Hormone Therapy With or Without Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Negative Breast Cancer (The TAILORx Trial)
Фаза 3 – широко изпитване преди одобрение
Заболявания:
Breast Adenocarcinoma
Hormone Receptor Positive
Stage IA Breast Cancer AJCC v7
Stage IB Breast Cancer AJCC v7
Stage IIA Breast Cancer AJCC v6 and v7
Stage IIB Breast Cancer AJCC v6 and v7
Stage IIIB Breast Cancer AJCC v7
Спонсор: National Cancer Institute (NCI)
Налично на:
БГ
Обобщение
This randomized phase III trial studies the best individual therapy for women who have node-negative, estrogen-receptor positive breast cancer by using a special test (Oncotype DX), and whether hormone therapy alone or hormone therapy together with combination chemotherapy is better for women who have an Oncotype DX recurrence score of 11-25. Estrogen can cause the growth of breast cancer cells. Hormone therapy may fight breast cancer by blocking the use of estrogen by the tumor cells or by lowering the amount of estrogen the body makes. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving hormone therapy together with more than one chemotherapy drug (combination chemotherapy) has been shown to reduce the chance of breast cancer recurrence, but the benefit of adding chemotherapy to hormone therapy for women with node-negative, estrogen-receptor positive breast cancer is small. New tests may provide information about which patients are more likely to benefit from chemotherapy.
Описание
PRIMARY OBJECTIVES:
I. To determine whether adjuvant hormonal therapy is not inferior to adjuvant chemohormonal in women whose tumors meet established clinical guidelines for adjuvant chemotherapy and fall in the "primary study group" category (Oncotype DX Recurrence Score 11-25).
II. To create a tissue and specimen bank for patients enrolled in this trial, including formalin fixed paraffin embedded tumor specimens, tissue microarrays, plasma, and deoxyribonucleic acid (DNA) obtained from peripheral blood.
SECONDARY OBJECTIVES:
I. To determine whether adjuvant hormonal therapy is sufficient treatment (i.e. 10 year distant disease-free survival of at least 95%) for women whose tumors meet established clinical guidelines for adjuvant chemotherapy and who fall into the "Secondary Study Group-1" category (Oncotype DX Recurrence Score =\< 10).
II. To compare the outcomes projected at 10 years by Adjuvant (with outcomes projected using classical pathologic information including tumor size, hormone receptor status, and histologic grade) with those made by the Genomic Health Oncotype DX test. Classical pathologic information and outcome results will also be used to create and refine models that would use classical information instead of or in combination with genomic tests.
III. To estimate failure rates as a function of recurrence score (RS) separately in the chemotherapy (arms C, D) and no chemotherapy (arms A, B) groups. The purpose of the analysis is to develop more precise estimates of the relationship between recurrence score and chemotherapy treatment effect, if any, at the upper range of the RS 11 - 25 group.
IV. To determine the prognostic significance of the Oncotype DX recurrence score and of the individual RS gene groups (proliferation gene group, human epidermal growth factor receptor \[HER\]2 gene group, estrogen receptor \[ER\] gene group, invasion gene group, and other genes).
TERTIARY OBJECTIVES:
I. To evaluate the effects of chemotherapy and hormonal therapy vs hormonal therapy alone on perceived cognitive impairment, fatigue, fear of recurrence among pre-menopausal patients, endocrine symptoms and sexual dysfunction, and overall health-related quality of life (HRQL).
II. To determine whether perceived cognitive impairment, fatigue, fear of recurrence, endocrine symptoms, and overall HRQL are similar for patients receiving chemotherapy plus hormonal therapy in secondary study group 2 as for those in the primary study group (arm D vs C).
III. To determine whether perceived cognitive impairment, fatigue, fear of recurrence, endocrine symptoms, and overall HRQL are similar for patients receiving hormonal therapy alone in secondary study group 1 as for those in the primary study group (arms A vs B).
IV. To determine whether age will be inversely associated with a fear of recurrence, independent of treatment assignment.
V. Among participants receiving hormonal treatment alone on arm A and arm B, to determine whether Oncotype DX
Кой може да участва
Inclusion Criteria:
* Patients with operable histologically confirmed adenocarcinoma of the female breast who have completed primary surgical treatment and meet the following criteria:
* ER and/or progesterone receptor (PR)-positive: Estrogen and/or progesterone receptor positive disease (as defined by local pathology laboratory)
* Negative axillary nodes: As assessed by a sentinel lymph node biopsy, an axillary dissection, or both, and as defined by the Sixth Edition of the American Joint Committee on Cancer (AJCC) staging criteria
* Tumor size 1.1-5.0 cm (or 5 mm-1.0 cm plus unfavorable histological features):
* Unfavorable features defined as intermediate or poor nuclear and/or histologic grade, or lymphovascular invasion
* NOTE: Definition of tumor size: The tumor size used for determination of eligibility is the pathologic tumor size, which is usually determined by the size of the tumor as measured by inspection of the gross specimen; if the tumor size is measured microscopically and the tumor includes ductal carcinoma in-situ, the measurement should include only the invasive component of the tumor
* The tumor must be human epidermal growth factor receptor 2 (Her2)/neu negative by either fluorescent in-situ hybridization (FISH) or immunohistochemistry (e.g. 0 or 1+ by DAKO Herceptest)
* The patient and physician must be agreeable to initiate standard chemotherapy and hormonal therapy as adjuvant therapy
* A tissue specimen from the primary breast cancer has been located and is ready to be shipped to the appropriate laboratory after consent is obtained and within 3 days following pre-registration; NOTE: For determination of the Oncotype Recurrence Score, tissue must be shipped to Genomic Health; if the Oncotype DX Recurrence Score was previously performed by Genomic Health (prior to pre-registration), tissue must be submitted to the Eastern Cooperative Oncology Group (ECOG)-American College of Radiology Imaging Network (ACRIN) Central Biorepository and Pathology Facility upon randomization
* Leukocyte count \>= 3500/mm\^3
* Platelets \>= 100,000/mm\^3
* Serum creatinine =\< 1.5 mg/dL
* Serum aspartate transaminase (AST) that is =\< 3-fold the upper institutional limits of normal
* Patients must be disease-free of prior invasive malignancies for \>= 5 years with the exception of curatively-treated basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix; patients with a previous ipsilateral or contralateral invasive breast cancer, or with bilateral synchronous cancers, are not eligible; patients with previous ipsilateral or contralateral ductal in situ carcinoma (DCIS) are not eligible
* Prior treatment
* Mandatory prior surgery criteria:
* Patient must pre-register within 84 days from the final surgical procedure required to adequately treat the primary tumor (please note that if margins are not clear and a resection has to be conducted after pre-registration but before randomization, the patient will be deemed to be within the 84 day window allowed by protocol and therefore eligible)
* All tumors should be removed by either a mastectomy or local excision plus an acceptable axillary procedure (i.e., sentinel lymph node biopsy, axillary dissection, or both); there must be adequate (at least 1 mm if margin width specified) tumor-free margins of resection (for invasive and ductal carcinoma in-situ) in order for the patients to be eligible; patients with lobular carcinoma in-situ involving the resection margins are eligible
* Criteria re: other prior treatments:
* No prior chemotherapy for this malignancy
* No prior radiation therapy for this malignancy; this includes no prior MammoSite Brachytherapy radiation therapy (RT)
* Hormonal therapy: Patients who develop breast cancer while receiving a selective estrogen-receptor modulator (SERM; e.g., tamoxifen, toremifene, raloxifene) or an aromatase inhibitor (e.g., anastrazole, letrozole, exemestane) for breast cancer prevention or a SERM for other indications (e.g., raloxifene for osteoporosis) are not eligible; however, patients may have received up to 8 weeks of a SERM or aromatase inhibitor for this malignancy and still be eligible for study entry
* Patients must have an anticipated life expectancy of at least 10 years
* Patients with the following medical conditions should not be enrolled on the study:
* Chronic obstructive pulmonary disease requiring treatment
* Chronic liver disease (e.g., cirrhosis, chronic active hepatitis)
* Previous history of a cerebrovascular accident
* History of congestive heart failure or other cardiac disease that would represent a contraindication to the use of an anthracycline (e.g., doxorubicin or epirubicin)
* Chronic psychiatric condition or other condition that would impair compliance with the treatment regimen
* Women must not be pregnant or breast-feeding; all females of childbearing potential must have a blood test or urine study within 2 weeks prior to pre-registration to rule out pregnancy
* Women of childbearing potential must be strongly advised to utilize an accepted and effective form of non-hormonal contraception (e.g. intrauterine device, condoms, diaphragm, abstinence)
* Patients must not have previously had the Oncotype DX Assay performed, with the exception of patients who have had the assay performed and have a recurrence score of 11-25
Интервенции
Anastrozole
DRUG
Exemestane
DRUG
Laboratory Biomarker Analysis
OTHER
Letrozole
DRUG
Quality-of-Life Assessment
OTHER
Radiation Therapy
RADIATION
Tamoxifen Citrate
DRUG
Места на провеждане
1224
Австралия (14)
Border Medical Oncology
Albury , New South Wales
Saint John of God Hospital - Bunbury
Bunbury , Western Australia
Coffs Harbour Health Campus-North Coast Cancer Institute
Coffs Harbour , New South Wales
Concord Repatriation General Hospital
Concord , New South Wales
Breast Unit-Mercy Private
East Melbourne , Victoria
Royal Brisbane and Women's Hospital
Herston , Queensland
Lismore Base Hospital
Lismore , New South Wales
Lingard Private Hospital
Merewether , New South Wales
Nambour Hospital
Nambour , Queensland
Sir Charles Gairdner Hospital
Nedlands , Western Australia
Royal Newcastle Hospital
Newcastle , New South Wales
Epworth Hospital
Richmond , Victoria
Royal Hobart Hospital
Saint Hobart , Tasmania
Calvary Mater Newcastle Hospital
Waratah , New South Wales
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Arthur J E Child Comprehensive Cancer Centre
Calgary , Alberta
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Kelowna , British Columbia
Trillium Health Partners - Credit Valley Hospital
Mississauga , Ontario
The Moncton Hospital
Moncton , New Brunswick
CIUSSSEMTL-Hopital Maisonneuve-Rosemont
Montreal , Quebec
McGill University Department of Oncology
Montreal , Quebec
CHUM-Hotel Dieu de Montreal
Montreal , Quebec
CHUM - Centre Hospitalier de l'Universite de Montreal
Montreal , Quebec
The Research Institute of the McGill University Health Centre (MUHC)
Montreal , Quebec
Jewish General Hospital
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Penticton Regional Hospital
Penticton , British Columbia
CHU de Quebec-Hopital du Saint-Sacrement (HSS)
Québec , Quebec
Allan Blair Cancer Centre
Regina , Saskatchewan
Atlantic Health Sciences Corporation-Saint John Regional Hospital
Saint John , New Brunswick
Saskatoon Cancer Centre
Saskatoon , Saskatchewan
BCCA-Fraser Valley Cancer Centre
Surrey , British Columbia
Thunder Bay Regional Health Science Centre
Thunder Bay , Ontario
Michael Garron Hospital
Toronto , Ontario
Odette Cancer Centre- Sunnybrook Health Sciences Centre
Toronto , Ontario
Saint Michael's Hospital
Toronto , Ontario
Trillium Health Partners - Queensway Health Centre
Toronto , Ontario
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Bon Secours Hospital
Cork , Co Cork
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Tallaght University Hospital
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Mater Private Hospital
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Albany , New York
Lovelace Medical Center-Downtown
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Hematology Oncology Associates
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Sacred Heart Hospital
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Augusta Oncology Associates PC-D'Antignac
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Bettendorf , Iowa
University of Iowa Healthcare Cancer Services Quad Cities
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Big Rapids , Michigan
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IU Health Bloomington
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Boise , Idaho
Saint Luke's Cancer Institute - Boise
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Tufts Medical Center
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Toledo Clinic Cancer Centers-Bowling Green
Bowling Green , Ohio
Bozeman Health Deaconess Hospital
Bozeman , Montana
Ocean University Medical Center
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United Hospital Center
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Hartford HealthCare - Saint Vincent's Medical Center
Bridgeport , Connecticut
Bridgeport Hospital
Bridgeport , Connecticut
Dana-Farber Cancer Institute at Boston Medical Center - Brighton
Brighton , Massachusetts
Wellmont Medical Associates Oncology and Hematology-Bristol
Bristol , Tennessee
Coney Island Hospital
Brooklyn , New York
Saint Joseph Regional Cancer Center
Bryan , Texas
Community Hospital and Wellness Centers
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Bryn Mawr Hospital
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Roswell Park Cancer Institute
Buffalo , New York
Providence Saint Joseph Medical Center/Disney Family Cancer Center
Burbank , California
The Center for Cancer and Blood Disorders-Burleson
Burleson , Texas
Mills-Peninsula Medical Center
Burlingame , California
Lahey Hospital and Medical Center
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University of Vermont and State Agricultural College
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Aurora Cancer Care-Southern Lakes VLCC
Burlington , Wisconsin
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Burnsville , Minnesota
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Graham Hospital Association
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Canton , Illinois
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Canton , Ohio
Aultman Health Foundation
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Valley Medical Oncology Consultants-Castro Valley
Castro Valley , California
Sandra L Maxwell Cancer Center
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Texas Oncology-Cedar Park
Cedar Park , Texas
Physicians' Clinic of Iowa PC
Cedar Rapids , Iowa
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Mercy Hospital
Cedar Rapids , Iowa
Oncology Associates at Mercy Medical Center
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Providence Regional Cancer System-Centralia
Centralia , Washington
Cancer Center of Kansas - Chanute
Chanute , Kansas
UNC Lineberger Comprehensive Cancer Center
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Roper Hospital
Charleston , South Carolina
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Charleston , South Carolina
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Sentara Martha Jefferson Hospital
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Saint Luke's Hospital
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Hematology and Oncology Associates
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Northwestern University
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John H Stroger Jr Hospital of Cook County
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University of Illinois
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Mercy Hospital and Medical Center
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Swedish Covenant Hospital
Chicago , Illinois
Presence Resurrection Medical Center
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University of Chicago Comprehensive Cancer Center
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Chippewa Falls , Wisconsin
The Christ Hospital
Cincinnati , Ohio
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Cincinnati , Ohio
Good Samaritan Hospital - Cincinnati
Cincinnati , Ohio
Oncology Hematology Care Inc-Blue Ash
Cincinnati , Ohio
The Center for Cancer and Blood Disorders-Cleburne
Cleburne , Texas
Case Western Reserve University
Cleveland , Ohio
MetroHealth Medical Center
Cleveland , Ohio
Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland , Ohio
Cleveland Clinic Foundation
Cleveland , Ohio
New York Oncology Hematology PC - Clifton Park
Clifton Park , New York
Finger Lakes Hematology and Oncology
Clifton Springs , New York
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive , Iowa
Community Cancer Institute
Clovis , California
North Coast Cancer Care-Clyde
Clyde , Ohio
Penrose-Saint Francis Healthcare
Colorado Springs , Colorado
UCHealth Memorial Hospital Central
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South Carolina Oncology Associates PA
Columbia , South Carolina
Missouri Cancer Associates
Columbia , Missouri
Veterans Administration
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Columbus , Georgia
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Columbus , Ohio
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Columbus , Ohio
Columbus NCI Community Oncology Research Program
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Columbus , Ohio
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Columbus , Ohio
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Columbus , Ohio
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Concord , North Carolina
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Cookeville , Tennessee
Mercy Hospital
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Cooperstown , New York
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Heartland Oncology and Hematology LLP
Council Bluffs , Iowa
Ochsner Health Center-Covington
Covington , Louisiana
Hematology and Oncology Associates of Rhode Island Inc
Cranston , Rhode Island
UPMC Western Maryland
Cumberland , Maryland
Medical City Dallas Hospital
Dallas , Texas
Parkland Memorial Hospital
Dallas , Texas
Clements University Hospital
Dallas , Texas
UT Southwestern/Simmons Cancer Center-Dallas
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Danbury , Connecticut
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Darby , Pennsylvania
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Davenport , Iowa
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Dayton , Ohio
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Presbyterian - Saint Lukes Medical Center - Health One
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Denver , Colorado
Mercy Capitol
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Iowa Methodist Medical Center
Des Moines , Iowa
Iowa-Wide Oncology Research Coalition NCORP
Des Moines , Iowa
UI Health Care Mission Cancer and Blood - Des Moines Clinic
Des Moines , Iowa
Mercy Medical Center - Des Moines
Des Moines , Iowa
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Des Moines , Iowa
Iowa Lutheran Hospital
Des Moines , Iowa
Wayne State University/Karmanos Cancer Institute
Detroit , Michigan
Henry Ford Hospital
Detroit , Michigan
Henry Ford Health Saint John Hospital
Detroit , Michigan
Cancer Center of Kansas - Dodge City
Dodge City , Kansas
Dana Farber Community Cancer Care-Dorchester
Dorchester , Massachusetts
Bayhealth Hospital Kent Campus
Dover , Delaware
Doylestown Hospital
Doylestown , Pennsylvania
Delaware County Memorial Hospital
Drexel Hill , Pennsylvania
City of Hope Comprehensive Cancer Center
Duarte , California
Oncology Hematology Associates of Northern Pennsylvania
DuBois , Pennsylvania
Finley Hospital
Dubuque , Iowa
Medical Associates Clinic PC
Dubuque , Iowa
Essentia Health Cancer Center
Duluth , Minnesota
Essentia Health Saint Mary's Medical Center
Duluth , Minnesota
Miller-Dwan Hospital
Duluth , Minnesota
Saint Luke's Hospital of Duluth
Duluth , Minnesota
Dallas Oncology Consultants PA
Duncanville , Texas
Duke University Medical Center
Durham , North Carolina
Michigan State University
East Lansing , Michigan
Pocono Medical Center
East Stroudsburg , Pennsylvania
Hematology Oncology Associates of Central New York-East Syracuse
East Syracuse , New York
University of Maryland Shore Medical Center at Easton
Easton , Maryland
Easton Hospital
Easton , Pennsylvania
HSHS Sacred Heart Hospital
Eau Claire , Wisconsin
Marshfield Clinic Cancer Center at Sacred Heart
Eau Claire , Wisconsin
Moorehead Memorial Hospital
Eden , North Carolina
Fairview Southdale Hospital
Edina , Minnesota
John F Kennedy Medical Center
Edison , New Jersey
Shaw Cancer Center
Edwards , Colorado
Cancer Center of Kansas - El Dorado
El Dorado , Kansas
The Center for Integrative Cancer Medicine
El Paso , Texas
Ascension Alexian Brothers - Elk Grove Village
Elk Grove Village , Illinois
Elkhart Clinic
Elkhart , Indiana
Elkhart General Hospital
Elkhart , Indiana
Christiana Care - Union Hospital
Elkton , Maryland
Elmhurst Memorial Hospital
Elmhurst , Illinois
Hematology Oncology Center Incorporated
Elyria , Ohio
Bay Area Breast Surgeons Inc
Emeryville , California
Englewood Hospital and Medical Center
Englewood , New Jersey
Swedish Medical Center
Englewood , Colorado
Ephrata Cancer Center
Ephrata , Pennsylvania
UPMC Hillman Cancer Center Erie
Erie , Pennsylvania
Saint Vincent Hospital
Erie , Pennsylvania
OSF Saint Francis Hospital and Medical Group
Escanaba , Michigan
Eureka Hospital
Eureka , Illinois
Illinois CancerCare-Eureka
Eureka , Illinois
NorthShore University HealthSystem-Evanston Hospital
Evanston , Illinois
Saint Francis Hospital
Evanston , Illinois
Exeter Hospital
Exeter , New Hampshire
Fairbanks Memorial Hospital
Fairbanks , Alaska
Saint Anne's Hospital
Fall River , Massachusetts
Inova Fairfax Hospital
Falls Church , Virginia
Sanford Broadway Medical Center
Fargo , North Dakota
University of Connecticut
Farmington , Connecticut
Cape Fear Valley Health System
Fayetteville , North Carolina
Saint Francis Hospital
Federal Way , Washington
Etzell, Paul S MD (UIA Investigator)
Fergus Falls , Minnesota
Lake Region Healthcare Corporation-Cancer Care
Fergus Falls , Minnesota
Swenson, Wade II, MD (UIA Investigator)
Fergus Falls , Minnesota
Blanchard Valley Hospital
Findlay , Ohio
Simonds-Sinon Regional Cancer Center
Fitchburg , Massachusetts
Hunterdon Medical Center
Flemington , New Jersey
Genesys Hurley Cancer Institute
Flint , Michigan
Hurley Medical Center
Flint , Michigan
Genesys Regional Medical Center-West Flint Campus
Flint , Michigan
McLaren Cancer Institute-Flint
Flint , Michigan
McLeod Regional Medical Center
Florence , South Carolina
Saint Agnes Hospital/Agnesian Cancer Center
Fond du Lac , Wisconsin
Poudre Valley Hospital
Fort Collins , Colorado
Holy Cross Hospital
Fort Lauderdale , Florida
Broward Health Medical Center
Fort Lauderdale , Florida
Brooke Army Medical Center
Fort Sam Houston , Texas
Sparks Regional Medical Center
Fort Smith , Arkansas
Mercy Hospital Fort Smith
Fort Smith , Arkansas
Fort Wayne Medical Oncology and Hematology Inc-Parkview
Fort Wayne , Indiana
The Center for Cancer and Blood Disorders-Fort Worth
Fort Worth , Texas
MetroWest Medical Center-Framingham Union Hospital
Framingham , Massachusetts
Vanderbilt-Ingram Cancer Center Cool Springs
Franklin , Tennessee
Atrium Medical Center-Middletown Regional Hospital
Franklin , Ohio
Aurora Cancer Care-Franklin
Franklin , Wisconsin
Frederick Memorial Hospital
Frederick , Maryland
Fredericksburg Oncology Inc
Fredericksburg , Virginia
CentraState Medical Center
Freehold , New Jersey
Kaiser Permanente-Fremont
Fremont , California
Valley Medical Oncology Consultants-Fremont
Fremont , California
Washington Hospital
Fremont , California
Fremont Memorial Hospital
Fremont , Ohio
California Cancer Associates for Research and Excellence (cCare)
Fresno , California
Unity Hospital
Fridley , Minnesota
Saint Jude Medical Center
Fullerton , California
UF Health Cancer Institute - Gainesville
Gainesville , Florida
Northeast Georgia Medical Center-Gainesville
Gainesville , Georgia
Galesburg Cottage Hospital
Galesburg , Illinois
Illinois CancerCare-Cottage
Galesburg , Illinois
Illinois CancerCare-Galesburg
Galesburg , Illinois
CaroMont Regional Medical Center
Gastonia , North Carolina
LaGrange Oncology Associates
Geneva , Illinois
Northwestern Medicine Cancer Center Delnor
Geneva , Illinois
Tidelands Georgetown Memorial Hospital
Georgetown , South Carolina
Jones Clinic
Germantown , Tennessee
Banner Thunderbird Medical Center
Glendale , Arizona
Glendale Memorial Hospital and Health Center
Glendale , California
Aurora Cancer Care-Glendale
Glendale , Wisconsin
Adirondack Cancer Center
Glens Falls , New York
Glens Falls Hospital
Glens Falls , New York
Addison Gilbert Hospital
Gloucester , Massachusetts
Peninsula Cancer Institute-Gloucester
Gloucester , Virginia
Wayne Memorial Hospital
Goldsboro , North Carolina
Wayne Radiation Oncology
Goldsboro , North Carolina
Goshen Center for Cancer Care
Goshen , Indiana
Altru Cancer Center
Grand Forks , North Dakota
Nebraska Cancer Specialists/Oncology Hematology West PC
Grand Island , Nebraska
Saint Mary's Hospital and Regional Medical Center
Grand Junction , Colorado
Cancer Research Consortium of West Michigan NCORP
Grand Rapids , Michigan
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids , Michigan
Trinity Health Grand Rapids Hospital
Grand Rapids , Michigan
Three Rivers Community Hospital
Grants Pass , Oregon
Benefis Sletten Cancer Institute
Great Falls , Montana
Berdeaux, Donald MD (UIA Investigator)
Great Falls , Montana
Great Falls Clinic
Great Falls , Montana
Banner North Colorado Medical Center
Greeley , Colorado
Green Bay Oncology at Saint Vincent Hospital
Green Bay , Wisconsin
Saint Vincent Hospital Cancer Center Green Bay
Green Bay , Wisconsin
Saint Vincent Hospital Cancer Center at Saint Mary's
Green Bay , Wisconsin
Aurora BayCare Medical Center
Green Bay , Wisconsin
Marin Cancer Care Inc
Greenbrae , California
Marin General Hospital
Greenbrae , California
Cone Health Cancer Center
Greensboro , North Carolina
Saint Francis Hospital
Greenville , South Carolina
Prisma Health Cancer Institute - Eastside
Greenville , South Carolina
East Carolina University
Greenville , North Carolina
Wayne Hospital
Greenville , Ohio
Greenwich Hospital
Greenwich , Connecticut
Legacy Mount Hood Medical Center
Gresham , Oregon
Hackensack University Medical Center
Hackensack , New Jersey
The Cancer Institute of New Jersey Hamilton
Hamilton , New Jersey
Virginia Oncology Associates-Hampton
Hampton , Virginia
Catskill Regional Medical Center
Harris , New York
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
Harrisburg , Pennsylvania
Hartford Hospital
Hartford , Connecticut
Smilow Cancer Hospital Care Center at Saint Francis
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