A Phase II Study of Single Agent Depsipeptide (FK228) in Radioiodine (RAI)-Refractory Metastatic Non-medullary (Papillary, Follicular, and Hurthle Cell Variants) Thyroid Carcinoma
Inclusion Criteria:
- Histologically or cytologically confirmed non-medullary thyroid carcinoma, including
the following cell types:
- Papillary
- Follicular
- Variants of papillary or follicular
- Hürthle cell
- Recurrent and/or metastatic disease
- Measurable disease
- At least 1 unidimensionally measurable lesion >= 20 mm by conventional
techniques OR >= 10 mm by spiral CT scan
- Progressive disease during or after prior treatment, as defined by >= 1 of the
following criteria:
- Presence of new or progressive lesions on CT scan or MRI
- New lesions on bone or positron-emission tomography scan
- Rising thyroglobulin level
- Minimum of 3 consecutive rises with an interval of >= 1 week between each
determination
- Refractory to radioactive iodine (RAI)
- Absent or insufficient RAI-uptake documented by whole-body RAI scan within the
past 6 months
- At least 1 lesion with absent RAI-uptake required for insufficient uptake
- No known brain metastases
- Performance status - Karnofsky 60-100%
- WBC >= 3,000/mm^3
- Absolute neutrophil count >= 1,500/mm^3
- Platelet count >= 100,00/mm^3
- Bilirubin normal
- AST and ALT =< 2.5 times upper limit of normal
- Chronic active viral hepatitis allowed provided patient is clinically stable and
fulfills liver function eligibility criteria
- Creatinine normal
- Creatinine clearance >= 60 mL/min
- QTc =< 480 msec by ECG
- ST segment depression < 2 mm
- LVEF >= 50 % by echocardiogram
- No left ventricular hypertrophy, as defined by end-diastolic wall thickness > 12 mm
in both the left ventricular posterior wall as well as septum or restrictive
cardiomyopathy
- No history of any of the following cardiac diseases:
- Canadian Cardiovascular Society (CCS) class II-IV angina pectoris
- Myocardial infarction within the past 12 months
- Sustained ventricular tachycardia, ventricular fibrillation, Torsade de Pointes,
or cardiac arrest unless currently addressed with an automatic implantable
cardioverter defibrillator
- Any cardiac arrhythmia requiring digitalis or another antiarrhythmic medication
other than a beta blocker or calcium channel blocker
- No uncontrolled hypertension (i.e., blood pressure >= 160/95)
- Mobitz II second degree block in patients who do not have a pacemaker
- First degree or Mobitz I second degree block, bradyarrhythmias or sick
sinus syndrome require Holter monitoring and evaluation by cardiology
- Uncontrolled dysrhythmias
- No history of congenital long QT syndrome
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Thyroid stimulating hormone normal or suppressed
- No history of allergic reaction attributed to compounds of similar chemical or
biologic composition to FR901228
- No ongoing or active infection
- No psychiatric illness or social situation that would preclude study participation
- No other concurrent uncontrolled illness
- At least 4 weeks since prior biologic or targeted agents (e.g., interferon alfa,
thalidomide, octreotide, or cetuximab)
- No concurrent antineoplastic biologic agents
- No prior FR901228 (depsipeptide)
- No prior cytotoxic chemotherapy
- Cytotoxic chemotherapy as a radiosensitizer allowed provided >= 3 months since
prior administration
- No other concurrent antineoplastic chemotherapy
- Not specified
- At least 4 weeks since prior external beam radiation therapy
- Documented disease progression required if patient received external beam
radiotherapy to index lesions
- At least 3 months since prior RAI therapy
- Diagnostic studies using =< 12 mCi of RAI are not considered RAI therapy
- No concurrent antineoplastic radiotherapy
- At least 2 weeks since prior anticancer cyclooxygenase-2 (COX-2) inhibitors,
isotretinoin, or complementary medications
- At least 4 weeks since prior tyrosine kinase inhibitors (e.g., gefitinib or
erlotinib)
- No other concurrent investigational agents
- No other concurrent anticancer therapy
- No concurrent drugs known to have histone deacetylase inhibitor activity (e.g.,
valproic acid)
- No concurrent combination anti-retroviral therapy for HIV-positive patients
- No concurrent hydrochlorothiazide
- No concurrent treatment dose warfarin
- No concurrent agents that cause QTc prolongation
- Concurrent daily aspirin given after myocardial infarction or COX-2 inhibitors at
standard anti-inflammatory or pain doses allowed