Vemurafenib and Cobimetinib for the Treatment of Patients With High Risk Differentiated Thyroid Carcinoma With BRAFV600E Mutation

Launched by CITY OF HOPE MEDICAL CENTER · Jun 1, 2024

Keywords

ClinConnect Summary

This clinical trial is looking at how effective two medications, vemurafenib and cobimetinib, are in treating patients with high-risk differentiated thyroid cancer that has a specific genetic change called the BRAFV600E mutation. These medications work by blocking signals that tell cancer cells to grow and divide, which may help control the cancer before patients undergo radioactive iodine therapy, a common treatment for thyroid cancer.

To be eligible for this trial, participants need to be at least 18 years old and have been diagnosed with certain types of thyroid cancer that show the BRAFV600E mutation. They must also be classified as high-risk for cancer recurrence based on certain medical criteria. Participants will need to commit to around 14 months of follow-up, during which they will receive the study medications and undergo regular health assessments. It's important to note that the trial is currently recruiting patients, and those interested should discuss with their healthcare provider to see if they meet the criteria and would like to participate.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Documented informed consent of the participant and/or legally authorized representative
• • Willingness to be followed for about 14 months
• • Males or females aged ≥ 18 years at the time of informed consent
• • Patients with thyroid carcinoma of follicular origin (papillary, follicular or Hurthle cell)
• • Known positive BRAFV600E mutation (determined on a previous analysis and/or on a representative formalin-fixed paraffin embedded (FFPE) tumor samples or on a biopsy sample)
• * High risk for recurrence according to the American Thyroid Association (ATA) guideline defined as having one or more of the features below:
• • Gross extrathyroidal extension
• • FTC with extensive vascular invasion (\> 4), although less likely to have BRAF mutation
• • PTC with vascular invasion
• • Advanced nodal disease of (any node \>3 cm, \> 4 nodes, or extra-nodal extension)
• • BRAF+TERT promoter mutation
• • Post op thyroglobulin (TG) suggestive of distant metastasis
• • Distant metastatic sites (only for exploratory arm)
• • Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1
• • Blood pressure (BP) ≤ 140/90 mm Hg at screening with or without antihypertensive medications and no change in antihypertensive medications within 1 week prior to treatment start
• • Creatinine clearance ≥ 50 mL/min according to the Cockcroft and Gault formula
• • Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
• • Hemoglobin ≥ 9.0 g/dL
• • Platelet count ≥ 100 x 109/L
• • Normal blood coagulation function as evidenced by an International Normalized Ratio (INR) ≤ 1.5
• • Bilirubin ≤ 1.5 × upper limit of normal (ULN) except for unconjugated hyperbilirubinemia or Gilbert's syndrome
• • Alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) ≤ 3 × ULN (≤ 5 × ULN if subject has liver metastases)
• • Women of childbearing potential must have a negative urine or serum β-HCG pregnancy test within 7 days prior to the administration of the first study treatment
• • Agreement by women of childbearing potential (WOCBP) and males of childbearing potential\* to use an effective\*\* method of birth control\*\* for at least 3 months prior to screening through 1 year of study follow-up.
• • Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for \> 1 year (women only)
• • Effective birth control defined as hormonal and/or barrier contraception
• • Non-English speaking persons and adults lacking capacity to consent are not excluded from participation
• Exclusion Criteria:
• • Prior RAI treatment
• • Prior anti-BRAF, anti-MEK treatment such as sorafenib, dabrafenib, vemurafenib, encorafenib, binimetinib, cobimetinib, trametinib, d selumitinib and other TKIs like, lenvatinib, sunitinib, axitinib, cabozantenib, vandatinib, pazopanib use
• • Low to intermediate risk differentiated thyroid cancer (DTC) cases (not having the high-risk features as described above)
• • RAI contraindication
• • Undifferentiated or Medullary (MTC) carcinoma of the thyroid
• • Major surgery within 4 weeks prior to the first dose of treatment
• • Subjects having \> 1 + proteinuria on urine dipstick testing will undergo 24 h urine collection for quantitative assessment of proteinuria. Subjects with urine protein ≥ 1 g/24 h will be ineligible
• • Need for locoregional treatment such as surgery, external beam radiation or thermoablation at inclusion
• • External beam radiation, for thyroid cancer, \<4 weeks prior initiation of treatment
• • Gastrointestinal malabsorption or any other condition that in the opinion of the investigator might affect the absorption of the drugs
• • History of congestive heart failure greater or equal to than New York Heart association (NYHA) Class II, unstable angina, myocardial infarction, or stroke within 6 months of the first dose of treatment, or cardiac arrhythmia associated with significant cardiovascular impairment and uncontrolled hypertension
• • Electrocardiogram (ECG) with QT interval (QTc) interval ≥ 480 msec
• • Active hemoptysis (bright red blood of at least 0.5 teaspoon) within 2 months prior to the first dose of treatment and any other active bleeding, coagulopathy or pathologic condition that would confer a high risk of bleeding
• • Active infection requiring systemic therapy
• • Active malignancy (except for DTC, or definitively treated melanoma in-situ, basal or squamous cell carcinoma of the skin, or carcinoma in-situ of the cervix or bladder) within the past 24 months
• • Any history of or concomitant medical condition that, in the opinion of the investigator, would compromise subject's ability to safely complete the protocol
• • Females who are pregnant or breastfeeding
• • Patients with an injection of radio-contrast agent within 12 weeks prior to enrollment (can be enrolled after 12 weeks)
• • Previous history of retinal vein occlusion
• • Previous history of central serious retinopathy
• • Known hypersensitivity to the study drugs or to any of the excipients
• • Any other condition (including psychosocial condition) that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
• • Any other condition that would confound study results
• • Noncompliance
• • Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)