Stanford APBI Trial

Clinical Trial

Overview

Intraoperative Radiotherapy (IORT) is one of three approaches used for accelerated, partial breast irradiation at Stanford.

Accelerated, partial breast irradiation (APBI) is a potentially important new way to incorporate radiotherapy in the treatment of women with breast cancer.

Currently, women with breast cancer who undergo a lumpectomy  typically have 6 1/2 weeks of radiation to the entire affected breast after surgery.  Accelerated, partial breast irradiation (APBI) changes this approach in two ways. It shortens the treatment time from 6 1/2 weeks to between 1 to 5 days, and reduces the treatment area from the entire breast to the area of the breast immediately around the lumpectomy site. This is the part of the breast where most cancers are likely to recur.

In many ways APBI is to current whole breast radiotherapy what a lumpectomy is to a mastectomy. The goal is to use a less invasive more focused treatment without compromising survival.

APBI has been used in limited trials in several hundred patients over the last 10 years. These trials show that in properly selected breast cancer patients APBI  worked just as well as whole breast radiotherapy. In the initial studies, investigators relied on the placement of many catheters in the breast tissue (interstial brachytherapy). Newer techniques will hopefully provide the same good results but will deliver the radiation in faster and/or more convenient ways. This could increase interest in APBI and allow additional clinical trials that test the safety and effectiveness of the newer approaches. These newer approaches could increase quality of life for many women with breast cancer.

Investigators at Stanford University Medical Center are currently offering an IRB approved clinical trial that uses three new approaches for APBI. These three approaches are:

    Intraoperative Radiotherapy (IORT) - 1 day

    Intracavitary Brachytherapy (MammoSite) - 5 days

    3-D Conformal/External Beam Radiotherapy - 5 days

The Stanford trial is led by Dr. Frederick Dirbas, Assistant Professor of Surgery, and by Dr. Donald Goffinet, Professor of Radiation Oncology. For further information about the trial please contact Janelle Maxwell or Triona Dolphin at (650) 498-7740.

Temsirolimus With or Without Megestrol Acetate and Tamoxifen Citrate in Treating Patients With Advanced, Persistent, or Recurrent Endometrial Cancer

This randomized phase II trial studies how well temsirolimus with or without megestrol acetate and tamoxifen citrate works in treating patients with endometrial cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment, has returned after a period of improvement, or is persistent. Temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Estrogen can cause the growth of endometrial cancer cells. Hormone therapy using megestrol acetate and tamoxifen citrate may fight endometrial cancer by blocking the use of estrogen by the tumor cells. It is not yet known whether temsirolimus is more effective when given alone or together with megestrol acetate and tamoxifen citrate in treating endometrial cancer.

Stanford is currently not accepting patients for this trial.

Stanford Investigator(s):

Intervention(s):

  • drug: megestrol acetate
  • drug: tamoxifen citrate
  • drug: temsirolimus
  • other: laboratory biomarker analysis

Eligibility


Inclusion Criteria:

   - Patients must have histologically confirmed advanced (International Federation of
   Gynecologists and Obstetricians [FIGO] stage III or IV), persistent, or recurrent
   endometrial carcinoma, which is not likely to be curable by surgery or radiotherapy;
   histologic documentation of the recurrence is not required

   - All patients must have measurable disease; measurable disease is defined as at least
   one lesion that can be accurately measured in at least one dimension (longest
   dimension to be recorded); each lesion must be >= 20 mm when measured by conventional
   techniques, including palpation, plain x-ray, computed tomography (CT), and magnetic
   resonance imaging (MRI), or >= 10 mm when measured by spiral CT

   - Patients must have at least one "target lesion" to be used to assess response, as
   defined by Response Evaluation Criteria In Solid Tumors (RECIST); tumors within a
   previously irradiated field will be designated as "non-target" lesions unless
   progression is documented

   - Prior chemoradiotherapy for a pelvic recurrence is permitted; prior chemotherapy in
   the adjuvant setting for stage I, II, or III disease is permitted

      - Note: no prior chemotherapy in the setting of stage IV disease is permitted
      unless the patient was without evidence of disease at the completion of
      chemotherapy and had at least six months of progression-free survival since the
      completion of chemotherapy

      - Regardless of circumstances, no more than one prior chemotherapy regimen
      (including chemoradiotherapy) is permitted

   - Patient must be able to take p.o. medications

   - Performance status must be 0-2

   - Absolute neutrophil count >= 1,500/mcL

   - Platelets >= 100,000/mcL

   - Total bilirubin within normal institutional limits

   - Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) =<
   2.5 times institutional upper limit of normal v 3.0 (=< 5 times upper limit of normal
   [ULN] for subjects with liver metastases)

   - Alkaline phosphatase =< 2.5 times institutional upper limit of normal v 3.0 (=< 5
   times ULN for subjects with liver metastases)

   - Creatinine =< 1.5 times normal institutional upper limit of normal

   - Cholesterol =< 350 mg/dL (fasting)

   - Triglycerides =< 400 mg/dL (fasting)

   - Albumin >= 3.0 mg/dL

   - At least 4 weeks must have elapsed since the patient underwent any major surgery
   (e.g., major: hysterectomy, resection of a lung nodule-minor: a Port-A-Cath placement)

   - Patients who have met the pre-entry requirements

   - Patients must have signed an approved informed consent including Health Insurance
   Portability and Accountability Act (HIPAA) authorization

Exclusion Criteria:

   - Patients with Gynecologic Oncology Group (GOG) performance status of 3 or 4

   - Patients cannot be receiving enzyme-inducing antiepileptic drugs (EIAEDs; e.g.,
   phenytoin, carbamazepine, phenobarbital) nor any other cytochrome P450, family 3,
   subfamily A, polypeptide 4 (CYP3A4) inducer such as rifampin or St. John's wort, as
   these may decrease temsirolimus levels; use of agents that potently inhibit CYP3A (and
   hence may raise temsirolimus levels), such as ketoconazole, is discouraged, but not
   specifically prohibited; the appropriateness of use of such agents is left to
   physician discretion

      - All concomitant medications must be recorded at baseline

   - Patients on maintenance corticosteroids are ineligible with the exception of short
   term use (fewer than 5 days)

   - Patients known to have congestive heart failure; patients with baseline requirement
   for oxygen; patients with serious concomitant illness that, in the opinion of the
   treating physician, will place patient at unreasonable risk from therapy on this
   protocol

   - Patients with a history of unprovoked deep vein thrombosis (DVT) or pulmonary embolism
   (PE), unless patient is maintained on anticoagulation for the duration of the trial;
   while the exact definition of "provoked" is left to the treating physician, a DVT in
   the setting of pelvic surgery or trauma would be considered "provoked"

   - Women of child-bearing potential must have a negative pregnancy test prior to
   treatment on study; breastfeeding should be discontinued if the mother is treated with
   temsirolimus

      - Women of child-bearing potential and men must agree to use adequate contraception
      (barrier method of birth control or abstinence; oral contraceptives [also known
      as "the pill"] are not acceptable) prior to study entry and for the duration of
      study participation; should a woman become pregnant or suspect she is pregnant
      while participating in this study, she should inform her treating physician
      immediately

   - Patients with a concomitant invasive malignancy or a history of other invasive
   malignancies, with the exception of non-melanoma skin cancer, are excluded if there is
   any evidence of other malignancy being present within the past five years; patients
   are also excluded if their previous cancer treatment contraindicates this protocol
   therapy

   - Patients who have received hormonal therapy or biologic therapy as treatment for
   endometrial carcinoma

   - Patients who have received chemotherapy directed at metastatic or recurrent
   endometrial carcinoma

Ages Eligible for Study

N/A - N/A

Genders Eligible for Study

Female

Not currently accepting new patients for this trial

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Cancer Clinical Trials Office
650-498-7061
Not Recruiting

What's New

Stanford’s APBI trial has now been expanded to include women with  ductal carcinoma in situ (DCIS). Please call 650-498-7740 for more information.