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Sorafenib with or without Everolimus in Treating Patients with Advanced, Radioactive Iodine Refractory Thyroid Cancer

Trial Status: Closed to Accrual

This randomized phase II trial studies the effects, good and bad, of using everolimus along with sorafenib versus sorafenib alone in treating patients with thyroid cancer that has spread to other places in the body (advanced) or cannot be removed by surgery (unresectable) and has not responded to treatment with radioactive iodine (refractory). Sorafenib 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 may cause more shrinkage of thyroid cancer and may prevent it from growing but it could also cause more side effects than sorafenib alone. It is not yet known whether this treatment with sorafenib and everolimus is better, the same, or worse than sorafenib alone.

Inclusion Criteria

  • 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
  • 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
  • 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)
  • Progressive disease defined by RECIST criteria =< 14 months
  • Patients must have metastatic disease or locally advanced unresectable disease
  • 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
  • No history of major surgery =< 28 days of registration
  • No history of intracranial brain metastasis
  • 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
  • No history of the following: * Child Pugh class B or C liver disease * “Chronic active” hepatitis defined as: ** Hepatitis B surface antigen (HBsAg) is positive > 6 months ** 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 ** Persistent or intermittent elevation in alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels ** Liver biopsy showing chronic hepatitis with moderate or severe necroinflammation
  • No history of gastrointestinal fistula or gastrointestinal perforation < 90 days of registration
  • No known history of prolonged QT syndrome
  • 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
  • Concomitant medications: * Chronic concomitant treatment with strong inhibitors of cytochrome P450, family 3, subfamily A, polypeptide 4 (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
  • 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
  • Eastern Cooperative Oncology Group (ECOG) performance status =< 2
  • Eligible patients must have histopathologically confirmed Hurthle cell thyroid cancer by central review
  • Absolute neutrophil count (ANC) >= 1,500/mm^3
  • Platelet count >= 100,000/mm^3
  • Creatinine =< 1.5 mg/dL OR calculated (calc.) 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
  • Fasting triglyceride =< 2.5 x ULN

Florida

Jacksonville
Mayo Clinic in Florida
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 855-776-0015

Illinois

Chicago
Northwestern University
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 312-695-1301

Iowa

Sioux City
Siouxland Regional Cancer Center
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 712-252-9326

Michigan

Ann Arbor
University of Michigan Comprehensive Cancer Center
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 800-865-1125

Minnesota

Rochester
Mayo Clinic
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 855-776-0015

Nebraska

Omaha
Nebraska Methodist Hospital
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 402-354-5144

New Jersey

Basking Ridge
Memorial Sloan Kettering Basking Ridge
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 212-639-7592
Middletown
Memorial Sloan Kettering Monmouth
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 212-639-7592
Montvale
Memorial Sloan Kettering Bergen
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 212-639-7592

New York

Commack
Memorial Sloan Kettering Commack
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 212-639-7592
New York
Memorial Sloan Kettering Cancer Center
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 212-639-7592
Sleepy Hollow
Memorial Sloan Kettering Sleepy Hollow
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 212-639-7202
Uniondale
Memorial Sloan Kettering Nassau
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 212-639-7592
West Harrison
Memorial Sloan Kettering Westchester
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 212-639-7592

North Carolina

Clinton
Southeastern Medical Oncology Center-Clinton
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 919-587-9077
Goldsboro
Southeastern Medical Oncology Center-Goldsboro
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 919-587-9077
Wayne Memorial Hospital
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 919-731-6687
Jacksonville
Southeastern Medical Oncology Center-Jacksonville
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 910-353-0824

Ohio

Columbus
Ohio State University Comprehensive Cancer Center
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 800-293-5066

Pennsylvania

Philadelphia
Fox Chase Cancer Center
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 215-728-4790

Wisconsin

Janesville
Mercyhealth Hospital and Cancer Center - Janesville
Status: CLOSED_TO_ACCRUAL
Contact: Site Public Contact
Phone: 800-928-1103

PRIMARY OBJECTIVE:

I. To compare the progression-free survival (PFS) between sorafenib tosylate (sorafenib) and everolimus versus (vs.) sorafenib alone in patients with radioactive iodine refractory Hurthle cell thyroid cancer.

SECONDARY OBJECTIVE:

I. To compare the confirmed response rate, overall survival (OS), and adverse event rates between sorafenib and everolimus vs. sorafenib alone.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive sorafenib tosylate orally (PO) twice daily (BID) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients with progressive disease may then receive everolimus PO once daily (QD) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive sorafenib tosylate as in Arm I and everolimus PO QD on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 2-6 weeks and then every 3-6 months for up to 5 years after registration.

Trial Phase Phase II

Trial Type Treatment

Lead Organization
Alliance for Clinical Trials in Oncology

Principal Investigator
Eric Jeffrey Sherman

  • Primary ID A091302
  • Secondary IDs NCI-2014-00623
  • Clinicaltrials.gov ID NCT02143726