Sunitinib Malate in Treating Patients With Thyroid Cancer That Did Not Respond to Iodine I 131 and Cannot Be Removed by Surgery
Condition: Differentiated Thyroid Gland Carcinoma; Recurrent Thyroid Gland Carcinoma; Refractory Thyroid Gland Carcinoma; Stage III Thyroid Gland Follicular Carcinoma AJCC v7; Stage III Thyroid Gland Medullary Carcinoma AJCC v7; Stage IV Thyroid Gland Follicular Carcinoma AJCC v7; Stage IV Thyroid Gland Medullary Carcinoma AJCC v7; Stage IV Thyroid Gland Papillary Carcinoma AJCC v7; Stage IVA Thyroid Gland Follicular Carcinoma AJCC v7; Stage IVA Thyroid Gland Medullary Carcinoma AJCC v7; Stage IVA Thyroid Gland Papillary Carcinoma AJCC v7; Stage IVB Thyroid Gland Follicular Carcinoma AJCC v7; Stage IVB Thyroid Gland Medullary Carcinoma AJCC v7; Stage IVB Thyroid Gland Papillary Carcinoma AJCC v7; Stage IVC Thyroid Gland Follicular Carcinoma AJCC v7; Stage IVC Thyroid Gland Medullary Carcinoma AJCC v7; Stage IVC Thyroid Gland Papillary Carcinoma AJCC v7; Thyroid Gland Oncocytic Carcinoma; Unresectable Thyroid Gland Carcinoma
MeSH terms: Carcinoma; Thyroid Neoplasms; Carcinoma, Medullary; Carcinoma, Neuroendocrine; Carcinoma, Papillary; Thyroid Cancer, Papillary; Adenocarcinoma, Follicular; Thyroid Diseases
Intervention: Laboratory Biomarker Analysis; Pharmacogenomic Study; Sunitinib; Sunitinib Malate
Intervention description: Optional correlative studies; Optional correlative studies; Given PO; Given PO
Intervention MeSH terms: Sunitinib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 63.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial studies how well sunitinib malate works in treating patients with thyroid
      cancer that did not respond to iodine I 131 (radioactive iodine) and cannot be removed by
      surgery. Sunitinib malate may stop the growth of tumor cells by blocking some of the enzymes
      needed for cell growth and by blocking blood flow to the tumor.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have histologically or cytologically confirmed papillary, follicular, or
             Hurthle cell carcinoma (cohort A) or medullary thyroid carcinoma (cohort B); their
             disease must have progressed despite treatment with iodine-131 therapy or they are not
             candidates for iodine-131 therapy and their disease cannot be completely removed by
             surgery; all patients with WDTC are expected to be on thyroxine suppression therapy

          -  Patients must have radiographically or biochemically measurable disease;
             radiographically measurable disease is defined as at least one lesion that can be
             accurately measured in at least one dimension (longest diameter to be recorded) as >=
             20 mm with conventional techniques or as >= 10 mm with spiral computed tomography (CT)
             scan; biochemically measurable disease is defined as an elevated thyroglobulin (WDTC
             patients) or calcitonin (MTC patients)

          -  Patients must have evidence of disease progression (objective growth of existing
             tumors or rising thyroglobulin or calcitonin levels) within the last 6 months

          -  Patients cannot have received prior receptor tyrosine kinase inhibitors; patients
             cannot have received more than one prior chemotherapy regimen for metastatic disease;
             patients cannot have received prior external beam radiation to the measured tumor
             constituting the target lesion(s)

          -  Life expectancy of greater than 12 weeks

          -  Eastern Cooperative Oncology Group (ECOG) performance status 0-2 (Karnofsky >= 60%)

          -  Leukocytes >= 3,000/mcL

          -  Absolute neutrophil count >= 1,500/mcL

          -  Platelets >= 100,000/mcL

          -  Hemoglobin >= 9 g/dL

          -  Serum calcium =< 12.0 mg/dL

          -  Total serum bilirubin within normal institutional limits

          -  Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
             [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
             =< 2.5 X institutional upper limit of normal OR =< 5 X institutional upper limit of
             normal if patient has liver metastases

          -  Creatinine within normal institutional limits OR creatinine clearance >= 60
             mL/min/1.73 m^2 for patients with creatinine levels above institutional normal

          -  Patients must have corrected QT interval (QTc) < 500 msec

          -  The following groups of patients are eligible provided they have New York Heart
             Association class II (NYHA) cardiac function on baseline echocardiogram
             (ECHO)/multigated acquisition scan (MUGA):

               -  Those with a history of class II heart failure who are asymptomatic on treatment

               -  Those with prior anthracycline exposure

               -  Those who have received central thoracic radiation that included the heart in the
                  radiotherapy port

          -  The effects of sunitinib on the developing human fetus at the recommended therapeutic
             dose are unknown; for this reason and because antiangiogenic agents are known to be
             teratogenic, women of childbearing potential and men must agree to use adequate
             contraception (hormonal or barrier method of birth control; abstinence) prior to study
             entry and for the duration of study participation; all women of childbearing potential
             must have a negative pregnancy test prior to receiving sunitinib; should a woman
             become pregnant or suspect she is pregnant while participating in this study, she
             should inform her treating physician immediately

          -  Ability to understand and the willingness to sign a written informed consent document

        Exclusion Criteria:

          -  Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
             nitrosoureas or mitomycin C) prior to entering the study or those who have not
             recovered from adverse events due to agents administered more than 4 weeks earlier; at
             least 4 weeks must have elapsed since any major surgery

          -  Patients may not be receiving any other investigational agents

          -  Patients who have received prior treatment with any other antiangiogenic agent (e.g.,
             bevacizumab, sorafenib, pazopanib, AZD2171, PTK787, vascular endothelial growth factor
             [VEGF] Trap, etc.)

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to sunitinib

          -  Patients with QTc prolongation (defined as a QTc interval equal to or greater than 500
             msec), serious ventricular arrhythmia (ventricular fibrillation or ventricular
             tachycardia greater than or equal to 3 beats in a row) or other significant
             electrocardiogram (ECG) abnormalities are excluded

          -  Patients with poorly controlled hypertension (systolic blood pressure of 140 mmHg or
             higher or diastolic blood pressure of 90 mmHg or higher) are ineligible

          -  Patients who require use of therapeutic doses of coumarin-derivative anticoagulants
             such as warfarin are excluded, although doses of up to 2 mg daily are permitted for
             prophylaxis of thrombosis; Note: Low molecular weight heparin is permitted provided
             the patient's prothrombin time (PT) international normalized ratio (INR) is =< 1.5

          -  Patients with any condition (e.g., gastrointestinal tract disease resulting in an
             inability to take oral medication or a requirement for intravenous [IV] alimentation,
             prior surgical procedures affecting absorption, or active peptic ulcer disease) that
             impairs their ability to swallow and retain sunitinib tablets are excluded

          -  Patients with any of the following conditions are excluded:

               -  Serious or non-healing wound, ulcer, or bone fracture

               -  History of abdominal fistula, gastrointestinal perforation, or intra-abdominal
                  abscess within 28 days of treatment

               -  Any history of cerebrovascular accident (CVA) or transient ischemic attack within
                  12 months prior to study entry

               -  History of myocardial infarction, cardiac arrhythmia, stable/unstable angina,
                  symptomatic congestive heart failure, or coronary/peripheral artery bypass graft
                  or stenting within 12 months prior to study entry

               -  History of pulmonary embolism within the past 12 months

               -  Class III or IV heart failure as defined by the NYHA functional classification
                  system

          -  Because sunitinib is metabolized primarily by the CYP3A4 liver enzyme, the eligibility
             of patients taking medications that are potent inducers or inhibitors of that enzyme
             will be determined following a review of their case by the principal investigator;
             every effort should be made to switch patients taking such agents or substances to
             other medications, particularly patients with gliomas or brain metastases who are
             taking enzyme-inducing anticonvulsant agents

          -  Patients with known brain metastases should be excluded because of their poor
             prognosis and because they often develop progressive neurologic dysfunction that would
             confound the evaluation of neurologic and other adverse events; N.B.: Patients with
             brain metastases with stable neurologic status following local therapy (surgery or
             radiation) for at least 8 weeks from definitive therapy and without neurologic
             dysfunction that would confound the evaluation of neurologic and other adverse events
             are eligible for participation; patients cannot be receiving enzyme inducing
             anti-convulsants including carbamazepine, phenobarbital, and phenytoin

          -  Patients with uncontrolled intercurrent illness including, but not limited to, ongoing
             or active infections or psychiatric illness/social situations that would limit
             compliance with study requirements are ineligible

          -  Pregnant women are excluded from this study because sunitinib is an antiangiogenic
             agent with the potential for teratogenic or abortifacient effects; because there is an
             unknown but potential risk for adverse events in nursing infants secondary to
             treatment of the mother with sunitinib, breastfeeding should be discontinued if the
             mother is treated with sunitinib malate

          -  Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral
             therapy are ineligible because of the potential for pharmacokinetic interactions with
             sunitinib; in addition, these patients are at increased risk of lethal infections when
             treated with marrow-suppressive therapy; appropriate studies will be undertaken in
             patients receiving combination antiretroviral therapy when indicated

          -  Patients with conditions classified as NYHA III or IV per the New York Heart
             Association classifications