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.

Donor-Derived Anti-CD33 CAR T Cell Therapy (VCAR33) in Patients With Relapsed or Refractory AML After Allogeneic Hematopoietic Cell Transplant

This is a Phase 1/2, multicenter, open-label, first-in-human (FIH) study of donor-derived anti-CD33 Chimeric Antigen Receptor (CAR) T cell therapy (VCAR33) in patients with relapsed or refractory Acute Myeloid Leukemia (AML) after human leukocyte antigen (HLA)-matched allogeneic hematopoietic cell transplant (alloHCT).

Stanford is currently accepting patients for this trial.

Stanford Investigator(s):

Intervention(s):

  • biological: VCAR33

Eligibility


Inclusion Criteria:

   1. Patients aged ≥18 years

   2. Patients must have CD33+ AML in relapse or refractory after alloHCT

   3. Patients must be a recipient of an 8/8 (A, B, C, DRB1) HLA-matched related or
   unrelated donor alloHCT. Patients previously transplanted with VOR33 in the VBP101
   study who have R/R AML may also be considered.

   4. Disease status at the time of enrollment:

      1. Arm A/Morphologic disease: Defined as ≥ 5% blasts (bone marrow) post-HCT

      2. Arm B/MRD positive: < 5% blasts (bone marrow) with minimal residual disease of at
      least 0.1% CD33+ leukemia cells by flow cytometry

   5. Performance status: ECOG 0 or 1

   6. Patient must have adequate organ function as defined by:

      1. Cardiac: Left ventricular ejection fraction (LVEF) ≥ 45% or fractional shortening
      ≥ 28%

      2. Pulmonary: Baseline oxygen saturation > 92% on room air at rest

      3. Hepatic: Total bilirubin < 3x institutional upper limit of normal (ULN) (except
      in case of patients with documented Gilbert's disease < 5x ULN) and aspartate
      aminotransferase (AST/SGOT)/alanine aminotransferase (ALT/SGPT) < 5x
      institutional ULN

      4. Renal: Serum creatinine must be ≤ 1.2x institutional ULN or creatinine clearance
      ≥ 60 mL/min for patients with creatinine levels above institutional normal

   7. Original alloHCT donor is available and willing to undergo apheresis

Exclusion Criteria:

   1. Patients who have undergone more than one alloHCT

   2. Patients who have undergone alloHCT with a mismatched unrelated donor, haploidentical
   donor, or with umbilical cord blood as the stem cell source

   3. Patients who will be less than 100 days post-alloHCT at the time of VCAR33 infusion.

   4. Patients with any history of Grade III or IV acute GVHD or severe chronic GVHD unless
   approved by the Sponsor Medical Monitor

   5. Patients with evidence of ongoing active acute or chronic GVHD and are taking systemic
   immunosuppressive agents (> 10 mg daily of prednisone equivalent or other
   GVHD-directed treatment, including extracorporeal photopheresis). Patients with Grade
   1 acute GVHD limited to the skin or mild chronic GVHD limited to the eyes, mouth, or
   skin controlled with only topical therapy are eligible.

   6. Patients with active CNS disease. A lumbar puncture is not required to exclude CNS
   disease in the absence of clinical signs or symptoms suggesting CNS disease.

   7. Patients with the following prior therapy:

      1. DLI within 28 days prior to enrollment

      2. Prior treatment with any CAR T cell therapy product

   8. Patients with active or uncontrolled viral, bacterial, or fungal infection

   9. Patients with a history of a human immunodeficiency virus (HIV) infection or acute or
   chronic active hepatitis B or C infection

10. Patients with a history of malignancy other than nonmelanoma skin cancer or carcinoma
   in situ (e.g., cervix, bladder, or breast) unless disease free for at least 3 years
   after the last definitive therapy

11. Female patients of childbearing potential who are pregnant or breastfeeding

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
Alyssa Michelle Kanegai
650-736-1596
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.