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While stroke survivors discharged from rehabilitation present with some recovery in mobility, their ability to ambulate in the community remains limited. The investigators propose to test a novel, low-cost, intensive and individually tailored intervention that combines virtual reality (VR) and field training to enhance community ambulation and participation in stroke survivors discharged from rehabilitation. The aims are to: (1) Assess feasibility, acceptability, safety and adherence of the intervention in stroke survivors; and (2) Examine the extent to which post-intervention changes in functional walking and participation to community walking vary according to walking, cognitive and visual-perceptual abilities. The investigators will use a virtual environment prototype simulating a shopping mall and surrounding streets, in which participants will interact using VR goggles and game controllers. Scenarios of increasing levels of complexity will be introduced. This intervention study involves a single group, multiple pre- multiple post- study design where chronic stroke participants will engage in a 4-week training program. The program will include VR training sessions performed in the clinical setting (3/week) and practice of community ambulation skills while supervised by family/caregivers (2/week). Participants will be assessed on measures of functional walking, balance \& mobility and participation to community walking. Adherence, safety and acceptability will be documented. This study will generate foundation knowledge on the response to the intervention based on individual capacities.
Conditions:
StrokeLocation:
- Jewish Rehabilitation Hospital, Laval, Quebec, Canada
- Institut de réadaptation en déficience physique de Québec, Québec, Quebec, Canada
Sex:
ALLAges:
40 - 74This phase I/II trial tests the safety, side effects, and best dose of selinexor given in combination with standard radiation therapy in treating children and young adults with newly diagnosed diffuse intrinsic pontine glioma (DIPG) or high-grade glioma (HGG) with a genetic change called H3 K27M mutation. It also tests whether combination of selinexor and standard radiation therapy works to shrink tumors in this patient population. Glioma is a type of cancer that occurs in the brain or spine. Glioma is considered high risk (or high-grade) when it is growing and spreading quickly. The term, risk, refers to the chance of the cancer coming back after treatment. DIPG is a subtype of HGG that grows in the pons (a part of the brainstem that controls functions like breathing, swallowing, speaking, and eye movements). This trial has two parts. The only difference in treatment between the two parts is that some subjects treated in Part 1 may receive a different dose of selinexor than the subjects treated in Part 2. In Part 1 (also called the Dose-Finding Phase), investigators want to determine the dose of selinexor that can be given without causing side effects that are too severe. This dose is called the maximum tolerated dose (MTD). In Part 2 (also called the Efficacy Phase), investigators want to find out how effective the MTD of selinexor is against HGG or DIPG. Selinexor blocks a protein called CRM1, which may help keep cancer cells from growing and may kill them. It is a type of small molecule inhibitor called selective inhibitors of nuclear export (SINE). Radiation therapy uses high energy to kill tumor cells and shrink tumors. The combination of selinexor and radiation therapy may be effective in treating patients with newly-diagnosed DIPG and H3 K27M-Mutant HGG.
Conditions:
Malignant GliomaLocation:
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- The Montreal Children's Hospital of the MUHC, Montreal, Quebec, Canada
- University of Alberta Hospital, Edmonton, Alberta, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Centre Hospitalier Universitaire de Sherbrooke-Fleurimont, Sherbrooke, Quebec, Canada
- McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Ontario, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
Sex:
ALLAges:
1 - 21This phase III trial studies whether inotuzumab ozogamicin added to post-induction chemotherapy and immunotherapy (chemo-immunotherapy) for patients with High-Risk B-cell Acute Lymphoblastic Leukemia (B-ALL) improves outcomes. This trial also studies the outcomes of patients with mixed phenotype acute leukemia (MPAL), and B-lymphoblastic lymphoma (B-LLy) when treated with ALL therapy without inotuzumab ozogamicin. Inotuzumab ozogamicin is a monoclonal antibody, called inotuzumab, linked to a type of chemotherapy called calicheamicin. Inotuzumab attaches to cancer cells in a targeted way and delivers calicheamicin to kill them. Other drugs used in the chemotherapy regimen, such as cyclophosphamide, cytarabine, dexamethasone, doxorubicin, daunorubicin, methotrexate, leucovorin, mercaptopurine, prednisone, thioguanine, vincristine, and pegaspargase or calaspargase pegol work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Blinatumomab is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. A monoclonal antibody is a type of protein that can bind to certain targets in the body, such as molecules that cause the body to make an immune response (antigens). This trial will also study the outcomes of patients with mixed phenotype acute leukemia (MPAL) and disseminated B lymphoblastic lymphoma (B-LLy) when treated with high-risk ALL chemotherapy. The overall goal of this study is to understand if adding inotuzumab ozogamicin to standard of care chemo-immunotherapy maintains or improves outcomes in High Risk B-cell Acute Lymphoblastic Leukemia (HR B-ALL). The first part of the study includes the first two phases of therapy: Induction and Consolidation. This part will collect information on the leukemia, as well as the effects of the initial treatment, to classify patients into post-consolidation treatment groups. On the second part of this study, patients with HR B-ALL will receive the remainder of the chemotherapy cycles (interim maintenance 1, delayed intensification, interim maintenance 2, maintenance), with some patients randomized to receive inotuzumab. The patients that receive inotuzumab will not receive part of delayed intensification. Other aims of this study include investigating whether treating both males and females with the same duration of chemotherapy maintains outcomes for males who have previously been treated for an additional year compared to girls, as well as to evaluate the best ways to help patients adhere to oral chemotherapy regimens. Finally, this study will be the first to track the outcomes of subjects with disseminated B-cell Lymphoblastic Leukemia (B-LLy) or Mixed Phenotype Acute Leukemia (MPAL) when treated with B-ALL chemotherapy.
Conditions:
B Acute Lymphoblastic Leukemia | Central Nervous System Leukemia | Testicular Leukemia | Mixed Phenotype Acute...Location:
- Alberta Children's Hospital, Calgary, Alberta, Canada
- Janeway Child Health Centre, Saint John's, Newfoundland and Labrador, Canada
- Children's Hospital, London, Ontario, Canada
- Centre Hospitalier Universitaire de Sherbrooke-Fleurimont, Sherbrooke, Quebec, Canada
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
- The Montreal Children's Hospital of the MUHC, Montreal, Quebec, Canada
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- McMaster Children's Hospital at Hamilton Health Sciences, Hamilton, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Saskatoon Cancer Centre, Saskatoon, Saskatchewan, Canada
- University of Alberta Hospital, Edmonton, Alberta, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
- Janeway Child Health Centre, St. John's, Newfoundland and Labrador, Canada
Sex:
ALLAges:
365 - 25The purpose of this Phase 3b study is to assess the efficacy, safety and tolerability of remibrutinib after switching from ocrelizumab and compared to continuous ocrelizumab treatment, in patients living with relapsing multiple sclerosis (plwRMS).
Conditions:
Relapsing Multiple SclerosisLocation:
- Novartis Investigative Site, Lévis, Quebec, Canada
- Novartis Investigative Site, Montreal, Quebec, Canada
- Novartis Investigative Site, Vancouver, British Columbia, Canada
Sex:
ALLAges:
40 - 70This study will assess the safety and efficacy of avutometinib (VS-6766) in combination with defactinib versus Investigator's choice of treatments (ICT) in subjects with recurrent LGSOC who have progressed on a prior platinum-based therapy.
Conditions:
Low Grade Serous Ovarian CancerLocation:
- Centre Hospitalier de l'Universite de Montreal (CHUM), Montréal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
- Princess Margaret Cancer Center, Toronto, Ontario, Canada
- Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
Sex:
FEMALEAges:
Over 18This phase II trial compares mosunetuzumab to the usual treatment (rituximab) for improving survival in patients with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). Rituximab and mosunetuzumab are monoclonal antibodies. They bind to a protein called CD20, which is found on B cells (a type of white blood cell) and some types of cancer cells. This may help the immune system kill cancer cells. Mosunetuzumab may be more effective at extending survival in patients with NLPHL than the usual approach with rituximab.
Conditions:
Recurrent Nodular Lymphocyte Predominant B-Cell Lymphoma | Refractory Nodular Lymphocyte Predominant B-Cell...Location:
- University Health Network-Princess Margaret Hospital, Toronto, Ontario, Canada
Sex:
ALLAges:
Over 18This MyeloMATCH Master Screening and Reassessment Protocol (MSRP) evaluates the use of a screening tool and specific laboratory tests to help improve participants' ability to register to clinical trials throughout the course of their myeloid cancer (acute myeloid leukemia or myelodysplastic syndrome) treatment. This study involves testing patients' bone marrow and blood for certain biomarkers. A biomarker (sometimes called a marker) is any molecule in the body that can be measured. Doctors look at markers to learn what is happening in the body. Knowing about certain markers can give doctors more information about what is driving the cancer and how to treat it. Testing patients' bone marrow and blood will show doctors if patients have markers that specific drugs can target. The marker testing in this study will let doctors know if they can match patients with a treatment study (myeloMATCH clinical trial) that tests treatment for the type of cancer they have or continue standard of care treatment with their doctor on the Tier Advancement Pathway (TAP).
Conditions:
Myelodysplastic Syndrome | Acute Myeloid Leukemia | Acute Myeloid Leukemia Post Cytotoxic...Location:
- Jewish General Hospital, Montreal, Quebec, Canada
- CIUSSSEMTL-Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- CancerCare Manitoba, Winnipeg, Manitoba, Canada
- QEII Health Sciences Centre/Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- CSSS Champlain-Charles Le Moyne, Greenfield Park, Quebec, Canada
- University of Alberta Hospital, Edmonton, Alberta, Canada
- Odette Cancer Centre- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University Health Network-Princess Margaret Hospital, Toronto, Ontario, Canada
- Arthur J E Child Comprehensive Cancer Centre, Calgary, Alberta, Canada
- Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada
Sex:
ALLAges:
Over 18This study will have two phases: a sacituzumab tirumotecan safety run-in and a Phase 3 portion. The safety run-in phase will be used to evaluate the efficacy and safety of sacituzumab tirumotecan at the dose for evaluation in the Phase 3 portion. The purpose of this study is to compare the efficacy and safety of sacituzumab tirumotecan versus treatment of physician's choice as second-line treatment for participants with recurrent or metastatic cervical cancer in the Phase 3 portion. The primary study hypotheses are that, in the Phase 3 portion, sacituzumab tirumotecan results in a superior overall survival compared to TPC in participants with high trophoblast cell surface antigen 2 (TROP2) expression level and in all participants.
Conditions:
Cervical CancerLocation:
- BC Cancer Kelowna ( Site 4007), Kelowna, British Columbia, Canada
- Centre Hospitalier de l'Université de Montréal ( Site 4001), Montréal, Quebec, Canada
- BC Cancer Surrey ( Site 4006), Surrey, British Columbia, Canada
- Centre intégré de cancérologie du CHU de Québec Université Laval, Hôpital de l'Enfant-Jésus ( Site 4, Quebec City, Quebec, Canada
- McGill University Health Centre ( Site 4000), Montreal, Quebec, Canada
- Hamilton Health Sciences-Juravinski Cancer Centre ( Site 4003), Hamilton, Ontario, Canada
- BC Cancer Victoria ( Site 4008), Victoria, British Columbia, Canada
- Royal Victoria Regional Health Centre ( Site 4009), Barrie, Ontario, Canada
- Centre intégré de cancérologie du CHU de Québec Université Laval, Hôpital de l'Enfant-Jésus ( Site 4002), Québec, Quebec, Canada
- Centre Hospitalier de l'Université de Montréal ( Site 4001), Montreal, Quebec, Canada
Sex:
FEMALEAges:
Over 18This phase II trial tests the addition of BMS-986016 (relatlimab) to the usual immunotherapy after initial treatment for nasopharyngeal cancer that has come back after a period of improvement (recurrent) or that has spread from where it first started (primary site) to other places in the body (metastatic). Relatlimab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. The usual approach of treatment is initial treatment with chemotherapy such as the combination of cisplatin (or carboplatin) and gemcitabine, along with immunotherapy such as nivolumab. After the initial treatment is finished, patients may continue to receive additional immunotherapy. Carboplatin is in a class of medications known as platinum-containing compounds. It works in a way similar to the anticancer drug cisplatin, but may be better tolerated than cisplatin. Carboplatin works by killing, stopping or slowing the growth of tumor cells. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Gemcitabine is a chemotherapy drug that blocks the cells from making deoxyribonucleic acid (DNA) and may kill cancer cells. Giving BMS-986016 in addition to the usual immunotherapy after initial treatment may extend the time without the tumor cells growing or spreading longer than the usual approach in patients with recurrent or metastatic nasopharyngeal cancer.
Conditions:
Recurrent Nasopharyngeal Carcinoma | Metastatic Nasopharyngeal Carcinoma | Stage IV Nasopharyngeal Carcinoma AJCC v8Location:
- University Health Network-Princess Margaret Hospital, Toronto, Ontario, Canada
Sex:
ALLAges:
Over 18PRACTICAL is a randomized multifactorial adaptive platform trial for acute hypoxemic respiratory failure (AHRF). This platform trial will evaluate novel interventions for patients with AHRF across a range of severity states (i.e., not intubated, intubated with lower or higher respiratory system elastance, requiring extracorporeal life support) and across a range of investigational phases (i.e., preliminary mechanistic trials, full-scale clinical trials). AHRF is a common and life-threatening clinical syndrome affecting millions globally every year. Patients with AHRF are at high risk of death and long-term morbidity. Patients who require invasive mechanical ventilation are at risk of ventilator-induced lung injury and ventilator-induced diaphragm dysfunction. New treatments and treatment strategies are needed to improve outcomes for these very ill patients. Utilizing advances in Bayesian adaptive trial design, the platform will facilitate efficient yet rigorous testing of new treatments for AHRF, with a particular focus on mechanical ventilation strategies and extracorporeal life support techniques as well as pharmacological agents and new medical devices. The platform is designed to enable evaluation of novel interventions at a variety of stages of investigation, including pilot and feasibility trials, trials focused on mechanistic surrogate endpoints for preliminary clinical evaluation, and full-scale clinical trials assessing the impact of interventions on patient-centered outcomes. Interventions will be evaluated within therapeutic domains. A domain is defined as a set of interventions that are intended to act on specific mechanisms of injury using different variations of a common therapeutic strategy. Domains are intended to function independently of each other, allowing independent evaluation of multiple therapies within the same patient. Once feasibility is established, Bayesian adaptive statistical modelling will be used to evaluate treatment efficacy at regular interim adaptive analyses of the pre-specified outcomes for each intervention in each domain. These adaptive analyses will compute the posterior probabilities of superiority, futility, inferiority, or equivalence for pre-specified comparisons within domains. Each of these potential conclusions will be pre-defined prior to commencing the intervention trial. Decisions about trial results (e.g., concluding superiority or equivalence) will be based on pre-specified threshold values for posterior probability. The primary outcome of interest, the definitions for superiority, futility, etc. (i.e., the magnitude of treatment effect) and the threshold values of posterior probability required to reach conclusions for superiority, futility etc., will vary from intervention to intervention depending on the phase of investigation and the nature of the intervention being evaluated. All of these parameters will be pre-specified as part of the statistical design for each intervention trial. In general, domains will be designed to evaluate treatment effect within four discrete clinical states: non-intubated patients, intubated patients with low respiratory system elastance (\<2.5 cm H2O/(mL/kg)), intubated patients with high respiratory system elastance (≥2.5 cm H2O/(mL/kg)), and patients requiring extracorporeal life support. Where appropriate, the model will specify dynamic borrowing between states to maximize statistical information available for trial conclusions. In this perpetual trial design, different interventions may be added or dropped over time. Where possible, the platform will be embedded within existing data collection repositories to enable greater efficiency in outcome ascertainment. Standardized systems for acquiring both physiological and biological measurements are embedded in the platform, to be acquired at sites with appropriate training, expertise, and facilities to collect those measurements.
Conditions:
Respiratory Insufficiency | Mechanical Ventilation Pressure High | Extracorporeal Membrane Oxygenation ComplicationLocation:
- Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada
- St. Boniface Hospital, Winnipeg, Manitoba, Canada
- William Osler Health System, Brampton, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Scarborough Health Network, Toronto, Ontario, Canada
- Cortellucci Vaughan Hospital, Vaughan, Ontario, Canada
- Sacre Coeur du Montreal, Montreal, Quebec, Canada
- University of Calgary, Calgary, Alberta, Canada
- St. Paul's Hospital, Vancouver, British Columbia, Canada
- Grace Hospital, Winnipeg, Manitoba, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- North York General Hospital, North York, Ontario, Canada
- Mackenzie Health, Richmond Hill, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
- Trois Riviere (CHAUR), Trois-Rivières, Quebec, Canada
- University of Alberta/Edmonton University Hospital, Edmonton, Alberta, Canada
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Lakeridge Hospital, Oshawa, Ontario, Canada
- Niagara Health Systems, Saint Catherines, Ontario, Canada
- Sinai Health, Mount Sinai Hospital, Toronto, Ontario, Canada
- MUHC - McGill University Health Centre (Glen Site), Montreal, Quebec, Canada
- Royal University Saskatoon, Saskatoon, Saskatchewan, Canada
- Surrey Memorial Hospital, Surrey, British Columbia, Canada
- Health Sciences Centre - Winnipeg, Winnipeg, Manitoba, Canada
- Brantford General Hospital, Brantford, Ontario, Canada
- Oak Valley Health, Markham, Ontario, Canada
- Ottawa Heart Research Institute, Ottawa, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Windsor Regional Health, Windsor, Ontario, Canada
- Centre Hospitalier Universite de Sherbrooke, Sherbrooke, Quebec, Canada
- University Health Network, Toronto, Ontario, Canada