Can Selumetinib make advanced thyroid cancer sensitive to radioactive iodine therapy again?

Not Applicable

• Conditions: Thyroid cancer; Cancer; Malignant neoplasm of thyroid gland

• Registration Number: ISRCTN17468602
• Lead Sponsor: Sheffield Teaching Hospitals NHS Trust

Brief Summary

2019 Protocol article in https://pubmed.ncbi.nlm.nih.gov/31200667/ protocol (added 08/12/2020)

Detailed Description

Not available

Study Timeline

• Results First Posted: 1900-01-01
• Study Start: 2015-12-02
• Study Completion: 2020-11-05
• Last Update Posted: 15 November 2021

Recruitment & Eligibility

• Status: Stopped
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

Current participant inclusion criteria as of 03/11/2021:
1. Diagnosed with locally advanced or metastatic differentiated thyroid cancer (papillary, follicular, Hürthle cell, or poorly differentiated carcinoma) with at least one measurable lesion as measured by computed tomography (CT) or magnetic resonance imaging (MRI)
2. Participants must have iodine refractory disease, defined below:
2.1. One or more measurable lesions that do not demonstrate iodine uptake on a previous radioiodine scan (diagnostic uptake or post therapy)
OR
2.2. One or more measurable lesions that have progressed by RECIST 1.1 criteria within 12 months of I131 therapy, despite demonstrable radioiodine avidity at the time of that treatment
3. Participants must have radiological progression by RECIST 1.1 criteria within the prior 12 months
4. Measurable disease by RECIST 1.1 criteria. Baseline scan must be completed within 4 weeks prior to the start of treatment.
5. ECOG Performance Status = 1 and able to tolerate radioiodine therapy
6. Life expectancy of at least 12 weeks
7. Required laboratory values within 14 days of day 1 of treatment:
7.1. Adequate thyroidstimulating hormone (TSH) suppression < 0.5 mU/L
7.2. Creatinine clearance >50 ml/min,
7.3. Absolute Neutrophil Count =1.5x109/L (1500 per mm3)
7.4. Platelets =100x109/L (100,000 per mm3)
7.5. Haemoglobin >9.0 g/dL
7.6. Serum bilirubin =1.5 x upper limit of normal (ULN)
7.7. Patients with no liver metastasis must have AST or ALT = 2.5 x ULN
7.8. Patients with liver metastasis must have AST or ALT = 5 x ULN. If patients have AST or ALT > 3.5 x ULN and = 5 x ULN they must have an ALP= 6 x ULN
8. Patient’s with Gilbert’s syndrome (persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in the
absence of evidence of haemolysis or hepatic pathology) will be eligible.
9. Able to give informed consent and willing to follow trial protocol.
10. Aged over 18
11. Female participants of childbearing potential must have a negative pregnancy test within 24 hours prior to starting therapy and agree to use dual methods of contraception for the duration of the trial and 6 months after completing treatment. Male participants must agree to use a barrier method of contraception for the duration of the trial and 4 months after completing treatment, if sexually active with a female of childbearing
potential.

Previous participant inclusion criteria:
1. Diagnosed with locally advanced or metastatic differentiated thyroid cancer (papillary, follicular, Hürthle cell, or poorly differentiated carcinoma) with at least one measurable lesion as measured by computed tomography (CT) or magnetic resonance imaging (MRI)
2. Participants must have iodine refractory disease, defined below:
2.1. One or more measurable lesions that do not demonstrate iodine uptake on a previous radioiodine scan (diagnostic uptake or post therapy)
OR
2.2. One or more measurable lesions that have progressed by RECIST 1.1 criteria within 12 months of I131 t

Exclusion Criteria

Current participant exclusion criteria as of 03/11/2021:
1. Foci of anaplastic thyroid cancer identified on histology
2. Able to receive curative surgery or radiation therapy
3. Major surgery with the exception of surgical placement for vascular access, open biopsy, or significant traumatic injury = 30 days prior to registration
4. Previous or concurrent cancer distinct in primary site or histology from thyroid cancer within previous 5 years, except for cervical cancer in situ, treated basal cell carcinoma, squamous cell carcinoma of the skin or superficial bladder tumour
5. Have received or are receiving an IMP or other systemic anticancer treatment within 4 weeks prior to the first dose of study treatment (6 weeks for nitrosoureas, mitomycin, and suramin), or within a period during which the IMP or anticancer treatment has not been cleared from the body (e.g. a period of 5 ‘halflives’), whichever is the most appropriate and as judged by the investigator
6. Any unresolved toxicity =CTCAE Grade 2 from previous anticancer therapy, except for alopecia
7. Prior exposure to Tyrosine Kinase, MEK, RAS or RAF inhibitors
8. Known or suspected allergy to Selumentinib or hypersensitivity to Selumetinib or any excipient agents or history of allergic reactions attributed to compounds of similar chemical or biologic composition to Selumetinib
9. Known or suspected brain metastases or spinal cord compression, unless the condition has been asymptomatic, has been treated with surgery and / or radiation, and has been stable without requiring corticosteroids nor anticonvulsant medications for at least 4 weeks prior to the first dose of study medication
10. Requiring medication with high iodine content (e.g. amiodarone)
11. Participants who have had a iodine contrast enhanced CT scan in previous 2 months
12. Ophthalmological conditions as follows:
12.1 Intra-ocular pressure >21 mmHg, or uncontrolled glaucoma (irrespective of intra-ocular pressure)
12.2 Current or past history of retinal pigment epithelial detachment (REPD)/central serous retinopathy or retinal vein occlusion
13. Any of the following cardiac conditions:
13.1 Uncontrolled hypertension (BP >150/95 mmHg despite medical therapy)
13.2 Acute coronary syndrome within 6 months prior to starting treatment
13.3 Uncontrolled angina (Canadian Cardiovascular Society grade II-IV despite medical therapy)
13.4 Symptomatic heart failure (NYHA grade II-IV), prior or current cardiomyopathy, or severe vascular disease
13.5 Prior or current cardiomyopathy including but not limited to the following:
13.5.1 known hypertrophic cardiomyopathy
13.5.2 known arrhythmogenic right ventricular cardiomyopathy
13.6 Severe valvular heart disease
13.7 Left ventricular ejection fraction <55% measured by echocardiography
13.8 Atrial fibrillation with a ventricular rate >100 bpm on ECG at rest
13.9 QTcF >450ms or other factors that increase the risk of QT prolongation
14. Participants known to be infected with human immunodeficiency virus (HIV) or hepatitis B

Previous

Study & Design

• Study Type: Interventional
• Study Design: Not specified