Sorafenib Tosylate With or Without Everolimus in Treating Patients With Advanced, Radioactive Iodine Refractory Hurthle Cell Thyroid Cancer

NCT ID: NCT02143726

Last Updated: 2025-01-27

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 35 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-10-09
• Study Completion Date: 2028-08-06

Brief Summary

This randomized phase II trial studies the effects, good and bad, of using everolimus along with sorafenib tosylate versus sorafenib tosylate alone in treating patients with advanced radioactive iodine refractory thyroid cancer. Sorafenib tosylate and everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. The addition of everolimus to sorafenib tosylate may cause more shrinkage of thyroid cancer and may prevent it from growing but it could also cause more side effects than sorafenib tosylate alone. It is not yet known whether this treatment with sorafenib tosylate and everolimus is better, the same, or worse than sorafenib tosylate alone.

Detailed Description

This randomized Phase II trial will compare the progression-free survival (PFS) of sorafenib and everolimus versus sorafenib alone in patients with radioactive iodine refractory hurthle cell thyroid cancer. Prior studies have shown that the median PFS is generally around 4.5 months for sorafenib alone in this disease population. It is hoped that the combination of everolimus and sorafenib can increase the median PFS to at least 9 months. In addition to PFS, this trial will also compare the confirmed response rate, overall survival (OS) and adverse event rates between sorafenib and everolimus vs. sorafenib alone. The primary and secondary objectives for the study are listed below.

Primary Objective:

To compare the progression free survival between sorafenib and everolimus versus sorafenib alone in patients with radioactive iodine refractory Hurthle cell thyroid cancer

Secondary Objective:

To compare the confirmed response rate, overall survival and adverse event rates between sorafenib and everolimus versus sorafenib alone.

Treatment will continue until disease progression or unacceptable adverse events. Patients will be followed for 5 years after randomization.

Conditions

Refractory Hurthle Cell Thyroid Cancer

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

sorafenib

Patients receive sorafenib 400 mg PO twice daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients with progressive disease may cross over and receive everolimus 10 mg PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Group Type: ACTIVE_COMPARATOR

sorafenib

Intervention Type: DRUG

Given PO

sorafenib and everolimus

Patients receive sorafenib 400 mg PO twice daily and everolimus 5 mg PO once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Group Type: EXPERIMENTAL

sorafenib

Intervention Type: DRUG

Given PO

everolimus

Intervention Type: DRUG

Given PO

Interventions

sorafenib

Given PO

Intervention Type: DRUG

everolimus

Given PO

Intervention Type: DRUG

Other Intervention Names

Nexavar ®, BAY 43-9006; RAD001, Afinitor ®

Eligibility Criteria

Inclusion Criteria

Eligibility Criteria:

1. Central pathology review submission - Patients must have 10 representative hematoxylin and eosin (H&E) stained thyroid tissue slides OR tumor block available for submission to central pathology review. This review is mandatory prior to registration to confirm eligibility.

2. Measurable disease - Patients must have measurable disease by Response Evaluation Criteria In Solid Tumors (RECIST) criteria, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as ≥ 20 mm with conventional techniques or as ≥ 10 mm with spiral computed tomography (CT) scan. CT must be performed within 28 days of registration.

3. Radioactive iodine (RAI) - refractory disease defined as 1 or more of the following:

• Patients who have received greater than 600 mCi of radioactive iodine in their lifetime OR
• RAI-avid metastatic lesion which remained stable in size or progressed despite RAI treatment within 9 months of RAI treatment OR
• 10% or more increase in serum thyroglobulin (on thyroid-stimulating hormone [TSH]-suppression) within 9 months of RAI treatment OR
• Index metastatic lesion non-RAI avid on a diagnostic RAI scan OR
• Presence of fluorodeoxyglucose (FDG) avid metastatic lesions on positron emission tomography (PET)/CT scan (standardized uptake values [SUV]max > 5 of any single lesion)

4. Progressive disease defined by RECIST criteria ≤ 14 months

5. Patients must have metastatic disease or locally advanced unresectable disease

6. Prior treatment

• Patients may have received prior radiation therapy to index lesions ≥ 28 days prior to registration on this protocol if there has been documented progression by RECIST criteria. Prior radiation therapy to the non-index lesions is allowed if ≥ 28 days prior to registration on this protocol.
• Prior RAI therapy is allowed if ≥ 90 days prior to registration on this protocol and evidence of progression (as defined above) has been documented in the interim (a diagnostic study using < 10 mCi of RAI is not considered RAI therapy).
• Prior chemotherapy is allowed if ≥ 28 days prior to registration on this protocol.
• Patient may have received any number of prior lines of therapy.
• No prior use of sorafenib or an mammalian target of rapamycin (mTOR) (including phosphoinositide 3-kinase [PI3k] or protein kinase B [AKT]) inhibitor for the treatment of thyroid cancer.

7. No history of major surgery ≤ 28 days of registration

8. No history of intracranial brain metastasis

9. Cardiovascular disease. No history of any of the following ≤ 6 months of registration:

• Myocardial infarction or unstable angina
• New York Heart Association grade III or greater congestive heart failure
• Cerebrovascular accident
• Grade 3 or 4 peripheral ischemia
• Grade 3 or 4 thromboembolic event

10. Liver disease: No history of the following:

• Child Pugh Class B or C liver disease
• "Chronic active" hepatitis defined as:

1. Hepatitis B surface antigen (HBsAg) > 6 months

2. Serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) 20,000 IU/ml (105 copies/ml), lower values 2,000-20,000 IU/ml (104-105 copies/ml) are often seen in hepatitis B e antigen (HBeAg)-negative chronic hepatitis B

3. Persistent or intermittent elevation in alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels

4. Liver biopsy showing chronic hepatitis with moderate or severe necroinflammation

11. No history of gastrointestinal fistula or gastrointestinal perforation < 90 days of registration.

12. No known history of prolonged QT syndrome

13. No Grade 3 or 4 hypertension (systolic blood pressure [BP] >160 and or diastolic BP > 100) that cannot be controlled with medication prior to registration.

14. Concomitant medications:

• Chronic concomitant treatment with strong inhibitors of cytochrome P450 3A4 (CYP3A4) is not allowed on this study. Patients on strong CYP3A4 inhibitors must discontinue the drug for 14 days prior to registration on the study.
• Chronic concomitant treatment with strong CYP3A4 inducers is not allowed. Patients must discontinue the drug 14 days prior to the start of study treatment.
• Patients requiring anticoagulation must be on stable dose of medication prior to registration.

15. Not pregnant and not nursing, because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown. Therefore, for women of childbearing potential only, a negative serum pregnancy test done ≤ 7 days prior to registration is required.

16. Age ≥ 18 years

17. Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 2

18. Required Initial Laboratory Values:

• Absolute neutrophil count (ANC) ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Creatinine ≤ 1.5 mg/dL OR
• Calculated creatinine clearance ≥ 30 mL/min
• Total bilirubin ≤ 1.5 x upper limits of normal (ULN)
• Serum glutamic oxaloacetic transaminase (SGOT) (AST) ≤ 2.5 x ULN
• Fasting serum cholesterol ≤ 300 mg/dL

19. Documentation of disease: Histologic Documentation - Eligible patients must have histopathologically confirmed Hürthle cell thyroid cancer by central review.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: collaborator

Novartis

INDUSTRY

Sponsor Role: collaborator

Alliance for Clinical Trials in Oncology

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Eric Sherman, M.D.

Role: STUDY_CHAIR

Memorial Sloan Kettering Cancer Center

Locations

Mayo Clinic in Florida

Jacksonville, Florida, United States

Northwestern University

Chicago, Illinois, United States

Siouxland Regional Cancer Center

Sioux City, Iowa, United States

University of Michigan Comprehensive Cancer Center

Ann Arbor, Michigan, United States

Mayo Clinic

Rochester, Minnesota, United States

Nebraska Methodist Hospital

Omaha, Nebraska, United States

Memorial Sloan Kettering Basking Ridge

Basking Ridge, New Jersey, United States

Memorial Sloan Kettering Monmouth

Middletown, New Jersey, United States

Memorial Sloan Kettering Bergen

Montvale, New Jersey, United States

Memorial Sloan Kettering Commack

Commack, New York, United States

Memorial Sloan Kettering Westchester

Harrison, New York, United States

Memorial Sloan Kettering Cancer Center

New York, New York, United States

Memorial Sloan Kettering Sleepy Hollow

Sleepy Hollow, New York, United States

Memorial Sloan Kettering Nassau

Uniondale, New York, United States

Southeastern Medical Oncology Center-Clinton

Clinton, North Carolina, United States

Southeastern Medical Oncology Center-Goldsboro

Goldsboro, North Carolina, United States

Wayne Memorial Hospital

Goldsboro, North Carolina, United States

Southeastern Medical Oncology Center-Jacksonville

Jacksonville, North Carolina, United States

Ohio State University Comprehensive Cancer Center

Columbus, Ohio, United States

Fox Chase Cancer Center

Philadelphia, Pennsylvania, United States

Mercy Health System

Janesville, Wisconsin, United States

Countries

United States

References

Matsuura D, Yuan A, Wang L, Ranganath R, Adilbay D, Harries V, Patel S, Tuttle M, Xu B, Ghossein R, Ganly I. Follicular and Hurthle Cell Carcinoma: Comparison of Clinicopathological Features and Clinical Outcomes. Thyroid. 2022 Mar;32(3):245-254. doi: 10.1089/thy.2021.0424.

Reference Type: DERIVED

PMID: 35078345 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

U10CA180821

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NCI-2014-00623

Identifier Type: REGISTRY

Identifier Source: secondary_id

A091302

Identifier Type: -

Identifier Source: org_study_id