Precision Medicine Applied to Locally Advanced or Metastatic Poorly Differentiated or Anaplastic Thyroid Cancer Using Tumor Derived Organoids and In-vitro Sensitivity Testing: a Phase 2, Single-center, Open-label, and Non-comparative Study

West China Hospital1 个研究点分布在 1 个国家目标入组 20 人开始时间: 2024年12月1日最近更新: 2024年12月3日

适应症

干预措施

试验速览

阶段: 2 期
状态: 尚未招募
发起方: West China Hospital
入组人数: 20
试验地点: 1
主要终点: Objective response rate (ORR)

研究概览研究设计入排标准研究组 & 干预措施结局指标研究者研究点记录与标识符相似试验

研究概览

简要总结

The current study aims to explore the potential advantages of chemotherapy that is implemented based on drug sensitivity testing. This pertains to individuals with locally advanced or metastatic poorly differentiated or anaplastic thyroid cancer who have undergone conventional therapy in the past or unresectable patients .

详细描述

This research trial aims to determine the efficacy of organoid-guided chemotherapy for patients with locally advanced or metastatic poorly differentiated or anaplastic thyroid cancer.

Currently, there are numerous clinical trials evaluating various molecularly targeted therapies for refractory, poorly differentiated thyroid cancer. Preoperative personalized targeted neoadjuvant therapy has been established as a critical approach in managing advanced thyroid cancer. However, clinical trials investigating personalized chemotherapy to guide the treatment of thyroid cancer remain scarce.

Tumor organoids represent a sophisticated three-dimensional pathological model that preserves the histological and molecular characteristics of the original tumor. These models can be utilized to assess the in vitro efficacy of multiple anticancer drugs. The investigators' objective is to validate the effectiveness and safety of selecting and processing chemotherapeutic agents through drug susceptibility testing, thereby ensuring pragmatic and precise treatment tailored to individual patients' needs.

The investigators will also investigate the variables affecting the effectiveness of chemotherapy that is guided by organoids. Additionally, side effects related to the medication are also studied.

研究设计

研究类型: Interventional
分配方式: Na
干预模型: Single Group
主要目的: Treatment
盲法: None

入排标准

年龄范围: 18 Years 至 —（Adult, Older Adult）
性别: All
接受健康志愿者: 否

入选标准

•At least 18 years of age on the day of signing informed consent
•Cytologically confirmed thyroid neoplasm, including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), poorly differentiated thyroid carcinoma (PDTC), medullary thyroid carcinoma (MTC), anaplastic thyroid carcinoma (ATC)
•Patients defined as poorly differentiated iodine-refractory thyroid tumors with inoperable locally advanced disease or metastases. The primary tumor may or may not be removed, but the risk of aerodigestive compression or bleeding should be excluded.
•Evidence of extrathyroidal extension and/or locally invasive disease and deemed at risk for R2 resection by treating team on clinical and/or fiberoptic examination and/or radiographic evaluation in the primary or recurrent setting. Evidence of "at risk for R2 resection" includes:
•Vocal cord paralysis by fiberoptic examination
•Extrathyroid and/or extranodal extension on CT or MRI, including tracheal and/or laryngeal cartilage invasion, esophageal involvement, and/or involvement of perithyroid muscles (e.g. strap, sternocleidomastoid, inferior constrictor muscles) or bone involvement
•Extension into the mediastinum with visceral and/or vascular involvement
•Involvement of the carotid artery or other major vessel by 180 degrees or more (exclusive of complete encasement)
•Other factors that make the participant to be "at risk for R2 resection" may be allowed, after discussion with the study's principal investigator
•At least one measurable lesion as defined by RECIST v1.1
•Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2 and no medical contraindication to surgery
•Surgical morbidity/complexity score of 1 to 4 (moderate, severe, very severe, or unresectable)
•The expected survival time was more than 2 months
•Adequate end-organ function (including bone marrow, coagulation, renal, liver and cardiac) 28 days prior to the study registration as defined below:
•leukocytes ≥3,000/mcL
•absolute neutrophil count ≥1,500/mcL
•platelets ≥100,000/mcL
•hemoglobin ≥ 9 g/dL (5.58 mmol/L)
•total bilirubin ≤1.5 x institutional upper limit of normal, unless attributed to Gilberts syndrome
•Alanine Aminotransferase (ALT)/Aspartate Aminotransferase (AST) < 2.5 x institutional upper limit of normal
•INR ≤1.5 x institutional upper limit of normal
•creatinine within normal institutional limits OR
•creatinine clearance ≥30 mL/min per Cockcroft-Gault formulation
•normal serum potassium, calcium, and magnesium levels (may be receiving supplements). Grade 1 hypocalcemia (corrected serum calcium > 8) is acceptable
•Willing to undergo tumor biopsy prior to trial treatment, unless in the opinion of the treating physician, a biopsy is not feasible or safe. Subjects must be willing to ultimately undergo surgery if their tumor becomes surgically resectable
•Ability to comply with outpatient treatment, laboratory monitoring, and require clinic visits for the duration of study participation
•Willing and able to provide written informed consent signed by study patient (or legally acceptable representative if applicable)
•Willingness of patients with partners of childbearing potential to use a highly effective contraceptive method during treatment with study drug and for 3 months following the last dose of study drug

排除标准

•Radiographically identified following findings: intraluminal airway tumor, complete carotid encasement/infiltration
•Patients with contraindications to the involved chemotherapy drugs (such as severe coagulopathy, severe liver function impairment, etc.)
•Any unresolved toxicities from prior therapy greater than Common Terminology Criteria for Adverse Events (CTCAE) grade 1 at the time of starting study treatment
•Gastrointestinal malabsorption or any other condition that in the opinion of the investigator might affect the absorption of study drug
•Patients with serious internal medicine underlying diseases, serious organ dysfunction, metabolic diseases or other diseases that seriously affect survival
•If > 1 + proteinuria on urine dipstick testing will undergo 24-hour urine collection for quantitative assessment of proteinuria. Participants with urine protein ≥1g/24 h will be ineligible
•Significant cardiovascular impairment: history of congestive heart failure greater than New York Heart Association (NYHA) Class II, unstable angina, myocardial infarction, or stroke within 6 months of the first dose of study drug, or cardiac arrhythmia requiring medical treatment
•Active hemoptysis (bright red blood ≥ 1/2 teaspoon) or other uncontrolled bleeding within 21 days prior to the study registration
•Arterial/venous thromboembolic events in the last 12 months Treatment within 30 days prior to study registration with anticoagulant or antiplatelet therapy, apart from aspirin 81 mg daily
•Active uncontrolled systemic bacterial, viral, or fungal infection, or serious ongoing intercurrent illness
•Uncontrolled symptomatic hyperthyroidism or hypothyroidism
•Females who are pregnant or breastfeeding
•Other progressive malignant diseases requiring treatment
•Radiotherapy with a limited field of radiation for palliation within 1 week of the first dose of study treatment, with the exception of patients receiving radiation to more than 30% of the bone marrow or with a wide field of radiation, which must be completed at least 4 weeks prior to the first dose of study treatment
•Symptomatic primary central nervous system (CNS) tumor, metastases, leptomeningeal carcinomatosis, or untreated spinal cord compression. Exception: Patients are eligible if neurological symptoms and CNS imaging are stable and no CNS surgery or radiation has been performed for 28 days, 14 days if stereotactic radiosurgery (SRS)
•Patients with incomplete clinical data
•History of significant neurological or mental disorder, including seizures or dementia, which would interfere compliance and sign of consent inform
•Patients deemed unsuitable for inclusion by the investigators