Farmington

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 studying tailored adjuvant treatments in women with early-stage endometrial cancer, focusing on two specific molecular types: POLE-mutated and p53 wildtype/no specific molecular profile (NSMP). This phase II study aims to compare a new, less intense treatment approach against the usual care, which typically involves surgery followed by additional therapies like radiation or chemotherapy based on pathology results. Participants receive treatment after surgery, which includes hysterectomy and removal of ovaries and fallopian tubes. The study involves two sub-studies: one for POLE-mutated cancer patients and another for those with p53 wildtype/NSMP cancer. Treatment may include vaginal brachytherapy using a vaginal cylinder or ovoids, or external beam radiotherapy (EBRT) with or without brachytherapy, delivered with specialized radiation equipment. Some patients may be placed under observation without additional radiation. During the study, participants are closely monitored with follow-up visits to assess treatment effects and check for cancer recurrence, particularly pelvic recurrence over three years. Researchers collect patient-reported outcomes through questionnaires in English, French, or other validated languages. The study tracks safety and effectiveness over time, requiring participants to be accessible for treatment and follow-up at the study centers, with treatment starting within ten weeks after surgery.

Researchers are evaluating the addition of olaparib, a PARP inhibitor, as maintenance therapy following surgery and chemotherapy in patients with pancreatic cancer that has been surgically removed and who have a pathogenic mutation in BRCA1, BRCA2, or PALB2 genes. This phase II randomized, double-blind study aims to determine if olaparib can improve relapse-free survival compared to placebo in these patients, who have completed perioperative chemotherapy and have no evidence of recurrent disease. Participants are randomly assigned to receive either olaparib or a placebo orally twice daily in 28-day cycles for up to 12 cycles, as long as there is no disease progression or unacceptable side effects. Throughout the treatment period, patients undergo imaging tests such as CT scans or MRI and blood sample collections. After completing the treatment cycles, patients are followed up at 30 days, every 4 months for the first year, and then every 6 months for up to 10 years after randomization to monitor their health and disease status. During the study, researchers assess relapse-free survival by documenting any return of cancer or death from 22 to 44 months after randomization. They also collect blood samples and perform imaging tests to monitor the disease and evaluate treatment effects. Safety is carefully monitored, and patients must have recovered from previous treatments before starting the study. The study includes long-term follow-up to observe survival outcomes and any differences based on genetic mutations or prior chemotherapy regimens.

Researchers are evaluating how to best recommend chemotherapy for patients with colon cancer after surgery by using the presence or absence of circulating tumor DNA (ctDNA) in the blood. This approach aims to identify microscopic residual tumor cells and may provide better risk prediction for cancer recurrence compared to traditional methods. The trial focuses on patients with Stage IIB, IIC, or III colon cancer who have undergone complete tumor removal. Participants will have their tumor tissue and blood tested centrally using the Signatera assay to determine ctDNA status. Patients without detectable ctDNA may avoid chemotherapy, while those with detectable ctDNA are considered at higher risk and will be randomly assigned to receive different chemotherapy regimens, including mFOLFOX6, CAPOX, or mFOLFIRINOX, given intravenously or orally over periods ranging from 3 to 6 months. The study includes initial screening, treatment, and possible second randomization for patients whose ctDNA status changes during monitoring. During the study, participants will undergo various assessments including blood tests, imaging scans, and performance evaluations to monitor their health and response to therapy. Researchers will track the time to ctDNA positivity and disease-free survival for up to 3 and 5 years, respectively. Safety and treatment effects will be closely observed throughout the study duration, ensuring thorough follow-up and monitoring for all participants.

Low back pain affects many people and can be caused by issues with the sacroiliac joint complex (SIJC), which receives nerve signals from both the front and back parts of the lower spine. This study compares two types of image-guided radiofrequency ablation (RFA) treatments targeting the nerves in the posterior sacral network (PSN) to reduce pain and improve function in patients with confirmed SIJC pain. The aim is to see if the newer bipolar strip lesion technique (N-SIJRFA) offers better pain relief and disability improvement than the conventional monopolar periforaminal method (C-SIJRFA). Participants will receive either the N-SIJRFA treatment, where electrodes are placed along specific sacral bone landmarks to create large bipolar lesions at 85 degrees Celsius for 180 seconds, or the C-SIJRFA treatment, which uses monopolar electrodes positioned at precise locations to target nerve branches for 90 seconds at 80 degrees Celsius. Both treatments involve injections of lidocaine before ablation and use imaging to confirm electrode placement. The study will follow patients for up to 24 months and track various outcomes. During the study, participants will complete pain diaries and outcome questionnaires to measure pain relief, disability, and quality of life at multiple time points. Researchers will monitor pain scores, functional improvements, patient satisfaction, procedural time, and any side effects or additional treatments used. The primary outcome is the change in pain rating three months after treatment. The study includes adults aged 18 to 90 years with chronic low back pain who have not improved with prior conservative care and have confirmed pain relief from diagnostic nerve or joint blocks.

Researchers are evaluating if adding adjuvant chemotherapy (ACT) to ovarian function suppression (OFS) plus endocrine therapy (ET) improves invasive breast cancer-free survival (IBCFS) compared to OFS plus ET alone. This Phase III trial focuses on premenopausal women with early-stage breast cancer that is estrogen receptor (ER)-positive, HER2-negative, and has a 21-gene recurrence score between 16-25 for node-negative patients or 0-25 for patients with 1-3 positive nodes. The study addresses the need for better treatment options for younger women diagnosed with this type of breast cancer, as younger age is linked to worse outcomes despite standard therapies. Participants receive one of two treatments: either OFS combined with an aromatase inhibitor (AI) for five years or adjuvant chemotherapy followed by the same OFS plus AI regimen. The specific AI and GnRH agonist used, along with their dosing schedules, are chosen by the investigator, commonly including goserelin, leuprolide, or triptorelin administered monthly or every three months. Bilateral oophorectomy may be used instead of ovarian suppression if preferred. Endocrine therapy beyond five years is at the investigator's discretion. During the trial, participants will be closely monitored for invasive breast cancer-free survival over an 11-year period from randomization. Assessments include clinical evaluations, hormone receptor testing, tumor staging, and genetic recurrence scoring prior to enrollment. Safety and effectiveness data will be collected throughout the study, with particular attention to treatment side effects and long-term outcomes. The trial involves detailed eligibility screening and ongoing follow-up to ensure accurate measurement of the study's primary outcome.

Researchers are evaluating whether high-dose gabapentin can prevent the need for opioid pain medication during chemoradiation therapy in patients with squamous cell carcinoma of the head and neck. Oral mucositis, a common side effect of radiation, causes severe pain and complications that often require opioid treatment, which has many side effects. This phase III trial aims to see if gabapentin can reduce opioid use and improve pain management in this patient group. Participants are randomly assigned to receive either gabapentin or a placebo starting with radiation treatment day 8. The dosing increases from once daily on day 1 to three times daily from day 3 onward. Both groups also receive standard chemotherapy, radiation, and pain medications as needed. Treatment continues until oral mucositis symptoms lessen and opioid use stops, followed by a gradual dose reduction over 11 days. Blood samples are collected throughout the study. Patients are followed up at 4 weeks, 3 months, and 6 months after completing chemoradiation therapy. Researchers measure the need for opioid use during treatment, time to first opioid use, patient-reported pain scores, quality of life, symptom outcomes, adverse events, tolerance to gabapentin, body mass index, lab results, feeding tube use, and opioid dosing. This comprehensive approach helps assess the effectiveness and safety of gabapentin in preventing opioid use for oral mucositis pain.

Researchers are evaluating a phase III trial comparing two treatment approaches for women with locally advanced cervical cancer that has spread to nearby tissues or lymph nodes. The study aims to see if adding induction chemotherapy with carboplatin, paclitaxel, and pembrolizumab before standard chemotherapy, radiation, and pembrolizumab maintenance can improve progression-free survival. This trial also investigates overall survival, treatment toxicity, treatment timing, and the role of biomarkers in predicting outcomes. Participants are randomly assigned to one of two groups. One group receives standard chemoradiation with cisplatin and pembrolizumab followed by pembrolizumab maintenance. The other group receives induction therapy with carboplatin, paclitaxel, and pembrolizumab, followed by chemoradiation with cisplatin and pembrolizumab, and then pembrolizumab maintenance. Radiation therapy includes external beam radiation and brachytherapy, given over several weeks. Treatments continue unless the cancer progresses or unacceptable side effects occur. Throughout the study, participants undergo various scans such as PET, CT, chest x-rays, and MRI, along with blood sample collections. After completing treatment, participants are followed every 3 months for 2 years, then every 6 months for 3 years to monitor cancer progression or survival. The primary outcome measured is progression-free survival up to 7 years. Additional assessments include treatment safety, biomarker studies, and radiation quality reviews.

Researchers are evaluating two chemotherapy treatments, mFOLFIRINOX and mFOLFOX, with or without the immunotherapy drug nivolumab, for advanced, unresectable, or metastatic HER2 negative adenocarcinoma of the esophagus, gastroesophageal junction, and stomach. This phase III trial aims to determine whether adding irinotecan to the usual FOLFOX regimen improves overall survival and other outcomes such as progression-free survival, response rates, and treatment tolerability. The study also explores biomarkers like PD-L1 combined positive score and cell free DNA to understand treatment effects better. Participants are randomly assigned to one of two treatment groups. One group receives fluorouracil, leucovorin calcium, oxaliplatin, and irinotecan (mFOLFIRINOX) with nivolumab as needed, while the other group receives fluorouracil, leucovorin calcium, and oxaliplatin (mFOLFOX) with nivolumab as needed. All drugs are given intravenously. Throughout the trial, patients undergo MRI and CT scans and may provide blood samples for additional testing. During the study, participants are closely monitored for overall survival for up to two years after randomization. Researchers assess safety, side effects, and patient-reported outcomes to evaluate treatment tolerability. The trial also tracks progression of disease and response to therapy using imaging and other clinical evaluations. Participation includes regular imaging, blood collection, and completing questionnaires to help understand the impact of these treatments.

Researchers are investigating whether observation is as effective as continuing pembrolizumab treatment in patients with early-stage triple-negative breast cancer who achieved a complete response after preoperative chemotherapy combined with pembrolizumab. This phase III trial aims to evaluate recurrence-free survival and quality of life, as well as the value of reducing immunotherapy treatment after surgery in these patients. The study also examines differences in adverse events, overall survival, and financial impacts between treatment approaches. Participants are randomly assigned to one of two groups after completing neoadjuvant chemotherapy with pembrolizumab and surgery. One group receives pembrolizumab intravenously as adjuvant therapy, while the other group undergoes observation without further treatment. Both groups have tumor biopsies and blood samples collected on study and during follow-up. Additional assessments include questionnaires and quality-of-life evaluations. During the study, researchers monitor participants for up to 10 years to measure recurrence-free survival. They assess quality of life using validated tools, track adverse events, and evaluate financial toxicity and work productivity. The study includes tumor tissue analysis, blood sample collection, and patient-reported outcomes to understand the long-term effects and value of treatment de-escalation in breast cancer care.