Colon Cancer Clinical Trial
Testing the Use of BRAF-Targeted Therapy After Surgery and Usual Chemotherapy for BRAF-Mutated Colon Cancer
Summary
This phase II/III trial compares treatment with encorafenib and cetuximab to usual care (patient observation) for reducing the chance of cancer recurrence after standard surgery and chemotherapy in patients with BRAF-mutated stage IIB-III colon cancer. Encorafenib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Cetuximab is in a class of medications called monoclonal antibodies. It binds to a protein called EGFR, which is found on some types of tumor cells. This may help keep tumor cells from growing. Giving encorafenib and cetuximab after standard surgery and chemotherapy may be more effective at reducing the chance of cancer recurrence compared to the usual patient observation.
Full Description
The primary and secondary objectives of the study:
PRIMARY OBJECTIVES:
I. To evaluate and compare 6 month circulating tumor deoxyribonucleic acid (ctDNA) clearance rate in study patients with detectable ctDNA prior to randomization to targeted BRAF therapy versus usual care after standard adjuvant chemotherapy. (Phase II) II. To evaluate and compare 6 month ctDNA recurrence-free survival (ctDNA-RFS) rate in study patients with undetectable ctDNA prior to randomization to targeted BRAF therapy versus usual care after standard adjuvant chemotherapy. (Phase II) III. To evaluate and compare disease-free survival (DFS) (measured from randomization) in patients with resected stage III or high-risk (pT4) stage II mismatch repair protein (MMR) proficient BRAF V600E colon cancer treated with targeted BRAF therapy versus usual care after standard adjuvant chemotherapy. (Phase III)
SECONDARY OBJECTIVES:
I. To evaluate and compare overall survival (OS) between the two treatment arms.
II. To evaluate and compare the toxicity profile between the two treatment arms.
III. To evaluate and compare the alternative DFS endpoint (measured from date of primary tumor resection) between the two treatment arms.
IV. To evaluate and compare DFS in the subset of patients with detectable ctDNA prior to randomization between the two treatment arms.
EXPLORATORY OBJECTIVE:
I. To evaluate and compare patient-reported outcomes for symptoms of rash, diarrhea, and fatigue according to Patient Reported Outcomes Version of Common Terminology Criteria for Adverse Events (PRO-CTCAE) between the two treatment arms.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients receive encorafenib orally (PO) and cetuximab intravenously (IV) on study. Patients also undergo collection of blood samples throughout the study and computed tomography (CT) or magnetic resonance imaging (MRI) during screening and follow-up.
ARM II: Patients undergo observation per usual care on study. Patients also undergo collection of blood samples throughout the study and CT or MRI during screening and follow-up.
Eligibility Criteria
Inclusion Criteria:
PRE-REGISTRATION (STEP 0) ELIGIBILITY CRITERIA:
BRAF V600 mutational status may be determined either locally or by central testing. This testing is mandatory prior to registration to determine eligibility. Tissue submission should be initiated as soon after surgery as possible. For tumors evaluated at local laboratories, formalin-fixed paraffin-embedded (FFPE) tumor tissue must still be submitted for central confirmation of BRAF status
REGISTRATION (STEP 1) ELIGIBILITY CRITERIA:
Histologically-proven stage III (any T [Tx, T1, T2, T3, or T4], N1-2M0; includes N1C) or high-risk (pT4) stage II colon adenocarcinoma. Tumors must be deemed to originate in the colon including tumors that extend into/involve the small bowel (e.g. those at the ileocecal valve) and must have been completely resected
BRAF V600E mutation
MMR proficient (pMMR) or microsatellite stable (MSS) tumor
Histologic documentation: adenocarcinoma
Stage: III (any T [Tx, T1, T2, T3, or T4], N1-2M0; includes N1C) or high-risk II (pT4)
Tumor site: colon
Patients must have received at least 3 months of adjuvant chemotherapy with either leucovorin calcium, fluorouracil, and oxaliplatin (FOLFOX) (minimum of 5 cycles) or capecitabine and oxaliplatin (CAPOX) (minimum of 3 cycles)
Adjuvant therapy must be completed at most 8 weeks prior to registration
No other prior medical therapy (chemotherapy, immunotherapy, biologic, or targeted therapy) or radiation therapy for the current colon cancer is permitted
Not pregnant and not nursing, because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects. Therefore, for women of childbearing potential only, a negative pregnancy test done =< 7 days prior to registration is required
Age >= 18 years
Eastern Cooperative Oncology Group (ECOG) performance status: 0-2
Absolute neutrophil count (ANC) >= 1.0 x 10^9/L
Platelet count >= 75 x 10^9/L
Hemoglobin > 9.0 g/dL
Total bilirubin =< 1.5 x upper limit of normal (ULN)
Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 3.0 x ULN
Corrected QT (QTc) Interval =< 480 msec
Creatinine = calculated (calc.) creatinine clearance >= 40 mL/min
Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
No medical condition such as uncontrolled infection, uncontrolled diabetes mellitus, or cardiac disease which, in the opinion of the treating physician, would make this protocol unreasonably hazardous for the patient
Patients with known history or current symptoms of cardiac disease or history of treatment with cardiotoxic agents in the last 12 months, 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 2B or better
No uncontrolled or poorly-controlled hypertension (> 180 mmHg systolic or > 130 mmHg diastolic)
No history of allergic reactions attributed to compounds of chemical or biologic composition similar to those of cetuximab
No "currently active" second malignancy other than non-melanoma skin cancers or cervical carcinoma in situ. Patients are not considered to have a "currently active" malignancy if they have completed therapy and are free of disease for >= 3 years
Patients are not considered to have a "currently active" malignancy if they had a gastric or bowel carcinoid < 1 cm, ductal carcinoma in situ (DCIS)/lobular carcinoma in situ (LCIS) of the breast without invasive cancer, or endometrial dysplasia/carcinoma in situ
Patients are not considered to have a "currently active" malignancy if they had a sebaceous neoplasm (sebaceous adenoma, sebaceous epithelioma, sebaceous adenocarcinoma, keratoacanthoma, and squamous cell carcinoma) that was noninvasive
No known medical condition causing an inability to swallow oral formulations of agents
No residual Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0 grade >= 2 toxicity from prior chemotherapy, with the exception of grade 2 alopecia or neuropathy
Drugs that prolong the QTc interval should be avoided if possible, as encorafenib can prolong the QTc interval. Drugs that are generally accepted to have a risk of causing Torsades de Pointes should be discontinued or replaced with drugs that do not carry this risk if at all possible. Patients who receive potential QTc-prolonging medications should be monitored closely
Chronic concomitant treatment with strong inhibitors of CYP3A4 is not allowed during treatment on this study. Patients on strong CYP3A4 inhibitors must discontinue the drug for 14 days prior to registration on the study
Chronic concomitant treatment with strong CYP3A4 inducers is not allowed during treatment on this study. Patients must discontinue the drug 14 days prior to registration on the study
Exclusion Criteria: N/A
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There are 152 Locations for this study
Frankford Delaware, 19945, United States More Info
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Newark Delaware, 19713, United States More Info
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Newark Delaware, 19713, United States More Info
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Rehoboth Beach Delaware, 19971, United States More Info
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Atlanta Georgia, 30308, United States More Info
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Atlanta Georgia, 30322, United States More Info
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Atlanta Georgia, 30342, United States More Info
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'Aiea Hawaii, 96701, United States More Info
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'Aiea Hawaii, 96701, United States More Info
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Honolulu Hawaii, 96813, United States More Info
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Honolulu Hawaii, 96813, United States More Info
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Honolulu Hawaii, 96813, United States More Info
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Honolulu Hawaii, 96813, United States More Info
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Honolulu Hawaii, 96817, United States More Info
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Boise Idaho, 83706, United States More Info
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Boise Idaho, 83712, United States
Caldwell Idaho, 83605, United States More Info
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Coeur d'Alene Idaho, 83814, United States More Info
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Fruitland Idaho, 83619, United States
Meridian Idaho, 83642, United States
Nampa Idaho, 83686, United States
Nampa Idaho, 83687, United States More Info
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Post Falls Idaho, 83854, United States More Info
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Sandpoint Idaho, 83864, United States More Info
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Twin Falls Idaho, 83301, United States
Bloomington Illinois, 61704, United States More Info
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Canton Illinois, 61520, United States More Info
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Carthage Illinois, 62321, United States More Info
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Chicago Illinois, 60611, United States More Info
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Chicago Illinois, 60637, United States More Info
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Danville Illinois, 61832, United States More Info
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Decatur Illinois, 62526, United States More Info
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Decatur Illinois, 62526, United States More Info
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DeKalb Illinois, 60115, United States More Info
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Dixon Illinois, 61021, United States More Info
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Effingham Illinois, 62401, United States More Info
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Effingham Illinois, 62401, United States More Info
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Eureka Illinois, 61530, United States More Info
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Galesburg Illinois, 61401, United States More Info
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Geneva Illinois, 60134, United States More Info
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Glenview Illinois, 60026, United States More Info
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Grayslake Illinois, 60030, United States More Info
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Kewanee Illinois, 61443, United States More Info
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Lake Forest Illinois, 60045, United States More Info
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Macomb Illinois, 61455, United States More Info
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Mattoon Illinois, 61938, United States More Info
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New Lenox Illinois, 60451, United States More Info
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O'Fallon Illinois, 62269, United States More Info
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Orland Park Illinois, 60462, United States More Info
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Orland Park Illinois, 60462, United States More Info
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Ottawa Illinois, 61350, United States More Info
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Pekin Illinois, 61554, United States More Info
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Peoria Illinois, 61615, United States More Info
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Peru Illinois, 61354, United States More Info
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Princeton Illinois, 61356, United States More Info
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Springfield Illinois, 62702, United States More Info
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Springfield Illinois, 62702, United States More Info
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Springfield Illinois, 62781, United States More Info
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Urbana Illinois, 61801, United States More Info
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Warrenville Illinois, 60555, United States More Info
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Washington Illinois, 61571, United States More Info
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Crown Point Indiana, 46307, United States More Info
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Dyer Indiana, 46311, United States More Info
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Hobart Indiana, 46342, United States More Info
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Hobart Indiana, 46342, United States More Info
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Indianapolis Indiana, 46312, United States More Info
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Munster Indiana, 46321, United States More Info
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Munster Indiana, 46321, United States More Info
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Valparaiso Indiana, 46383, United States More Info
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Ankeny Iowa, 50023, United States More Info
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Cedar Rapids Iowa, 52403, United States More Info
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Cedar Rapids Iowa, 52403, United States More Info
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Des Moines Iowa, 50309, United States More Info
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Ann Arbor Michigan, 48106, United States More Info
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Brighton Michigan, 48114, United States More Info
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Brighton Michigan, 48114, United States More Info
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Canton Michigan, 48188, United States More Info
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Canton Michigan, 48188, United States More Info
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Chelsea Michigan, 48118, United States More Info
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Chelsea Michigan, 48118, United States More Info
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Flint Michigan, 48503, United States More Info
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Flint Michigan, 48503, United States More Info
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Flint Michigan, 48503, United States More Info
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Flint Michigan, 48503, United States More Info
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Livonia Michigan, 48154, United States More Info
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Macomb Michigan, 48044, United States More Info
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Ypsilanti Michigan, 48106, United States More Info
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Ypsilanti Michigan, 48197, United States More Info
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Bemidji Minnesota, 56601, United States More Info
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Coon Rapids Minnesota, 55433, United States More Info
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Saint Paul Minnesota, 55102, United States More Info
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Cape Girardeau Missouri, 63703, United States More Info
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Anaconda Montana, 59711, United States More Info
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Billings Montana, 59101, United States More Info
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Bozeman Montana, 59715, United States More Info
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Great Falls Montana, 59405, United States More Info
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Missoula Montana, 59804, United States More Info
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Basking Ridge New Jersey, 07920, United States More Info
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Middletown New Jersey, 07748, United States More Info
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Montvale New Jersey, 07645, United States More Info
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Buffalo New York, 14263, United States More Info
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Commack New York, 11725, United States More Info
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Glens Falls New York, 12801, United States More Info
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Harrison New York, 10604, United States More Info
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New York New York, 10065, United States More Info
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Oswego New York, 13126, United States More Info
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Syracuse New York, 13210, United States More Info
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Syracuse New York, 13215, United States More Info
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Uniondale New York, 11553, United States More Info
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Verona New York, 13478, United States More Info
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Clinton North Carolina, 28328, United States More Info
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Goldsboro North Carolina, 27534, United States More Info
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Jacksonville North Carolina, 28546, United States More Info
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Bismarck North Dakota, 58501, United States More Info
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Fargo North Dakota, 58122, United States More Info
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Fargo North Dakota, 58122, United States More Info
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Canton Ohio, 44710, United States More Info
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Centerville Ohio, 45459, United States More Info
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Cleveland Ohio, 44111, United States More Info
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Cleveland Ohio, 44195, United States More Info
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Dayton Ohio, 45409, United States More Info
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Dayton Ohio, 45409, United States More Info
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Dayton Ohio, 45415, United States More Info
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Franklin Ohio, 45005, United States More Info
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Greenville Ohio, 45331, United States More Info
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Independence Ohio, 44131, United States More Info
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Mansfield Ohio, 44906, United States More Info
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Mayfield Heights Ohio, 44124, United States More Info
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Sandusky Ohio, 44870, United States More Info
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Strongsville Ohio, 44136, United States More Info
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Toledo Ohio, 43623, United States More Info
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Troy Ohio, 45373, United States More Info
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Warrensville Heights Ohio, 44122, United States More Info
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Wooster Ohio, 44691, United States More Info
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Oklahoma City Oklahoma, 73104, United States More Info
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Ontario Oregon, 97914, United States More Info
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Portland Oregon, 97213, United States More Info
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Portland Oregon, 97225, United States More Info
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Allentown Pennsylvania, 18103, United States More Info
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Bethlehem Pennsylvania, 18017, United States More Info
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Danville Pennsylvania, 17822, United States More Info
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East Stroudsburg Pennsylvania, 18301, United States More Info
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Hazleton Pennsylvania, 18201, United States More Info
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Lewisburg Pennsylvania, 17837, United States More Info
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Pottsville Pennsylvania, 17901, United States More Info
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Scranton Pennsylvania, 18510, United States More Info
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Wilkes-Barre Pennsylvania, 18711, United States More Info
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Boiling Springs South Carolina, 29316, United States More Info
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Easley South Carolina, 29640, United States More Info
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Gaffney South Carolina, 29341, United States More Info
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Greenville South Carolina, 29605, United States More Info
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Greenville South Carolina, 29605, United States More Info
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Greenville South Carolina, 29615, United States More Info
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Greer South Carolina, 29650, United States More Info
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Greer South Carolina, 29651, United States More Info
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Seneca South Carolina, 29672, United States More Info
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Spartanburg South Carolina, 29303, United States More Info
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Union South Carolina, 29379, United States More Info
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Sioux Falls South Dakota, 57104, United States More Info
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Sioux Falls South Dakota, 57117, United States More Info
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Dallas Texas, 75235, United States More Info
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Dallas Texas, 75237, United States More Info
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Dallas Texas, 75390, United States More Info
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Fort Worth Texas, 76104, United States More Info
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Richardson Texas, 75080, United States More Info
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Charleston West Virginia, 25304, United States More Info
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Appleton Wisconsin, 54911, United States More Info
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Berlin Wisconsin, 54923, United States More Info
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Mukwonago Wisconsin, 53149, United States More Info
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Neenah Wisconsin, 54956, United States More Info
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Oconomowoc Wisconsin, 53066, United States More Info
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Shawano Wisconsin, 54166, United States More Info
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Waukesha Wisconsin, 53188, United States More Info
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Waupaca Wisconsin, 54981, United States More Info
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