Differentiated Thyroid Cancer: is There a Need for Radioiodine Ablation in Low Risk Patients?

NCT ID: NCT01837745

Last Updated: 2023-05-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

776 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-05-13

Study Completion Date

2030-01-01

Brief Summary

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Open-label randomized phase III trial, using a non-inferiority comparison design. After randomization,patients will receive either post-operative radioiodine ablation with an activity of 1.1 GBq (30 mCi) after stimulation by rhTSH, and then be followed-up (ablation group) or be followed-up (without postoperative radioiodine ablation) (follow-up group).

The objective is to assess the non-inferiority of the proportion of patients without tumor-related event evaluated at three years after randomisation in the absence of radioiodine ablation (follow-up group) compared to the ablation group, in patients with low-risk differentiated thyroid cancer treated with total thyroidectomy with or without lymph node dissection (pT1am N0 or Nx, pT1b N0 or Nx)

Detailed Description

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Conditions

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Low Risk Differentiated Thyroid Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Ablation group

* Administration of 1.1 GBq of I131 is given after the second intramuscular injections of rhTSH (0.9 mg). A whole body scan (WBS) is performed 2 to 5 days after the administration or I131 with determination of the neck uptake.
* Follow-up consists in:

* 10 (+/- 2 months) after randomization: neck ultrasound + a serum Tg measurement after rhTSH stimulation
* 2 years (+/- 2 months) after randomization: serum Tg measurement under LT4 treatment (Tg/LT4)
* 3 years (+/- 2 months) after randomization: neck ultrasound and a serum Tg/LT4
* 4 years (+/- 2 months) after randomization: a serum Tg/LT4
* 5 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 8 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 10 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 12 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4

Group Type ACTIVE_COMPARATOR

rhTSH stimulation

Intervention Type DRUG

Intramuscular injections of rhTSH (0.9 mg) on two consecutive days on LT4 treatment

I131

Intervention Type DRUG

An activity of 1.1 GBq of I131 is given orally 24 hours after the second injection of rhTSH.

Follow up

Intervention Type OTHER

* 10 (+/- 2 months) after randomization: a neck ultrasound and a serum Tg measurement after rhTSH or LT4 stimulation
* 2 years (+/- 2 months) after randomization: a serum Tg measurement under LT4 treatment (Tg/LT4)
* 3 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 4 years (+/- 2 months) after randomization: a serum Tg/LT4
* 5 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 8 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 10 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 12 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4

Follow up group

Patients randomized in the follow up group neither received 131I nor rhTSH. Patients will undergo the same followup procedures as patients randomized to the ablation group, except that at 10 months after randomization, Tg will be measured under LT4 treatment and not after rhTSH stimulation.

Group Type EXPERIMENTAL

Follow up

Intervention Type OTHER

* 10 (+/- 2 months) after randomization: a neck ultrasound and a serum Tg measurement after rhTSH or LT4 stimulation
* 2 years (+/- 2 months) after randomization: a serum Tg measurement under LT4 treatment (Tg/LT4)
* 3 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 4 years (+/- 2 months) after randomization: a serum Tg/LT4
* 5 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 8 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 10 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 12 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4

Interventions

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rhTSH stimulation

Intramuscular injections of rhTSH (0.9 mg) on two consecutive days on LT4 treatment

Intervention Type DRUG

I131

An activity of 1.1 GBq of I131 is given orally 24 hours after the second injection of rhTSH.

Intervention Type DRUG

Follow up

* 10 (+/- 2 months) after randomization: a neck ultrasound and a serum Tg measurement after rhTSH or LT4 stimulation
* 2 years (+/- 2 months) after randomization: a serum Tg measurement under LT4 treatment (Tg/LT4)
* 3 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 4 years (+/- 2 months) after randomization: a serum Tg/LT4
* 5 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 8 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 10 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4
* 12 years (+/- 2 months) after randomization: a neck ultrasound and a serum Tg/LT4

Intervention Type OTHER

Other Intervention Names

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Thyrogen

Eligibility Criteria

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Inclusion Criteria

1. Patients with differentiated thyroid cancer (papillary, follicular or with Hurthle cells) in the absence of aggressive histological subtypes (poorly differentiated, tall-clear-cylindric cell, diffuse sclerosing or with an anaplastic component)
2. Patients having undergone a total thyroidectomy with complete (R0) tumor resection, with or without lymph node neck dissection
3. Total thyroidectomy performed 2 to 5 months before inclusion
4. Patients with low risk of recurrence: pT1amN0 or pT1amNx with a sum of the size of the lesions above 1 cm and equal to or less than 2 cm, or pT1bN0 or pT1bNx (TNM 2010 classification).
5. Post-operative neck ultrasound (performed 2 to 5 months after surgery) showing the absence of abnormalities in the lateral lymph node compartments, or if abnormalities, no lymph nodes with abnormal cytology and/or thyroglobulin concentration in the aspirate fluid \> 10 ng/mL
6. Age \>=18 years
7. Performance status of 0 or 1
8. Patients who signed the informed consent
9. Patients who can be followed-up annually during 5 years in order to assess the objectives of the study
10. Women of childbearing age should have a negative pregnancy test before any radioiodine administration
11. Both patients with or without thyroglobulin antibodies are eligible

Exclusion Criteria

1. Patients having undergone less than a total thyroidectomy
2. Patients with aggressive histotype (poorly differentiated, tall-clear-cylindric cell, diffuse sclerosing, or with an anaplastic component)
3. Patients having undergone total thyroidectomy less than 2 months or more than 5 months before inclusion
4. Patients with cancer classified as pT1a unifocal (in which ablation is not necessary), or pT1N1, pT2, pT3, pT4 or N1 (who have a higher risk of recurrence) (classification TNM 2010)
5. Patient with known distant metastasis
6. Abnormal post-operative neck ultrasound of the lateral lymph node compartments
7. Patients with another malignancy not in remission for at least 2 years (except for in situ cervix uterine cancer, basocellular skin cancer)
8. Patients with a recent history of drugs affecting thyroid function, including injection of radiocontrast agents during the last 8 weeks.
9. Patients previously treated with radioactive iodine or who previously underwent a whole body scan with radioactive iodine
10. Pregnant or breast feeding women
11. Subject with any kind of disorder that may compromise his/her ability to give written informed consent and/or to comply with study procedures
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Gustave Roussy, Cancer Campus, Grand Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Institut Gustave Roussy

Villejuif, Val De Marne, France

Site Status

Countries

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France

References

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Leboulleux S, Bournaud C, Chougnet CN, Lamartina L, Zerdoud S, Do Cao C, Catargi B, Dygai I, Kelly A, Barge ML, Vera P, Rusu D, Schneegans O, Roux J, Raymond P, Benisvy D, Eberle MC, Bidault S, Nascimento C, Bastie D, Giraudet AL, Bardet S, Le Moullec N, Roudaut N, Drui D, Godbert Y, Zalzali M, Drutel A, Morel O, Velayoudom FL, Al Ghuzlan A, Schlumberger M, Buffet C, Borget I. Thyroidectomy without radioiodine in patients with low-risk thyroid cancer: 5 years of follow-up of the prospective randomised ESTIMABL2 trial. Lancet Diabetes Endocrinol. 2025 Jan;13(1):38-46. doi: 10.1016/S2213-8587(24)00276-6. Epub 2024 Nov 22.

Reference Type DERIVED
PMID: 39586309 (View on PubMed)

Leboulleux S, Bournaud C, Chougnet CN, Zerdoud S, Al Ghuzlan A, Catargi B, Do Cao C, Kelly A, Barge ML, Lacroix L, Dygai I, Vera P, Rusu D, Schneegans O, Benisvy D, Klein M, Roux J, Eberle MC, Bastie D, Nascimento C, Giraudet AL, Le Moullec N, Bardet S, Drui D, Roudaut N, Godbert Y, Morel O, Drutel A, Lamartina L, Schvartz C, Velayoudom FL, Schlumberger MJ, Leenhardt L, Borget I. Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer. N Engl J Med. 2022 Mar 10;386(10):923-932. doi: 10.1056/NEJMoa2111953.

Reference Type DERIVED
PMID: 35263518 (View on PubMed)

Other Identifiers

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2012/1913

Identifier Type: OTHER

Identifier Source: secondary_id

2012-A01569-34

Identifier Type: -

Identifier Source: org_study_id

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