Bonne Terre

Researchers are evaluating the effectiveness of active surveillance and chemotherapy treatments in pediatric, adolescent, and adult patients with low risk and standard risk germ cell tumors. This phase III trial focuses on monitoring patients after tumor removal and comparing the outcomes of carboplatin-based versus cisplatin-based chemotherapy regimens. The study aims to maintain high overall survival rates for low risk patients and to compare event-free survival between the two chemotherapy options in standard risk patients. Additional objectives include assessing side effects such as hearing loss and neuropathy, and exploring tumor marker changes and other biological measures related to treatment outcomes. Patients with low risk stage I germ cell tumors undergo surgery followed by observation, with the option to transfer to standard risk treatment if the tumor recurs. Those with standard risk tumors are randomly assigned to one of four chemotherapy regimens combining bleomycin, etoposide, carboplatin, or cisplatin. Treatments are given intravenously on specific schedules every 21 days for up to 3 or 4 cycles, depending on the group. Throughout the trial, patients receive imaging scans, blood tests, tumor biopsies if needed, and pulmonary function tests to monitor treatment response and side effects. Participants are closely followed after treatment completion with regular visits every 2 months for the first year, then less frequently up to 10 years. Researchers collect data through imaging, blood samples, lung tests, and questionnaires to measure survival, disease recurrence, and side effects like hearing loss. The study also includes exploratory analyses of tumor markers and patient-reported outcomes to better understand treatment impacts and improve future care for germ cell tumor patients.

Researchers are collecting and storing tissue and blood samples from patients with various types of cancer to create models that help study cancer and test new treatments. This observational study focuses on patients with confirmed or suspected cancer diagnoses, including solid tumors and hematologic malignancies, to improve laboratory research and drug development. The study involves obtaining tumor tissue and blood samples during medically necessary procedures related to the patient's cancer treatment. These samples will be preserved using xenograft models (transplantation into another species) or cell cultures for future analysis. Sample collection is timed carefully around treatment cycles to ensure tissue viability. Participants will undergo tissue and blood collection as part of their clinical care, with no additional procedures solely for the study. Researchers will review pathology and flow cytometry reports to confirm viable cancer cells in the samples. The main outcome is the successful procurement and storage of these biological materials for research over a follow-up period of up to five years.

Researchers are evaluating a screening and multi-sub-study randomized phase II/III trial called Lung-MAP, designed for patients with previously treated non-small cell lung cancer. The trial aims to establish a genomic screening method to assign patients to biomarker-driven or non-matched sub-studies. Depending on the cancer biomarker type, participants may receive new targeted cancer therapies or combinations compared to standard care, with the goal of approving new treatments. An optional ancillary study explores patient and physician attitudes about returning genetic findings related to germline mutations. The study involves testing patient specimens to determine eligibility for various sub-studies under the Lung-MAP protocol. Patients undergo screening to analyze tumor tissue and blood samples for biomarkers including PD-L1 and c-MET. Those requiring a fresh biopsy also submit blood for circulating tumor DNA testing. Sub-study assignment depends on the molecular profile results. This screening process includes both patients progressing after prior therapy and those pre-screened before progression on current treatment. Participants provide informed consent and tumor tissue that meets quality standards for testing. Researchers collect clinical data including smoking history and performance status. Outcomes focus on screening success, such as adequate tissue submission and matching to biomarker-driven sub-studies, tracked for up to three years. The study also monitors patient and physician knowledge and preferences regarding genomic findings. Participation duration varies based on screening and sub-study assignment.

Researchers are evaluating the effectiveness of radiation therapy with or without the chemotherapy drug cisplatin in patients with stage III-IVA squamous cell carcinoma of the head and neck who have had surgery to remove their tumors. This phase II trial aims to understand if adding cisplatin to radiation therapy improves disease-free survival, especially considering the role of p53 mutations in the cancer cells. The study also investigates toxicities and potential genomic factors that might influence treatment outcomes. Patients are randomly assigned to one of two treatment groups. One group receives intensity-modulated radiation therapy (IMRT) alone once daily, five days a week for six weeks. The other group receives the same radiation treatment combined with weekly intravenous cisplatin over one to two hours, also for six weeks. Treatment continues as long as there is no disease progression or unacceptable side effects. During the study, participants undergo regular follow-ups every six months for three years and then yearly for seven more years to monitor for cancer recurrence or new tumors. Researchers assess disease-free survival, tracking the time from randomization until cancer returns, a second tumor develops, or death. Additional laboratory tests and biomarker analyses are performed to understand genetic changes and treatment effects. Safety and toxicities are closely monitored throughout the study period.

Researchers are studying patients with metastatic HER-2-positive breast cancer who are receiving trastuzumab-based treatments to understand the risk of heart problems related to their cancer therapy. The study includes two groups: one large observational group of patients already taking beta blockers, ACE inhibitors, or ARBs alongside their cancer treatment, and a smaller randomized group comparing patients who receive carvedilol, a heart medication, to those who do not. The trial aims to assess how often heart issues occur and whether carvedilol can help prevent heart damage from chemotherapy. It also investigates biomarkers and heart function measures as predictors of cardiac risk. In the randomized part, patients not already on beta blockers, ACE inhibitors, or ARBs are assigned to receive carvedilol twice daily or no additional treatment for up to 108 weeks, with treatment cycles repeated every 12 weeks if there is no disease progression or unacceptable side effects. Patients already taking these heart medications join the observational cohort and are monitored for up to 108 weeks without any change in their therapy. The study collects blood samples and performs regular heart imaging to evaluate heart function and strain. Participants will have regular echocardiograms every 12 weeks to monitor heart function, with both local and central readings compared. Blood samples are collected for biomarker analysis, and patient health status is assessed throughout the study. The main outcome measured is the time until any heart dysfunction is first detected, followed for up to 108 weeks. The study also tracks interruptions in cancer therapy due to heart problems and explores genetic and plasma markers that might predict heart risk. Participants are followed closely for safety and treatment effects during the entire study period.

Researchers are evaluating how well serum tumor marker directed disease monitoring (STMDDM) works for patients with hormone receptor positive, HER2 negative metastatic breast cancer. The study compares STMDDM with the usual care approach to see if overall survival is not worse using STMDDM. The trial also looks at healthcare costs, patient anxiety, quality of life, and preferences related to disease monitoring. Patients are randomly assigned to one of two groups. One group receives usual care with imaging at least every 12 weeks and other monitoring at the doctor's discretion for up to 312 weeks if the disease does not progress. The other group has their serum tumor markers checked every 4 to 8 weeks, with imaging only if markers are elevated, also for up to 312 weeks without progression. Additional assessments include quality-of-life and anxiety questionnaires. Throughout the study, participants undergo regular evaluations including imaging, blood tests for tumor markers, and patient-reported outcome questionnaires. Researchers track overall survival up to 312 weeks after randomization, along with healthcare costs and patient experiences. Participants must provide informed consent and are monitored for safety during the study period.

Researchers are evaluating how well osimertinib works in treating adults with advanced non-small cell lung cancer (NSCLC) that has a specific EGFR exon 20 insertion mutation. This phase II study focuses on patients with stage IIIB-IV or recurrent disease after improvement. The trial aims to assess the tumor response to osimertinib and to understand its safety, impact on survival, and molecular markers related to treatment response and resistance. Participants receive osimertinib orally once daily in 21-day cycles, continuing until disease progression or unacceptable side effects occur. The study includes procedures like echocardiography or multigated acquisition scans to monitor heart function, plus MRI or CT scans with contrast to evaluate the cancer. Blood samples are collected throughout to analyze tumor DNA and other biomarkers. After treatment ends, participants are followed up at 30 days and then every three months for up to five years. During the trial, patients undergo regular imaging and heart function tests to monitor treatment effects and safety. Researchers track the best objective tumor response and collect data on progression-free and overall survival. The study also involves ongoing assessments of molecular markers through blood and tissue samples to understand how the cancer responds or becomes resistant to osimertinib. The total participation time can extend up to five years due to long-term follow-up visits.

Researchers are evaluating the combination of cabozantinib, nivolumab, and ipilimumab to treat patients with rare genitourinary tumors that have spread from their original location to other parts of the body. This phase II trial aims to measure how effective this combination is by looking at tumor response rates and survival outcomes. The study also assesses safety and supports tissue banking and clinical follow-up to better understand these rare cancers, including specific evaluation for patients with bone-only disease. Participants receive cabozantinib orally once daily during the first four cycles on a 21-day schedule and then continuously on a 28-day schedule for subsequent cycles. Nivolumab and ipilimumab are given intravenously on day 1 of cycles 1 to 4, followed by nivolumab alone on day 1 of later cycles. Treatment continues for up to 2 years unless the disease progresses or side effects become unacceptable. Patients may undergo several imaging tests such as CT, MRI, bone scans, PET/CT, and echocardiography throughout the study. During the trial, patients provide blood and urine samples regularly and undergo imaging to monitor disease status and treatment effects. Researchers track tumor response, progression-free survival, overall survival, and clinical benefit rates. After finishing treatment, participants are followed every two months for up to five years to observe long-term outcomes and safety.

Researchers are evaluating the effects of several targeted drugs—vismodegib, FAK inhibitor GSK2256098, capivasertib, and abemaciclib—on patients with progressive meningiomas that have specific genetic mutations. This phase II trial focuses on tumors that are growing, spreading, or worsening despite prior treatment. The study aims to measure how well these drugs work in slowing tumor progression and improving response rates, especially in patients whose tumors have mutations in SMO, PTCH1, NF2, AKT1, PIK3CA, PTEN, and CDK-related pathways. Patients are assigned to one of four treatment groups based on their tumor's genetic mutation profile. Those with SMO or PTCH1 mutations receive vismodegib daily by mouth, those with NF2 mutations receive the FAK inhibitor GSK2256098 twice daily, patients with AKT1, PIK3CA, or PTEN mutations take capivasertib twice daily for four days each week, and those with CDK pathway alterations receive abemaciclib every 12 hours. Each treatment cycle is 28 days, continuing unless the disease worsens or side effects become unacceptable. After treatment ends, patients are followed every six months for up to five years. Participants undergo various assessments including imaging scans and genetic testing to confirm eligibility and monitor tumor status. Researchers track progression-free survival at six months and response rates up to two years. Safety is monitored through adverse event reporting and lab tests. The study also collects data on overall survival and treatment tolerability. Patients are carefully evaluated before and during treatment to ensure safety and measure the drugs' effects on tumor growth and patient health over time.