Decitabine in Treating Patients With Metastatic Papillary Thyroid Cancer or Follicular Thyroid Cancer Unresponsive to Iodine I 131
Condition: Recurrent Thyroid Cancer; Stage IVA Follicular Thyroid Cancer; Stage IVA Papillary Thyroid Cancer; Stage IVB Follicular Thyroid Cancer; Stage IVB Papillary Thyroid Cancer; Stage IVC Follicular Thyroid Cancer; Stage IVC Papillary Thyroid Cancer
MeSH terms: Thyroid Neoplasms; Thyroid Cancer, Papillary; Adenocarcinoma, Follicular; Thyroid Diseases
Intervention: Decitabine; Iodine I 131; Recombinant thyrotropin alfa; Fludeoxyglucose F 18; Positron emission tomography
Intervention description: Starting dose 6 mg/m^2 intravenously over 1 hour every day for 5 successive days for 2 weeks (10 doses), with possible second course.; Undergo thyrotropin-alfa stimulated radioactive iodine scan; Undergo thyrotropin-alfa stimulated radioactive iodine scan; Optional correlative studies; Optional correlative studies
Intervention MeSH terms: Decitabine; Azacitidine; Fluorodeoxyglucose F18
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 12.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial is studying how well decitabine works in treating patients with
      metastatic papillary thyroid cancer or follicular thyroid cancer that has stopped responding
      to radioactive iodine. Iodine I 131 (radioactive iodine) kills thyroid cancer cells.
      Metastatic thyroid cancer cells can lose the ability to be treated with radioactive iodine.
      Decitabine may help thyroid cancer cells regain the ability to respond to treatment with
      radioactive iodine.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Histologically confirmed papillary thyroid or follicular thyroid carcinoma:

               -  Differentiated disease;

                    -  Metastatic disease documented by ultrasound, computed tomography (CT) scan
                       (without iodinated contrast), or MRI - All metastatic disease foci =< 10 mm
                       in all dimensions

          -  Must have been treated with total or near-total thyroidectomy AND at least 1 course of
             iodine I 131 (131I)(>=29.9 mCi) OR demonstrated negative uptake on a postoperative
             low-dose131I scan

          -  Must have undergone whole body 131I scan 1-3 days after administration of =< 5.5 mCi
             of 131I demonstrating no visible iodine uptake within the lesions unless demonstrated
             negative uptake on a postoperative low-dose131I scan within the past 12 weeks:

               -  Must have 24-hour urine iodine excretion =< 500 mcg within 1 week of 131I scan

          -  Must be receiving thyroid hormone therapy AND have thyroid-stimulating hormone level
             =< 0.5 mU/L

          -  No known brain metastases

          -  Performance status:

               -  Eastern Cooperative Oncology Group (ECOG) 0-2 OR Karnofsky 60-100%

          -  Hematopoietic:

               -  Absolute neutrophil count >= 1,500/mm3;

               -  Platelet count >= 100,000/mm3;

               -  White Blood Count (WBC) >= 3,000/mm3

          -  Hepatic:

               -  aspartate aminotransferase-alanine aminotransferase (AST and ALT) =< 2.5 times
                  upper limit of normal;

               -  Bilirubin normal

          -  Renal:

               -  Creatinine not elevated OR

               -  Creatinine clearance >= 60 mL/min

          -  Cardiovascular:

               -  No symptomatic congestive heart failure;

               -  No unstable angina pectoris;

               -  No cardiac arrhythmia

          -  Not pregnant or nursing

          -  Negative pregnancy test

          -  Fertile patients must use effective contraception

          -  No prior allergic reaction attributed to compounds of similar chemical or biological
             composition to decitabine

          -  No concurrent uncontrolled illness

          -  No active or ongoing infection

          -  No psychiatric illness or social situation that would preclude study compliance

          -  No prior cytotoxic chemotherapy for thyroid cancer

          -  At least 6 months since prior external beam radiotherapy administered for locoregional
             disease in the thyroid bed or to the cervical or upper mediastinal lymph node regions
             (no more than 6,000 cGy)

          -  More than 6 months since other prior radiotherapy and recovered

          -  More than 6 months since prior therapeutic 131I > 10 mCi

          -  More than 18 months since prior cumulative 131I activity of at least 500 mCi

          -  More than 12 months since prior amiodarone (Unless 24-hour urinary iodine excretion is
             =< 500 mcg)

          -  No concurrent combination antiretroviral therapy for HIV-positive patients

          -  No other concurrent anticancer therapy

          -  No other concurrent investigational agents

          -  More than 6 months since prior intrathecal iodinated contrast (Unless 24-hour urinary
             iodine excretion is =< 500 mcg)

          -  More than 3 months since prior IV or oral iodinated contrast for radiographic studies
             (Unless 24-hour urinary iodine excretion is =< 500 mcg)