Clinical trial NCT05837260: Investigating Utility of ctDNA and Tumour Evolution in Advanced Thyroid Cancer
Official title: A Multicentre Prospective Study Investigating the Utility of ctDNA as a Biomarker of Disease Burden, Genetic Heterogeneity and Tumour Evolution in Advanced Thyroid Cancer
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Thyroid Cancer
Lead sponsor: Royal Marsden NHS Foundation Trust
Sponsor class: OTHER
First posted: 2023-05-01
Enrollment: 120
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients with thyroid cancer

Brief summary: Although most thyroid cancers are treated and cured successfully there are still 30% who recur after many years. This will eventually progress and at this point may become incurable with treatment options including complex and high risk surgery. The overall efficacy of systemic treatment in advanced thyroid cancer has a good initial response in most patients but not all. The study will collect tissues and blood samples for various protein analysis, nucleic acid extraction and live cell analysis in order to try and detect the presence of plasma ctDNA at baseline of eligible patients.

Detailed description: The treatment decisions are based on relying on radiological parameters such as using the RECIST criteria and measuring the rise in certain serum tumour biomarkers. However, the disadvantage of this is that this method can take many months to detect a change in disease volume. An improved understanding of genetics and cancer and potential gene sequencing can help achieve personalised treatment for patients. However, there are many questions and issues that still need to be answered and require urgent attention before being able to achieve optimate patient stratification. We need to identify better tumour biomarkers to detect disease progression, show real time response to treatment and understand why tumours evolve to becoming more aggressive. This study hopes to address these issues by proposing a multicentre prospective study to investigate the presence and role of ctDNA in advanced thyroid cancer including differentiated thyroid cancer , medullary thyroid cancer and Anaplastic Thyroid Cancer.

Eligibility criteria: Inclusion Criteria:

* Age 18 years or older. (all cohorts)
* Patients diagnosed with radioiodine refractory differentiated thyroid carcinoma (RR-DTC) under surveillance. (cohort 1)
* Patients with newly diagnosed resectable locally advanced medullary thyroid cancer Or Patients with newly diagnosed metastatic medullary thyroid cancer for surveillance Or Patients with locally advanced or metastatic medullary thyroid cancer on surveillance (cohort 2)
* Patients with RR-DTC starting systemic therapy Or Patients with RR-DTC on systemic therapy Or Patients with MTC starting systemic therapy Or Patients with MTC on systemic therapy (cohort 3)
* Patients with newly diagnosed anaplastic thyroid cancer (cohort 4)
* Availability of tissue from one archival diagnostic tumour tissue block or be willing to have biopsy of accessible disease (all cohorts)
* Patients must be willing to undergo standard monitoring and treatment as recommended by their clinical team (all cohorts)
* Ability to give informed consent for biological sample collection. (all cohorts)

Exclusion Criteria:

* Previous or concurrent illness, which in the investigator's opinion would interfere with collection of the complete sample collection
* Any invasive malignancy within previous 5 years (other than non-melanomatous skin carcinoma or carcinoma in situ)
* Pregnancy

Primary outcomes:
measure: The primary objective of the proposed study is to determine the sensitivity of detecting the presence of plasma ctDNA in patients with advanced and recurrent thyroid cancer
timeFrame: 5 years
Secondary outcomes:
measure: Specificity of the absence of plasma ctDNA in patients with advanced and recurrent thyroid cancer at baseline
timeFrame: 5 years
measure: Association of ctDNA levels as biomarker of disease burden compared with standard biochemical markers and radiological response
timeFrame: 5 years
measure: Changes in ctDNA levels as biomarker of disease burden compared with standard biochemical markers and radiological response
timeFrame: 5 years
measure: ctDNA as a biomarker of response to systemic therapy (levels and timing) compared with standard biochemical markers and radiological response in patients starting/during systemic therapy
timeFrame: 5 years
measure: ctDNA as a biomarker of progression free and overall survival
timeFrame: 5 years
Other outcomes:
Locations:
city: London
country: United Kingdom
facility: The Royal Marsden NHS Foundation Trust
Study officials:
affiliation: Royal Marsden NHS Foundation Trust
name: Kate Newbold
role: PRINCIPAL_INVESTIGATOR
References: