A Trial of E7080 in 131-I-Refractory Differentiated Thyroid Cancer

Phase 3

• Conditions: 131-I-Refractory Differentiated Thyroid Cancer

• Registration Number: JPRN-jRCT2080221533
• Lead Sponsor: Eisai Co., Ltd.

Brief Summary

Results from this study demonstrate that lenvatinib is effective in the treatment of radioiodine refractory DTC and has an acceptable safety profile when treatment is initiated at 24 mg once daily (QD) and adjusted by a dose-titration algorithm to manage toxicity.

Detailed Description

Not available

Study Timeline

• Study Start: 2011-08-05
• Results First Posted: 2015-02-12
• Last Update Posted: 17 October 2023

Recruitment & Eligibility

• Sex: All
• Target Recruitment: 392

Inclusion Criteria

1.Subjects must have histologically or cytologically confirmed diagnosis of one of the following DTC subtypes:
(1)Papillary thyroid cancer (PTC)
* Follicular variant
* Variants (including but not limited to tall cell, columnar cell, cribriform-morular, solid, oxyphil, Warthin's-like, trabecular, tumor with nodular fasciitis-like stroma, Hurthle cell variant of papillary carcinoma, poorly differentiated)

(2)Follicular thyroid cancer (FTC)
* Hurthle cell
* Clear cell
* Insular

2. Measurable disease meeting the following criteria and confirmed by central radiographic review:
* At least 1 lesion of >- 1.0 cm in the longest diameter for a non-lymph node or >- 1.5 cm in the short-axis diameter for a lymph node which is serially measurable according to RECIST 1.1 using computerized tomography/magnetic resonance imaging (CT/MRI).If there is only one target lesion and it is a non-lymph node, it should have a longest diameter of >- 1.5 cm
* Lesions that have had external beam radiotherapy(EBRT) or loco-regional therapies such as radiofrequency (RF) ablation must show evidence of progressive disease based on RECIST 1.1 to be deemed a target lesion

3. Subjects must show evidence of disease progression within 12 months (an additional month will be allowed to accommodate actual dates of performance of scans, i.e., within -< 13 months) prior to signing informed consent, according to RECIST 1.1 assessed and confirmed by central radiographic review of CT and / or MRI scans

4. Subjects must be 131I-refractory / resistant as defined by at least one of the following:
* One or more measurable lesions that do not demonstrate 131-I uptake on any radioiodine scan
* One or more measurable lesions that has progressed by RECIST 1.1 within 12 months of 131-I therapy, despite demonstration of radioiodine avidity at the time of that treatment by pre- or post-treatment scanning
* Cumulative activity of 131I of > 600 mCi or 22 gigabequerels (GBq), with the last dose administered at least 6 months prior to study entry

5. Subjects may have received 0 or 1 prior VEGF / VEGFR-targeted therapy ( for example sorafenib, sunitinib, pazopanib, etc.)

6. Patients with known brain metastases who have completed whole brain radiotherapy, stereotactic radiosurgery or complete surgical resection, will be eligible if they have remained clinically stable, asymptomatic and off of steroids for one month

7. Subjects must be receiving thyroxine suppression therapy and thyroid stimulating hormone (TSH) should not be elevated (TSH should be -< 5.50 mcu/mL).When tolerated by the subject, thyroxine dose should be changed to achieve TSH suppression (TSH < 0.50 mcu/mL) and this dose can be changed concurrently upon starting E7080

8. All chemotherapy or radiation-related toxicities must have resolved to < Grade 2 severity, except alopecia and infertility

9. Subjects must have an Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 - 2

10. Adequately controlled blood pressure with or without antihypertensive medications, defined as BP < 150/90 mmHg at screening and no change in antihypertensive medications within 1 week prior to the Screening Visit

11. Adequate renal function defined as calculated creatinine clearance >- 30 mL/min per the Cockcroft and Gault formula (Appendix 4)

12. Adequate bone marrow function:
* Absolute neutrophil count (ANC) >- 1500/mm3 (>- 1.5 x 103/microliter)
* Platelets >- 100,000/mm3 (>- 100 x 109/L)
* Hemoglobin >- 9.0 g/dL

13. Ade

Exclusion Criteria

Subjects who meet any of the following criteria will be excluded from this study:

1.Anaplastic or Medullary carcinoma of the thyroid
2.Two or more prior VEGF / VEGFR-targeted therapies or any ongoing treatment for 131I-refractory DTC other than TSH-suppressive thyroid hormone therapy
3.Prior treatment with E7080
4.Subjects who have received any anti-cancer treatment within 21 days or any investigational agent within 30 days prior to the first dose of study drug and should have recovered from any toxicity related to previous anti-cancer treatment. This does not apply to the use of TSH-suppressive thyroid hormone therapy
5.Major surgery within 3 weeks prior to the first dose of study drug
6.Subjects having > 1+ proteinuria on urine dipstick testing will undergo 24h urine collection for quantitative assessment of proteinuria. Subjects with urine protein >- 1 g/24h will be ineligible
7.Gastrointestinal malabsorption, or any other condition in the opinion of the investigator that might affect the absorption of E7080
8.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
9.Prolongation of QTcF interval to > 480 msec
10.Bleeding or thrombotic disorders or use of anticoagulants, such as warfarin, or similar agents requiring therapeutic international normalized ration (INR) monitoring. (Treatment with low molecular weight heparin (LMWH) is allowed)
11.Active hemoptysis (bright red blood of at least 0.5 teaspoon) within 3 weeks prior to the first dose of study drug
12.Active infection (any infection requiring treatment)
13.Active malignancy (except for differentiated thyroid carcinoma, or definitively treated melanoma in-situ, basal or squamous cell carcinoma of the skin, or carcinoma in-situ of the cervix) within the past 24 months
14.Known intolerance to any of the study drugs (or any of the excipients)
15.Any medical or other condition which, in the opinion of the investigator, would preclude participation in a clinical trial
16.Females who are pregnant or breastfeeding

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Progression-Free-Survival<br>To compare the Progression-free Survival (PFS) of subjects with 131IRefractory differentiated thyroid cancer (DTC) with radiographic evidence of disease progression within the prior 12 months treated with E7080 versus Placebo. [ Time Frame: Date of randomization to the date of disease progression (measured every 8 weeks) or death (whichever occurs first) as determined by blinded independent imaging review ] [ Designated as safety issue: No ]