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.

Daratumumab-SC for Highly Sensitized Patients Awaiting Heart Transplantation

The purpose of this study is to test whether Daratumumab-SC, a drug that eliminates antibody-producing plasma cells, can effectively lower the level of preformed antibodies in patients awaiting heart transplantation. These preformed antibodies limit the number of donor hearts that are compatible for the patients. If Daratumumab-SC can effectively remove preformed, donor-specific antibodies, then highly allosensitized patients will have more compatible hearts available to them, potentially decreasing transplant waitlist time and reducing mortality.

Stanford is currently not accepting patients for this trial.

Intervention(s):

  • drug: Daratumumab-SC

Eligibility


Inclusion Criteria:

   - Participant is on an active list for a heart transplant.

   - Participant has a high level of allosensitization, defined as a calculated PRA (panel
   of reactive antibodies) of 50%, based on their antibody status at the time of entry
   into the study.

   - Ability to understand and willingness to sign an informed consent form prior to any
   study-related procedures.

   - Women of childbearing potential must have a negative pregnancy test at screening.

   - Both male and female patients must use effective methods of birth control, must not
   donate eggs or sperm during the course of the study and for 3 months after stopping
   daratumumab-SC.

   - Adequate bone marrow function.

   - Adequate renal function (estimated GFR greater than or equal to 15 mL/min by the
   Cockcroft-Gault formula).

Exclusion Criteria:

   - History of allergy or intolerance to daratumumab or Daratumumab-SC.

   - Prior diagnosis of myeloma or light chain amyloidosis.

   - Active infection.

   - Women who are pregnant or breastfeeding.

   - Ongoing desensitization treatment with another agent. Subjects are excluded if they
   have received:

      - a. IVIG within 30 days of enrollment.

      - b. Proteasome inhibitor within 60 days of enrollment.

      - c. Rituximab within 180 days of enrollment.

   - Any condition which could interfere with, or the treatment for which might interfere
   with, the conduct of the study or which would, in the opinion of the Investigator,
   unacceptably increase the subject's risk by participating in the study.

   - Contraindication to herpes zoster prophylaxis.

   - Known to be seropositive for human immunodeficiency virus (HIV).

   - Known to be seropositive for hepatitis B (defined by a positive test for hepatitis B
   surface antigen [HBsAg]). Subjects with resolved infection (ie, subjects who are HBsAg
   negative but positive for antibodies to hepatitis B core antigen [anti-HBc] and/or
   antibodies to hepatitis B surface antigen [anti-HBs]) must be screened using real-time
   polymerase chain reaction (PCR) measurement of hepatitis B virus (HBV) DNA levels.
   Those who are PCR positive will be excluded. EXCEPTION: Subjects with serologic
   findings suggestive of HBV vaccination (anti-HBs positivity as the only serologic
   marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV
   DNA by PCR.

   - Known to be seropositive for hepatitis C (except in the setting of a sustained
   virologic response (SVR), defined as aviremia at least 12 weeks after completion of
   antiviral therapy).

   - Known chronic obstructive pulmonary disease (COPD) with a forced expiratory volume in
   1 second (FEV1) <50% of predicted normal. Note that FEV1 testing is required for
   subjects suspected of having COPD and subjects must be excluded if FEV1 is <50% of
   predicted normal.

   - Known moderate or severe persistent asthma within the past 2 years, or uncontrolled
   asthma of any classification.

   - Known history of human immunodeficiency virus (HIV).

   - History of blood product transfusion within 60 days of enrollment, or anticipated need
   for blood product transfusion during the course of the study.

   - Moderate-severe liver dysfunction.

Ages Eligible for Study

18 Years - 75 Years

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
SPECTRUM
xxx-xxx-xxxx
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.