An Initial Study of Lithium in Patients With Medullary Thyroid Cancer
Condition: Medullary Thyroid Cancer
MeSH terms: Thyroid Neoplasms; Carcinoma, Neuroendocrine; Thyroid Diseases
Intervention: Lithium carbonate
Intervention description: Lithium 300mg by mouth, three times daily, escalating to a lithium level of 0.8-1.2; Continue until progressive disease/unacceptable toxicity; Evaluate every 4 weeks.
Intervention MeSH terms: Lithium Carbonate
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 5.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: medullary thyroid cancer; lithium

Summary:

      Primary objective is to evaluate the tumor response rate of patients with MTC treated with
      Lithium carbonate
    

Eligibility criteria:

        Inclusion Criteria:

          -  Histologically confirmed MTC with signs of residual/persistent disease based on tumor
             marker levels and/or radiographic imaging. Pathologic diagnosis must be confirmed at
             UWCCC. Grading must be confirmed by pathologic review performed at UWCCC.

          -  Elevated neuroendocrine markers at least 1 month post -op. In MTC, persistently
             elevated neuroendocrine markers such as calcitonin and CEA are indicative of
             persistent disease.

          -  Disease progression is not required for this trial

               -  4 weeks from the completion of major surgery, chemotherapy, or other systemic
                  therapy or local liver therapy to study registration. Subjects will have had
                  standard of care prior to enrollment. Subjects will have had standard of care
                  prior to enrollment (for example it could include total thyroidectomy, central
                  lymph node dissection, and when necessary ipsilateral radical neck dissection but
                  is tailored to the patient).

               -  3 weeks from the completion of radiation therapy to study registration

          -  The following laboratory values obtained within 14 days prior to registration:

               -  Absolute neutrophils count (ANC) ≥ 1000/mm3

               -  Platelets ≥ 75,000/mm3

               -  Hemoglobin ≥ 8.0 g/dL

               -  Total bilirubin greater than or equal to 2.0 X the upper limit of normal (ULN)

               -  AST greater than or equal to 3 X ULN or greater than or equal to 5 X ULN if liver
                  metastases are present

               -  Creatinine greater than or equal to ULN

               -  Serum sodium within normal limits

          -  ECOG performance status of 2

          -  Capable of understanding the investigational nature, potential risks and benefits of
             the study, and able to provide valid informed consent.

          -  Availability of tissue specimens to be analyzed for pathologic confirmation.

          -  Age ≥ 18 years.

          -  Women must not be pregnant or lactating due to the deleterious effects of Lithium
             carbonate on a fetus or small child. All females of childbearing potential must have a
             blood test or urine study within 2 weeks prior to registration to rule out pregnancy.

          -  Women of childbearing potential and sexually active males are required to use an
             accepted and effective method of contraception.

          -  Patients must not have known history of allergic reactions or adverse reactions to
             Lithium or its derivatives.

          -  Patients are not allowed to be on concurrent chemotherapy or radiation therapy.

        Exclusion Criteria:

          -  Gastrointestinal tract disease resulting in an inability to take oral medication (i.e.
             ulcerative disease, uncontrolled nausea, vomiting, diarrhea, bowel obstruction, or
             inability to swallow the tablets).

          -  Significant, active cardiac disease

          -  Patients must not be taking the following medications: diuretics, ACE inhibitors,
             NSAIDs (except aspirin or sulindac), neuroleptics, tetracycline, and COX2 inhibitors.

          -  Patients with radiographic evidence of disease will be presented the option to undergo
             a tumor biopsy although this is not mandatory.

          -  Patients already taking Lithium for any reason are not allowed on study