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.

Bone, Immunologic, and Virologic Effects of a Antiretroviral Regimen

The main purpose of this study was to compare the effects on bones of the following two drug combinations:

- maraviroc (MVC), emtricitabine (FTC), plus darunavir/ritonavir (DRV/r)

- tenofovir (TDF) plus emtricitabine (FTC) plus darunavir/ritonavir (DRV/r)

Additional study objectives were the following:

- To see how the drug combinations affect the brain and kidneys.

- To see how well the drug combinations lower the HIV viral load.

- To see how safe the drug combinations are, how well people are able to take the study drug combinations, and how well their immune systems respond to the study drugs.

Stanford is currently not accepting patients for this trial.

Stanford Investigator(s):

Intervention(s):

  • drug: Tenofovir disoproxil fumarate
  • drug: Placebo for Tenofovir disoproxil fumarate
  • drug: Placebo for Maraviroc
  • drug: emtricitabine
  • drug: darunavir
  • drug: ritonavir
  • drug: Darunavir
  • drug: Ritonavir
  • drug: Tenofovir disoproxil fumarate
  • drug: Emtricitabine
  • drug: Placebo for Tenofovir disoproxil fumarate
  • drug: Placebo for Maraviroc
  • drug: Maraviroc

Eligibility


Inclusion Criteria:

   - HIV-1 infection

   - No evidence of exclusionary resistance mutations defined as evidence of any major NRTI
   mutation according to the current IAS list of HIV-1 Resistance Mutations Associated
   with Drug Resistance, or any DRV RAMs (refer to the A5303 PSWP for a list of these
   mutations) on any genotype; or evidence of significant NRTI or DRV resistance on any
   phenotype performed at any time prior to study entry. NNRTI-associated resistance
   mutations were not exclusionary.

   - ARV drug-naïve, defined as    in the instances defined in section 4.1.3 of the protocol.

   - R5-only tropism based on Trofile testing performed within 90 days prior to study
   entry.

   - Screening HIV-1 RNA >1000 copies/mL obtained within 90 days prior to study entry by
   any FDA-approved test for quantifying HIV-1 RNA at any laboratory that has a CLIA
   certification or its equivalent.

   - Known hepatitis C virus (HCV) antibody status (performed at any laboratory that had a
   CLIA certification or its equivalent).

   - Certain laboratory values obtained within 60 days prior to study entry, as defined in
   section 4.1.7 of the protocol.

   - For women of reproductive potential, negative serum or urine pregnancy test with a
   sensitivity of ≤25 mIU/mL within 72 hours prior to study entry.

   - Female subjects of reproductive potential, who were participating in sexual activity
   that could lead to pregnancy, must agree to use at least one reliable method of
   contraception (as defined in section 4.1.9.1 of the protocol) while receiving the
   study drugs and for 6 weeks after stopping the medications.

   - Female subjects who were not of reproductive potential or whose male partner(s) had
   azoospermia were eligible to take study drugs without the use of contraceptives.

   - Ability and willingness of subject or legal guardian/representative to give written
   informed consent.

   - Willingness to undergo neuropsychological testing.

   - DXA scan performed after confirmation of the subject's eligibility by Trofile testing
   but no more than 4 weeks prior to randomization.

Exclusion Criteria:

   - Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), HIV vaccine,
   systemic cytotoxic chemotherapy, or investigational therapy within 30 days prior to
   study entry.

   - New use of hormonal therapies within 6 months prior to study entry. (Stable therapy
   for ≥6 months was permitted.)

   - New use of oral contraceptive pills (OCPs) in the past 3 months. (Stable therapy for
   ≥3 months was permitted.)

   - Any oral, intravenous, or inhaled steroids within 30 days prior to study entry.
   (Intranasal steroids and topical corticosteroids were allowed.)

   - Known allergy/sensitivity to study drugs or their formulations. (A history of sulfa
   allergy was not an exclusionary condition.)

   - Known hypersensitivity to soy lecithin.

   - Serious illness requiring systemic treatment and/or hospitalization until subject
   either completes therapy or was clinically stable on therapy, in the opinion of the
   site investigator, for at least 7 days prior to study entry. (Oral candidiasis,
   vaginal candidiasis, mucocutaneous herpes simplex, and other minor illnesses (as
   judged by the site investigator) were not exclusionary conditions.)

   - Requirement for any current medications that were prohibited with any study drugs.
   (Prohibited medications must be discontinued at least 30 days prior to entry. Refer to
   the A5303 PSWP for a list of prohibited medications.)

   - The presence of decompensated cirrhosis.

   - A history of or current, active HBV infection defined as positive hepatitis B surface
   antigen test (or positive HBV DNA in subjects with isolated HBcAb positivity, defined
   as negative HBsAg, negative HBsAb, and positive HBcAb) at screening.

   - Current or prior use of biphosphonates, teriparatide, raloxifene, or denosumab.

   - Weight >300 lbs (exceeds weight limit of DXA scanners).

   - History after 18 years of age of fracture of the spine, hip, wrist, or other site
   thought to be related to osteoporosis or bone fragility.

   - Currently breastfeeding.

   - Any active psychiatric illness including schizophrenia, severe depression, or severe
   bipolar affective disorder that, in the opinion of the investigator, could confound
   the analysis of the neurological examination or neuropsychological test results.

   - Active drug or alcohol abuse that, in the investigator's opinion, could prevent
   compliance with study procedures or confound the analysis of study endpoints.

   - Active brain infection (except for HIV-1), fungal meningitis, toxoplasmosis, central
   nervous system (CNS) lymphoma, brain neoplasm, or space-occupying brain lesion
   requiring acute or chronic therapy.

Ages Eligible for Study

18 Years - N/A

Genders Eligible for Study

All

Not currently accepting new patients for this trial

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Debbie Slamowitz, RN, BSN, ACRN
(650) 723-2804
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.