Rituximab, Bendamustine Hydrochloride, and Bortezomib Followed by Rituximab and Lenalidomide in Treating Older Patients With Previously Untreated Mantle Cell Lymphoma

Sponsor

Eastern Cooperative Oncology Group (Other)

Overall Status

Active, not recruiting

CT.gov ID

NCT01415752

Collaborator

National Cancer Institute (NCI) (NIH)

373

Enrollment

418

Locations

Arms

231.3

Anticipated Duration (Months)

0.9

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

RATIONALE: Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some find cancer cells and help kill them or carry cancer-killing substances to them. Others interfere with the ability of cancer cells to grow and spread. Drugs used in chemotherapy, such as bendamustine hydrochloride, also work in different ways to kill cancer cells or stop them from dividing. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Lenalidomide may stop the growth of mantle cell lymphoma by blocking blood flow to the cancer. It is not yet known whether giving rituximab together with bendamustine and bortezomib is more effective than rituximab and bendamustine, followed by rituximab alone or with lenalidomide in treating mantle cell lymphoma.

PURPOSE: This randomized phase II trial studies rituximab, bortezomib, bendamustine, and lenalidomide in treating previously untreated older patients with mantle cell lymphoma.

Condition or Disease	Intervention/Treatment	Phase
Lymphoma Neurotoxicity Therapy-related Toxicity	Biological: rituximab Drug: bendamustine hydrochloride Drug: bortezomib Drug: lenalidomide	Phase 2

Detailed Description

OBJECTIVES:

Primary

To determine whether the addition of bortezomib (RBV) to an induction regimen of rituximab-bendamustine hydrochloride (RB) improves progression-free survival (PFS) compared to RB alone in patients ≥ 60 years of age with previously untreated mantle cell lymphoma.
To determine whether the addition of lenalidomide to a consolidation regimen of rituximab following an induction regimen of RB or RBV improves PFS compared to consolidation rituximab alone in this patient population.

Secondary

To determine whether the addition of bortezomib to induction therapy improves the positron emission tomography (PET)-documented complete response (CR) rate compared to RB alone.
To determine the objective response rate (ORR) for RB and RBV.
Among patients who do not have PET-documented CR at the end of induction, to determine whether the addition of lenalidomide to consolidation therapy improves CR and ORR compared with rituximab alone.
To determine overall survival (OS) in the treatment arms.
To determine safety, with attention to the addition of bortezomib in the induction regimen and lenalidomide-rituximab (LR) as consolidation therapy.
To collect paraffin-embedded tissue for creation of tissue microarray.
To collect and bank serum and blood mononuclear cells for future studies.
To collect formalin-fixed paraffin-embedded (FFPE) tissue to analyze potential prognostic factors (Ki-67 proliferation index by immunohistochemistry and correlation with proposed 5-gene set of proliferation markers analyzed by RNA PCR; SOX 11 expression by immunohistochemistry; and Micro-RNA levels by microarray).
Using patient-reported outcomes data, to determine the extent and severity of neuropathy associated with the addition of bortezomib to induction treatment.
Using patient-reported outcomes data, to determine the extent and severity of fatigue associated with the addition of lenalidomide to consolidation treatment.
To evaluate the effects of the addition of bortezomib and lenalidomide on patient-reported health-related quality of life.
To evaluate the effects of bortezomib-related neuropathy on patient-reported health-related quality of life.
To evaluate the response of lymphoma-specific symptoms to treatment.
Using longitudinal patient-reported outcomes data, to describe the trajectory of lymphoma symptoms, neuropathy, fatigue, and overall health-related quality of life prior to, during, and following treatment among older adults with MCL.

Tertiary

To assess the proportion of patients up and down staging when fludeoxyglucose F 18- (FDG) PET/CT is added to standard Ann Arbor staging.
To assess the ability of pre-treatment FDG-PET/CT (SUVmax) to predict response rate and PFS.
Among patients with interim (post-cycle 3) FDG-PET/CT imaging, to assess the correlation of interim FDG-PET/CT imaging with response rate and PFS both during induction and consolidation therapy.
To assess standard FDG-PET/CT metrics including SUVmax, tumor metabolic burden, total tumor burden, and association with pathology features (blastoid variant vs other, and Ki67) in the setting of MCL.
To assess differences in overall and CR rates when using Deauville vs International Harmonization Project FDG-PET/CT interpretation criteria.
To determine whether there is a correlation between FDG-PET/CT response and residual disease assessment by molecular and/or flow cytometric techniques.
To determine whether the number of malignant cells in circulation predict the number of cells in marrow.
To determine whether the number of malignant cells in circulation/in marrow at the end of induction correlate with CR and 2-year PFS.
To determine whether there is a higher rate of minimal residual disease (MRD) negativity among patients randomized to RBV as compared with RB, and among patients treated with LR maintenance compared with rituximab.
To compare the two methods of MRD detection - molecular techniques and flow cytometry - as prognostic markers for outcome.

OUTLINE: This is a multicenter study. Patients are stratified according to mantle cell lymphoma International Prognostic Index risk score (low vs intermediate vs high). Patients are randomized to 1 of 4 treatment arms.

Arm A: Patients receive induction therapy comprising rituximab IV on day 1 and bendamustine hydrochloride IV over 60 minutes on days 1-2. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
Arm E: Patients receive consolidation therapy comprising rituximab IV on day 1. Courses repeat every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.
Arm B: Patients receive induction therapy comprising bortezomib IV or subcutaneously (SC) on days 1, 4, 8, and 11 and rituximab and bendamustine hydrochloride as patients in arm A. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
Arm F: Patients receive consolidation therapy comprising rituximab IV on day 1. Courses repeat every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.
Arm C: Patients receive induction therapy comprising rituximab and bendamustine hydrochloride as patients in arm A. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
Arm G: Patients receive consolidation therapy comprising lenalidomide orally (PO) daily on days 1-21 every 4 weeks and rituximab IV every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.
Arm D: Patients receive bortezomib, rituximab, and bendamustine hydrochloride as patients in arm B. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity.
Arm H: Patients receive consolidation therapy comprising lenalidomide PO daily on days 1-21 every 4 weeks and rituximab IV every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.

Patients may undergo blood and bone marrow sample collection at baseline and during treatment for correlative studies.

Patients complete the Functional Assessment of Cancer Therapy - Lymphoma (FACT-Lym), the FACT/GOG-Neurotoxicity scale (FACT/GOG-Ntx), FACT-Fatigue, and FACT-General questionnaires at baseline and periodically during study and follow up.

After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then annually for 10 years.

Study Design

Study Type:

Interventional

Actual Enrollment :

373 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Intergroup Randomized Phase 2 Four Arm Study In Patients ≥ 60 With Previously Untreated Mantle Cell Lymphoma Of Therapy With: Arm A = Rituximab+ Bendamustine Followed By Rituximab Consolidation (RB → R); Arm B = Rituximab + Bendamustine + Bortezomib Followed By Rituximab Consolidation (RBV→ R), Arm C = Rituximab + Bendamustine Followed By Lenalidomide + Rituximab Consolidation (RB → LR) or Arm D = Rituximab + Bendamustine + Bortezomib Followed By Lenalidomide + Rituximab Consolidation (RBV → LR)

Actual Study Start Date :

May 22, 2012

Actual Primary Completion Date :

May 28, 2022

Anticipated Study Completion Date :

Sep 1, 2031

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Arm A Patients receive induction therapy comprising rituximab IV on day 1 and bendamustine hydrochloride IV over 60 minutes on days 1-2. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then proceed to arm E.	Biological: rituximab Given IV Drug: bendamustine hydrochloride Given IV
Experimental: Arm B Patients receive induction therapy comprising bortezomib IV subcutaneously (SC) on days 1, 4, 8, and 11 and rituximab and bendamustine hydrochloride as patients in arm A. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then proceed to arm F.	Biological: rituximab Given IV Drug: bendamustine hydrochloride Given IV Drug: bortezomib Given IV or SC
Experimental: Arm C Patients receive induction therapy comprising rituximab and bendamustine hydrochloride as patients in arm A. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then proceed to arm G.	Biological: rituximab Given IV Drug: bendamustine hydrochloride Given IV Drug: lenalidomide Given PO
Experimental: Arm D Patients receive bortezomib, rituximab, and bendamustine hydrochloride as patients in arm B. Treatment repeats every 4 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then proceed to arm H.	Biological: rituximab Given IV Drug: bendamustine hydrochloride Given IV Drug: bortezomib Given IV or SC Drug: lenalidomide Given PO
Experimental: Arm E Patients receive consolidation therapy comprising rituximab IV on day 1. Courses repeat every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.	Biological: rituximab Given IV
Experimental: Arm F Patients receive consolidation therapy comprising rituximab IV on day 1. Courses repeat every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.	Biological: rituximab Given IV
Experimental: Arm G Patients receive consolidation therapy comprising lenalidomide orally (PO) daily on days 1-21 every 4 weeks and rituximab IV every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.	Biological: rituximab Given IV Drug: lenalidomide Given PO
Experimental: Arm H Patients receive consolidation therapy comprising lenalidomide PO daily on days 1-21 every 4 weeks and rituximab IV every 8 weeks for 2 years in the absence of disease progression or unacceptable toxicity.	Biological: rituximab Given IV Drug: lenalidomide Given PO

Outcome Measures

Primary Outcome Measures

2-year PFS rate of patients treated with RBV to an induction regimen of RB compared to RB alone []
PFS improvement of patients treated with lenalidomide added to a consolidation regimen []

Secondary Outcome Measures

PET-documented CR rate []
Response rate to RB and RBV []
Toxicity []
Quality of life []

Eligibility Criteria

Criteria

Ages Eligible for Study:

60 Years to 120 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

DISEASE CHARACTERISTICS:

Histologically confirmed untreated mantle cell lymphoma (MCL), with documented cyclin D1 by immunohistochemical stains and/or t(11;14) by cytogenetics or fluorescence in situ hybridization (FISH)
Patients must have at least one objective measurable disease parameter
Abnormal PET scans will not constitute evaluable disease, unless verified by CT scan or other appropriate imaging
Measurable disease in the liver is required if the liver is the only site of lymphoma
Patient must have no CNS involvement

PATIENT CHARACTERISTICS:

ECOG performance status 0-2
ANC ≥ 1,500/mcL (1.5 x 10^9/L)*
Platelets ≥ 100,000/mcL (100 x 10^9/L)* NOTE: *Unless due to marrow involvement.
AST/ALT ≤ 2 times upper limit of normal (ULN)
Bilirubin ≤ 2 times ULN
Calculated creatinine clearance by Cockroft-Gault formula ≥ 30 mL/min
Women (sexually mature female) must not be pregnant or breast-feeding
Negative pregnancy test
Women of childbearing potential and sexually active males use an accepted and effective method of contraception
Men must agree to use a latex condom during sexual contact with a female of child-bearing potential, even if they have had a successful vasectomy
All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure
No evidence of prior malignancy except adequately treated non-melanoma skin cancer, in situ cervical carcinoma, or any surgically or radiation-cured malignancy continuously disease free for ≥ 5 years so as not to interfere with interpretation of radiographic response
Patient agrees that if randomized to Arms C or D, and proceed onto Arms G or H, they must register into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®
Patients must have no medical contra-indications to, and be willing to take, deep vein thrombosis (DVT) prophylaxis as all patients registering to the lenalidomide/rituximab Arms G and H will be required to have DVT prophylaxis
Patients randomized to Arms G or H who have a history of a thrombotic vascular event will be required to have therapeutic doses of low-molecular weight heparin or warfarin to maintain an INR between 2.0 - 3.0
Patients on Arms G and H without a history of a thromboembolic event are required to take a daily aspirin (81 mg or 325 mg) for DVT prophylaxis
Patients who are unable to tolerate aspirin should receive low molecular weight heparin therapy or warfarin treatment
Women must agree to abstain from donating blood during study participation and for at least 28 days after discontinuation from protocol treatment
Males must agree to abstain from donating blood, semen, or sperm during study participation and for at least 28 days after discontinuation from protocol treatment
HIV-positive patients are not excluded but, to enroll, must meet all of the below criteria:
HIV is sensitive to antiretroviral therapy
Must be willing to take effective antiretroviral therapy, if indicated
No history of CD4 prior to or at the time of lymphoma diagnosis < 300 cells/mm³
No history of AIDS-defining conditions
If on antiretroviral therapy, must not be taking zidovudine or stavudine
Must be willing to take prophylaxis for Pneumocystis jiroveci pneumonia (PCP) during therapy and until at least 2 months following the completion of therapy or until the CD4 cells recover to over 250 cells/mm³, whichever occurs later
Patients must not have grade 2 or greater peripheral neuropathy
Patients must not have NYHA Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia
Patients must not have hypersensitivity to bortezomib, boron, or mannitol
Patients must not have a serious medical or psychiatric illness likely to interfere with study participation

PRIOR CONCURRENT THERAPY:

No prior therapy for MCL, except < 1 week of steroid therapy for symptom control
HIV-positive patients are not excluded, but to enroll, must meet all of the below criteria:
Must be willing to take effective antiretroviral therapy if indicated
If on antiretroviral therapy, must not be taking zidovudine or stavudine
Patients must not be participating in any other clinical trial or taking any other experimental medications within 14 days prior to registration

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Alaska Breast Care and Surgery LLC	Anchorage	Alaska	United States	99508
2	Alaska Women's Cancer Care	Anchorage	Alaska	United States	99508
3	Anchorage Oncology Centre	Anchorage	Alaska	United States	99508
4	Katmai Oncology Group	Anchorage	Alaska	United States	99508
5	Providence Alaska Medical Center	Anchorage	Alaska	United States	99508
6	Kaiser Permanente-Deer Valley Medical Center	Antioch	California	United States	94531
7	Kaiser Permanente, Fremont	Fremont	California	United States	94538
8	Kaiser Permanente	Fresno	California	United States	93720
9	Los Angeles County-USC Medical Center	Los Angeles	California	United States	90033
10	USC / Norris Comprehensive Cancer Center	Los Angeles	California	United States	90033
11	Kaiser Permanente-Modesto	Modesto	California	United States	95356
12	Kaiser Permanente-Oakland	Oakland	California	United States	94611
13	Kaiser Permanente-Redwood City	Redwood City	California	United States	94063
14	Kaiser Permanente-Richmond	Richmond	California	United States	94801
15	Kaiser Permanente-Roseville	Roseville	California	United States	95661
16	Kaiser Permanente-South Sacramento	Sacramento	California	United States	95823
17	Kaiser Permanente - Sacramento	Sacramento	California	United States	95825
18	Kaiser Permanente-San Francisco	San Francisco	California	United States	94115
19	Kaiser Permanente-Santa Teresa-San Jose	San Jose	California	United States	95119
20	Kaiser Permanente San Leandro	San Leandro	California	United States	94577
21	Kaiser Permanente-San Rafael	San Rafael	California	United States	94903
22	Kaiser Permanente Medical Center - Santa Clara	Santa Clara	California	United States	95051
23	Kaiser Permanente-Santa Rosa	Santa Rosa	California	United States	95403
24	Kaiser Permanente-South San Francisco	South San Francisco	California	United States	94080
25	Stanford University Hospitals and Clinics	Stanford	California	United States	94305
26	Kaiser Permanente-Stockton	Stockton	California	United States	95210
27	Kaiser Permanente Medical Center-Vacaville	Vacaville	California	United States	95688
28	Kaiser Permanente-Vallejo	Vallejo	California	United States	94589
29	Kaiser Permanente-Walnut Creek	Walnut Creek	California	United States	94596
30	Rocky Mountain Cancer Centers-Aurora	Aurora	Colorado	United States	80012
31	The Medical Center of Aurora	Aurora	Colorado	United States	80012
32	Boulder Community Hospital	Boulder	Colorado	United States	80301
33	Rocky Mountain Cancer Centers-Boulder	Boulder	Colorado	United States	80304
34	Penrose-Saint Francis Healthcare	Colorado Springs	Colorado	United States	80907
35	Rocky Mountain Cancer Centers-Penrose	Colorado Springs	Colorado	United States	80907
36	Kaiser Permanente-Franklin	Denver	Colorado	United States	80205
37	Porter Adventist Hospital	Denver	Colorado	United States	80210
38	Exempla Saint Joseph Hospital	Denver	Colorado	United States	80218
39	Presbyterian - Saint Lukes Medical Center - Health One	Denver	Colorado	United States	80218
40	Rocky Mountain Cancer Centers-Midtown	Denver	Colorado	United States	80218
41	Rocky Mountain Cancer Centers-Rose	Denver	Colorado	United States	80220
42	Rose Medical Center	Denver	Colorado	United States	80220
43	Colorado Cancer Research Program CCOP	Denver	Colorado	United States	80224-2522
44	Colorado Blood Cancer Institute	Denver	Colorado	United States	80907
45	Mercy Medical Center	Durango	Colorado	United States	81301
46	Southwest Oncology PC	Durango	Colorado	United States	81301
47	Comprehensive Cancer Care and Research Institute of Colorado LLC	Englewood	Colorado	United States	80113
48	Swedish Medical Center	Englewood	Colorado	United States	80113
49	Poudre Valley Hospital	Fort Collins	Colorado	United States	80524
50	Mountain Blue Cancer Care Center	Golden	Colorado	United States	80401
51	North Colorado Medical Center	Greeley	Colorado	United States	80631
52	Rocky Mountain Cancer Centers-Greenwood Village	Greenwood Village	Colorado	United States	80111
53	Kaiser Permanente-Rock Creek	Lafayette	Colorado	United States	80026
54	Rocky Mountain Cancer Centers-Lakewood	Lakewood	Colorado	United States	80228
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	Kaiser Permanente-Lone Tree	Lone Tree	Colorado	United States	80124
59	Rocky Mountain Cancer Centers-Sky Ridge	Lone Tree	Colorado	United States	80124
60	Sky Ridge Medical Center	Lone Tree	Colorado	United States	80124
61	Longmont United Hospital	Longmont	Colorado	United States	80501
62	Rocky Mountain Cancer Centers-Longmont	Longmont	Colorado	United States	80501
63	McKee Medical Center	Loveland	Colorado	United States	80539
64	Parker Adventist Hospital	Parker	Colorado	United States	80138
65	Rocky Mountain Cancer Centers-Parker	Parker	Colorado	United States	80138
66	Saint Mary Corwin Medical Center	Pueblo	Colorado	United States	81004
67	Rocky Mountain Cancer Centers - Pueblo	Pueblo	Colorado	United States	81008
68	Rocky Mountain Cancer Centers-Thornton	Thornton	Colorado	United States	80260
69	Exempla Lutheran Medical Center	Wheat Ridge	Colorado	United States	80033
70	Saint Francis Hospital and Medical Center	Hartford	Connecticut	United States	06105
71	Beebe Medical Center	Lewes	Delaware	United States	19958
72	Christiana Gynecologic Oncology LLC	Newark	Delaware	United States	19713
73	Delaware Clinical and Laboratory Physicians PA	Newark	Delaware	United States	19713
74	Helen F Graham Cancer Center	Newark	Delaware	United States	19713
75	Medical Oncology Hematology Consultants PA	Newark	Delaware	United States	19713
76	Regional Hematology and Oncology PA	Newark	Delaware	United States	19713
77	Christiana Care Health System-Christiana Hospital	Newark	Delaware	United States	19718
78	Beebe Health Campus	Rehoboth Beach	Delaware	United States	19971
79	Nanticoke Memorial Hospital	Seaford	Delaware	United States	19973
80	Christiana Care Health System-Wilmington Hospital	Wilmington	Delaware	United States	19801
81	Lombardi Comprehensive Cancer Center at Georgetown University	Washington	District of Columbia	United States	20057
82	Baptist Cancer Institute	Jacksonville	Florida	United States	32207
83	UF Cancer Center at Orlando Health	Orlando	Florida	United States	32806
84	Oncare Hawaii Inc-Pali Momi	'Aiea	Hawaii	United States	96701
85	Pali Momi Medical Center	'Aiea	Hawaii	United States	96701
86	Oncare Hawaii Inc-POB II	Honolulu	Hawaii	United States	96813
87	Queen's Medical Center	Honolulu	Hawaii	United States	96813
88	Straub Clinic and Hospital	Honolulu	Hawaii	United States	96813
89	University of Hawaii Cancer Center	Honolulu	Hawaii	United States	96813
90	OnCare Hawaii-Liliha	Honolulu	Hawaii	United States	96817-3169
91	Oncare Hawaii Inc-Kuakini	Honolulu	Hawaii	United States	96817
92	Kaiser Permanente Moanalua Medical Center	Honolulu	Hawaii	United States	96819
93	Kapiolani Medical Center for Women and Children	Honolulu	Hawaii	United States	96826
94	Castle Medical Center	Kailua	Hawaii	United States	96734
95	Wilcox Memorial Hospital and Kauai Medical Clinic	Lihue	Hawaii	United States	96766
96	Saint Alphonsus Cancer Care Center-Boise	Boise	Idaho	United States	83706
97	Idaho Urologic Institute-Meridian	Meridian	Idaho	United States	83642
98	Kootenai Cancer Center	Post Falls	Idaho	United States	83854
99	Kootenai Cancer	Sandpoint	Idaho	United States	83864
100	Memorial Hospital of Carbondale	Carbondale	Illinois	United States	62902
101	Centralia Oncology Clinic	Centralia	Illinois	United States	62801
102	Mount Sinai Hospital Medical Center	Chicago	Illinois	United States	60608
103	Hematology and Oncology Associates	Chicago	Illinois	United States	60611
104	Northwestern University	Chicago	Illinois	United States	60611
105	John H Stroger Jr Hospital of Cook County	Chicago	Illinois	United States	60612-3785
106	Carle on Vermilion	Danville	Illinois	United States	61832
107	Cancer Care Center of Decatur	Decatur	Illinois	United States	62526
108	Decatur Memorial Hospital	Decatur	Illinois	United States	62526
109	Carle Physician Group-Effingham	Effingham	Illinois	United States	62401
110	Crossroads Cancer Center	Effingham	Illinois	United States	62401
111	Hematology Oncology Associates of Illinois-Highland Park	Highland Park	Illinois	United States	60035
112	Presence Saint Mary's Hospital	Kankakee	Illinois	United States	60901
113	North Shore Hematology Oncology	Libertyville	Illinois	United States	60048
114	Carle Physician Group-Mattoon/Charleston	Mattoon	Illinois	United States	61938
115	Good Samaritan Regional Health Center	Mount Vernon	Illinois	United States	62864
116	Illinois Cancer Specialists-Niles	Niles	Illinois	United States	60714
117	SwedishAmerican Regional Cancer Center/ACT	Rockford	Illinois	United States	61107
118	Hematology Oncology Associates of Illinois - Skokie	Skokie	Illinois	United States	60076
119	Memorial Medical Center	Springfield	Illinois	United States	62781-0001
120	Carle Cancer Center	Urbana	Illinois	United States	61801
121	The Carle Foundation Hospital	Urbana	Illinois	United States	61801
122	IU Health Arnett Cancer Care	Lafayette	Indiana	United States	47904
123	Franciscan Saint Anthony Health-Michigan City	Michigan City	Indiana	United States	46360
124	Woodland Cancer Care Center	Michigan City	Indiana	United States	46360
125	Reid Hospital and Health Care Services	Richmond	Indiana	United States	47374
126	Mary Greeley Medical Center	Ames	Iowa	United States	50010
127	McFarland Clinic PC-William R Bliss Cancer Center	Ames	Iowa	United States	50010
128	Hematology Oncology Associates-Quad Cities	Bettendorf	Iowa	United States	52722
129	McFarland Clinic PC-Boone	Boone	Iowa	United States	50036
130	Cedar Rapids Oncology Association	Cedar Rapids	Iowa	United States	52403
131	Mercy Hospital	Cedar Rapids	Iowa	United States	52403
132	Oncology Associates at Mercy Medical Center	Cedar Rapids	Iowa	United States	52403
133	McFarland Clinic PC-Trinity Cancer Center	Fort Dodge	Iowa	United States	50501
134	McFarland Clinic PC-Jefferson	Jefferson	Iowa	United States	50129
135	McFarland Clinic PC-Marshalltown	Marshalltown	Iowa	United States	50158
136	Siouxland Hematology Oncology Associates	Sioux City	Iowa	United States	51101
137	Mercy Medical Center-Sioux City	Sioux City	Iowa	United States	51104
138	Saint Luke's Regional Medical Center	Sioux City	Iowa	United States	51104
139	Lawrence Memorial Hospital	Lawrence	Kansas	United States	66044
140	Menorah Medical Center	Overland Park	Kansas	United States	66209
141	Saint Luke's South Hospital	Overland Park	Kansas	United States	66213
142	Kansas City CCOP	Prairie Village	Kansas	United States	66208
143	Wesley Medical Center	Wichita	Kansas	United States	67214
144	Oncology Hematology Care Inc-Crestview	Crestview Hills	Kentucky	United States	41017
145	Ochsner Health Center-Summa	Baton Rouge	Louisiana	United States	70809
146	Ochsner Baptist Medical Center	New Orleans	Louisiana	United States	70115
147	Ochsner Medical Center Jefferson	New Orleans	Louisiana	United States	70121
148	Harold Alfond Center for Cancer Care	Augusta	Maine	United States	04330
149	Eastern Maine Medical Center	Bangor	Maine	United States	04401
150	Penobscot Bay Medical Center	Rockport	Maine	United States	04856
151	Franklin Square Hospital Center	Baltimore	Maryland	United States	21237
152	Union Hospital of Cecil County	Elkton	Maryland	United States	21921
153	Holy Cross Hospital	Silver Spring	Maryland	United States	20910
154	Tufts Medical Center	Boston	Massachusetts	United States	02111
155	Simonds-Sinon Regional Cancer Center	Fitchburg	Massachusetts	United States	01420
156	Baystate Medical Center	Springfield	Massachusetts	United States	01199
157	University of Massachusetts Medical School	Worcester	Massachusetts	United States	01655
158	Saint Joseph Mercy Hospital	Ann Arbor	Michigan	United States	48106-0995
159	Michigan Cancer Research Consortium Community Clinical Oncology Program	Ann Arbor	Michigan	United States	48106
160	Bronson Battle Creek	Battle Creek	Michigan	United States	49017
161	Spectrum Health Big Rapids Hospital	Big Rapids	Michigan	United States	49307
162	Oakwood Hospital and Medical Center	Dearborn	Michigan	United States	48124
163	Wayne State University/Karmanos Cancer Institute	Detroit	Michigan	United States	48201
164	Saint John Hospital and Medical Center	Detroit	Michigan	United States	48236
165	Green Bay Oncology - Escanaba	Escanaba	Michigan	United States	49431
166	Weisberg Cancer Treatment Center	Farmington Hills	Michigan	United States	48334
167	Hurley Medical Center	Flint	Michigan	United States	48502
168	Genesys Hurley Cancer Institute	Flint	Michigan	United States	48503
169	Genesys Regional Medical Center	Grand Blanc	Michigan	United States	48439
170	Grand Rapids Clinical Oncology Program	Grand Rapids	Michigan	United States	49503
171	Mercy Health Saint Mary's	Grand Rapids	Michigan	United States	49503
172	Spectrum Health at Butterworth Campus	Grand Rapids	Michigan	United States	49503
173	Green Bay Oncology - Iron Mountain	Iron Mountain	Michigan	United States	49801
174	Allegiance Health	Jackson	Michigan	United States	49201
175	Borgess Medical Center	Kalamazoo	Michigan	United States	49001
176	Bronson Methodist Hospital	Kalamazoo	Michigan	United States	49007
177	West Michigan Cancer Center	Kalamazoo	Michigan	United States	49007
178	Sparrow Hospital	Lansing	Michigan	United States	48912
179	Saint Mary Mercy Hospital	Livonia	Michigan	United States	48154
180	Mercy Health Mercy Campus	Muskegon	Michigan	United States	49444
181	Lakeland Community Hospital	Niles	Michigan	United States	49120
182	Saint Joseph Mercy Oakland	Pontiac	Michigan	United States	48341
183	Saint Joseph Mercy Port Huron	Port Huron	Michigan	United States	48060
184	Spectrum Health Reed City Hospital	Reed City	Michigan	United States	49677
185	Saint Mary's of Michigan	Saginaw	Michigan	United States	48601
186	Lakeland Hospital	Saint Joseph	Michigan	United States	49085
187	Marie Yeager Cancer Center	Saint Joseph	Michigan	United States	49085
188	Munson Medical Center	Traverse City	Michigan	United States	49684
189	Saint John Macomb-Oakland Hospital	Warren	Michigan	United States	48093
190	Sanford Clinic North-Bemidgi	Bemidji	Minnesota	United States	56601
191	Fairview Ridges Hospital	Burnsville	Minnesota	United States	55337
192	Mercy Hospital	Coon Rapids	Minnesota	United States	55433
193	Essentia Health Cancer Center	Duluth	Minnesota	United States	55805
194	Essentia Health Saint Mary's Medical Center	Duluth	Minnesota	United States	55805
195	Miller-Dwan Hospital	Duluth	Minnesota	United States	55805
196	Fairview-Southdale Hospital	Edina	Minnesota	United States	55435
197	Unity Hospital	Fridley	Minnesota	United States	55432
198	Hutchinson Area Health Care	Hutchinson	Minnesota	United States	55350
199	Minnesota Oncology Hematology PA-Maplewood	Maplewood	Minnesota	United States	55109
200	Saint John's Hospital - Healtheast	Maplewood	Minnesota	United States	55109
201	Abbott-Northwestern Hospital	Minneapolis	Minnesota	United States	55407
202	Hennepin County Medical Center	Minneapolis	Minnesota	United States	55415
203	Health Partners Inc	Minneapolis	Minnesota	United States	55454
204	New Ulm Medical Center	New Ulm	Minnesota	United States	56073
205	North Memorial Medical Health Center	Robbinsdale	Minnesota	United States	55422
206	Mayo Clinic	Rochester	Minnesota	United States	55905
207	Metro-Minnesota CCOP	Saint Louis Park	Minnesota	United States	55416
208	Park Nicollet Clinic - Saint Louis Park	Saint Louis Park	Minnesota	United States	55416
209	Regions Hospital	Saint Paul	Minnesota	United States	55101
210	United Hospital	Saint Paul	Minnesota	United States	55102
211	Saint Francis Regional Medical Center	Shakopee	Minnesota	United States	55379
212	Lakeview Hospital	Stillwater	Minnesota	United States	55082
213	Ridgeview Medical Center	Waconia	Minnesota	United States	55387
214	Rice Memorial Hospital	Willmar	Minnesota	United States	56201
215	Minnesota Oncology and Hematology PA-Woodbury	Woodbury	Minnesota	United States	55125
216	Parkland Health Center-Bonne Terre	Bonne Terre	Missouri	United States	63628
217	Saint Francis Medical Center	Cape Girardeau	Missouri	United States	63703
218	Southeast Cancer Center	Cape Girardeau	Missouri	United States	63703
219	University of Missouri - Ellis Fischel	Columbia	Missouri	United States	65212
220	Centerpoint Medical Center LLC	Independence	Missouri	United States	64057
221	Capital Region Medical Center-Goldschmidt Cancer Center	Jefferson City	Missouri	United States	65109
222	Freeman Health System	Joplin	Missouri	United States	64804
223	Saint Luke's Hospital of Kansas City	Kansas City	Missouri	United States	64111
224	Heartland Hematology and Oncology Associates Incorporated	Kansas City	Missouri	United States	64118
225	Research Medical Center	Kansas City	Missouri	United States	64132
226	Saint Luke's East - Lee's Summit	Lee's Summit	Missouri	United States	64086
227	Liberty Radiation Oncology Center	Liberty	Missouri	United States	64068
228	Phelps County Regional Medical Center	Rolla	Missouri	United States	65401
229	Saint John's Clinic-Rolla-Cancer and Hematology	Rolla	Missouri	United States	65401
230	Heartland Regional Medical Center	Saint Joseph	Missouri	United States	64506
231	Saint Louis Cancer and Breast Institute-South City	Saint Louis	Missouri	United States	63109
232	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
233	Missouri Baptist Medical Center	Saint Louis	Missouri	United States	63131
234	Comprehensive Cancer Care PC	Saint Louis	Missouri	United States	63141
235	Saint John's Mercy Medical Center	Saint Louis	Missouri	United States	63141
236	Mercy Hospital Springfield	Springfield	Missouri	United States	65804
237	Ozark Health Ventures LLC-Cancer Research for The Ozarks Springfield	Springfield	Missouri	United States	65804
238	CoxHealth South Hospital	Springfield	Missouri	United States	65807
239	Missouri Baptist Sullivan Hospital	Sullivan	Missouri	United States	63080
240	Missouri Baptist Outpatient Center-Sunset Hills	Sunset Hills	Missouri	United States	63127
241	Montana Cancer Consortium CCOP	Billings	Montana	United States	59101
242	Saint Vincent Healthcare	Billings	Montana	United States	59101
243	Frontier Cancer Center and Blood Institute-Billings	Billings	Montana	United States	59102
244	Billings Clinic Cancer Center	Billings	Montana	United States	59107
245	Bozeman Deaconess Hospital	Bozeman	Montana	United States	59715
246	Saint James Community Hospital and Cancer Treatment Center	Butte	Montana	United States	59701
247	Benefis Healthcare- Sletten Cancer Institute	Great Falls	Montana	United States	59405
248	Great Falls Clinic	Great Falls	Montana	United States	59405
249	Northern Montana Hospital	Havre	Montana	United States	59501
250	Saint Peter's Community Hospital	Helena	Montana	United States	59601
251	Glacier Oncology PLLC	Kalispell	Montana	United States	59901
252	Kalispell Medical Oncology	Kalispell	Montana	United States	59901
253	Kalispell Regional Medical Center	Kalispell	Montana	United States	59901
254	Community Medical Hospital	Missoula	Montana	United States	59801
255	Montana Cancer Specialists	Missoula	Montana	United States	59802
256	Saint Patrick Hospital - Community Hospital	Missoula	Montana	United States	59802
257	Dartmouth Hitchcock Medical Center	Lebanon	New Hampshire	United States	03756
258	Norris Cotton Cancer Center Nashua	Nashua	New Hampshire	United States	03063
259	Cooper Hospital University Medical Center	Camden	New Jersey	United States	08103
260	Veterans Adminstration New Jersey Health Care System	East Orange	New Jersey	United States	07018-1095
261	Hematology Oncology Associates of Central New York-Auburn	Auburn	New York	United States	13021
262	Albert Einstein College of Medicine	Bronx	New York	United States	10461
263	Montefiore Medical Center - Moses Campus	Bronx	New York	United States	10467-2490
264	Hematology Oncology Associates of Central New York-East Syracuse	East Syracuse	New York	United States	13057
265	Glens Falls Hospital	Glens Falls	New York	United States	12801
266	Hematology Oncology Associates of Central New York-Liverpool	Liverpool	New York	United States	13088
267	Orange Regional Medical Center	Middletown	New York	United States	10940
268	Mount Sinai Medical Center	New York	New York	United States	10029
269	Weill Medical College of Cornell University	New York	New York	United States	10065
270	University of Rochester	Rochester	New York	United States	14642
271	Hematology Oncology Associates of Central New York-Rome	Rome	New York	United States	13440
272	Hematology Oncology Associates of Central New York-Onondaga Hill	Syracuse	New York	United States	13215
273	Southeastern Medical Oncology Center-Clinton	Clinton	North Carolina	United States	28328
274	Southeastern Medical Oncology Center-Goldsboro	Goldsboro	North Carolina	United States	27534
275	Wayne Memorial Hospital	Goldsboro	North Carolina	United States	27534
276	Hendersonville Hematology and Oncology at Pardee	Hendersonville	North Carolina	United States	28739
277	Margaret R Pardee Memorial Hospital	Hendersonville	North Carolina	United States	28791
278	Park Ridge Hospital Breast Health Center	Hendersonville	North Carolina	United States	28792
279	Southeastern Medical Oncology Center-Jacksonville	Jacksonville	North Carolina	United States	28546
280	Kinston Medical Specialists PA	Kinston	North Carolina	United States	28501
281	Iredell Memorial Hospital	Statesville	North Carolina	United States	28677
282	Southeastern Medical Oncology Center-Wilson	Wilson	North Carolina	United States	27893
283	Wake Forest University Health Sciences	Winston-Salem	North Carolina	United States	27157
284	Roger Maris Cancer Center	Fargo	North Dakota	United States	58122
285	Sanford Clinic North-Fargo	Fargo	North Dakota	United States	58122
286	Sanford Medical Center-Fargo	Fargo	North Dakota	United States	58122
287	Summa Akron City Hospital/Cooper Cancer Center	Akron	Ohio	United States	44304
288	Summa Barberton Hospital	Barberton	Ohio	United States	44203
289	Cleveland Clinic Cancer Center Beachwood	Beachwood	Ohio	United States	44122
290	Oncology Hematology Care Inc-Mercy West	Cincinnati	Ohio	United States	45211
291	Oncology and Hematology Care Inc-Taft	Cincinnati	Ohio	United States	45219
292	Oncology Hematology Care Inc - Anderson	Cincinnati	Ohio	United States	45230
293	Oncology Hematology Care Inc - Kenwood	Cincinnati	Ohio	United States	45236
294	Oncology Hematology Care Inc-Blue Ash	Cincinnati	Ohio	United States	45242
295	University of Cincinnati	Cincinnati	Ohio	United States	45267
296	Case Western Reserve University	Cleveland	Ohio	United States	44106
297	MetroHealth Medical Center	Cleveland	Ohio	United States	44109
298	Cleveland Clinic Cancer Center/Fairview Hospital	Cleveland	Ohio	United States	44111
299	Cleveland Clinic Foundation	Cleveland	Ohio	United States	44195
300	Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center	Columbus	Ohio	United States	43210
301	Grandview Hospital	Dayton	Ohio	United States	45405
302	Good Samaritan Hospital - Dayton	Dayton	Ohio	United States	45406
303	Miami Valley Hospital	Dayton	Ohio	United States	45409
304	Samaritan North Health Center	Dayton	Ohio	United States	45415
305	Dayton CCOP	Dayton	Ohio	United States	45420
306	Mercy Cancer Center-Elyria	Elyria	Ohio	United States	44035
307	Oncology Hematology Care Inc-Healthplex	Fairfield	Ohio	United States	45014
308	Blanchard Valley Hospital	Findlay	Ohio	United States	45840
309	Atrium Medical Center-Middletown Regional Hospital	Franklin	Ohio	United States	45005-1066
310	Wayne Hospital	Greenville	Ohio	United States	45331
311	Cleveland Clinic Cancer Center Independence	Independence	Ohio	United States	44131
312	Kettering Medical Center	Kettering	Ohio	United States	45429
313	Cleveland Clinic Cancer Center Mansfield	Mansfield	Ohio	United States	44906
314	Hillcrest Hospital Cancer Center	Mayfield Heights	Ohio	United States	44124
315	Lake University Ireland Cancer Center	Mentor	Ohio	United States	44060
316	North Coast Cancer Care	Sandusky	Ohio	United States	44870
317	Cleveland Clinic Cancer Center Strongsville	Strongsville	Ohio	United States	44136
318	Upper Valley Medical Center	Troy	Ohio	United States	45373
319	South Pointe Hospital	Warrensville Heights	Ohio	United States	44122
320	University Pointe	West Chester	Ohio	United States	45069
321	UH-Seidman Cancer Center at Saint John Medical Center	Westlake	Ohio	United States	44145
322	Cleveland Clinic Wooster Specialty Center	Wooster	Ohio	United States	44691
323	Greene Memorial Hospital	Xenia	Ohio	United States	45385
324	University of Oklahoma Health Sciences Center	Oklahoma City	Oklahoma	United States	73104
325	Tulsa Cancer Institute	Tulsa	Oklahoma	United States	74146
326	Clackamas Radiation Oncology Center	Clackamas	Oregon	United States	97015
327	Providence Milwaukie Hospital	Milwaukie	Oregon	United States	97222
328	Providence Newberg Medical Center	Newberg	Oregon	United States	97132
329	Providence Willamette Falls Medical Center	Oregon City	Oregon	United States	97045
330	Providence Portland Medical Center	Portland	Oregon	United States	97213
331	Western Oncology Research Consortium	Portland	Oregon	United States	97213
332	Providence Saint Vincent Medical Center	Portland	Oregon	United States	97225
333	Geisinger Medical Center	Danville	Pennsylvania	United States	17822
334	Geisinger Medical Center-Cancer Center Hazleton	Hazleton	Pennsylvania	United States	18201
335	Geisinger Medical Oncology at Evangelical Community Hospital	Lewisburg	Pennsylvania	United States	17837
336	Lewistown Hospital	Lewistown	Pennsylvania	United States	17044
337	Fox Chase Cancer Center	Philadelphia	Pennsylvania	United States	19111
338	Pottstown Memorial Medical Center	Pottstown	Pennsylvania	United States	19464
339	Geisinger Medical Oncology-Pottsville	Pottsville	Pennsylvania	United States	17901
340	Geisinger Medical Group	State College	Pennsylvania	United States	16801
341	Mount Nittany Medical Center	State College	Pennsylvania	United States	16803
342	Reading Hospital	West Reading	Pennsylvania	United States	19611
343	Geisinger Wyoming Valley	Wilkes-Barre	Pennsylvania	United States	18711
344	AnMed Health Cancer Center	Anderson	South Carolina	United States	29621
345	Saint Francis Hospital	Greenville	South Carolina	United States	29601
346	Gibbs Cancer Center-Pelham	Greer	South Carolina	United States	29651
347	Spartanburg Regional Medical Center	Spartanburg	South Carolina	United States	29303
348	Upstate Carolina CCOP	Spartanburg	South Carolina	United States	29303
349	Wellmont Bristol Regional Medical Center	Bristol	Tennessee	United States	37620
350	Wellmont Medical Associates Oncology and Hematology-Bristol	Bristol	Tennessee	United States	37620
351	Wellmont Holston Valley Hospital and Medical Center	Kingsport	Tennessee	United States	37660
352	Wellmont Medical Associates Oncology and Hematology-Kingsport	Kingsport	Tennessee	United States	37660
353	Vanderbilt-Ingram Cancer Center	Nashville	Tennessee	United States	37232
354	Parkland Memorial Hospital	Dallas	Texas	United States	75235
355	University of Texas Southwestern Medical Center	Dallas	Texas	United States	75390
356	University of Virginia	Charlottesville	Virginia	United States	22908
357	Memorial Hospital Of Martinsville	Martinsville	Virginia	United States	24115
358	Southwest VA Regional Cancer Center	Norton	Virginia	United States	24273
359	Massey Cancer Center at Virginia Commonwealth University	Richmond	Virginia	United States	23298-0037
360	Kadlec Clinic Hematology and Oncology	Kennewick	Washington	United States	99336
361	EvergreenHealth Medical Center	Kirkland	Washington	United States	98033
362	Seattle Cancer Care Alliance at EvergreenHealth	Kirkland	Washington	United States	98034
363	Saint John Medical Center	Longview	Washington	United States	98632
364	Skagit Valley Hospital Regional Cancer Care Center	Mount Vernon	Washington	United States	98273
365	Skagit Valley Hospital	Mount Vernon	Washington	United States	98274
366	Olympic Medical Center	Port Angeles	Washington	United States	98362
367	Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium	Seattle	Washington	United States	98109
368	Seattle Cancer Care Alliance	Seattle	Washington	United States	98109
369	University of Washington Medical Center	Seattle	Washington	United States	98195
370	Olympic Medical Cancer Care Center	Sequim	Washington	United States	98384
371	Cancer Care Northwest - Spokane South	Spokane	Washington	United States	99202
372	Cancer Care Northwest-Valley	Spokane	Washington	United States	99216
373	Cancer Care Northwest-North Spokane	Spokane	Washington	United States	99218
374	PeaceHealth Southwest Medical Center	Vancouver	Washington	United States	98664
375	Compass Oncology Vancouver	Vancouver	Washington	United States	98684
376	Wenatchee Valley Hospital and Clinics	Wenatchee	Washington	United States	98801
377	West Virginia University Healthcare	Morgantown	West Virginia	United States	26506
378	Langlade Hospital and Cancer Center	Antigo	Wisconsin	United States	54409
379	Marshfield Clinic Cancer Center at Sacred Heart	Eau Claire	Wisconsin	United States	54701
380	Sacred Heart Hospital	Eau Claire	Wisconsin	United States	54701
381	Agnesian Cancer Center	Fond Du Lac	Wisconsin	United States	54935
382	Green Bay Oncology at Saint Vincent Hospital	Green Bay	Wisconsin	United States	54301-3526
383	Saint Vincent Hospital	Green Bay	Wisconsin	United States	54301
384	Green Bay Oncology Limited at Saint Mary's Hospital	Green Bay	Wisconsin	United States	54303
385	Saint Mary's Hospital	Green Bay	Wisconsin	United States	54303
386	UW Cancer Center Johnson Creek	Johnson Creek	Wisconsin	United States	53038
387	Gundersen Lutheran Medical Center	La Crosse	Wisconsin	United States	54601
388	University of Wisconsin Hospital and Clinics	Madison	Wisconsin	United States	53792
389	Holy Family Memorial Hospital	Manitowoc	Wisconsin	United States	54221
390	Bay Area Medical Center	Marinette	Wisconsin	United States	54143
391	Marshfield Clinic	Marshfield	Wisconsin	United States	54449
392	Saint Joseph's Hospital	Marshfield	Wisconsin	United States	54449
393	Froedtert and the Medical College of Wisconsin	Milwaukee	Wisconsin	United States	53226
394	Marshfield Clinic-Minocqua Center	Minocqua	Wisconsin	United States	54548
395	D N Greenwald Center	Mukwonago	Wisconsin	United States	53149
396	Cancer Center of Western Wisconsin	New Richmond	Wisconsin	United States	54017
397	Oconomowoc Memorial Hospital-ProHealth Care Inc	Oconomowoc	Wisconsin	United States	53066-3896
398	Green Bay Oncology - Oconto Falls	Oconto Falls	Wisconsin	United States	54154
399	Marshfield Clinic at James Beck Cancer Center	Rhinelander	Wisconsin	United States	54501
400	Saint Mary's Hospital	Rhinelander	Wisconsin	United States	54501
401	Marshfield Clinic-Rice Lake Center	Rice Lake	Wisconsin	United States	54868
402	Saint Nicholas Hospital	Sheboygan	Wisconsin	United States	53081
403	Marshfield Clinic Cancer Care at Saint Michael's Hospital	Stevens Point	Wisconsin	United States	54481
404	Saint Michael's Hospital	Stevens Point	Wisconsin	United States	54481
405	Green Bay Oncology - Sturgeon Bay	Sturgeon Bay	Wisconsin	United States	54235
406	Waukesha Memorial Hospital - ProHealth Care	Waukesha	Wisconsin	United States	53188
407	Aspirus Regional Cancer Center	Wausau	Wisconsin	United States	54401
408	Marshfield Clinic-Wausau Center	Wausau	Wisconsin	United States	54401
409	Diagnostic and Treatment Center	Weston	Wisconsin	United States	54476
410	Marshfield Clinic - Weston Center	Weston	Wisconsin	United States	54476
411	Saint Clare's Hospital	Weston	Wisconsin	United States	54476
412	Marshfield Clinic - Wisconsin Rapids Center	Wisconsin Rapids	Wisconsin	United States	54494
413	Rocky Mountain Oncology	Casper	Wyoming	United States	82609
414	Big Horn Basin Cancer Center	Cody	Wyoming	United States	82414
415	Billings Clinic-Cody	Cody	Wyoming	United States	82414
416	Welch Cancer Center	Sheridan	Wyoming	United States	82801
417	The Moncton Hospital	Moncton	New Brunswick	Canada	E1C 6Z8
418	Allan Blair Cancer Centre	Regina	Saskatchewan	Canada	S4T 7T1