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.

Crizotinib in Treating Patients With Stage IB-IIIA Non-small Cell Lung Cancer That Has Been Removed by Surgery and ALK Fusion Mutations (An ALCHEMIST Treatment Trial)

This randomized phase III trial studies how well crizotinib works in treating patients with stage IB-IIIA non-small cell lung cancer that has been removed by surgery and has a mutation in a protein called anaplastic lymphoma kinase (ALK). Mutations, or changes, in ALK can make it very active and important for tumor cell growth and progression. Crizotinib may stop the growth of tumor cells by blocking the ALK protein from working. Crizotinib may be an effective treatment for patients with non-small cell lung cancer and an ALK fusion mutation.

Stanford is currently accepting patients for this trial.

Intervention(s):

  • drug: Crizotinib
  • other: Laboratory Biomarker Analysis
  • other: Clinical Observation

Eligibility


Inclusion Criteria:

   - Patients must have undergone complete surgical resection of their stage IB (>= 4 cm),
   II, or non-squamous IIIA NSCLC per American Joint Committee on Cancer (AJCC) 7th
   edition and have had negative margins; N3 disease is not allowed

   - Baseline chest computed tomography (CT) with or without contrast must be performed
   within 6 months (180 days) prior to randomization to ensure no evidence of disease; if
   clinically indicated additional imaging studies must be performed to rule out
   metastatic disease

   - Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1

   - Patients must be registered to the ALCHEMIST-SCREEN (ALLIANCE A151216) trial prior to
   randomization

   - Positive for translocation or inversion events involving the ALK gene locus (e.g.
   resulting in echinoderm microtubule associated protein like 4 [EML4]-ALK fusion) as
   determined by the Vysis Break Point fluorescence in situ hybridization (FISH) assay
   and defined by an increase in the distance between 5? and 3? ALK probes or the loss of
   the 5? probe; this must have been performed:

      - By a local Clinical Laboratory Improvement Amendments (CLIA) certified
      laboratory: report must indicate the results as well as the CLIA number of the
      laboratory which performed the assay; tissue must be available for submission for
      central, retrospective confirmation of the ALK fusion status via ALCHEMIST-SCREEN
      (ALLIANCE A151216) OR

      - Patient registered to and the ALK fusion status performed centrally on the
      ALCHEMIST-SCREEN (ALLIANCE A151216)

   - Women must not be pregnant or breast-feeding

   - All females of childbearing potential must have a blood or urine pregnancy test within
   72 hours prior to randomization to rule out pregnancy; a female of childbearing
   potential is any woman, regardless of sexual orientation or whether they have
   undergone tubal ligation, who meets the following criteria: 1) has not undergone a
   hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal
   for at least 24 consecutive months (i.e., has had menses at any time in the preceding
   24 consecutive months)

   - Women of childbearing potential and sexually active males must be strongly advised to
   practice abstinence or use an accepted and effective method of contraception

   - Patients must NOT have uncontrolled intercurrent illness including, but not limited
   to, serious ongoing or active infection, symptomatic congestive heart failure,
   unstable angina pectoris, uncontrolled cardiac arrhythmia, or psychiatric
   illness/social situations that would limit compliance with study requirements

   - No known interstitial fibrosis or interstitial lung disease

   - No prior treatment with crizotinib or another ALK inhibitor

   - No ongoing cardiac dysrhythmias of grade >= 2 National Cancer Institute (NCI) Common
   Terminology Criteria for Adverse Events (CTCAE) version 4.0, uncontrolled atrial
   fibrillation (any grade), or corrected QT (QTc) interval > 470 msec

   - No use of medications, herbals, or foods that are known potent cytochrome P450,
   subfamily 3A, polypeptide 4 (CYP3A4) inhibitors or inducers, included but not limited
   to those outlined

   - Patients must be adequately recovered from surgery at the time of randomization

   - The minimum time requirement between date of surgery and randomization must be at
   least 4 weeks (28 days)

   - The maximum time requirement between surgery and randomization must be:

      - 3 months (90 days) if no adjuvant chemotherapy was administered

      - 8 months (240 days) if adjuvant chemotherapy was administered

      - 10 months (300 days) if adjuvant chemotherapy and radiation therapy were
      administered

   - Patients must have completed any prior adjuvant chemotherapy or radiation therapy 2 or
   more weeks (6 or more weeks for mitomycin and nitrosoureas) prior to randomization and
   be adequately recovered at the time of randomization

      - NOTE: Patients taking low dose methotrexate for non-malignant conditions and
      other cytotoxic agents for non-malignant conditions are allowed to continue
      treatment while on study

      - NOTE: Neo-adjuvant chemotherapy or radiation therapy for the resected lung cancer
      is not permitted

   - Serum aspartate aminotransferase (AST) and serum alanine aminotransferase (ALT) =< 2.5
   x upper limit of normal (ULN)

   - Total serum bilirubin =< 1.5 x ULN

   - Absolute neutrophil count (ANC) >= 1500/mm^3

   - Platelets >= 30,000/mm^3

   - Hemoglobin >= 8.0 g/dL

   - Serum creatinine =< 2 x ULN

   - Prior to randomization patients with any non-hematologic toxicity from surgery,
   chemotherapy, or radiation must have recovered to grade =< 1 with the exception of
   alopecia and the criteria outlined

   - Patients must not have any history of locally advanced or metastatic cancer requiring
   systemic therapy within 5 years from randomization, with the exception of in-situ
   carcinomas and non-melanoma skin cancer; patients must have no previous primary lung
   cancer diagnosed concurrently or within the past 2 years

   - Patients may not be receiving any other investigational agents while on study

Ages Eligible for Study

18 Years - N/A

Genders Eligible for Study

All

Now accepting new patients

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Lisa Zhou
650-736-4112
I'm interested

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.