RECRUITING Phase 3 ClinicalTrials.gov

Testing Whether Hormone Therapy With Ribociclib is as Effective as Chemotherapy Followed by Hormone Therapy With Ribociclib for the Treatment of High Anatomic Stage Breast Cancer With Low Recurrence Risk, The RxFINE-Low Trial

Sponsor: National Cancer Institute (NCI) • ClinicalTrials.gov ID: NCT07391774

Registry updated: 2026-10-20

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Description

This phase III trial compares standard of care hormone therapy plus ribociclib to chemotherapy followed by hormone therapy plus ribociclib for the treatment of patients with high anatomic stage breast cancer with low risk of the cancer returning (low risk recurrence). Ribociclib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Hormone therapy, with letrozole, anastrozole or exemestane, lowers the amount of estrogen made by the body. This may help stop the growth of tumor cells that need estrogen to grow. Chemotherapy drugs 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. Hormone therapy plus ribociclib may work as well as chemotherapy followed by hormone therapy plus ribociclib for the treatment of high anatomic stage breast cancer with low recurrence risk.

Interventions

Anastrozole (Drug)
Given PO
Biospecimen Collection (Procedure)
Undergo blood sample collection
Bone Scan (Procedure)
Undergo bone scan
Chemotherapy (Drug)
Receive standard of care chemotherapy
Computed Tomography (Procedure)
Undergo CT scan
Exemestane (Drug)
Given PO
Letrozole (Drug)
Given PO
Oncotype DX Breast Cancer Assay (Procedure)
Undergo risk recurrence testing
Positron Emission Tomography (Procedure)
Undergo FDG PET scan
Ribociclib Succinate (Drug)
Given PO

Eligibility criteria

Inclusion Criteria: * STEP 0: Patient must be ≥ 18 years of age * STEP 0: Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 within 28 days prior to Step 0 pre-registration * STEP 0: Patient must be a postmenopausal woman or a man * NOTE: Menopause can be determined by any of the following: * Prior bilateral oophorectomy * Age ≥ 60 years * Age \< 60 years with amenorrhea for ≥ 12 months and estradiol and follicle stimulating hormone (FSH) levels in the postmenopausal range * NOTE: FSH and estradiol levels should be repeated as clinically indicated to ensure menopausal status in patients with breast cancer with chemotherapy-induced amenorrhea * STEP 0: Patient must meet one of the following staging criteria postoperatively according to American Joint Committee on Cancer (AJCC) 8th edition criteria * pT0-T3 with 3 positive ipsilateral lymph nodes (micro-or macrometastatic disease) and no planned axillary lymph node dissection after definitive surgery in the breast and axilla with curative intent. * pT0-T3 with N2 or N3 * pT3 with N0-N3 * NOTES: * Patients with T4 breast cancer are not eligible. * Positive isolated tumor cells (ITCs) in axillary nodes without micro- or macrometastasis are considered N0 for eligibility purposes. * ITC does not contribute to nodal count for staging purposes * STEP 0: Patient must have a primary breast tumor that is estrogen receptor (ER) positive with \> 10% ER expression by immunohistochemistry (IHC) as per 2020 American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) Estrogen Receptor Testing Guideline. * NOTE: ER 1-10% are reported as ER low positive. These tumors have less endocrine-sensitive disease and are not eligible) * STEP 0: Patient must have a primary breast tumor that is HER2-negative by current ASCO/CAP guidelines utilizing immunohistochemistry and/or fluorescence in situ hybridization (FISH) * STEP 0: Patient may have multicentric or multifocal breast cancer if the highest stage tumor meets eligibility criteria outlined above, and the tumor sites are felt to represent a single disease process by local pathology or other sites of disease are also ER-positive (\> 10%) and HER2 negative, if such testing is completed. If local pathology feels that multicentric or multifocal disease may represent distinct disease processes repeat disease receptor testing is required other sites of disease must also be also ER-positive (\> 10%) and HER2-negative * STEP 0: For patients who have undergone a lumpectomy, the margins of the resected specimen or re-excision must be histologically free of invasive tumor and ductal carcinoma in situ (DCIS) as determined by the local pathologist. If pathologic examination demonstrates tumor at the line of resection, additional excisions may be performed to obtain clear margins. Positive posterior margin is allowed if surgeon deems no further resection possible. Patients with margins positive for lobular carcinoma in situ (LCIS) are eligible without additional resection * STEP 0: For patients who have undergone mastectomy, the margins must be free of residual gross tumor. Patients with microscopic positive margins are eligible if post-mastectomy radiation treatment (RT) of the chest wall will be administered * STEP 0: Patient must have undergone axillary staging with sentinel lymph node biopsy (SLNB), targeted axillary dissection (TAD), or axillary lymph node dissection (ALND) * STEP 0: Patient must have no evidence of locoregional or distant metastatic disease by clinical history and physical exam. Treating physician can consider additional imaging evaluation per National Comprehensive Cancer Network (NCCN) guidelines and/or institutional practice * STEP 0: Patient must be able to have Oncotype DX testing performed. * If Oncotype DX testing was previously performed, the results of Recurrence Score (RS) must be available and must meet Step 1 eligibility criteria. * If Oncotype DX testing was not performed yet, tissue from the core, excisional biopsy or surgical specimen of the tumor lesion must be available and must be shipped to Exact Sciences for determination of the Oncotype DX Recurrence Score (RS) for eligibility and stratification. * NOTE: Exact Sciences will notify the submitting institution of Recurrence Score results within two (2) weeks of receipt of the tumor specimen. Institutions will receive an email notification of eligibility status once Recurrence Score results are entered into Rave by the submitting institution * STEP 0: Patient must have had their final cancer surgery for breast cancer (including re-excision of margins) less than 16 weeks prior to Step 0 Pre-Registration. * NOTE: This excludes additional surgery for reconstructive purposes * STEP 0: 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 * STEP 0: Patients with synchronous DCIS or LCIS are eligible * STEP 0: Patient with prior history of ER-negative DCIS diagnosed at least 5 years prior to Step 0 Pre-Registration without evidence of recurrence are eligible * STEP 0: Patient must not have a prior history of invasive ER-positive breast cancer. Patients with a history of ER-negative breast cancer are eligible if they were diagnosed at least 5 years prior to Step 0 Pre-Registration and have had no evidence of recurrence * STEP 0: Patients must not have received prior endocrine therapy such as tamoxifen, raloxifene, or aromatase inhibitors for chemoprevention within 5 years prior to Step 0 Pre-Registration with the exception of a short course of endocrine therapy of less than 6 weeks duration prior to Step 0 Pre-Registration. * NOTE: The Oncotype DX for study eligibility must be performed on specimen obtained prior to initiation of any endocrine therapy * STEP 0: Patient must not be concurrently using systemic hormone replacement therapy (HRT). If receiving HRT at the time of breast cancer diagnosis, this must be discontinued prior to Step 0 Pre-Registration with appropriate washout * STEP 0: Absolute neutrophil count (ANC) ≥ 1,500/µL (obtained ≤ 28 days prior to Step 0 Pre-Registration) * STEP 0: Hemoglobin ≥ 9.0 g/dL (obtained ≤ 28 days prior to Step 0 Pre-Registration) * STEP 0: Platelets ≥ 100,000/µL (obtained ≤ 28 days prior to Step 0 Pre-Registration) * STEP 0: Total bilirubin ≤ institutional upper limit of normal (ULN) or \< 1.5 x ULN for patients who have a bilirubin elevation in patients with well documented Gilbert's disease or similar syndrome involving slow conjugation of bilirubin (obtained ≤ 28 days prior to Step 0 Pre-Registration) * STEP 0: Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]) ≤ 2.5 × institutional ULN (obtained ≤ 28 days prior to Step 0 Pre-Registration) * STEP 0: Estimated glomerular filtration rate (eGFR) ≥ 30 mL/minute/1.73 m\^2 (obtained ≤ 28 days prior to Step 0 Pre-Registration) * STEP 0: Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of Step 0 Pre-Registration are eligible for this trial * STEP 0: For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated * STEP 0: Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load * STEP 0: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2 or better * STEP 0: Patient must have a standard 12-lead electrocardiogram (ECG) within 28 days prior to Step 0 Pre-Registration, documenting: * QT interval using Fridericia's correction (QTcF) \< 450 msec. * Resting heart rate 50-90 beats per minute (determined from the ECG) * STEP 0: Patient must have the ability to understand and the willingness to sign a written informed consent document. Patients with impaired decision-making capacity (IDMC) who have a legally authorized representative (LAR) or caregiver and/or family member available will also be considered eligible * STEP 0: Patient must not have comorbidities considered a safety risk for standard adjuvant chemotherapy, endocrine therapy or CDK4/6 inhibitor as per Investigator's discretion * STEP 0: Patient must not have a contraindication to adjuvant chemotherapy based on treating physician's discretion * STEP 0: Patient must not have received prior chemotherapy for this malignancy * STEP 0: Patient must not have received prior CDK4/6 inhibitor * STEP 0: Patient must not have a known contraindication to ribociclib per current Food and Drug Administration (FDA) indication * STEP 0: Patient must not have a known hypersensitivity to any of the excipients of ribociclib and/or endocrine therapy (ET) (e.g. rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, glucose-galactose malabsorption, and soy allergy) * STEP 0: Males must not expect to father children and males and their partners must be willing to use highly effective methods of contraception while on protocol treatment. Males must not donate sperm while on protocol treatment and for at least 12 weeks following the last dose of protocol treatment. Highly effective methods include the following: * Intrauterine device * Bilateral tubal occlusion * Vasectomized partner * Sexual abstinence If the highly effective contraceptive methods are contraindicated or strictly declined by the patient, or in the event of sexual activity of low frequency, a combination of male condom with cap, diaphragm, or sponge with spermicide (double-barrier methods) is also considered an acceptable birth control method. Local regulation/guidelines are to be followed with regard to highly effective birth control method, if more restrictive * STEP 1: Patient must meet all Step 0 Pre-Registration eligibility criteria at the time of their Step 1 randomization * STEP 1: Patient must not have had any major surgery or radiotherapy within 14 days prior to Step 1 randomization * STEP 1: Patient must have a Recurrence Score (RS) of 0-25 from Oncotype DX testing from diagnostic biopsy or surgical specimen as reported by the Exact Sciences assay

Conditions

Anatomic Stage II Breast Cancer AJCC v8 Anatomic Stage IIIA Breast Cancer AJCC v8 Anatomic Stage IIIC Breast Cancer AJCC v8 Estrogen Receptor-Positive Breast Carcinoma HER2-Negative Breast Carcinoma

Locations

NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro — Jonesboro, Arkansas, United States
Sutter Auburn Faith Hospital — Auburn, California, United States
Alta Bates Summit Medical Center-Herrick Campus — Berkeley, California, United States
Tower Cancer Research Foundation — Beverly Hills, California, United States
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care — Irvine, California, United States
Memorial Medical Center — Modesto, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center — Orange, California, United States
Palo Alto Medical Foundation Health Care — Palo Alto, California, United States
Huntington Memorial Hospital — Pasadena, California, United States
Sutter Roseville Medical Center — Roseville, California, United States
Sutter Medical Center Sacramento — Sacramento, California, United States
University of California Davis Comprehensive Cancer Center — Sacramento, California, United States
California Pacific Medical Center-Pacific Campus — San Francisco, California, United States
Mills Health Center — San Mateo, California, United States
Ridley-Tree Cancer Center — Santa Barbara, California, United States
Cedars-Sinai Cancer - Tarzana — Tarzana, California, United States
Sutter Solano Medical Center/Cancer Center — Vallejo, California, United States
UCI Health - Yorba Linda — Yorba Linda, California, United States
Stamford Hospital/Bennett Cancer Center — Stamford, Connecticut, United States
Beebe South Coastal Health Campus — Millville, Delaware, United States
Helen F Graham Cancer Center — Newark, Delaware, United States
Medical Oncology Hematology Consultants PA — Newark, Delaware, United States
Beebe Health Campus — Rehoboth Beach, Delaware, United States
The Watson Clinic — Lakeland, Florida, United States
Kootenai Health - Coeur d'Alene — Coeur d'Alene, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls — Post Falls, Idaho, United States
Kootenai Clinic Cancer Services - Sandpoint — Sandpoint, Idaho, United States
Illinois CancerCare-Bloomington — Bloomington, Illinois, United States
Illinois CancerCare-Canton — Canton, Illinois, United States
SIH Cancer Institute — Carterville, Illinois, United States
Illinois CancerCare-Carthage — Carthage, Illinois, United States
Northwestern University — Chicago, Illinois, United States
Northwestern Medicine Cancer Center Old Irving Park — Chicago, Illinois, United States
Carle at The Riverfront — Danville, Illinois, United States
Cancer Care Specialists of Illinois - Decatur — Decatur, Illinois, United States
Decatur Memorial Hospital — Decatur, Illinois, United States
Northwestern Medicine Cancer Center Kishwaukee — DeKalb, Illinois, United States
Carle Physician Group-Effingham — Effingham, Illinois, United States
Illinois CancerCare-Eureka — Eureka, Illinois, United States
Illinois CancerCare-Galesburg — Galesburg, Illinois, United States
Northwestern Medicine Cancer Center Delnor — Geneva, Illinois, United States
Northwestern Medicine Glenview Outpatient Center — Glenview, Illinois, United States
Northwestern Medicine Grayslake Outpatient Center — Grayslake, Illinois, United States
Northwestern Medicine Huntley Hospital — Huntley, Illinois, United States
Illinois CancerCare-Kewanee Clinic — Kewanee, Illinois, United States
Northwestern Medicine Lake Forest Hospital — Lake Forest, Illinois, United States
Illinois CancerCare-Macomb — Macomb, Illinois, United States
Carle Physician Group-Mattoon/Charleston — Mattoon, Illinois, United States
Northwestern Medicine McHenry Hospital — McHenry, Illinois, United States
SSM Health Good Samaritan — Mount Vernon, Illinois, United States
Carle BroMenn Medical Center — Normal, Illinois, United States
Carle Cancer Institute Normal — Normal, Illinois, United States
Cancer Care Center of O'Fallon — O'Fallon, Illinois, United States
HSHS Saint Elizabeth's Hospital — O'Fallon, Illinois, United States
Northwestern Medicine Oak Brook — Oak Brook, Illinois, United States
Northwestern Medicine Orland Park — Orland Park, Illinois, United States
Illinois CancerCare-Ottawa Clinic — Ottawa, Illinois, United States
Illinois CancerCare-Pekin — Pekin, Illinois, United States
Illinois CancerCare-Peoria — Peoria, Illinois, United States
Illinois CancerCare-Peru — Peru, Illinois, United States
Illinois CancerCare-Princeton — Princeton, Illinois, United States
Southern Illinois University School of Medicine — Springfield, Illinois, United States
Springfield Clinic — Springfield, Illinois, United States
Springfield Memorial Hospital — Springfield, Illinois, United States
Carle Cancer Center — Urbana, Illinois, United States
Northwestern Medicine Cancer Center Warrenville — Warrenville, Illinois, United States
Illinois CancerCare - Washington — Washington, Illinois, United States
IU Health West Hospital — Avon, Indiana, United States
IU Health North Hospital — Carmel, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center — Indianapolis, Indiana, United States
Mary Greeley Medical Center — Ames, Iowa, United States
McFarland Clinic - Ames — Ames, Iowa, United States
UI Health Care Mission Cancer and Blood - Ankeny Clinic — Ankeny, Iowa, United States
Saint Anthony Regional Hospital — Carroll, Iowa, United States
Mercy Hospital — Cedar Rapids, Iowa, United States
Oncology Associates at Mercy Medical Center — Cedar Rapids, Iowa, United States
UI Health Care Mission Cancer and Blood - West Des Moines Clinic — Clive, Iowa, United States
Iowa Methodist Medical Center — Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Des Moines Clinic — Des Moines, Iowa, United States
Broadlawns Medical Center — Des Moines, Iowa, United States
Mercy Medical Center - Des Moines — Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Laurel Clinic — Des Moines, Iowa, United States
McFarland Clinic - Trinity Cancer Center — Fort Dodge, Iowa, United States
UI Healthcare Mission Cancer and Blood - Fort Dodge — Fort Dodge, Iowa, United States
McFarland Clinic - Marshalltown — Marshalltown, Iowa, United States
UI Health Care Mission Cancer and Blood - Waukee Clinic — Waukee, Iowa, United States
University of Kansas Cancer Center — Kansas City, Kansas, United States
The University of Kansas Cancer Center - Olathe — Olathe, Kansas, United States
University of Kansas Cancer Center-Overland Park — Overland Park, Kansas, United States
University of Kansas Hospital-Indian Creek Campus — Overland Park, Kansas, United States
University of Kansas Health System Saint Francis Campus — Topeka, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center — Westwood, Kansas, United States
Ochsner Medical Center Jefferson — New Orleans, Louisiana, United States
UM Upper Chesapeake Hematology and Oncology - Aberdeen — Aberdeen, Maryland, United States
University of Maryland/Greenebaum Cancer Center — Baltimore, Maryland, United States
Greater Baltimore Medical Center — Baltimore, Maryland, United States
UM Upper Chesapeake Medical Center — Bel Air, Maryland, United States
University of Maryland Shore Medical Center at Easton — Easton, Maryland, United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton — Brighton, Michigan, United States
Henry Ford Cancer Institute-Downriver — Brownstown, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Canton — Canton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital — Chelsea, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township — Clinton Township, Michigan, United States
Henry Ford Medical Center-Fairlane — Dearborn, Michigan, United States
Henry Ford Hospital — Detroit, Michigan, United States
Cancer Hematology Centers - Flint — Flint, Michigan, United States
Genesys Hurley Cancer Institute — Flint, Michigan, United States
Allegiance Health — Jackson, Michigan, United States
University of Michigan Health - Sparrow Lansing — Lansing, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital — Livonia, Michigan, United States
Henry Ford Medical Center-Columbus — Novi, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland Hospital — Pontiac, Michigan, United States
Henry Ford West Bloomfield Hospital — West Bloomfield, Michigan, United States
Henry Ford Wyandotte Hospital — Wyandotte, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus — Ypsilanti, Michigan, United States
Sanford Joe Lueken Cancer Center — Bemidji, Minnesota, United States
Essentia Health Saint Joseph's Medical Center — Brainerd, Minnesota, United States
Mercy Hospital — Coon Rapids, Minnesota, United States
Essentia Health - Deer River Clinic — Deer River, Minnesota, United States
Essentia Health Saint Mary's - Detroit Lakes Clinic — Detroit Lakes, Minnesota, United States
Essentia Health Cancer Center — Duluth, Minnesota, United States
Miller-Dwan Hospital — Duluth, Minnesota, United States
Essentia Health Hibbing Clinic — Hibbing, Minnesota, United States
Abbott-Northwestern Hospital — Minneapolis, Minnesota, United States
Coborn Cancer Center at Saint Cloud Hospital — Saint Cloud, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park — Saint Louis Park, Minnesota, United States
Regions Hospital — Saint Paul, Minnesota, United States
United Hospital — Saint Paul, Minnesota, United States
Essentia Health Sandstone — Sandstone, Minnesota, United States
Saint Francis Regional Medical Center — Shakopee, Minnesota, United States
Sanford Thief River Falls Medical Center — Thief River Falls, Minnesota, United States
Essentia Health Virginia Clinic — Virginia, Minnesota, United States
Sanford Cancer Center Worthington — Worthington, Minnesota, United States
Baptist Memorial Hospital and Cancer Center-Golden Triangle — Columbus, Mississippi, United States
Baptist Cancer Center-Grenada — Grenada, Mississippi, United States
Baptist Memorial Hospital and Cancer Center-Union County — New Albany, Mississippi, United States
Baptist Memorial Hospital and Cancer Center-Oxford — Oxford, Mississippi, United States
Baptist Memorial Hospital and Cancer Center-Desoto — Southhaven, Mississippi, United States
Mercy Oncology and Hematology - Clayton-Clarkson — Ballwin, Missouri, United States
Saint Francis Medical Center — Cape Girardeau, Missouri, United States
Parkland Health Center - Farmington — Farmington, Missouri, United States
University of Kansas Cancer Center - Briarcliff — Kansas City, Missouri, United States
University of Kansas Cancer Center - North — Kansas City, Missouri, United States
University of Kansas Cancer Center - Lee's Summit — Lee's Summit, Missouri, United States
Liberty Hospital — Liberty, Missouri, United States
Sainte Genevieve County Memorial Hospital — Sainte Genevieve, Missouri, United States
Missouri Baptist Medical Center — St Louis, Missouri, United States
Missouri Baptist Sullivan Hospital — Sullivan, Missouri, United States
Billings Clinic Cancer Center — Billings, Montana, United States
Bozeman Health Deaconess Hospital — Bozeman, Montana, United States
Benefis Sletten Cancer Institute — Great Falls, Montana, United States
Logan Health Medical Center — Kalispell, Montana, United States
Community Medical Center — Missoula, Montana, United States
Jefferson Cherry Hill Hospital — Cherry Hill, New Jersey, United States
Monmouth Medical Center — Long Branch, New Jersey, United States
Rutgers Cancer Institute of New Jersey — New Brunswick, New Jersey, United States
Sidney Kimmel Cancer Center Washington Township — Sewell, New Jersey, United States
University of New Mexico Cancer Center — Albuquerque, New Mexico, United States
NYU Langone Hospital - Brooklyn — Brooklyn, New York, United States
Roswell Park Cancer Institute — Buffalo, New York, United States
The Cancer Institute at Saint Francis Hospital — East Hills, New York, United States
NYU Langone Hospital - Long Island — Mineola, New York, United States
Mount Sinai Chelsea — New York, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone — New York, New York, United States
Mount Sinai West — New York, New York, United States
Mount Sinai Hospital — New York, New York, United States
Good Samaritan University Hospital — West Islip, New York, United States
Duke Cancer Center Cary — Cary, North Carolina, United States
Southeastern Medical Oncology Center-Clinton — Clinton, North Carolina, United States
Duke University Medical Center — Durham, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro — Goldsboro, North Carolina, United States
Southeastern Medical Oncology Center-Jacksonville — Jacksonville, North Carolina, United States
Duke Women's Cancer Care Raleigh — Raleigh, North Carolina, United States
Sanford Bismarck Medical Center — Bismarck, North Dakota, United States
Essentia Health Cancer Center-South University Clinic — Fargo, North Dakota, United States
Sanford Broadway Medical Center — Fargo, North Dakota, United States
Sanford Roger Maris Cancer Center — Fargo, North Dakota, United States
Aultman Health Foundation — Canton, Ohio, United States
Miami Valley Hospital South — Centerville, Ohio, United States
Ohio State University Comprehensive Cancer Center — Columbus, Ohio, United States
Miami Valley Hospital — Dayton, Ohio, United States
Premier Blood and Cancer Center — Dayton, Ohio, United States
Miami Valley Hospital North — Dayton, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital — Franklin, Ohio, United States
Miami Valley Cancer Care and Infusion — Greenville, Ohio, United States
Upper Valley Medical Center — Troy, Ohio, United States
University of Oklahoma Health Sciences Center — Oklahoma City, Oklahoma, United States
Penn State Milton S Hershey Medical Center — Hershey, Pennsylvania, United States
Thomas Jefferson University Hospital — Philadelphia, Pennsylvania, United States
Jefferson Torresdale Hospital — Philadelphia, Pennsylvania, United States
Asplundh Cancer Pavilion — Willow Grove, Pennsylvania, United States
Lexington Health — West Columbia, South Carolina, United States
Sanford Cancer Center Oncology Clinic — Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls — Sioux Falls, South Dakota, United States
Baptist Memorial Hospital and Cancer Center-Collierville — Collierville, Tennessee, United States
Baptist Memorial Hospital and Cancer Center-Memphis — Memphis, Tennessee, United States
Augusta Health Center for Cancer and Blood Disorders — Fishersville, Virginia, United States
Centra Alan B Pearson Regional Cancer Center — Lynchburg, Virginia, United States
Bon Secours Memorial Regional Medical Center — Mechanicsville, Virginia, United States
Bon Secours Saint Francis Medical Center — Midlothian, Virginia, United States
Bon Secours Richmond Community Hospital — Richmond, Virginia, United States
Bon Secours Saint Mary's Hospital — Richmond, Virginia, United States
VCU Massey Comprehensive Cancer Center — Richmond, Virginia, United States
Duluth Clinic Ashland — Ashland, Wisconsin, United States
Northwest Wisconsin Cancer Center — Ashland, Wisconsin, United States
Essentia Health-Hayward Clinic — Hayward, Wisconsin, United States
ProHealth D N Greenwald Center — Mukwonago, Wisconsin, United States
Cancer Center of Western Wisconsin — New Richmond, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital — Oconomowoc, Wisconsin, United States
Essentia Health-Spooner Clinic — Spooner, Wisconsin, United States
Essentia Health Saint Mary's Hospital - Superior — Superior, Wisconsin, United States
ProHealth Waukesha Memorial Hospital — Waukesha, Wisconsin, United States
UW Cancer Center at ProHealth Care — Waukesha, Wisconsin, United States
Doctors Cancer Center — Manati, Puerto Rico
Centro Comprensivo de Cancer de UPR — San Juan, Puerto Rico
PROncology — San Juan, Puerto Rico
San Juan City Hospital — San Juan, Puerto Rico

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