Sunshine

Researchers are investigating treatment options for patients diagnosed with advanced non-small cell lung cancer NSCLC who have a poor prognosis with current therapies. This pilot study aims to evaluate the safety and feasibility of adding stereotactic ablative radiotherapy SABR to the lung tumor before standard systemic therapy in these patients. The study hopes to determine if radiotherapy to the primary lung tumor can be safely delivered before the third cycle of standard systemic therapy and whether this approach is feasible for a larger phase III trial. Participants will be randomly assigned to one of two groups one receiving standard of care SoC systemic therapy alone, and the other receiving radiotherapy to the lung primary tumor prior to the third cycle of SoC systemic therapy. Radiotherapy doses vary based on tumor size and location, and systemic therapy includes chemoimmunotherapy regimens such as Pembrolizumab combined with Carboplatin, Paclitaxel, or Pemetrexed depending on the cancer subtype. Biospecimens will be collected to support future research. During the study, participants will be monitored for radiation toxicity and adverse events through scheduled visits at baseline, radiotherapy if applicable, cycle 3 of systemic therapy, and at 12 and 24 weeks after starting treatment, as well as at disease progression. CT scans will be performed every six weeks to track disease status. The primary outcome is to assess the feasibility of delivering radiotherapy as planned, while secondary outcomes include patient willingness to be randomized, safety, and progression-free survival. The total recruitment period is 18 months, with follow-up extending to 24 months.

Researchers are evaluating treatments for community-acquired pneumonia CAP, especially in patients admitted to intensive care units ICUs. This trial also adapts to study treatments for respiratory pandemics like COVID-19. The goal is to determine which treatment strategies improve outcomes for patients with severe pneumonia, using a flexible, ongoing approach that can test multiple therapies simultaneously and update as new information becomes available. Participants receive different treatment strategies based on random assignment to study groups. Treatments include various antibiotics, steroids, antivirals, immune modulators, anticoagulation methods, and ventilation strategies. Some treatment options have been closed to recruitment, reflecting the trials adaptive nature. The trial includes several domains targeting specific infections such as influenza and COVID-19, with dosing and duration guided by clinical practice and local guidelines. During the study, participants are monitored closely with assessments including survival up to 90 days, days alive without organ support in ICU, ICU and hospital length of stay, ventilator-free days, organ failure-free days, and quality of life up to 6 months. Researchers collect detailed data on patient outcomes, organ support needs, and hospital discharge status. The study runs until February 2028, with ongoing evaluation to improve pneumonia treatment strategies in ICU settings and during respiratory pandemics.