Comparison of Standard of Care Treatment With a Triplet Combination of Targeted Immunotherapeutic Agents

Sponsor

National Cancer Institute (NCI) (NIH)

Overall Status

Recruiting

CT.gov ID

NCT04739800

Collaborator

NRG Oncology (Other)

164

Enrollment

374

Locations

Arms

31.6

Anticipated Duration (Months)

0.4

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This phase II trial studies the possible benefits of treatment with different combinations of the drugs durvalumab, olaparib and cediranib vs. the usual treatment in patients with ovarian, primary peritoneal, or fallopian tube cancer that has come back after a period of improvement with platinum therapy (recurrent platinum resistant). Usual treatment is the type of treatment most patients with this condition receive if they are not part of a clinical study. Combination therapies studied in this trial include MEDI4736 (durvalumab) plus olaparib and cediranib, durvalumab and cediranib, or olaparib and cediranib. Monoclonal antibodies, such as durvalumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumors cells to grow and spread. Olaparib is an inhibitor of PARP, an enzyme that helps repair deoxyribonucleic acid (DNA) when it becomes damaged. Blocking PARP may help keep cancer cells from repairing their damaged DNA, causing them to die. PARP inhibitors are a type of targeted therapy. Cediranib may stop the growth of tumor cells by blocking VEGF (an enzyme). needed for cell growth. Giving different combinations of durvalumab, olaparib and cediranib may work better in increasing the duration of time that the cancer does not progress compared to the usual treatment.

Condition or Disease	Intervention/Treatment	Phase
Fallopian Tube Mucinous Adenocarcinoma Ovarian Seromucinous Carcinoma Platinum-Refractory Fallopian Tube Carcinoma Platinum-Refractory Ovarian Carcinoma Platinum-Refractory Primary Peritoneal Carcinoma Recurrent Fallopian Tube Clear Cell Adenocarcinoma Recurrent Fallopian Tube Endometrioid Adenocarcinoma Recurrent Fallopian Tube High Grade Serous Adenocarcinoma Recurrent Fallopian Tube Mucinous Adenocarcinoma Recurrent Fallopian Tube Transitional Cell Carcinoma Recurrent Fallopian Tube Undifferentiated Carcinoma Recurrent Low Grade Fallopian Tube Serous Adenocarcinoma Recurrent Ovarian Clear Cell Adenocarcinoma Recurrent Ovarian Endometrioid Adenocarcinoma Recurrent Ovarian High Grade Serous Adenocarcinoma Recurrent Ovarian Low Grade Serous Adenocarcinoma Recurrent Ovarian Mucinous Adenocarcinoma Recurrent Ovarian Seromucinous Carcinoma Recurrent Ovarian Transitional Cell Carcinoma Recurrent Ovarian Undifferentiated Carcinoma Recurrent Platinum-Resistant Fallopian Tube Carcinoma Recurrent Platinum-Resistant Ovarian Carcinoma Recurrent Platinum-Resistant Primary Peritoneal Carcinoma Recurrent Primary Peritoneal Clear Cell Adenocarcinoma Recurrent Primary Peritoneal Endometrioid Adenocarcinoma Recurrent Primary Peritoneal High Grade Serous Adenocarcinoma Recurrent Primary Peritoneal Low Grade Serous Adenocarcinoma Recurrent Primary Peritoneal Transitional Cell Carcinoma Recurrent Primary Peritoneal Undifferentiated Carcinoma Refractory Fallopian Tube Clear Cell Adenocarcinoma Refractory Fallopian Tube Endometrioid Adenocarcinoma Refractory Fallopian Tube High Grade Serous Adenocarcinoma Refractory Fallopian Tube Mucinous Adenocarcinoma Refractory Fallopian Tube Transitional Cell Carcinoma Refractory Fallopian Tube Undifferentiated Carcinoma Refractory Low Grade Fallopian Tube Serous Adenocarcinoma Refractory Ovarian Clear Cell Adenocarcinoma Refractory Ovarian Endometrioid Adenocarcinoma Refractory Ovarian High Grade Serous Adenocarcinoma Refractory Ovarian Low Grade Serous Adenocarcinoma Refractory Ovarian Mucinous Adenocarcinoma Refractory Ovarian Seromucinous Carcinoma Refractory Ovarian Transitional Cell Carcinoma Refractory Ovarian Undifferentiated Carcinoma Refractory Primary Peritoneal Clear Cell Adenocarcinoma Refractory Primary Peritoneal Endometrioid Adenocarcinoma Refractory Primary Peritoneal High Grade Serous Adenocarcinoma Refractory Primary Peritoneal Low Grade Serous Adenocarcinoma Refractory Primary Peritoneal Transitional Cell Carcinoma Refractory Primary Peritoneal Undifferentiated Carcinoma	Drug: Cediranib Maleate Biological: Durvalumab Drug: Olaparib Drug: Paclitaxel Drug: Pegylated Liposomal Doxorubicin Hydrochloride Drug: Topotecan Hydrochloride	Phase 2

Detailed Description

PRIMARY OBJECTIVE:

To assess the efficacy of the combinations durvalumab (MEDI4736) plus olaparib and cediranib, durvalumab (MEDI4736) plus cediranib, or olaparib and cediranib, as measured by progression-free survival (PFS), as compared to physician's choice standard of care chemotherapy, in patients with recurrent platinum-resistant ovarian, primary peritoneal or fallopian tube cancer who had prior bevacizumab.

SECONDARY OBJECTIVES:

To assess the efficacy of the combinations durvalumab (MEDI4736) plus olaparib and cediranib, durvalumab (MEDI4736) plus cediranib, or olaparib and cediranib, as measured by overall response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, as compared to physician's choice standard of care chemotherapy, in patients with recurrent platinum-resistant ovarian, primary peritoneal or fallopian tube cancer who had prior bevacizumab.
To assess the efficacy of the combinations durvalumab (MEDI4736) plus olaparib and cediranib, durvalumab (MEDI4736) plus cediranib, or olaparib and cediranib, as measured by overall survival (OS), as compared to physician's choice standard of care chemotherapy, in patients with recurrent platinum-resistant ovarian, primary peritoneal or fallopian tube cancer who had prior bevacizumab.

OUTLINE: Patients are randomized to 1 of 4 arms.

ARM I: Patients receive paclitaxel intravenously (IV) over 60 minutes on days 1, 8, and 15, or pegylated liposomal doxorubicin hydrochloride IV over 60 minutes on day 1, or topotecan hydrochloride IV over 30 minutes on days 1, 8 and 15 or days 1-5 per the discretion of the treating physician. Cycles repeat every 21 or 28 days in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive durvalumab IV over 60 minutes on day 1, cediranib maleate orally (PO) once daily (QD) Monday through Friday, and olaparib PO twice daily (BID) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM III: Patients receive durvalumab IV over 60 minutes on day 1 and cediranib maleate PO QD Monday through Friday. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM IV: Patients receive cediranib maleate PO QD on days 1-28 and olaparib PO BID on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up periodically for up to 5 years.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

164 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Randomized Phase II Trial of Triplet Therapy (A PD-L1 Inhibitor Durvalumab (MEDI4736) in Combination With Olaparib and Cediranib) Compared to Olaparib and Cediranib or Durvalumab (MEDI4736) and Cediranib or Standard of Care Chemotherapy in Women With Platinum-Resistant Recurrent Epithelial Ovarian Cancer, Primary Peritoneal or Fallopian Cancer Who Have Received Prior Bevacizumab

Actual Study Start Date :

Apr 28, 2021

Anticipated Primary Completion Date :

Dec 15, 2023

Anticipated Study Completion Date :

Dec 15, 2023

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Arm I (paclitaxel, doxorubicin, topotecan hydrochloride)) Patients receive paclitaxel IV over 60 minutes on days 1, 8, and 15, or pegylated liposomal doxorubicin hydrochloride IV over 60 minutes on day 1, or topotecan hydrochloride IV over 30 minutes on days 1, 8 and 15 or days 1-5 per the discretion of the treating physician. Cycles repeat every 21 or 28 days in the absence of disease progression or unacceptable toxicity.	Drug: Paclitaxel Given IV Other Names: Anzatax Asotax Bristaxol Praxel Taxol Taxol Konzentrat Drug: Pegylated Liposomal Doxorubicin Hydrochloride Given IV Other Names: ATI-0918 Caelyx Dox-SL Doxil Doxilen Doxorubicin HCl Liposomal Doxorubicin HCl Liposome Doxorubicin Hydrochloride Liposome Duomeisu Evacet LipoDox Lipodox 50 Liposomal Adriamycin Liposomal Doxorubicin Hydrochloride Liposomal-Encapsulated Doxorubicin Pegylated Doxorubicin HCl Liposome S-Liposomal Doxorubicin Stealth Liposomal Doxorubicin TLC D-99 Drug: Topotecan Hydrochloride Given IV Other Names: Hycamptamine Hycamtin SKF S-104864-A Topotecan HCl topotecan hydrochloride (oral)
Experimental: Arm II (durvalumab, cediranib maleate, olaparib) Patients receive durvalumab IV over 60 minutes on day 1, cediranib maleate PO QD Monday through Friday, and olaparib PO BID on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.	Drug: Cediranib Maleate Given PO Other Names: AZD2171 AZD2171 Maleate Recentin Biological: Durvalumab Given IV Other Names: Imfinzi Immunoglobulin G1, Anti-(Human Protein B7-H1) (Human Monoclonal MEDI4736 Heavy Chain), Disulfide with Human Monoclonal MEDI4736 Kappa-chain, Dimer MEDI-4736 MEDI4736 Drug: Olaparib Given PO Other Names: AZD 2281 AZD-2281 AZD2281 KU-0059436 Lynparza PARP Inhibitor AZD2281
Experimental: Arm III (durvalumab, cediranib maleate) Patients receive durvalumab IV over 60 minutes on day 1 and cediranib maleate PO QD Monday through Friday. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.	Drug: Cediranib Maleate Given PO Other Names: AZD2171 AZD2171 Maleate Recentin Biological: Durvalumab Given IV Other Names: Imfinzi Immunoglobulin G1, Anti-(Human Protein B7-H1) (Human Monoclonal MEDI4736 Heavy Chain), Disulfide with Human Monoclonal MEDI4736 Kappa-chain, Dimer MEDI-4736 MEDI4736
Experimental: Arm IV (cediranib maleate, olaparib) Patients receive cediranib maleate PO QD on days 1-28 and olaparib PO BID on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.	Drug: Cediranib Maleate Given PO Other Names: AZD2171 AZD2171 Maleate Recentin Drug: Olaparib Given PO Other Names: AZD 2281 AZD-2281 AZD2281 KU-0059436 Lynparza PARP Inhibitor AZD2281

Outcome Measures

Primary Outcome Measures

Progression free survival [From study entry to time of progression or death, whichever occurs first, assessed up to 5 years]
Will be presented by Kaplan Meier methods.

Secondary Outcome Measures

Objective response rate [From the start of the treatment until disease progression/recurrence, assessed up to 5 years]
Quantified as the binomial proportion of patients with measurable disease at enrollment who have a best overall response of complete response (CR) or partial response (PR).
Duration of response [From the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented, assessed up to 5 years]
Will be presented by Kaplan Meier methods.
Overall survival [Time from study entry to date of death from any cause, assessed up to 5 years]
Will be presented by Kaplan Meier methods.
Incidence of adverse events [Up to 30 days post treatment]
All adverse events, including severe adverse events and treatment-related adverse events, will be categorized and graded for severity according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

Female

Accepts Healthy Volunteers:

Inclusion Criteria:

Women with recurrent/persistent platinum-resistant ovarian, primary peritoneal, or fallopian tube cancers; platinum-resistant disease is defined as progression within < 6 months from completion of platinum based therapy. The date should be calculated from the last administered dose of platinum therapy
Patients must have histologically or cytologically confirmed ovarian cancer, peritoneal cancer or fallopian tube cancer and must have a histological diagnosis of high grade serous, grade 3 endometrioid or clear cell carcinoma based on local histopathological findings. Patients with low grade serous, grade 1 or 2 endometrioid, mixed epithelial, undifferentiated carcinoma, or mucinous carcinoma histologies are also eligible, provided that the patient has a known deleterious BRCA1 or BRCA2 mutation identified through testing at a clinical laboratory. Histologic confirmation of the original primary tumor is required via the pathology report (upload of report required). Confirmation of BRCA1 and BRCA2 germline and/or somatic mutation status and hormone receptor (HR) status is required for all entered patients (if available) via testing report (upload of report[s] required)
Evaluable disease - defined as RECIST 1.1 measurable disease OR non-measurable disease (defined as solid and/or cystic abnormalities on radiographic imaging that do not meet RECIST 1.1 definitions for target lesions OR ascites and/or pleural effusion that has been pathologically demonstrated to be disease-related in the setting of a CA125 >= 2 x upper limit of normal [ULN])
Prior therapy:
At least two prior treatment regimens (including primary therapy) but up to 5 lines of systemic anticancer therapy. Hormonal therapy (such as tamoxifen, aromatase inhibitors) will not count as a previous treatment regimen.
Prior use of bevacizumab in the upfront or recurrent setting is required.
Prior use of PARP inhibitor is allowed.
Prior use of immune checkpoint blockade (e.g., a PD-L1/PD-1inhibitor or a CTLA-4 inhibitor) is allowed
Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
Absolute neutrophil count (ANC) >= 1,500/mcL
Hemoglobin > 10 g/dL
Platelets >= 100,000/mcL
Creatinine clearance (CrCL) or estimated glomerular filtration rate (eGFR) of > 50 mL/min estimated using either the Cockcroft-Gault equation, the Modification of Diet in Renal Disease Study, or as reported in the comprehensive metabolic panel/basic metabolic panel (eGFR)
Urine protein: creatinine ratio (UPC) of =< 1
Total serum bilirubin level =< 1.5 x ULN (patients with known Gilbert's disease who have bilirubin level =< 3 x ULN may be enrolled)
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x ULN
Age >= 18 years
Body weight > 30 kg
Adequately controlled blood pressure (systolic blood pressure [SBP] =< 140; diastolic blood pressure [DBP] =< 90 mmHg) on a maximum of three antihypertensive medications. Patients must have a BP of =< 140/90 mmHg taken in the clinic setting by a medical professional within 2 weeks prior to study registration. It is strongly recommended that patients who are on three antihypertensive medications be followed by a cardiologist or a primary care physician for management of BP while on protocol. Patients must be willing and able to check and record daily blood pressure readings. BP cuffs will be provided to patients randomized to the cediranib-containing arms
Adequately controlled thyroid dysfunction with no symptoms of thyroid dysfunction and normal thyroid stimulating hormone (TSH). If TSH is not within normal range despite no symptoms of thyroid dysfunction, normal free T4 level is required
Able to swallow and retain oral medications and no gastrointestinal (GI) illnesses that would preclude absorption of olaparib and cediranib as judged by treating physician
Toxicities of prior therapy (excepting alopecia and vitiligo), should be resolved to less than or equal to grade 1 as per Common Terminology Criteria for Adverse Events (CTCAE) v5.0
Women of childbearing potential (WOCBP) must agree to use two forms of birth control (hormonal or barrier method of birth control; abstinence). Note: Definition of women of no longer having childbearing potential: Postmenopausal or evidence of non-childbearing status for women of childbearing potential as confirmed by a negative urine or serum pregnancy test within 7 days prior to start of study treatment. Postmenopausal is defined as: Age >= 60 years, or age < 60 with any one or more of the conditions below:
Amenorrhoeic for >= 1 year in the absence of chemotherapy and/or hormonal treatments,
Luteinizing hormone and/or follicle stimulating hormone and/or estradiol levels in the post-menopausal range,
Radiation-induced oophorectomy with last menses > 1 year ago,
Chemotherapy-induced menopause with > 1 year interval since last menses,
Surgical sterilization (bilateral oophorectomy or hysterectomy)
The patient or a legally authorized representative must provide study-specific informed consent prior to study entry and authorization permitting release of personal health information

Exclusion Criteria:

Primary platinum-refractory disease defined as progression during first-line platinum-based chemotherapy
Rising CA-125 only without RECIST 1.1 evaluable disease
Prior therapy:
Patients who have had chemotherapy, investigational drugs or radiotherapy within 3 weeks prior to study registration or those who have not recovered from adverse events due to agents administered more than 3 weeks earlier.
Patients may not have had hormonal therapy within 2 weeks of study registration. Patients receiving raloxifene for bone health as per Food and Drug Administration (FDA) indication may remain on raloxifene absent other drug interactions.
Prior use of concurrent olaparib and cediranib combination.
Patients who have had prior PARP inhibitor or immune checkpoint blockade requiring dose modifications as they cannot start this study at full dose
History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 3 months prior to study registration
Current signs and/or symptoms of bowel obstruction or signs and/or symptoms of bowel obstruction within 3 months of study registration except temporary (< 24 hr) improved with medical management, within last 3 months
Any prior grade >= 3 immune-related adverse event (irAE) while receiving any previous immunotherapy agent, or any unresolved irAE > grade 1
Dependency on IV hydration or total parenteral nutrition (TPN)
Pregnant women. Because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with these drugs, breastfeeding should be discontinued. These potential risks may also apply to other agents used in this study
Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
Patients with untreated brain metastases, spinal cord compression, or evidence of symptomatic brain metastases or leptomeningeal disease as noted on computed tomography (CT) or magnetic resonance imaging (MRI) scans should not be included on this study, since neurologic dysfunction may confound the evaluation of neurologic and other adverse events. Patients with treated brain metastases and resolution of any associated symptoms must demonstrate stable post-therapeutic imaging for at least 6 months following therapy prior to starting study registration
Patients who have the following clinical conditions are considered to be at increased risk for cardiac toxicities. Patients with any cardiac history of the following conditions:
History of myocardial infarction or myocarditis within six months of study registration
Unstable angina
Resting electrocardiogram (ECG) with clinically significant abnormal findings.
New York Heart Association functional classification of III or IV
If cardiac function assessment is clinically indicated or performed: left ventricular ejection fraction (LVEF) less than normal per institutional guidelines, or < 55%, if threshold for normal not otherwise specified by institutional guidelines. Patients with the following risk factors should have a baseline cardiac function assessment:
Prior treatment with anthracyclines
Prior treatment with trastuzumab or T-DM1
Prior central thoracic radiation therapy (RT), including RT to the heart
History of myocardial infarction within 6 to 12 months (Patients with history of myocardial infarction within 6 months are excluded from the study)
Prior history of impaired cardiac function
History of stroke or transient ischemic attack within six months of study registration
Clinically significant peripheral vascular disease or vascular disease (aortic aneurysm or aortic dissection)
Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of study treatment. Patients must have recovered from any effects of any major surgery and surgical wound should have healed prior to starting treatment. Note: Local surgery of isolated lesions for palliative intent is acceptable
Evidence of coagulopathy or bleeding diathesis. Therapeutic anticoagulation for prior thromboembolic events, including warfarin, is permitted. Patients receiving warfarin are recommended to have careful monitoring of international normalized ratio (INR)
Evidence suggestive of myelodysplastic syndrome (MDS) or acute myelogenous leukemia (AML) on peripheral blood smear or bone marrow biopsy, if clinically indicated. No prior allogeneic bone marrow transplant or double umbilical cord blood transplantation (dUBCT)
Human immunodeficiency virus (HIV) positive patients due to potential drug and drug interactions
Patients may not use any complementary or alternative medicines including natural herbal products or folk remedies as they may interfere with the effectiveness of the study treatments
Receipt of live attenuated vaccine within 30 days prior to the first dose of study treatment. Note: Patients, if enrolled, should not receive live vaccine whilst receiving study treatment and up to 30 days after the last dose of study treatment
Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia (other than atrial fibrillation with controlled ventricular rate), or psychiatric illness/social situations that would limit compliance with study requirements, substantially increase risk of incurring adverse events or compromise the ability of the patient to given written informed consent
Patients receiving any medications or substances that are strong inhibitors or inducers of CYP3A4. Dihydropyridine calcium-channel blockers are permitted for management of hypertension
Current or prior use of immunosuppressive medication within 14 days of study registration. The following are exceptions to this criterion:
Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra articular injection)
Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent
Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication)
History of allergic reactions attributed to compounds of similar chemical or biologic composition to durvalumab, olaparib, or cediranib
Patients with active autoimmune disease that has required systemic treatment in the past 2 years (i.e., with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and tuberculosis [TB] testing in line with local practice), hepatitis B (known positive hepatitis B virus [HBV] surface antigen (HBsAg) result), or hepatitis C. Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for hepatitis C virus (HCV) ribonucleic acid (RNA)
Patients who have a history of (non-infectious) pneumonitis that required steroids, or current pneumonitis

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Anchorage Associates in Radiation Medicine	Anchorage	Alaska	United States	98508
2	Anchorage Radiation Therapy Center	Anchorage	Alaska	United States	99504
3	Alaska Breast Care and Surgery LLC	Anchorage	Alaska	United States	99508
4	Alaska Oncology and Hematology LLC	Anchorage	Alaska	United States	99508
5	Alaska Women's Cancer Care	Anchorage	Alaska	United States	99508
6	Anchorage Oncology Centre	Anchorage	Alaska	United States	99508
7	Katmai Oncology Group	Anchorage	Alaska	United States	99508
8	Providence Alaska Medical Center	Anchorage	Alaska	United States	99508
9	Fairbanks Memorial Hospital	Fairbanks	Alaska	United States	99701
10	CTCA at Western Regional Medical Center	Goodyear	Arizona	United States	85338
11	Cancer Center at Saint Joseph's	Phoenix	Arizona	United States	85004
12	Mercy Hospital Fort Smith	Fort Smith	Arkansas	United States	72903
13	CHI Saint Vincent Cancer Center Hot Springs	Hot Springs	Arkansas	United States	71913
14	University of Arkansas for Medical Sciences	Little Rock	Arkansas	United States	72205
15	Mission Hope Medical Oncology - Arroyo Grande	Arroyo Grande	California	United States	93420
16	Sutter Auburn Faith Hospital	Auburn	California	United States	95602
17	Sutter Cancer Centers Radiation Oncology Services-Auburn	Auburn	California	United States	95603
18	Alta Bates Summit Medical Center-Herrick Campus	Berkeley	California	United States	94704
19	Providence Saint Joseph Medical Center/Disney Family Cancer Center	Burbank	California	United States	91505
20	Sutter Cancer Centers Radiation Oncology Services-Cameron Park	Cameron Park	California	United States	95682
21	Eden Hospital Medical Center	Castro Valley	California	United States	94546
22	John Muir Medical Center-Concord Campus	Concord	California	United States	94520
23	Sutter Davis Hospital	Davis	California	United States	95616
24	City of Hope Comprehensive Cancer Center	Duarte	California	United States	91010
25	Palo Alto Medical Foundation-Fremont	Fremont	California	United States	94538
26	City of Hope Antelope Valley	Lancaster	California	United States	93534
27	Los Angeles County-USC Medical Center	Los Angeles	California	United States	90033
28	USC / Norris Comprehensive Cancer Center	Los Angeles	California	United States	90033
29	Memorial Medical Center	Modesto	California	United States	95355
30	Palo Alto Medical Foundation-Camino Division	Mountain View	California	United States	94040
31	Palo Alto Medical Foundation-Gynecologic Oncology	Mountain View	California	United States	94040
32	Palo Alto Medical Foundation Health Care	Palo Alto	California	United States	94301
33	Sutter Cancer Centers Radiation Oncology Services-Roseville	Roseville	California	United States	95661
34	Sutter Roseville Medical Center	Roseville	California	United States	95661
35	Sutter Medical Center Sacramento	Sacramento	California	United States	95816
36	California Pacific Medical Center-Pacific Campus	San Francisco	California	United States	94115
37	Pacific Central Coast Health Center-San Luis Obispo	San Luis Obispo	California	United States	93401
38	Palo Alto Medical Foundation-Santa Cruz	Santa Cruz	California	United States	95065
39	Mission Hope Medical Oncology - Santa Maria	Santa Maria	California	United States	93444
40	Sutter Pacific Medical Foundation	Santa Rosa	California	United States	95403
41	City of Hope South Pasadena	South Pasadena	California	United States	91030
42	Palo Alto Medical Foundation-Sunnyvale	Sunnyvale	California	United States	94086
43	City of Hope Upland	Upland	California	United States	91786
44	Sutter Cancer Centers Radiation Oncology Services-Vacaville	Vacaville	California	United States	95687
45	Sutter Solano Medical Center/Cancer Center	Vallejo	California	United States	94589
46	John Muir Medical Center-Walnut Creek	Walnut Creek	California	United States	94598
47	Rocky Mountain Cancer Centers-Aurora	Aurora	Colorado	United States	80012
48	Rocky Mountain Cancer Centers-Boulder	Boulder	Colorado	United States	80304
49	Rocky Mountain Cancer Centers - Centennial	Centennial	Colorado	United States	80112
50	Penrose-Saint Francis Healthcare	Colorado Springs	Colorado	United States	80907
51	Rocky Mountain Cancer Centers-Penrose	Colorado Springs	Colorado	United States	80907
52	Porter Adventist Hospital	Denver	Colorado	United States	80210
53	Mercy Medical Center	Durango	Colorado	United States	81301
54	Southwest Oncology PC	Durango	Colorado	United States	81301
55	Saint Anthony Hospital	Lakewood	Colorado	United States	80228
56	Rocky Mountain Cancer Centers-Littleton	Littleton	Colorado	United States	80120
57	Littleton Adventist Hospital	Littleton	Colorado	United States	80122
58	Rocky Mountain Cancer Centers-Sky Ridge	Lone Tree	Colorado	United States	80124
59	Longmont United Hospital	Longmont	Colorado	United States	80501
60	Rocky Mountain Cancer Centers-Longmont	Longmont	Colorado	United States	80501
61	McKee Medical Center	Loveland	Colorado	United States	80539
62	Parker Adventist Hospital	Parker	Colorado	United States	80138
63	Saint Mary Corwin Medical Center	Pueblo	Colorado	United States	81004
64	Northside Hospital	Atlanta	Georgia	United States	30342
65	CTCA at Southeastern Regional Medical Center	Newnan	Georgia	United States	30265
66	Saint Alphonsus Cancer Care Center-Boise	Boise	Idaho	United States	83706
67	Saint Luke's Cancer Institute - Boise	Boise	Idaho	United States	83712
68	Saint Alphonsus Cancer Care Center-Caldwell	Caldwell	Idaho	United States	83605
69	Kootenai Health - Coeur d'Alene	Coeur d'Alene	Idaho	United States	83814
70	Walter Knox Memorial Hospital	Emmett	Idaho	United States	83617
71	Saint Luke's Cancer Institute - Fruitland	Fruitland	Idaho	United States	83619
72	Idaho Urologic Institute-Meridian	Meridian	Idaho	United States	83642
73	Saint Luke's Cancer Institute - Meridian	Meridian	Idaho	United States	83642
74	Saint Alphonsus Medical Center-Nampa	Nampa	Idaho	United States	83686
75	Saint Luke's Cancer Institute - Nampa	Nampa	Idaho	United States	83686
76	Kootenai Clinic Cancer Services - Post Falls	Post Falls	Idaho	United States	83854
77	Kootenai Cancer Clinic	Sandpoint	Idaho	United States	83864
78	Saint Luke's Cancer Institute - Twin Falls	Twin Falls	Idaho	United States	83301
79	Saint Anthony's Health	Alton	Illinois	United States	62002
80	Rush - Copley Medical Center	Aurora	Illinois	United States	60504
81	Illinois CancerCare-Bloomington	Bloomington	Illinois	United States	61704
82	Illinois CancerCare-Canton	Canton	Illinois	United States	61520
83	Memorial Hospital of Carbondale	Carbondale	Illinois	United States	62902
84	SIH Cancer Institute	Carterville	Illinois	United States	62918
85	Illinois CancerCare-Carthage	Carthage	Illinois	United States	62321
86	Centralia Oncology Clinic	Centralia	Illinois	United States	62801
87	John H Stroger Jr Hospital of Cook County	Chicago	Illinois	United States	60612
88	Rush University Medical Center	Chicago	Illinois	United States	60612
89	University of Chicago Comprehensive Cancer Center	Chicago	Illinois	United States	60637
90	Carle on Vermilion	Danville	Illinois	United States	61832
91	Cancer Care Specialists of Illinois - Decatur	Decatur	Illinois	United States	62526
92	Decatur Memorial Hospital	Decatur	Illinois	United States	62526
93	Illinois CancerCare-Dixon	Dixon	Illinois	United States	61021
94	Carle Physician Group-Effingham	Effingham	Illinois	United States	62401
95	Crossroads Cancer Center	Effingham	Illinois	United States	62401
96	Illinois CancerCare-Eureka	Eureka	Illinois	United States	61530
97	NorthShore University HealthSystem-Evanston Hospital	Evanston	Illinois	United States	60201
98	Illinois CancerCare-Galesburg	Galesburg	Illinois	United States	61401
99	Western Illinois Cancer Treatment Center	Galesburg	Illinois	United States	61401
100	NorthShore University HealthSystem-Glenbrook Hospital	Glenview	Illinois	United States	60026
101	Ingalls Memorial Hospital	Harvey	Illinois	United States	60426
102	NorthShore University HealthSystem-Highland Park Hospital	Highland Park	Illinois	United States	60035
103	Sudarshan K Sharma MD Limited-Gynecologic Oncology	Hinsdale	Illinois	United States	60521
104	Illinois CancerCare-Kewanee Clinic	Kewanee	Illinois	United States	61443
105	Illinois CancerCare-Macomb	Macomb	Illinois	United States	61455
106	Carle Physician Group-Mattoon/Charleston	Mattoon	Illinois	United States	61938
107	Good Samaritan Regional Health Center	Mount Vernon	Illinois	United States	62864
108	UC Comprehensive Cancer Center at Silver Cross	New Lenox	Illinois	United States	60451
109	Cancer Care Center of O'Fallon	O'Fallon	Illinois	United States	62269
110	University of Chicago Medicine-Orland Park	Orland Park	Illinois	United States	60462
111	Illinois CancerCare-Ottawa Clinic	Ottawa	Illinois	United States	61350
112	Illinois CancerCare-Pekin	Pekin	Illinois	United States	61554
113	Illinois CancerCare-Peoria	Peoria	Illinois	United States	61615
114	Methodist Medical Center of Illinois	Peoria	Illinois	United States	61636
115	Illinois CancerCare-Peru	Peru	Illinois	United States	61354
116	Valley Radiation Oncology	Peru	Illinois	United States	61354
117	Illinois CancerCare-Princeton	Princeton	Illinois	United States	61356
118	Southern Illinois University School of Medicine	Springfield	Illinois	United States	62702
119	Springfield Clinic	Springfield	Illinois	United States	62702
120	Memorial Medical Center	Springfield	Illinois	United States	62781
121	Carle Cancer Center	Urbana	Illinois	United States	61801
122	The Carle Foundation Hospital	Urbana	Illinois	United States	61801
123	Northwestern Medicine Cancer Center Warrenville	Warrenville	Illinois	United States	60555
124	Illinois CancerCare - Washington	Washington	Illinois	United States	61571
125	Rush-Copley Healthcare Center	Yorkville	Illinois	United States	60560
126	Midwestern Regional Medical Center	Zion	Illinois	United States	60099
127	Mary Greeley Medical Center	Ames	Iowa	United States	50010
128	McFarland Clinic PC - Ames	Ames	Iowa	United States	50010
129	McFarland Clinic PC-Boone	Boone	Iowa	United States	50036
130	Mercy Hospital	Cedar Rapids	Iowa	United States	52403
131	Oncology Associates at Mercy Medical Center	Cedar Rapids	Iowa	United States	52403
132	Medical Oncology and Hematology Associates-West Des Moines	Clive	Iowa	United States	50325
133	Mercy Cancer Center-West Lakes	Clive	Iowa	United States	50325
134	Alegent Health Mercy Hospital	Council Bluffs	Iowa	United States	51503
135	Greater Regional Medical Center	Creston	Iowa	United States	50801
136	Medical Oncology and Hematology Associates-Laurel	Des Moines	Iowa	United States	50314
137	Mercy Medical Center - Des Moines	Des Moines	Iowa	United States	50314
138	McFarland Clinic PC-Trinity Cancer Center	Fort Dodge	Iowa	United States	50501
139	University of Iowa/Holden Comprehensive Cancer Center	Iowa City	Iowa	United States	52242
140	McFarland Clinic PC-Jefferson	Jefferson	Iowa	United States	50129
141	McFarland Clinic PC-Marshalltown	Marshalltown	Iowa	United States	50158
142	Mercy Medical Center-West Lakes	West Des Moines	Iowa	United States	50266
143	Central Care Cancer Center - Garden City	Garden City	Kansas	United States	67846
144	Central Care Cancer Center - Great Bend	Great Bend	Kansas	United States	67530
145	Flaget Memorial Hospital	Bardstown	Kentucky	United States	40004
146	Commonwealth Cancer Center-Corbin	Corbin	Kentucky	United States	40701
147	Saint Joseph Radiation Oncology Resource Center	Lexington	Kentucky	United States	40504
148	Saint Joseph Hospital East	Lexington	Kentucky	United States	40509
149	Saint Joseph London	London	Kentucky	United States	40741
150	Jewish Hospital	Louisville	Kentucky	United States	40202
151	Saints Mary and Elizabeth Hospital	Louisville	Kentucky	United States	40215
152	UofL Health Medical Center Northeast	Louisville	Kentucky	United States	40245
153	Jewish Hospital Medical Center South	Shepherdsville	Kentucky	United States	40165
154	Our Lady of the Lake Medical Oncology	Baton Rouge	Louisiana	United States	70817
155	Harold Alfond Center for Cancer Care	Augusta	Maine	United States	04330
156	Lafayette Family Cancer Center-EMMC	Brewer	Maine	United States	04412
157	Maine Medical Center- Scarborough Campus	Scarborough	Maine	United States	04074
158	Greater Baltimore Medical Center	Baltimore	Maryland	United States	21204
159	National Institutes of Health Clinical Center	Bethesda	Maryland	United States	20892
160	University of Michigan Comprehensive Cancer Center	Ann Arbor	Michigan	United States	48109
161	Fairview Ridges Hospital	Burnsville	Minnesota	United States	55337
162	Minnesota Oncology - Burnsville	Burnsville	Minnesota	United States	55337
163	Cambridge Medical Center	Cambridge	Minnesota	United States	55008
164	Mercy Hospital	Coon Rapids	Minnesota	United States	55433
165	Fairview Southdale Hospital	Edina	Minnesota	United States	55435
166	Unity Hospital	Fridley	Minnesota	United States	55432
167	Fairview Clinics and Surgery Center Maple Grove	Maple Grove	Minnesota	United States	55369
168	Minnesota Oncology Hematology PA-Maplewood	Maplewood	Minnesota	United States	55109
169	Saint John's Hospital - Healtheast	Maplewood	Minnesota	United States	55109
170	Abbott-Northwestern Hospital	Minneapolis	Minnesota	United States	55407
171	Hennepin County Medical Center	Minneapolis	Minnesota	United States	55415
172	Health Partners Inc	Minneapolis	Minnesota	United States	55454
173	Monticello Cancer Center	Monticello	Minnesota	United States	55362
174	New Ulm Medical Center	New Ulm	Minnesota	United States	56073
175	Fairview Northland Medical Center	Princeton	Minnesota	United States	55371
176	North Memorial Medical Health Center	Robbinsdale	Minnesota	United States	55422
177	Park Nicollet Clinic - Saint Louis Park	Saint Louis Park	Minnesota	United States	55416
178	Regions Hospital	Saint Paul	Minnesota	United States	55101
179	United Hospital	Saint Paul	Minnesota	United States	55102
180	Saint Francis Regional Medical Center	Shakopee	Minnesota	United States	55379
181	Lakeview Hospital	Stillwater	Minnesota	United States	55082
182	Ridgeview Medical Center	Waconia	Minnesota	United States	55387
183	Rice Memorial Hospital	Willmar	Minnesota	United States	56201
184	Minnesota Oncology Hematology PA-Woodbury	Woodbury	Minnesota	United States	55125
185	Fairview Lakes Medical Center	Wyoming	Minnesota	United States	55092
186	Saint Louis Cancer and Breast Institute-Ballwin	Ballwin	Missouri	United States	63011
187	Central Care Cancer Center - Bolivar	Bolivar	Missouri	United States	65613
188	Saint Francis Medical Center	Cape Girardeau	Missouri	United States	63703
189	Southeast Cancer Center	Cape Girardeau	Missouri	United States	63703
190	Parkland Health Center - Farmington	Farmington	Missouri	United States	63640
191	Capital Region Southwest Campus	Jefferson City	Missouri	United States	65109
192	Freeman Health System	Joplin	Missouri	United States	64804
193	Mercy Hospital Joplin	Joplin	Missouri	United States	64804
194	Delbert Day Cancer Institute at PCRMC	Rolla	Missouri	United States	65401
195	Mercy Clinic-Rolla-Cancer and Hematology	Rolla	Missouri	United States	65401
196	Heartland Regional Medical Center	Saint Joseph	Missouri	United States	64506
197	Saint Louis Cancer and Breast Institute-South City	Saint Louis	Missouri	United States	63109
198	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
199	Mercy Hospital South	Saint Louis	Missouri	United States	63128
200	Missouri Baptist Medical Center	Saint Louis	Missouri	United States	63131
201	Mercy Hospital Saint Louis	Saint Louis	Missouri	United States	63141
202	Sainte Genevieve County Memorial Hospital	Sainte Genevieve	Missouri	United States	63670
203	Mercy Hospital Springfield	Springfield	Missouri	United States	65804
204	CoxHealth South Hospital	Springfield	Missouri	United States	65807
205	Missouri Baptist Sullivan Hospital	Sullivan	Missouri	United States	63080
206	Missouri Baptist Outpatient Center-Sunset Hills	Sunset Hills	Missouri	United States	63127
207	Mercy Hospital Washington	Washington	Missouri	United States	63090
208	Community Hospital of Anaconda	Anaconda	Montana	United States	59711
209	Billings Clinic Cancer Center	Billings	Montana	United States	59101
210	Bozeman Deaconess Hospital	Bozeman	Montana	United States	59715
211	Benefis Healthcare- Sletten Cancer Institute	Great Falls	Montana	United States	59405
212	Great Falls Clinic	Great Falls	Montana	United States	59405
213	Kalispell Regional Medical Center	Kalispell	Montana	United States	59901
214	Saint Patrick Hospital - Community Hospital	Missoula	Montana	United States	59802
215	Community Medical Hospital	Missoula	Montana	United States	59804
216	CHI Health Saint Francis	Grand Island	Nebraska	United States	68803
217	CHI Health Good Samaritan	Kearney	Nebraska	United States	68847
218	Saint Elizabeth Regional Medical Center	Lincoln	Nebraska	United States	68510
219	Cancer Partners of Nebraska - Pine Lake	Lincoln	Nebraska	United States	68516
220	Southeast Nebraska Cancer Center - 68th Street Place	Lincoln	Nebraska	United States	68516
221	Nebraska Methodist Hospital	Omaha	Nebraska	United States	68114
222	Alegent Health Immanuel Medical Center	Omaha	Nebraska	United States	68122
223	Alegent Health Bergan Mercy Medical Center	Omaha	Nebraska	United States	68124
224	Alegent Health Lakeside Hospital	Omaha	Nebraska	United States	68130
225	Creighton University Medical Center	Omaha	Nebraska	United States	68131
226	Midlands Community Hospital	Papillion	Nebraska	United States	68046
227	Women's Cancer Center of Nevada	Las Vegas	Nevada	United States	89106
228	Jersey Shore Medical Center	Neptune	New Jersey	United States	07753
229	University of New Mexico Cancer Center	Albuquerque	New Mexico	United States	87102
230	Memorial Medical Center - Las Cruces	Las Cruces	New Mexico	United States	88011
231	Presbyterian Rust Medical Center/Jorgensen Cancer Center	Rio Rancho	New Mexico	United States	87124
232	Northwell Health Imbert Cancer Center	Bay Shore	New York	United States	11706
233	Island Gynecologic Oncology	Brightwaters	New York	United States	11718
234	Roswell Park Cancer Institute	Buffalo	New York	United States	14263
235	Northwell Health/Center for Advanced Medicine	Lake Success	New York	United States	11042
236	State University of New York Upstate Medical University	Syracuse	New York	United States	13210
237	Dickstein Cancer Treatment Center	White Plains	New York	United States	10601
238	Southeastern Medical Oncology Center-Clinton	Clinton	North Carolina	United States	28328
239	Southeastern Medical Oncology Center-Goldsboro	Goldsboro	North Carolina	United States	27534
240	Southeastern Medical Oncology Center-Jacksonville	Jacksonville	North Carolina	United States	28546
241	Summa Health System - Akron Campus	Akron	Ohio	United States	44304
242	Aultman Alliance Community Hospital	Alliance	Ohio	United States	44601
243	UHHS-Chagrin Highlands Medical Center	Beachwood	Ohio	United States	44122
244	Strecker Cancer Center-Belpre	Belpre	Ohio	United States	45714
245	Aultman Health Foundation	Canton	Ohio	United States	44710
246	Geauga Hospital	Chardon	Ohio	United States	44024
247	Adena Regional Medical Center	Chillicothe	Ohio	United States	45601
248	Good Samaritan Hospital - Cincinnati	Cincinnati	Ohio	United States	45220
249	Bethesda North Hospital	Cincinnati	Ohio	United States	45242
250	TriHealth Cancer Institute-Westside	Cincinnati	Ohio	United States	45247
251	TriHealth Cancer Institute-Anderson	Cincinnati	Ohio	United States	45255
252	Case Western Reserve University	Cleveland	Ohio	United States	44106
253	Cleveland Clinic Cancer Center/Fairview Hospital	Cleveland	Ohio	United States	44111
254	Cleveland Clinic Foundation	Cleveland	Ohio	United States	44195
255	Ohio State University Comprehensive Cancer Center	Columbus	Ohio	United States	43210
256	Mount Carmel East Hospital	Columbus	Ohio	United States	43213
257	Columbus Oncology and Hematology Associates Inc	Columbus	Ohio	United States	43214
258	Riverside Methodist Hospital	Columbus	Ohio	United States	43214
259	Grant Medical Center	Columbus	Ohio	United States	43215
260	The Mark H Zangmeister Center	Columbus	Ohio	United States	43219
261	Mount Carmel Health Center West	Columbus	Ohio	United States	43222
262	Doctors Hospital	Columbus	Ohio	United States	43228
263	Delaware Health Center-Grady Cancer Center	Delaware	Ohio	United States	43015
264	Grady Memorial Hospital	Delaware	Ohio	United States	43015
265	Dublin Methodist Hospital	Dublin	Ohio	United States	43016
266	Central Ohio Breast and Endocrine Surgery	Gahanna	Ohio	United States	43230
267	Mount Carmel Grove City Hospital	Grove City	Ohio	United States	43123
268	Fairfield Medical Center	Lancaster	Ohio	United States	43130
269	Saint Rita's Medical Center	Lima	Ohio	United States	45801
270	OhioHealth Mansfield Hospital	Mansfield	Ohio	United States	44903
271	Marietta Memorial Hospital	Marietta	Ohio	United States	45750
272	OhioHealth Marion General Hospital	Marion	Ohio	United States	43302
273	Hillcrest Hospital Cancer Center	Mayfield Heights	Ohio	United States	44124
274	UH Seidman Cancer Center at Lake Health Mentor Campus	Mentor	Ohio	United States	44060
275	Knox Community Hospital	Mount Vernon	Ohio	United States	43050
276	Licking Memorial Hospital	Newark	Ohio	United States	43055
277	Newark Radiation Oncology	Newark	Ohio	United States	43055
278	Mercy Health Perrysburg Cancer Center	Perrysburg	Ohio	United States	43551
279	Southern Ohio Medical Center	Portsmouth	Ohio	United States	45662
280	Saint Vincent Mercy Medical Center	Toledo	Ohio	United States	43608
281	Mercy Health - Saint Anne Hospital	Toledo	Ohio	United States	43623
282	University Hospitals Sharon Health Center	Wadsworth	Ohio	United States	44281
283	Saint Ann's Hospital	Westerville	Ohio	United States	43081
284	UH Seidman Cancer Center at Saint John Medical Center	Westlake	Ohio	United States	44145
285	Genesis Healthcare System Cancer Care Center	Zanesville	Ohio	United States	43701
286	Cancer Centers of Southwest Oklahoma Research	Lawton	Oklahoma	United States	73505
287	University of Oklahoma Health Sciences Center	Oklahoma City	Oklahoma	United States	73104
288	Mercy Hospital Oklahoma City	Oklahoma City	Oklahoma	United States	73120
289	Oklahoma Cancer Specialists and Research Institute-Tulsa	Tulsa	Oklahoma	United States	74146
290	Saint Alphonsus Medical Center-Baker City	Baker City	Oregon	United States	97814
291	Saint Charles Health System	Bend	Oregon	United States	97701
292	Clackamas Radiation Oncology Center	Clackamas	Oregon	United States	97015
293	Providence Cancer Institute Clackamas Clinic	Clackamas	Oregon	United States	97015
294	Bay Area Hospital	Coos Bay	Oregon	United States	97420
295	Providence Newberg Medical Center	Newberg	Oregon	United States	97132
296	Saint Alphonsus Medical Center-Ontario	Ontario	Oregon	United States	97914
297	Legacy Good Samaritan Hospital and Medical Center	Portland	Oregon	United States	97210
298	Providence Portland Medical Center	Portland	Oregon	United States	97213
299	Providence Saint Vincent Medical Center	Portland	Oregon	United States	97225
300	Saint Charles Health System-Redmond	Redmond	Oregon	United States	97756
301	Legacy Meridian Park Hospital	Tualatin	Oregon	United States	97062
302	Paoli Memorial Hospital	Paoli	Pennsylvania	United States	19301
303	Thomas Jefferson University Hospital	Philadelphia	Pennsylvania	United States	19107
304	UPMC-Magee Womens Hospital	Pittsburgh	Pennsylvania	United States	15213
305	West Penn Hospital	Pittsburgh	Pennsylvania	United States	15224
306	University of Pittsburgh Cancer Institute (UPCI)	Pittsburgh	Pennsylvania	United States	15232
307	Asplundh Cancer Pavilion	Willow Grove	Pennsylvania	United States	19090
308	Lankenau Medical Center	Wynnewood	Pennsylvania	United States	19096
309	Women and Infants Hospital	Providence	Rhode Island	United States	02905
310	Medical University of South Carolina	Charleston	South Carolina	United States	29425
311	Saint Francis Hospital	Greenville	South Carolina	United States	29601
312	Saint Francis Cancer Center	Greenville	South Carolina	United States	29607
313	Bristol Regional Medical Center	Bristol	Tennessee	United States	37620
314	Ballad Health Cancer Care - Kingsport	Kingsport	Tennessee	United States	37660
315	Wellmont Holston Valley Hospital and Medical Center	Kingsport	Tennessee	United States	37660
316	Thompson Cancer Survival Center	Knoxville	Tennessee	United States	37916
317	Thompson Cancer Survival Center - West	Knoxville	Tennessee	United States	37932
318	Saint Joseph Regional Cancer Center	Bryan	Texas	United States	77802
319	Parkland Memorial Hospital	Dallas	Texas	United States	75235
320	UT Southwestern/Simmons Cancer Center-Dallas	Dallas	Texas	United States	75390
321	Houston Methodist Hospital	Houston	Texas	United States	77030
322	Methodist Willowbrook Hospital	Houston	Texas	United States	77070
323	Houston Methodist West Hospital	Houston	Texas	United States	77094
324	Houston Methodist Sugar Land Hospital	Sugar Land	Texas	United States	77479
325	Houston Methodist The Woodlands Hospital	The Woodlands	Texas	United States	77385
326	Wellmont Medical Associates-Bristol	Bristol	Virginia	United States	24201
327	Southwest VA Regional Cancer Center	Norton	Virginia	United States	24273
328	Providence Regional Cancer System-Aberdeen	Aberdeen	Washington	United States	98520
329	PeaceHealth Saint Joseph Medical Center	Bellingham	Washington	United States	98225
330	Harrison Medical Center	Bremerton	Washington	United States	98310
331	Highline Medical Center-Main Campus	Burien	Washington	United States	98166
332	Providence Regional Cancer System-Centralia	Centralia	Washington	United States	98531
333	Swedish Cancer Institute-Edmonds	Edmonds	Washington	United States	98026
334	Saint Elizabeth Hospital	Enumclaw	Washington	United States	98022
335	Providence Regional Cancer Partnership	Everett	Washington	United States	98201
336	Saint Francis Hospital	Federal Way	Washington	United States	98003
337	Swedish Cancer Institute-Issaquah	Issaquah	Washington	United States	98029
338	Kadlec Clinic Hematology and Oncology	Kennewick	Washington	United States	99336
339	Providence Regional Cancer System-Lacey	Lacey	Washington	United States	98503
340	Saint Clare Hospital	Lakewood	Washington	United States	98499
341	PeaceHealth Saint John Medical Center	Longview	Washington	United States	98632
342	Jefferson Healthcare	Port Townsend	Washington	United States	98368
343	Pacific Gynecology Specialists	Seattle	Washington	United States	98104
344	Swedish Medical Center-Ballard Campus	Seattle	Washington	United States	98107
345	Swedish Medical Center-First Hill	Seattle	Washington	United States	98122-4307
346	Swedish Medical Center-Cherry Hill	Seattle	Washington	United States	98122-5711
347	PeaceHealth United General Medical Center	Sedro-Woolley	Washington	United States	98284
348	Providence Regional Cancer System-Shelton	Shelton	Washington	United States	98584
349	Franciscan Research Center-Northwest Medical Plaza	Tacoma	Washington	United States	98405
350	PeaceHealth Southwest Medical Center	Vancouver	Washington	United States	98664
351	Legacy Salmon Creek Hospital	Vancouver	Washington	United States	98686
352	Providence Saint Mary Regional Cancer Center	Walla Walla	Washington	United States	99362
353	Providence Regional Cancer System-Yelm	Yelm	Washington	United States	98597
354	West Virginia University Charleston Division	Charleston	West Virginia	United States	25304
355	Saint Vincent Hospital Cancer Center Green Bay	Green Bay	Wisconsin	United States	54301
356	Saint Vincent Hospital Cancer Center at Saint Mary's	Green Bay	Wisconsin	United States	54303
357	Gundersen Lutheran Medical Center	La Crosse	Wisconsin	United States	54601
358	Medical College of Wisconsin	Milwaukee	Wisconsin	United States	53226
359	ProHealth D N Greenwald Center	Mukwonago	Wisconsin	United States	53149
360	Cancer Center of Western Wisconsin	New Richmond	Wisconsin	United States	54017
361	ProHealth Oconomowoc Memorial Hospital	Oconomowoc	Wisconsin	United States	53066
362	Saint Vincent Hospital Cancer Center at Oconto Falls	Oconto Falls	Wisconsin	United States	54154
363	Saint Vincent Hospital Cancer Center at Sturgeon Bay	Sturgeon Bay	Wisconsin	United States	54235-1495
364	ProHealth Waukesha Memorial Hospital	Waukesha	Wisconsin	United States	53188
365	UW Cancer Center at ProHealth Care	Waukesha	Wisconsin	United States	53188
366	Billings Clinic-Cody	Cody	Wyoming	United States	82414
367	Welch Cancer Center	Sheridan	Wyoming	United States	82801
368	Cancer Center-Metro Medical Center Bayamon	Bayamon		Puerto Rico	00959-5060
369	HIMA San Pablo Oncologic Hospital	Caguas		Puerto Rico	00726
370	Doctors Cancer Center	Manati		Puerto Rico	00674
371	Instituto Oncologia Moderna Ponce	Ponce		Puerto Rico	00716
372	San Juan Community Oncology Group	San Juan		Puerto Rico	00917
373	Centro Comprensivo de Cancer de UPR	San Juan		Puerto Rico	00927
374	San Juan City Hospital	San Juan		Puerto Rico	00936