Phase II Trial of Sunitinib (SU11248) in Iodine-131 Refractory, Unresectable Differentiated Thyroid Cancers and Medullary Thyroid Cancers
Inclusion Criteria:
- Histologically or cytologically confirmed diagnosis of 1 of the following:
- Well-differentiated thyroid carcinoma (WDTC), including any of the following
subtypes:
- Papillary
- Follicular
- Hürthle cell
- Medullary thyroid carcinoma (MTC)
- Must show evidence of disease progression within the past 6 months despite treatment
with iodine I 131 therapy OR ineligible for iodine I 131 therapy
- Unresectable disease
- Patients with WDTC must be receiving thyroxine suppression therapy
- Measurable disease meeting 1 of the following criteria:
- Radiographically measurable disease defined as ≥ 1 lesion that can be accurately
measured in ≥ 1 dimension as ≥ 20 mm by conventional techniques or as ≥ 10 mm by
spiral CT scan
- Biochemically measurable disease defined as an elevated thyroglobulin (WDTC
patients) or calcitonin (MTC patients)
- No known brain metastases
- Patients with brain metastases with stable neurologic status after local therapy
(surgery or radiotherapy) for ≥ 8 weeks from definitive therapy and without
neurologic dysfunction that would confound the evaluation of neurologic and
other adverse events are eligible
- ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
- Life expectancy > 12 weeks
- WBC ≥ 3,000/mm³
- Absolute neutrophil count ≥ 1,500/mm³
- Platelet count ≥ 100,000/mm³
- Hemoglobin ≥ 9 g/dL
- Calcium ≤ 12.0 mg/dL
- Bilirubin normal
- AST or ALT ≤ 2.5 times upper limit of normal (ULN) (or ≤ 5.0 times ULN if patient has
liver metastases)
- Creatinine normal OR creatinine clearance ≥ 60 mL/min
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- No history of allergic reactions attributed to compounds of similar chemical or
biological composition to sunitinib malate
- No poorly controlled hypertension, defined as systolic blood pressure (BP) ≥ 140 mm
Hg or diastolic BP ≥ 90 mm Hg
- No condition that would impair ability to swallow and retain sunitinib malate
tablets, including any of the following:
- Gastrointestinal tract disease resulting in an inability to take oral medication
or a requirement of IV alimentation
- Prior surgical procedures affecting absorption
- Active peptic ulcer disease
- No serious or nonhealing wound, ulcer, or bone fracture
- No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within
the past 28 days
- No pulmonary embolism within the past 12 months
- QTc < 500 msec
- No significant ECG abnormalities
- No cerebrovascular accident or transient ischemic attack within the past 12 months
- No myocardial infarction, cardiac arrhythmia, stable or unstable angina, symptomatic
congestive heart failure, or coronary or peripheral artery bypass graft or stenting
within the past 12 months
- No New York Heart Association (NYHA) class III-IV heart failure or other condition
- No serious ventricular arrhythmia (i.e., ventricular fibrillation or ventricular
tachycardia ≥ 3 beats in a row)
- Patients with any of the following conditions must have NYHA class II cardiac
function confirmed on baseline ECHO/MUGA scan
- History of class II heart failure and asymptomatic on treatment
- Prior anthracycline exposure
- Received central thoracic radiation that included the heart in the radiotherapy
port
- No uncontrolled intercurrent illness, including, but not limited to, any of the
following:
- Ongoing or active infections
- Psychiatric illness or social situation that would preclude study compliance
- Recovered from prior therapy
- No more than 1 prior chemotherapy regimen for metastatic disease
- No prior external-beam radiation to the measured tumor constituting the target
lesion(s)
- No prior receptor tyrosine kinase inhibitors
- No prior antiangiogenic agents (e.g., bevacizumab, sorafenib, pazopanib, AZD2171,
vatalanib, VEGF Trap)
- At least 4 weeks since prior radiotherapy or chemotherapy (6 weeks for nitrosoureas
or mitomycin C)
- At least 4 weeks since prior major surgery
- No other concurrent anticancer agents or therapies
- No other concurrent investigational agents
- No concurrent therapeutic doses of coumarin-derivative anticoagulants, such as
warfarin
- Doses ≤ 2 mg daily for prophylaxis of thrombosis allowed
- Low molecular weight heparin allowed provided PT INR ≤ 1.5
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No concurrent enzyme-inducing anticonvulsants
- No concurrent agents with proarrhythmic potential, including any of the following:
- Terfenadine
- Quinidine
- Procainamide
- Disopyramide
- Sotalol
- Probucol
- Bepridil
- Haloperidol
- Risperidone
- Indapamide
- Flecainide
- At least 7 days since prior and no concurrent inhibitors of CYP3A4, including any of
the following:
- Azole antifungals (e.g., ketoconazole, itraconazole)
- Clarithromycin, erythromycin
- Diltiazem
- Verapamil
- HIV-protease inhibitors (e.g., indinavir, saquinavir, ritonavir, atazanavir,
nelfinavir)
- Delavirdine
- At least 12 days since prior and no concurrent inducers of CYP3A4, including any of
the following:
- Rifampin
- Rifabutin
- Carbamazepine
- Phenobarbital
- Phenytoin
- Hypericum perforatum (St. John's wort)
- Efavirenz
- Tipranavir