at McKay-Dee Hospital Center	Ogden	Utah	United States	84403
689	Utah Valley Regional Medical Center - Provo	Provo	Utah	United States	84604
690	Dixie Regional Medical Center - East Campus	Saint George	Utah	United States	84770
691	LDS Hospital	Salt Lake City	Utah	United States	84103
692	Utah Cancer Specialists at UCS Cancer Center	Salt Lake City	Utah	United States	84106
693	Mountainview Medical	Berlin	Vermont	United States	05602
694	Fletcher Allen Health Care - University Health Center Campus	Burlington	Vermont	United States	05401
695	Fredericksburg Oncology, Incorporated	Fredericksburg	Virginia	United States	22401
696	Lynchburg Hematology-Oncology Clinic	Lynchburg	Virginia	United States	24501
697	Southwest Virginia Regional Cancer Center at Wellmonth Health	Norton	Virginia	United States	24273
698	Virginia Commonwealth University Massey Cancer Center	Richmond	Virginia	United States	23298-0037
699	Carilion Cancer Center of Western Virginia	Roanoke	Virginia	United States	24014
700	Auburn Regional Center for Cancer Care	Auburn	Washington	United States	98002
701	Overlake Cancer Center at Overlake Hospital Medical Center	Bellevue	Washington	United States	98004
702	St. Joseph Cancer Center	Bellingham	Washington	United States	98225
703	Olympic Hematology and Oncology	Bremerton	Washington	United States	98310
704	Providence Centralia Hospital	Centralia	Washington	United States	98531-9027
705	St. Francis Hospital	Federal Way	Washington	United States	98003
706	Cascade Cancer Center at Evergreen Hospital Medical Center	Kirkland	Washington	United States	98033
707	Providence St. Peter Hospital Regional Cancer Center	Olympia	Washington	United States	98506-5166
708	Good Samaritan Cancer Center	Puyallup	Washington	United States	98372
709	Valley Medical Center	Renton	Washington	United States	98055
710	CCOP - Virginia Mason Research Center	Seattle	Washington	United States	98101
711	Fred Hutchinson Cancer Research Center	Seattle	Washington	United States	98104
712	Group Health Central Hospital	Seattle	Washington	United States	98112
713	Swedish Cancer Institute at Swedish Medical Center - First Hill Campus	Seattle	Washington	United States	98122-4307
714	Rockwood Clinic Cancer Treatment Center	Spokane	Washington	United States	99204-2967
715	Cancer Care Northwest - North	Spokane	Washington	United States	99218
716	Franciscan Cancer Center at St. Joseph Medical Center	Tacoma	Washington	United States	98405-3004
717	Allenmore Hospital	Tacoma	Washington	United States	98405
718	CCOP - Northwest	Tacoma	Washington	United States	98405
719	MultiCare Regional Cancer Center at Tacoma General Hospital	Tacoma	Washington	United States	98405
720	Madigan Army Medical Center - Tacoma	Tacoma	Washington	United States	98431
721	St. Clare Hospital	Tacoma	Washington	United States	98499
722	Southwest Washington Medical Center Cancer Center	Vancouver	Washington	United States	98668
723	St. Mary Regional Cancer Center at St. Mary Medical Center	Walla Walla	Washington	United States	99362
724	Wenatchee Valley Medical Center	Wenatchee	Washington	United States	98801-2028
725	North Star Lodge Cancer Center at Yakima Valley Memorial Hospital	Yakima	Washington	United States	98902
726	Washington Hematology-Oncology Specialists	Yakima	Washington	United States	98902
727	West Virginia University Health Sciences Center - Charleston	Charleston	West Virginia	United States	25304
728	United Hospital Center	Clarksburg	West Virginia	United States	26301
729	Edwards Comprehensive Cancer Center at Cabell Huntington Hospital	Huntington	West Virginia	United States	25701
730	St. Mary's Regional Cancer Center at St. Mary's Medical Center	Huntington	West Virginia	United States	25702
731	Mary Babb Randolph Cancer Center at West Virginia University Hospitals	Morgantown	West Virginia	United States	26506
732	Community Comprehensive Cancer Center at Camden-Clark Memorial Hospital	Parkersburg	West Virginia	United States	26102
733	Schiffler Cancer Center at Wheeling Hospital	Wheeling	West Virginia	United States	26003
734	Marshfield Clinic - Chippewa Center	Chippewa Falls	Wisconsin	United States	54729
735	Marshfield Clinic Cancer Care at Regional Cancer Center	Eau Claire	Wisconsin	United States	54701
736	Luther Midlelfort Hospital	Eau Claire	Wisconsin	United States	54702
737	Midelfort Clinic - Luther	Eau Claire	Wisconsin	United States	54703-1510
738	Vince Lombardi Cancer Center at Aurora Lakeland Medical Center - Elkhorn	Elkhorn	Wisconsin	United States	53121
739	Oncology Alliance, SC - Milwaukee - East	Glendale	Wisconsin	United States	53212-1038
740	Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center	Green Bay	Wisconsin	United States	54301-3526
741	Green Bay Oncology, Limited at St. Mary's Hospital	Green Bay	Wisconsin	United States	54303
742	St. Mary's Hospital Medical Center - Green Bay	Green Bay	Wisconsin	United States	54303
743	St. Vincent Hospital Regional Cancer Center	Green Bay	Wisconsin	United States	54307-3508
744	Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center	Green Bay	Wisconsin	United States	54311
745	Mercy Regional Cancer Center	Janesville	Wisconsin	United States	53547
746	Gundersen Lutheran Center for Cancer and Blood	La Crosse	Wisconsin	United States	54601
747	Dean Medical Center - Madison	Madison	Wisconsin	United States	53717
748	Holy Family Memorial Medical Center Cancer Care Center	Manitowoc	Wisconsin	United States	54221-1450
749	Bay Area Cancer Care Center at Bay Area Medical Center	Marinette	Wisconsin	United States	54143
750	Vince Lombardi Cancer Clinic - Marinette	Marinette	Wisconsin	United States	54143
751	Marshfield Clinic - Marshfield Center	Marshfield	Wisconsin	United States	54449
752	Saint Joseph's Hospital	Marshfield	Wisconsin	United States	54449
753	Columbia Saint Mary's Hospital - Ozaukee	Mequon	Wisconsin	United States	53097
754	Aurora Sinai Medical Center	Milwaukee	Wisconsin	United States	53201-0342
755	Columbia-Saint Mary's Cancer Care Center	Milwaukee	Wisconsin	United States	53211
756	Medical Consultants, Limited	Milwaukee	Wisconsin	United States	53215
757	Medical College of Wisconsin Cancer Center	Milwaukee	Wisconsin	United States	53226
758	Marshfield Clinic - Lakeland Center	Minocqua	Wisconsin	United States	54548
759	Regional Cancer Center at Oconomowoc Memorial Hospital	Oconomowoc	Wisconsin	United States	53066
760	Green Bay Oncology, Limited - Oconto Falls	Oconto Falls	Wisconsin	United States	54154
761	Vince Lombardi Cancer Clinic - Oshkosh	Oshkosh	Wisconsin	United States	54904
762	All Saints Cancer Center at Wheaton Franciscan Healthcare	Racine	Wisconsin	United States	53405
763	Ministry Medical Group at Saint Mary's Hospital	Rhinelander	Wisconsin	United States	54501
764	Marshfield Clinic - Indianhead Center	Rice Lake	Wisconsin	United States	54868
765	Vince Lombardi Cancer Clinic - Sheboygan	Sheboygan	Wisconsin	United States	53081
766	Saint Michael's Hospital Cancer Center	Stevens Point	Wisconsin	United States	54481
767	Green Bay Oncology, Limited - Sturgeon Bay	Sturgeon Bay	Wisconsin	United States	54235
768	Vince Lombardi Cancer Clinic - Two Rivers	Two Rivers	Wisconsin	United States	54241
769	Waukesha Memorial Hospital Regional Cancer Center	Waukesha	Wisconsin	United States	53188
770	Marshfield Clinic - Wausau Center	Wausau	Wisconsin	United States	54401
771	University of Wisconcin Cancer Center at Aspirus Wausau Hospital	Wausau	Wisconsin	United States	54401
772	Aurora Women's Pavilion of West Allis Memorial Hospital	West Allis	Wisconsin	United States	53227
773	Diagnostic and Treatment Center	Weston	Wisconsin	United States	54476
774	Marshfield Clinic - Weston Center	Weston	Wisconsin	United States	54476
775	Marshfield Clinic - Wisconsin Rapids Center	Wisconsin Rapids	Wisconsin	United States	54494
776	Riverview UW Cancer Center at Riverview Hospital	Wisconsin Rapids	Wisconsin	United States	54494
777	Welch Cancer Center at Sheridan Memorial Hospital	Sheridan	Wyoming	United States	82801
778	British Columbia Cancer Agency - Centre for the Southern Interior	Kelowna	British Columbia	Canada	V1Y 5L3
779	BCCA - Fraser Valley Cancer Centre	Surrey	British Columbia	Canada	V3V 1Z2
780	British Columbia Cancer Agency - Vancouver Cancer Centre	Vancouver	British Columbia	Canada	V5Z 4E6
781	British Columbia Cancer Agency - Vancouver Island Centre	Victoria	British Columbia	Canada	V8R 6V5
782	CancerCare Manitoba	Winnipeg	Manitoba	Canada	R3E 0V9
783	Cancer Centre of Southeastern Ontario at Kingston General Hospital	Kingston	Ontario	Canada	K7L 5P9
784	Carlo Fidani Peel Regional Cancer Centre at Credit Valley Hospital	Mississauga	Ontario	Canada	L5M 2N1
785	Northeastern Ontario Regional Cancer Centre	Sudbury	Ontario	Canada	P3E 5J1
786	Cancer Care Program at Thunder Bay Regional Health Sciences	Thunder Bay	Ontario	Canada	P7B 6V4
787	Mount Sinai Hospital - Toronto	Toronto	Ontario	Canada	M5G 1X5
788	Princess Margaret Hospital	Toronto	Ontario	Canada	M5G 2M9
789	Hopital Notre-Dame du CHUM	Montreal	Quebec	Canada	H2L 4M1
790	CHUM - Hotel Dieu Hospital	Montreal	Quebec	Canada	H2W 1T8
791	CHUM - Hopital Saint-Luc	Montreal	Quebec	Canada	H2X 3J4
792	Royal Victoria Hospital - Montreal	Montreal	Quebec	Canada	H3A 1A1
793	Jewish General Hospital - Montreal	Montreal	Quebec	Canada	H3T 1E2
794	St. Mary's Hospital Center	Montreal	Quebec	Canada	H3T 1M5
795	Hopital du Saint-Sacrement - Quebec	Quebec City	Quebec	Canada	G1S 4L8
796	Cork University Hospital	Cork		Ireland
797	South Infirmary Victoria Hospital	Cork		Ireland
798	Beaumont Hospital	Dublin		Ireland	0009
799	Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital	Dublin		Ireland	24
800	St. Vincent's University Hospital	Dublin		Ireland	4
801	Mater Misericordiae University Hospital	Dublin		Ireland	7
802	St. James's Hospital	Dublin		Ireland	8
803	University College Hospital	Galway		Ireland	GY.
804	Mid-Western Cancer Centre at Mid-Western Regional Hospital	Limerick		Ireland	0009
805	Sligo General Hospital	Sligo		Ireland	Sligo
806	Waterford Regional Hospital	Waterford		Ireland	0009

Sponsors and Collaborators

• NSABP Foundation Inc
• National Cancer Institute (NCI)
• Novartis

Investigators

• Principal Investigator: Norman Wolmark, MD, NSABP Foundation Inc

Study Documents (Full-Text)

None provided.

More Information

Additional Information:

• Data Available: Select individual patient-level data from this trial can be requested from the NCTN/NCORP Data Archive

Publications

• Mamounas EP, Lembersky B, Jeong JH, Cronin W, Harkins B, Geyer C, Wickerham DL, Paik S, Costantino J, Wolmark N. NSABP B-42: a clinical trial to determine the efficacy of five years of letrozole compared with placebo in patients completing five years of hormonal therapy consisting of an aromatase inhibitor (AI) or tamoxifen followed by an AI in prolonging disease-free survival in postmenopausal women with hormone receptor-positive breast cancer. Clin Breast Cancer. 2006 Dec;7(5):416-21.

• Responsible Party: NSABP Foundation Inc
• ClinicalTrials.gov Identifier: NCT00382070
• Other Study ID Numbers: NSABP B-42; U10CA012027
• First Posted: Sep 28, 2006
• Last Update Posted: Oct 6, 2021
• Last Verified: Feb 1, 2021

• Keywords provided by NSABP Foundation Inc: stage I breast cancer; stage II breast cancer; stage IIIA breast cancer
• Additional relevant MeSH terms: Breast Neoplasms; Letrozole

Study Results

Participant Flow

Arm/Group Title	Group 2 Letrozole	Group 1 Placebo
Arm/Group Description	Patients receive oral letrozole once daily for up to 5 years. Letrozole: Letrozole 2.5 mg taken orally once daily for 5 years	Patients receive oral placebo once daily for up to 5 years. Placebo: Placebo tablet taken orally once daily for 5 years
Period Title: Overall Study
STARTED	1983	1983
COMPLETED	1950	1953
NOT COMPLETED	33	30

Baseline Characteristics

Arm/Group Title	Placebo	Letrozole	Total
Arm/Group Description	Placebo	Letrozole	Total of all reporting groups
Overall Participants	1983	1983	3966
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	63 (8.4)	63 (8.7)	63 (8.6)
Sex: Female, Male (Count of Participants)
Female	1983 100%	1983 100%	3966 100%
Male	0 0%	0 0%	0 0%

Outcome Measures

1. Primary Outcome

Title	Disease-free Survival
Description	Percentage of patients free from DFS events. DFS events include local, regional, or distant recurrence, second primary cancer or death from any cause prior to recurrence or second primary cancer.
Time Frame	7 years.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Group 2 Letrozole	Group 1 Placebo
Arm/Group Description	Patients receive oral letrozole once daily for up to 5 years. Letrozole: Letrozole 2.5 mg taken orally once daily for 5 years	Patients receive oral placebo once daily for up to 5 years. Placebo: Placebo tablet taken orally once daily for 5 years
Measure Participants	1950	1953
Number [percentage of patients free of disease]	84.7	81.3

2. Secondary Outcome

Title	Overall Survival
Description	Percentage of patients alive
Time Frame	7 years

Outcome Measure Data

Analysis Population Description

Patients with any type of follow up.

Arm/Group Title	Group 2 Letrozole	Group 1 Placebo
Arm/Group Description	Patients receive oral letrozole once daily for up to 5 years. Letrozole: Letrozole 2.5 mg taken orally once daily for 5 years	Patients receive oral placebo once daily for up to 5 years. Placebo: Placebo tablet taken orally once daily for 5 years
Measure Participants	1959	1964
Number [percentage of patients alive]	91.8	92.3

3. Secondary Outcome

Title	Breast Cancer-free Interval
Description	Cumulative incidence of breast-cancer-free interval events. BCFI events include local-regional recurrence, distant recurrence or contralateral breast cancer as a first event.
Time Frame	7 years

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Group 2 Letrozole	Group 1 Placebo
Arm/Group Description	Patients receive oral letrozole once daily for up to 5 years. Letrozole: Letrozole 2.5 mg taken orally once daily for 5 years	Patients receive oral placebo once daily for up to 5 years. Placebo: Placebo tablet taken orally once daily for 5 years
Measure Participants	1950	1953
Number [percentage of patients]	6.7	10

4. Secondary Outcome

Title	Distant Recurrence
Description	Cumulative incidence of distant recurrences.
Time Frame	7 years

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Group 2 Letrozole	Group 1 Placebo
Arm/Group Description	Patients receive oral letrozole once daily for up to 5 years. Letrozole: Letrozole 2.5 mg taken orally once daily for 5 years	Patients receive oral placebo once daily for up to 5 years. Placebo: Placebo tablet taken orally once daily for 5 years
Measure Participants	1950	1953
Number [percentage of patients]	3.9	5.8

5. Secondary Outcome

Title	Osteoporotic-related Fractures
Description	Cumulative incidence of osteoporotic-related fractures defined as Colles', hip or spinal fractures
Time Frame	7 years

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Group 2 Letrozole	Group 1 Placebo
Arm/Group Description	Patients receive oral letrozole once daily for up to 5 years. Letrozole: Letrozole 2.5 mg taken orally once daily for 5 years	Patients receive oral placebo once daily for up to 5 years. Placebo: Placebo tablet taken orally once daily for 5 years
Measure Participants	1950	1953
Number [percentage of patients]	5.4	4.8

6. Secondary Outcome

Title	Arterial Thrombotic Events
Description	Cumulative incidence of arterial thrombotic events, as defined by CTCAE version 4.0 (grade ≥1 stroke or transient ischaemic attack; grade ≥2 acute coronary syndrome or cerebrovascular ischaemia; grade ≥3 myocardial infarction, peripheral ischaemia, or visceral arterial ischaemia; and grade ≥4 selected thromboembolic events [cerebrovascular event, arterial insufficiency]).
Time Frame	7 years

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Group 2 Letrozole	Group 1 Placebo
Arm/Group Description	Patients receive oral letrozole once daily for up to 5 years. Letrozole: Letrozole 2.5 mg taken orally once daily for 5 years	Patients receive oral placebo once daily for up to 5 years. Placebo: Placebo tablet taken orally once daily for 5 years
Measure Participants	1950	1953
Number [percentage of patients]	4.0	3.4

Adverse Events

Adverse Event Reporting Description	Participants at Risk includes any patient who submitted an AE form.
Arm/Group Title	Placebo		Letrozole
Arm/Group Description	Placebo		Letrozole
All Cause Mortality
	Placebo		Letrozole
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	Placebo		Letrozole
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	87/1938 (4.5%)		80/1951 (4.1%)
Blood and lymphatic system disorders
Anemia	5/1938 (0.3%)		2/1951 (0.1%)
Cardiac disorders
Atrial fibrillation	1/1938 (0.1%)		1/1951 (0.1%)
Cardiac arrest	3/1938 (0.2%)		4/1951 (0.2%)
Cardiac disorders - Other, specify	3/1938 (0.2%)		2/1951 (0.1%)
Heart failure	2/1938 (0.1%)		5/1951 (0.3%)
Myocardial infarction	9/1938 (0.5%)		4/1951 (0.2%)
Pericardial effusion	1/1938 (0.1%)		1/1951 (0.1%)
Ventricular fibrillation	0/1938 (0%)		1/1951 (0.1%)
Acute coronary syndrome	0/1938 (0%)		1/1951 (0.1%)
Right ventricular dysfunction	1/1938 (0.1%)		0/1951 (0%)
Aortic valve disease	5/1938 (0.3%)		3/1951 (0.2%)
Left ventricular systolic dysfunction	2/1938 (0.1%)		6/1951 (0.3%)
Gastrointestinal disorders
Rectal hemorrhage	1/1938 (0.1%)		0/1951 (0%)
Small intestinal obstruction	1/1938 (0.1%)		0/1951 (0%)
Upper gastrointestinal hemorrhage	0/1938 (0%)		1/1951 (0.1%)
General disorders
Death NOS	1/1938 (0.1%)		1/1951 (0.1%)
Multi-organ failure	2/1938 (0.1%)		0/1951 (0%)
Hepatobiliary disorders
Hepatic failure	0/1938 (0%)		1/1951 (0.1%)
Hepatobiliary disorders - Other, specify	0/1938 (0%)		1/1951 (0.1%)
Infections and infestations
Bladder infection	0/1938 (0%)		1/1951 (0.1%)
Infections and infestations - Other, specify	1/1938 (0.1%)		0/1951 (0%)
Sepsis	2/1938 (0.1%)		4/1951 (0.2%)
Skin infection	0/1938 (0%)		1/1951 (0.1%)
Urinary tract infection	2/1938 (0.1%)		4/1951 (0.2%)
Wound infection	0/1938 (0%)		1/1951 (0.1%)
Lung infection	6/1938 (0.3%)		0/1951 (0%)
Injury, poisoning and procedural complications
Aortic injury	1/1938 (0.1%)		0/1951 (0%)
Fracture	0/1938 (0%)		2/1951 (0.1%)
Injury, poisoning and procedural complications - Other, specify	0/1938 (0%)		1/1951 (0.1%)
Tracheal obstruction	0/1938 (0%)		1/1951 (0.1%)
Investigations
Alanine aminotransferase increased (ALT/SGPT)	1/1938 (0.1%)		2/1951 (0.1%)
Aspartate aminotransferase increased (AST/SGOT)	3/1938 (0.2%)		2/1951 (0.1%)
Blood bilirubin increased	0/1938 (0%)		1/1951 (0.1%)
Cardiac troponin I increased	2/1938 (0.1%)		1/1951 (0.1%)
Cardiac troponin T increased	1/1938 (0.1%)		1/1951 (0.1%)
Creatinine increased	1/1938 (0.1%)		1/1951 (0.1%)
Lipase increased	0/1938 (0%)		2/1951 (0.1%)
Neutrophil count decreased	0/1938 (0%)		1/1951 (0.1%)
Platelet count decreased	1/1938 (0.1%)		1/1951 (0.1%)
Serum amylase increased	0/1938 (0%)		1/1951 (0.1%)
White blood cell decreased	0/1938 (0%)		1/1951 (0.1%)
Metabolism and nutrition disorders
Dehydration	2/1938 (0.1%)		0/1951 (0%)
Hypercalcemia	2/1938 (0.1%)		2/1951 (0.1%)
Hyperglycemia	0/1938 (0%)		2/1951 (0.1%)
Hyperkalemia	1/1938 (0.1%)		2/1951 (0.1%)
Hypertriglyceridemia	1/1938 (0.1%)		0/1951 (0%)
Hyperuricemia	1/1938 (0.1%)		1/1951 (0.1%)
Hypocalcemia	0/1938 (0%)		1/1951 (0.1%)
Hypokalemia	0/1938 (0%)		4/1951 (0.2%)
Hyponatremia	2/1938 (0.1%)		1/1951 (0.1%)
Musculoskeletal and connective tissue disorders
Soft tissue necrosis lower limb	0/1938 (0%)		1/1951 (0.1%)
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Myelodysplastic syndrome	4/1938 (0.2%)		2/1951 (0.1%)
Neoplasms benign, malignant and unspecified (incl cysts and polyps) - Other, specify	5/1938 (0.3%)		4/1951 (0.2%)
Leukemia secondary to oncology chemotherapy	1/1938 (0.1%)		3/1951 (0.2%)
Treatment related secondary malignancy	0/1938 (0%)		2/1951 (0.1%)
Nervous system disorders
Amnesia	1/1938 (0.1%)		0/1951 (0%)
Encephalopathy	2/1938 (0.1%)		0/1951 (0%)
Intracranial hemorrhage	2/1938 (0.1%)		6/1951 (0.3%)
Nervous system disorders - Other, specify	3/1938 (0.2%)		2/1951 (0.1%)
Stroke	2/1938 (0.1%)		2/1951 (0.1%)
Psychiatric disorders
Depression	6/1938 (0.3%)		2/1951 (0.1%)
Personality change	0/1938 (0%)		1/1951 (0.1%)
Psychosis	1/1938 (0.1%)		0/1951 (0%)
Suicidal ideation	0/1938 (0%)		1/1951 (0.1%)
Suicide attempt	1/1938 (0.1%)		1/1951 (0.1%)
Renal and urinary disorders
Urinary incontinence	1/1938 (0.1%)		0/1951 (0%)
Urinary tract obstruction	0/1938 (0%)		1/1951 (0.1%)
Chronic kidney disease	0/1938 (0%)		1/1951 (0.1%)
Acute kidney injury	2/1938 (0.1%)		2/1951 (0.1%)
Respiratory, thoracic and mediastinal disorders
Adult respiratory distress syndrome	1/1938 (0.1%)		0/1951 (0%)
Aspiration	1/1938 (0.1%)		1/1951 (0.1%)
Dyspnea	1/1938 (0.1%)		2/1951 (0.1%)
Respiratory failure	6/1938 (0.3%)		7/1951 (0.4%)
Respiratory, thoracic and mediastinal disorders - Other, specify	1/1938 (0.1%)		1/1951 (0.1%)
Mediastinal hemorrhage	0/1938 (0%)		1/1951 (0.1%)
Vascular disorders
Hematoma	1/1938 (0.1%)		2/1951 (0.1%)
Hypertension	2/1938 (0.1%)		1/1951 (0.1%)
Hypotension	1/1938 (0.1%)		0/1951 (0%)
Thromboembolic event	8/1938 (0.4%)		1/1951 (0.1%)
Other (Not Including Serious) Adverse Events
	Placebo		Letrozole
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	336/1938 (17.3%)		400/1951 (20.5%)
Musculoskeletal and connective tissue disorders
Arthralgia	302/1938 (15.6%)		347/1951 (17.8%)
Myalgia	118/1938 (6.1%)		149/1951 (7.6%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding trial results for a period that is less than or equal to 60 days. The sponsor cannot require changes to the communication and cannot extend the embargo.