Stanford APBI Trial
Clinical Trial
Overview
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 Study of Atezolizumab Versus Observation as Adjuvant Therapy in Participants With High-Risk Muscle-Invasive Urothelial Carcinoma (UC) After Surgical Resection
This Phase III, open-label, randomized, multicenter study is to evaluate the efficacy and safety of adjuvant treatment with atezolizumab compared with observation in participants with muscle-invasive UC who are at high risk for recurrence following resection. Eligible participants were randomized by a 1:1 ratio into atezolizumab group or control group.
Stanford is currently not accepting patients for this trial.
Stanford Investigator(s):
Intervention(s):
- drug: Atezolizumab
Eligibility
Inclusion Criteria:
- Histologically confirmed muscle-invasive UC (also termed transitional cell carcinoma)
of the bladder or upper urinary tract (i.e., renal pelvis or ureters)
- For participants treated with prior neoadjuvant chemotherapy: tumor stage of ypT2-4a
or ypN+ (ypT2-4 or ypN+ for participants with upper urinary tract UC) and M0
- For participants who have not received prior neoadjuvant chemotherapy: tumor stage of
pT3-4a or pN+ (pT3-4 or pN+ for participants with upper urinary tract UC) and M0
- Representative formalin-fixed paraffin-embedded tumor specimens from surgical
resection (i.e., radical cystectomy, nephroureterectomy, or lymph node dissection) in
paraffin blocks (blocks preferred) or at least 15 unstained slides, with an associated
pathology report, for central testing and determined to be evaluable for tumor
programmed death-ligand 1 (PD-L1) expression prior to study enrollment
- Absence of residual disease and absence of metastasis, as confirmed by a negative
baseline computed tomography (CT) or magnetic resonance imaging scan of the pelvis,
abdomen, and chest no more than 4 weeks prior to randomization
- Full recovery from cystectomy or nephroureterectomy within 14 weeks following surgery
- Eastern Cooperative Oncology Group performance status of less than or equal to (=) 2
- Life expectancy greater than or equal to (>/=) 12 weeks
- Adequate hematologic and end-organ function
- For women who are not postmenopausal or surgically sterile: agreement to remain
abstinent or use contraceptive methods that result in a failure rate of less than (<)
1 percent (%) per year during the treatment period and for at least 5 months after the
last dose of atezolizumab
Exclusion Criteria:
- Any approved anti-cancer therapy within 3 weeks prior to initiation of study treatment
- Adjuvant chemotherapy or radiation therapy for UC following surgical resection
- Treatment with any other investigational agent or participation in another clinical
trial with therapeutic intent within 28 days or five half-lives of the drug prior to
enrollment
- Malignancies other than UC within 5 years prior to Cycle 1, Day 1
- Pregnancy or breastfeeding
- Significant cardiovascular disease
- Severe infections within 4 weeks prior to Cycle 1, Day 1
- Major surgical procedure other than for diagnosis within 28 days prior to Cycle 1, Day
1
- History of severe allergic, anaphylactic, or other hypersensitivity reactions to
chimeric or humanized antibodies or fusion proteins
- Known hypersensitivity to biopharmaceuticals produced in Chinese hamster ovary cells
or any component of the atezolizumab formulation
- History of autoimmune disease
- Prior allogeneic stem cell or solid organ transplant
- History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced
pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening
chest CT scan
- Positive test for human immunodeficiency virus and/or active hepatitis B or hepatitis
C or tuberculosis
- Administration of a live, attenuated vaccine within 4 weeks before Cycle 1 Day 1
- Prior treatment with cluster of differentiation 137 (CD137) agonists or immune
checkpoint blockade therapies, including anti-CD40, anti-cytotoxic
T-lymphocyte-associated protein 4 (anti-CTLA-4), anti-programmed death-1 (anti-PD-1),
and anti-PD-L1 therapeutic antibodies
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.