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 Tilsotolimod in Combo With Ipilimumab vs Ipilimumab Alone in Subjects With Anti-PD-1 Refractory Melanoma
A Phase 3 comparison of ipilimumab with and without IMO-2125 in advanced melanoma
Stanford is currently not accepting patients for this trial.
Stanford Investigator(s):
Intervention(s):
- drug: Ipilimumab
- drug: Tilsotolimod with Ipilimumab
Eligibility
Inclusion Criteria:
1. Subjects must be willing and able to sign the informed consent and comply with the
study protocol.
2. Subjects must be ≥18 years of age.
3. Subjects must have histologically confirmed metastatic melanoma with measurable (by
RECIST v1.1), stage III (lymph node or in transit lesions) or stage IVA, IVB, or IVC
disease that is accessible for injection.
4. Patients must have confirmed progression during or after treatment with a PD-1
inhibitor (cannot be part of a bi-specific antibody) e.g. nivolumab or pembrolizumab.
Confirmed progression is defined as:
- Radiological progression (confirmed at least 4 weeks after the initial scan
showing PD); or
- (For progression based solely on worsening of non-target or new, non-measurable
disease) confirmation by an additional scan at least 4 weeks after the initial
scan unless it is accompanied by correlative symptoms.
In addition, all the following must hold:
1. No intervening anti-cancer therapy between the last course of PD-1 inhibitor
treatment and the first dose of study treatment is allowed except for local
measures (e.g., surgical excision or biopsy, focal radiation therapy).
2. The interval between last PD-1 inhibitor and start of study treatment should be
at least 21 days with no residual anti-PD-1-related immune toxicities in excess
of Grade 1 severity.
3. If BRAF mutation status is unknown, before randomization the subject must have
BRAF testing performed using an approved assay method.
4. Patients with BRAF-positive tumor(s) are eligible for the study if they received
prior treatment with a BRAF inhibitor (alone of in combination with a MEK
inhibitor) or declined targeted therapy.
5. Patients must have Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 1.
6. Patients must meet the following laboratory criteria:
1. Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L (1500/mm3)
2. Platelet count ≥ 75 x 10^9/L (75,000/mm3)
3. Hemoglobin ≥ 8.0 g/dL (4.96 mmol/L)
4. Serum creatinine ≤ 1.5 x upper limit of normal (ULN) or calculated creatinine
clearance ≥ 60 mL/minute
5. Aspartate aminotransferase (AST) ≤ 2.5 x ULN; alanine aminotransferase (ALT) ≤
2.5 x ULN; AST/ALT < 5 x ULN if liver involvement
6. Serum bilirubin ≤ 1.5 x ULN, except in subjects with Gilbert's Syndrome who must
have a total bilirubin < 3 mg/dL
7. Women of childbearing potential (WOCBP) and men must agree to use effective
contraceptive methods from Screening throughout the study treatment period and until
at least 90 days after the last dose of either ipilimumab or IMO-2125, whichever is
later.
8. WOCBP must have a negative pregnancy test (serum or urine).
Exclusion Criteria:
1. Ocular melanoma.
2. Prior therapy with a toll-like receptor (TLR) agonist, excluding topical agents.
3. Prior ipilimumab treatment with the exception of adjuvant treatment completed ≥6
months prior to enrollment
4. Systemic treatment with interferon (IFN)-α within the previous 6 months.
5. Known hypersensitivity to any oligodeoxynucleotide.
6. Active autoimmune disease requiring disease-modifying therapy at the time of
Screening.
7. Subjects requiring systemic steroid therapy receiving >10 mg/day of prednisone (or
equivalent) for the 2 weeks preceding start of study.
8. Subjects with another primary malignancy that has not been in remission for at least 3
years, with the exception of non-melanoma skin cancer, curatively treated localized
prostate cancer with non-detectable prostate-specific antigen, cervical carcinoma in
situ on biopsy or a squamous intraepithelial lesion on Papanicolaou (Pap) smear, and
thyroid cancer (except anaplastic).
9. Active systemic infections requiring antibiotics
10. Active hepatitis A, B, or C infection.
11. Known diagnosis of human immunodeficiency virus (HIV) infection.
12. Women who are pregnant or breastfeeding.
13. Prior severe reaction to treatment with a human antibody that cannot be managed with
standard supportive measures.
14. Presence of known central nervous system, meningeal, or epidural metastatic disease.
However, subjects with known brain metastases are allowed if the brain metastases are
stable for ≥4 weeks before the first dose of study treatment. Stable is defined as
neurological symptoms not present or resolved to baseline, no radiologic evidence of
progression, and steroid requirement of prednisone ≤10 mg/day or equivalent
15. Impaired cardiac function or clinically significant cardiac disease.
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
Phuong Pham
650-725-9810
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.