Efficacy of Organoid-Based Chemotherapy Drug Precision Screening to Guide Treatment for Thyroid Cancer

Launched by WEST CHINA HOSPITAL · Dec 1, 2024

Keywords

ClinConnect Summary

This clinical trial is looking at a new way to personalize chemotherapy for patients with advanced thyroid cancer. Specifically, it aims to test how effective chemotherapy drugs are based on individual tumor characteristics. This approach is designed for adults aged 18 and older who have specific types of thyroid cancer that are hard to treat with standard therapies, especially if their tumors cannot be surgically removed. Participants in this study must have clear evidence of their cancer, such as measurable tumors, and be healthy enough to undergo additional treatments and monitoring.

If you or a loved one are considering joining this trial, you can expect to go through some tests to confirm your eligibility, including a biopsy to examine your tumor. Throughout the study, you will receive personalized treatment based on how your cancer responds to different chemotherapy drugs, and you will have regular check-ups to monitor your health. It’s important to note that this trial is not yet recruiting participants, so there may be a wait before it officially begins.

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ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. At least 18 years of age on the day of signing informed consent
• • 2. Cytologically confirmed thyroid neoplasm, including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), poorly differentiated thyroid carcinoma (PDTC), medullary thyroid carcinoma (MTC), anaplastic thyroid carcinoma (ATC)
• • 3. Patients defined as poorly differentiated iodine-refractory thyroid tumors with inoperable locally advanced disease or metastases. The primary tumor may or may not be removed, but the risk of aerodigestive compression or bleeding should be excluded.
• 4. Evidence of extrathyroidal extension and/or locally invasive disease and deemed at risk for R2 resection by treating team on clinical and/or fiberoptic examination and/or radiographic evaluation in the primary or recurrent setting. Evidence of "at risk for R2 resection" includes:
• • 1. Vocal cord paralysis by fiberoptic examination
• • 2. Extrathyroid and/or extranodal extension on CT or MRI, including tracheal and/or laryngeal cartilage invasion, esophageal involvement, and/or involvement of perithyroid muscles (e.g. strap, sternocleidomastoid, inferior constrictor muscles) or bone involvement
• • 3. Extension into the mediastinum with visceral and/or vascular involvement
• • 4. Involvement of the carotid artery or other major vessel by 180 degrees or more (exclusive of complete encasement)
• • 5. Other factors that make the participant to be "at risk for R2 resection" may be allowed, after discussion with the study's principal investigator
• • 5. At least one measurable lesion as defined by RECIST v1.1
• • 6. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2 and no medical contraindication to surgery
• • 7. Surgical morbidity/complexity score of 1 to 4 (moderate, severe, very severe, or unresectable)
• • 8. The expected survival time was more than 2 months
• 9. Adequate end-organ function (including bone marrow, coagulation, renal, liver and cardiac) 28 days prior to the study registration as defined below:
• • 1. leukocytes ≥3,000/mcL
• • 2. absolute neutrophil count ≥1,500/mcL
• • 3. platelets ≥100,000/mcL
• • 4. hemoglobin ≥ 9 g/dL (5.58 mmol/L)
• • 5. total bilirubin ≤1.5 x institutional upper limit of normal, unless attributed to Gilberts syndrome
• • 6. Alanine Aminotransferase (ALT)/Aspartate Aminotransferase (AST) \< 2.5 x institutional upper limit of normal
• • 7. INR ≤1.5 x institutional upper limit of normal
• • 8. creatinine within normal institutional limits OR
• • 9. creatinine clearance ≥30 mL/min per Cockcroft-Gault formulation
• • 10. normal serum potassium, calcium, and magnesium levels (may be receiving supplements). Grade 1 hypocalcemia (corrected serum calcium \> 8) is acceptable
• • 10. Willing to undergo tumor biopsy prior to trial treatment, unless in the opinion of the treating physician, a biopsy is not feasible or safe. Subjects must be willing to ultimately undergo surgery if their tumor becomes surgically resectable
• • 11. Ability to comply with outpatient treatment, laboratory monitoring, and require clinic visits for the duration of study participation
• • 12. Willing and able to provide written informed consent signed by study patient (or legally acceptable representative if applicable)
• • 13. Willingness of patients with partners of childbearing potential to use a highly effective contraceptive method during treatment with study drug and for 3 months following the last dose of study drug
• Exclusion Criteria:
• • 1. Radiographically identified following findings: intraluminal airway tumor, complete carotid encasement/infiltration
• • 2. Patients with contraindications to the involved chemotherapy drugs (such as severe coagulopathy, severe liver function impairment, etc.)
• • 3. Any unresolved toxicities from prior therapy greater than Common Terminology Criteria for Adverse Events (CTCAE) grade 1 at the time of starting study treatment
• • 4. Gastrointestinal malabsorption or any other condition that in the opinion of the investigator might affect the absorption of study drug
• • 5. Patients with serious internal medicine underlying diseases, serious organ dysfunction, metabolic diseases or other diseases that seriously affect survival
• • 6. If \> 1 + proteinuria on urine dipstick testing will undergo 24-hour urine collection for quantitative assessment of proteinuria. Participants with urine protein ≥1g/24 h will be ineligible
• • 7. Significant cardiovascular impairment: history of congestive heart failure greater than New York Heart Association (NYHA) Class II, unstable angina, myocardial infarction, or stroke within 6 months of the first dose of study drug, or cardiac arrhythmia requiring medical treatment
• • 8. Active hemoptysis (bright red blood ≥ 1/2 teaspoon) or other uncontrolled bleeding within 21 days prior to the study registration
• • 9. Arterial/venous thromboembolic events in the last 12 months Treatment within 30 days prior to study registration with anticoagulant or antiplatelet therapy, apart from aspirin 81 mg daily
• • 10. Active uncontrolled systemic bacterial, viral, or fungal infection, or serious ongoing intercurrent illness
• • 11. Uncontrolled symptomatic hyperthyroidism or hypothyroidism
• • 12. Females who are pregnant or breastfeeding
• • 13. Other progressive malignant diseases requiring treatment
• • 14. Radiotherapy with a limited field of radiation for palliation within 1 week of the first dose of study treatment, with the exception of patients receiving radiation to more than 30% of the bone marrow or with a wide field of radiation, which must be completed at least 4 weeks prior to the first dose of study treatment
• • 15. Symptomatic primary central nervous system (CNS) tumor, metastases, leptomeningeal carcinomatosis, or untreated spinal cord compression. Exception: Patients are eligible if neurological symptoms and CNS imaging are stable and no CNS surgery or radiation has been performed for 28 days, 14 days if stereotactic radiosurgery (SRS)
• • 16. Patients with incomplete clinical data
• • 17. History of significant neurological or mental disorder, including seizures or dementia, which would interfere compliance and sign of consent inform
• • 18. Patients deemed unsuitable for inclusion by the investigators