Guilford

Researchers are evaluating the effectiveness of niraparib compared to temozolomide (TMZ) in adults recently diagnosed with MGMT unmethylated glioblastoma multiforme (GBM). This Phase 3 trial aims to determine if niraparib can improve overall survival compared to the standard treatment with TMZ. The study will enroll 450 participants who have not received prior GBM treatment except surgery or biopsy. Participants will be randomly assigned to receive either niraparib or TMZ. Niraparib will be taken orally at 200 mg once daily starting on the first day of radiation therapy (RT) and continued daily during RT for 6-7 weeks, followed by adjuvant niraparib taken daily on Days 1 to 28 of each 28-day cycle until disease progression. The TMZ group will receive 75 mg/m2 orally once daily with RT, then after a 4-week rest, will take adjuvant TMZ 150-200 mg/m2 orally once daily on Days 1 to 5 of each 28-day cycle for up to 6 cycles or until progression. Participants will complete scheduled study visits and keep a diary recording their study medication intake. Researchers will monitor overall survival over 24 months and assess safety and efficacy throughout the study period. Participants must meet specific health and diagnostic criteria and will be closely followed for treatment effects and adverse events.

Researchers are evaluating the safety and effects of a medicine called disitamab vedotin for adults with advanced breast cancer that is hard to treat and has spread in the body. This study focuses on participants whose tumors express HER2 and who have received previous treatments for their advanced breast cancer. The goal is to understand how well this medicine works and its safety in these patients through a Phase 1b/2 open-label study. All participants will receive disitamab vedotin intravenously (IV) once every two weeks at the study clinic. They will continue the treatment until they or their doctor decide to stop, which could be due to cancer progression, side effects, or personal choice. During treatment, study visits occur every two weeks. After stopping treatment, participants will have follow-up visits about every six weeks, and later follow-up phone calls approximately every twelve weeks. Participants will undergo evaluations including assessments of their cancer response by the study doctors, following recognized criteria. The study team will monitor the participants for up to about two years or until their disease progresses or they pass away. This includes safety monitoring and collecting information about the medicine’s effects to determine its safety and effectiveness.

Researchers are evaluating whether adding immunotherapy drugs brentuximab vedotin and nivolumab to standard chemotherapy, with or without radiation, can improve survival for patients aged 5 to 60 years with newly diagnosed stage I or II classical Hodgkin lymphoma. This phase III trial compares outcomes in groups based on their early response to initial chemotherapy, aiming to understand if immunotherapy can lead to better progression-free survival and overall survival compared to standard treatment alone. The study also looks at side effects, quality of life, and long-term health impacts across different patient groups. Participants first receive two cycles of standard ABVD chemotherapy every 28 days, followed by imaging to classify their response as rapid or slow early responders and their risk status as favorable or unfavorable. Based on these factors, patients are assigned to one of eight treatment arms that include either continued standard chemotherapy regimens or immunotherapy with brentuximab vedotin and nivolumab, sometimes combined with involved-site radiation therapy. Treatments are given intravenously or orally depending on the drugs, and cycles typically last 28 days. Imaging and blood samples are collected regularly throughout the study. Throughout the trial, participants undergo frequent scans such as FDG-PET, CT, MRI, and PET-CT to monitor their disease status. Blood samples and questionnaires assess treatment effects and quality of life. After completing treatment, patients have scheduled follow-up visits every 3 months for the first year, then every 6 months for two years, and annually up to 12 years to track long-term outcomes, side effects, and survival. The main measurements focus on progression-free survival, overall survival, treatment-related adverse events, and patient-reported experiences.

Researchers are evaluating the safety and effects of the medicine PF-07248144 combined with fulvestrant for treating hormone receptor-positive, HER2-negative advanced or metastatic breast cancer. This type of breast cancer involves cancer cells that grow in response to hormones like estrogen and progesterone but have little or no HER2 protein. The study focuses on people whose breast cancer worsened after treatment with cyclin dependent kinase (CDK) 4/6 inhibitor therapy. The trial is a phase 3, open-label, randomized study comparing PF-07248144 plus fulvestrant to other therapies chosen by doctors. Participants will receive either PF-07248144 tablets daily at home in 28-day cycles combined with fulvestrant injections at the clinic, or the usual treatment of everolimus tablets with endocrine therapy (either exemestane or fulvestrant). The study doctor will help decide the hormone therapy before starting treatment. The trial compares the experiences of those taking PF-07248144 plus fulvestrant with those receiving standard treatments to assess safety and effectiveness. During the study, researchers will monitor participants for disease progression or death, using blinded independent central review based on standard tumor response criteria. The main outcome measure is progression-free survival for up to about 2 years from randomization. Regular assessments, including clinical visits for injections and evaluations, will help track treatment effects and safety throughout the study.

Researchers are evaluating an adaptive decision support system called EMBED designed to help emergency department (ED) physicians follow standard care for administering buprenorphine to patients with opioid use disorder (OUD). This stage 2, round 1 study is part of a larger project aiming to refine and optimize the EMBED clinical decision support (CDS) system to increase physician adherence to best practices. The study uses a Multiphase Optimization Strategy (MOST) framework that includes preparation, optimization, and confirmation phases, focusing now on improving the usability of the CDS interface and workflow. The current optimization phase involves serial rapid-cycle randomized testing with five planned rounds of A-B testing. In this first round, investigators compare nurse prompts for completing the Clinical Opioid Withdrawal Scale (COWS) placed as either required or optional documentation during patient encounters. The refined EMBED CDS system is tested against different configurations to reduce user errors, task disruption, and abandonment. Future rounds will build upon insights gained, and the final evaluation phase will compare the optimized CDS package to the original EMBED system regarding initiation of buprenorphine treatment in the ED. Participants are emergency department patients aged 18 years or older with moderate to severe opioid use disorder. Researchers monitor how often the COWS assessment is completed during encounters up to three months. The study includes assessments of workflow, user interaction with nurse prompts, and documentation completion. Safety and treatment monitoring are embedded within the clinical workflow, with data collected through the electronic health record system. The study does not have open enrollment and focuses on improving clinical decision support usability to enhance treatment initiation for OUD in emergency settings.

Researchers are evaluating improvements to the EMBED clinical decision support (CDS) system to increase the number of emergency department (ED) physicians following standard care for giving buprenorphine to patients with opioid use disorder. The study uses a Multiphase Optimization Strategy (MOST) framework with preparation, optimization, and confirmatory phases to refine and optimize this user-centered CDS tool that integrates into electronic health records and supports diagnosis, withdrawal assessment, patient motivation, and workflow automation. The optimization phase has two stages. Stage 1 involves a 2x2x2 factorial trial testing sustainable implementation strategies such as nurse prompts for withdrawal assessment, clinician prompts to use the CDS, and patient-facing materials to promote equity and readiness for treatment. Stage 2 focuses on improving CDS usability through serial randomized testing to reduce user errors, workflow disruption, and abandonment. The evaluation phase is a randomized trial comparing the optimized intervention package to the original EMBED CDS on rates of buprenorphine initiation in the ED. Participants are emergency department patients aged 18 or older with moderate to severe opioid use disorder. Researchers will measure outcomes including the proportion of ED encounters where buprenorphine is started at discharge and clinician engagement with the CDS over up to 18 months. The study tracks usability, uptake, and effectiveness of the optimized CDS package, aiming to support better clinical decision-making and treatment initiation for opioid use disorder during emergency care.

Researchers are investigating the addition of an immunotherapy drug called durvalumab to standard chemotherapy treatment in patients with MammaPrint High 2 Risk (MP2) stage II-III hormone receptor positive, HER2 negative breast cancer. This phase III trial aims to compare the effectiveness of usual chemotherapy alone versus chemotherapy combined with durvalumab. Immunotherapy with durvalumab may help the immune system attack cancer cells and prevent tumor growth and spread, while chemotherapy drugs like paclitaxel, doxorubicin, and cyclophosphamide work to stop cancer cells from growing or dividing. Previous studies suggest patients with an MP2 result might respond better to this combined treatment approach. Participants first undergo MammaPrint testing to confirm MP2 status before randomization into two groups. One group receives paclitaxel intravenously on days 1 and 8 every 14 days for 6 cycles, followed by doxorubicin and cyclophosphamide intravenously on day 1 every 14 days for 4 cycles. The other group receives the same chemotherapy schedule plus durvalumab intravenously over 60 minutes on specified cycles during both chemotherapy phases. Mammography is performed during screening, and optional tissue and blood samples are collected for future studies. Throughout the study, participants are monitored through various assessments including imaging, physical exams, laboratory tests, and quality of life questionnaires focusing on fatigue and physical and mental health. Researchers track breast cancer event-free survival and other outcomes such as treatment side effects and response rates. After completing treatment, patients are followed for up to 10 years or until death to evaluate long-term outcomes and safety.

Researchers are evaluating the addition of nivolumab to the usual treatment of paclitaxel and ramucirumab in patients with advanced or locally unresectable stomach or esophageal adenocarcinoma. This phase II/III trial aims to determine if adding nivolumab improves progression-free survival and overall survival compared to paclitaxel and ramucirumab alone. The study also assesses response rates, disease control, safety, tolerability, and quality of life in participants with PD-L1 CPS 21 1 advanced gastric or esophageal cancer. Participants are randomly assigned to one of two treatment groups. The first group receives nivolumab IV on day 1 of each 28-day cycle, ramucirumab IV on days 1 and 15, and paclitaxel IV on days 1, 8, and 15. The second group receives ramucirumab IV on days 1 and 15 and paclitaxel IV on days 1, 8, and 15 of each cycle. Treatment continues every 28 days until disease progression or unacceptable side effects occur. Optional blood samples may be collected during the study. Imaging with CT and MRI is performed throughout. Participants undergo scans and assessments at baseline and during treatment to monitor cancer progression and treatment effects. They also complete questionnaires on quality of life and symptoms. After treatment ends, participants are followed up at 30, 60, and 90 days and then every 6 months for up to 3 years. Researchers measure progression-free survival and overall survival as primary outcomes, along with other safety and patient-reported measures.

Researchers are evaluating the effects of adding cemiplimab, an immunotherapy drug that blocks the PD-1 pathway to help the immune system attack tumor cells, to the usual treatment of docetaxel and ramucirumab in patients with stage IV or recurrent non-small cell lung cancer. This phase II/III Expanded Lung-MAP trial compares cemiplimab combined with docetaxel and ramucirumab versus docetaxel and ramucirumab alone, aiming to improve treatment outcomes in patients who previously received platinum chemotherapy and immunotherapy but developed resistance or disease progression. Participants are randomly assigned to one of two treatment arms. In Arm I, patients receive dexamethasone orally twice daily on days 0-2, ramucirumab and docetaxel intravenously on day 1 of each 21-day cycle. In Arm II, patients receive the same treatments plus cemiplimab intravenously on day 1 of each cycle. Treatment cycles continue every 21 days until disease progression or unacceptable side effects occur. Throughout the study, patients undergo regular blood sample collection and imaging scans such as CT or MRI to monitor disease status. During the study, participants are closely monitored with scans, blood tests, and physical exams to assess overall survival and other outcomes like progression-free survival, response rates, and treatment safety. Researchers also collect blood samples for future molecular studies. After completing treatment, patients are followed up every 3 to 6 months for up to 3 years to track long-term survival and health status. The study measures overall survival from randomization to death from any cause, assessed up to 3 years.

Researchers are investigating treatments for people with newly diagnosed Stage I HER2-positive invasive breast cancer. This phase II study compares two different combinations of HER2-targeted therapies after surgery to evaluate their effects and side effects. The study focuses on whether trastuzumab-emtansine (T-DM1) followed by subcutaneous trastuzumab has fewer side effects than the standard treatment of paclitaxel combined with subcutaneous trastuzumab, while also looking at long-term benefits and disease-free survival. Participants will be randomly assigned to one of two groups. One group will receive trastuzumab-emtansine (T-DM1) through intravenous infusion followed by subcutaneous trastuzumab injections. The other group will receive paclitaxel through intravenous infusion combined with subcutaneous trastuzumab injections. Treatments will be given for a total of one year. T-DM1 is a targeted therapy that combines an antibody with chemotherapy to directly attack cancer cells. During the study, participants will undergo screening, laboratory tests, and regular follow-up visits over five years after treatment ends. Researchers will monitor side effects during the first 18 weeks of treatment and measure disease-free survival up to 72 months. The study includes assessments of heart function, blood tests, and collection of tumor tissue for research. About 500 people are expected to participate.