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.

A Phase II Study to Evaluate the Efficacy and Safety of Oral Ceritinib in Patients With ALK-positive NSCLC Metastatic to the Brain and/or to Leptomeninges

This was a phase II, multi-center, open-label, five-arm study in which the efficacy and safety of oral ceritinib treatment was assessed in patients with NSCLC metastatic to the brain and/or to leptomeninges harboring a confirmed ALK rearrangement, using the FDA approved Vysis ALK Break Apart FISH Probe Kit (Abbott Molecular Inc.) test and scoring algorithm (including positivity criteria). If documentation of ALK rearrangement as described above was not locally available, a test to confirm ALK rearrangement was performed by a Novartis designated central laboratory. Patients waited for the central laboratory result of the ALK rearrangement status before initiating treatment with ceritinib.

Stanford is currently not accepting patients for this trial.

Intervention(s):

  • drug: Ceritinib

Eligibility


Inclusion Criteria:

   - Histologically or cytologically confirmed diagnosis of metastatic NSCLC according to
   the 7th edition of the AJCC Cancer Staging Manual. In addition, the NSCLC must harbor
   an ALK rearrangement, as assessed using the FDA approved Vysis ALK Break Apart FISH
   Probe Kit (Abbott Molecular Inc.) test and scoring algorithm (including positivity
   criteria). If documentation of ALK rearrangement as described above was not locally
   available, a test to confirm ALK rearrangement was to be performed by a Novartis
   designated central laboratory. Patients had to wait for the central laboratory result
   of the ALK rearrangement status before initiating treatment with ceritinib

   - At least one extracranial measurable lesion as defined by RECIST 1.1. A previously
   irradiated site lesion could only be counted as a target lesion if there was clear
   sign of progression since the irradiation.

   - Patients could or could not have neurological symptoms but must have been able to
   swallow and retain oral medication.

   - Patients had to be neurologically stable within at least 1 week prior to the first
   dose of study drug.

   - Patients could have received prior chemotherapy, crizotinib (other ALK inhibitors were
   not allowed), biologic therapy or other investigational agents.

   - Patients must have recovered from all toxicities related to prior anticancer therapies
   to grade ≤ 1 (CTCAE v 4.03). Patients with any grade of alopecia were allowed to enter
   the study.

   - Patient had life expectancy ≥ 6 weeks.

   - Patient had a WHO performance status 0-2.

Patients in Arm 1 to 4 had to also meet the following inclusion criteria:

- Patients had to have active brain metastases from NSCLC, confirmed by Gadolinium-enhanced
MRI without concomitant leptomeningeal carcinomatosis. Dose of steroids had to be stable
for 5 days before the baseline brain MRI.

Patients in Arm 5 had to also meet the following inclusion criteria:

- Patients must have been diagnosed with leptomeningeal carcinomatosis.

Exclusion Criteria:

   - Patients who needed whole brain radiation to control the brain metastases. Patients
   were not eligible unless treated brain lesions were progressive or new brain lesions
   were observed since the post whole brain radiation therapy MRI.

   - Planning of any brain local treatment (including but not limited to surgery,
   stereotactic radiosurgery, whole brain radiation, intrathecal chemotherapy) following
   the administration of the first dose of study drug.

   - Patient with a concurrent malignancy or history of a malignant disease other than
   NSCLC that had been diagnosed and/or required therapy within the past 3 years.
   Exceptions to this exclusion included the following: completely resected basal cell
   and squamous cell skin cancers, and completely resected carcinoma in situ of any type.

   - Patient had impairment of GI function or GI disease that could significantly alter the
   absorption of ceritinib (e.g., ulcerative diseases, uncontrolled nausea, vomiting,
   diarrhea, or malabsorption syndrome).

   - Patient was receiving unstable or increasing doses of corticosteroids.

   - Patient had other severe, acute, or chronic medical conditions including uncontrolled
   diabetes mellitus or psychiatric conditions or laboratory abnormalities that in the
   opinion of the investigator could increase the risk associated with study
   participation, or that could interfere with the interpretation of study results.

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
CCTO
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.