Decitabine in Treating Patients With Metastatic Papillary Thyroid Cancer or Follicular Thyroid Cancer Unresponsive to Iodine I 131

NCT ID: NCT00085293

Last Updated: 2018-11-29

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2004-05-31

Study Completion Date

2014-05-31

Brief Summary

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This phase II trial is studying how well decitabine works in treating patients with metastatic papillary thyroid cancer or follicular thyroid cancer that has stopped responding to radioactive iodine. Iodine I 131 (radioactive iodine) kills thyroid cancer cells. Metastatic thyroid cancer cells can lose the ability to be treated with radioactive iodine. Decitabine may help thyroid cancer cells regain the ability to respond to treatment with radioactive iodine.

Detailed Description

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PRIMARY OBJECTIVE:

I. Determine whether decitabine can restore iodine I 131 (131I) uptake in patients with metastatic papillary thyroid or follicular thyroid cancer lesions that are undetectable by low-dose iodine 131I scanning.

SECONDARY OBJECTIVES:

I. Determine the efficacy of 131I therapy, administered after restoration of 131I uptake by decitabine, in these patients.

II. Determine the effect of decitabine on clinical and molecular markers of thyroid cancer cell differentiation in these patients.

III. Determine the safety and tolerability of decitabine in patients undergoing thyroid hormone withdrawal-induced hypothyroidism and 131I therapy.

OUTLINE: This is an open-label, multicenter study.

Patients receive decitabine intravenous (IV) over 1 hour on days 1-5 and 8-12 of weeks 1 and 2 (course 1). On week 3, patients undergo iodine I 131 (131I) scanning using thyrotropin alfa injections. Patients whose scan does not demonstrate iodine uptake continue suppressive thyroid hormone therapy but receive no further study therapy. These patients undergo study follow up.

Patients whose scan demonstrates iodine uptake undergo thyroid hormone withdrawal on weeks 4-8 and receive a second course of decitabine (as in course 1) on weeks 7 and 8. Patients then receive 131I therapy on week 9.

Patients are followed at 3 and 6 months.

Conditions

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Recurrent Thyroid Cancer Stage IVA Follicular Thyroid Cancer Stage IVA Papillary Thyroid Cancer Stage IVB Follicular Thyroid Cancer Stage IVB Papillary Thyroid Cancer Stage IVC Follicular Thyroid Cancer Stage IVC Papillary Thyroid Cancer

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Treatment

Starting dose 6 mg/m\^2 Decitabine intravenous (IV) over 1 hour on days 1-5 and 8-12 of weeks 1 and 2 (course 1). Week 3, Iodine I 131 (131I) scanning using thyrotropin alfa injections. Participants whose scan do not demonstrate iodine uptake continue suppressive thyroid hormone therapy but no further study therapy; these participants who do show uptake undergo thyroid hormone withdrawal on weeks 4-8 and second course of decitabine (as in course 1) on weeks 7 and 8, with 131I therapy on week 9.

Group Type EXPERIMENTAL

Decitabine

Intervention Type DRUG

Starting dose 6 mg/m\^2 intravenously over 1 hour every day for 5 successive days for 2 weeks (10 doses), with possible second course.

Iodine I 131

Intervention Type RADIATION

Undergo thyrotropin-alfa stimulated radioactive iodine scan

Recombinant thyrotropin alfa

Intervention Type BIOLOGICAL

Undergo thyrotropin-alfa stimulated radioactive iodine scan

Fludeoxyglucose F 18

Intervention Type RADIATION

Optional correlative studies

Positron emission tomography

Intervention Type PROCEDURE

Optional correlative studies

Interventions

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Decitabine

Starting dose 6 mg/m\^2 intravenously over 1 hour every day for 5 successive days for 2 weeks (10 doses), with possible second course.

Intervention Type DRUG

Iodine I 131

Undergo thyrotropin-alfa stimulated radioactive iodine scan

Intervention Type RADIATION

Recombinant thyrotropin alfa

Undergo thyrotropin-alfa stimulated radioactive iodine scan

Intervention Type BIOLOGICAL

Fludeoxyglucose F 18

Optional correlative studies

Intervention Type RADIATION

Positron emission tomography

Optional correlative studies

Intervention Type PROCEDURE

Other Intervention Names

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FDG-PET PET PET scan 5-aza-dCyd 5AZA DAC I 131 Iodotope Iodotrope Thyrogen 18FDG FDG tomography, emission computed

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed papillary thyroid or follicular thyroid carcinoma:

* Differentiated disease;

* Metastatic disease documented by ultrasound, computed tomography (CT) scan (without iodinated contrast), or MRI - All metastatic disease foci =\< 10 mm in all dimensions
* Must have been treated with total or near-total thyroidectomy AND at least 1 course of iodine I 131 (131I)(\>=29.9 mCi) OR demonstrated negative uptake on a postoperative low-dose131I scan
* Must have undergone whole body 131I scan 1-3 days after administration of =\< 5.5 mCi of 131I demonstrating no visible iodine uptake within the lesions unless demonstrated negative uptake on a postoperative low-dose131I scan within the past 12 weeks:

* Must have 24-hour urine iodine excretion =\< 500 mcg within 1 week of 131I scan
* Must be receiving thyroid hormone therapy AND have thyroid-stimulating hormone level =\< 0.5 mU/L
* No known brain metastases
* Performance status:

* Eastern Cooperative Oncology Group (ECOG) 0-2 OR Karnofsky 60-100%
* Hematopoietic:

* Absolute neutrophil count \>= 1,500/mm3;
* Platelet count \>= 100,000/mm3;
* White Blood Count (WBC) \>= 3,000/mm3
* Hepatic:

* aspartate aminotransferase-alanine aminotransferase (AST and ALT) =\< 2.5 times upper limit of normal;
* Bilirubin normal
* Renal:

* Creatinine not elevated OR
* Creatinine clearance \>= 60 mL/min
* Cardiovascular:

* No symptomatic congestive heart failure;
* No unstable angina pectoris;
* No cardiac arrhythmia
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception
* No prior allergic reaction attributed to compounds of similar chemical or biological composition to decitabine
* No concurrent uncontrolled illness
* No active or ongoing infection
* No psychiatric illness or social situation that would preclude study compliance
* No prior cytotoxic chemotherapy for thyroid cancer
* At least 6 months since prior external beam radiotherapy administered for locoregional disease in the thyroid bed or to the cervical or upper mediastinal lymph node regions (no more than 6,000 cGy)
* More than 6 months since other prior radiotherapy and recovered
* More than 6 months since prior therapeutic 131I \> 10 mCi
* More than 18 months since prior cumulative 131I activity of at least 500 mCi
* More than 12 months since prior amiodarone (Unless 24-hour urinary iodine excretion is =\< 500 mcg)
* No concurrent combination antiretroviral therapy for HIV-positive patients
* No other concurrent anticancer therapy
* No other concurrent investigational agents
* More than 6 months since prior intrathecal iodinated contrast (Unless 24-hour urinary iodine excretion is =\< 500 mcg)
* More than 3 months since prior IV or oral iodinated contrast for radiographic studies (Unless 24-hour urinary iodine excretion is =\< 500 mcg)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Steven Sherman

Role: PRINCIPAL_INVESTIGATOR

M.D. Anderson Cancer Center

Locations

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University of Colorado at Denver

Aurora, Colorado, United States

Site Status

Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center

Columbus, Ohio, United States

Site Status

M D Anderson Cancer Center

Houston, Texas, United States

Site Status

Countries

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United States

Related Links

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http://www.mdanderson.org

University of Texas MD Anderson Cancer Center Official Website

Other Identifiers

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NCI-2009-00033

Identifier Type: REGISTRY

Identifier Source: secondary_id

CDR0000368467

Identifier Type: -

Identifier Source: secondary_id

5954

Identifier Type: -

Identifier Source: secondary_id

2003-0308

Identifier Type: OTHER

Identifier Source: secondary_id

5954

Identifier Type: OTHER

Identifier Source: secondary_id

P30CA016672

Identifier Type: NIH

Identifier Source: secondary_id

View Link

N01CM62207

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NCI-2009-00033

Identifier Type: -

Identifier Source: org_study_id

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