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NEO- and Adjuvant Targeted Therapy in Braf-mutated Anaplastic Cancer of the Thyroid (NEO-ATACT Study) (NEO-ATACT)

Primary Purpose

Anaplastic Thyroid Cancer

Status
Recruiting
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
dabrafenib/trametinib
Sponsored by
Leiden University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Anaplastic Thyroid Cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Informed consent. Age over 18 years old. World Health Organization (WHO) Performance Status 0 or I. Histologically confirmed ATC (centrally reviewed). Confirmed presence of BRAFV600E/K mutation in primary tumor tissue. No distant metastases (M0). Free or secured airway. Able to swallow pills. Patients must have undergone complete disease staging including: PET-CT scan and CT-neck/thorax/abdomen. No prior anticancer systemic treatment (including chemotherapy, immunotherapy, oncolytic viral therapy, other systemic therapies). No prior radiotherapy to site of interest. Screening laboratory values must meet the following criteria: WBC ≥ 2.0x109/L, Neutrophils ≥ 1.0x109/L, Platelets ≥ 100 x109/L, Hemoglobin ≥ 6.5 mmol/L, AST ≤ 2.5 x ULN, ALT ≤ 2.5 x ULN, Total bilirubin ≤ 1.5 X ULN, INR and PTT in normal range, LDH < 2xULN. Serum creatinine ≤ 1.5 × ULN; or calculated creatinine clearance ≥ 50 mL/min by Cockcroft-Gault formula; or estimated glomerular filtration rate > 50 mL/min/1.73m2. Absence of additional severe and/or uncontrolled concurrent disease. Exclusion Criteria: No informed consent. History of cancer within 2 years from diagnosis of ATC (exception: basal cell skin cancer, in situ carcinoma). Poorly differentiated transformation of previous differentiated thyroid cancer. Presence of distant metastases. Underlying medical conditions that, in the Investigator's opinion, will make the administration of study treatment hazardous or obscure the interpretation of toxicity determination or adverse events History of congestive heart failure, active cardiac conditions, including unstable coronary syndromes, significant arrhythmias and severe valvular disease must be evaluated for risks of undergoing general anesthesia. Pregnancy or nursing.

Sites / Locations

  • Ellen KapiteijnRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

neo-adjuvant and adjuvant braf/mek-inhibition

Arm Description

Participants will undergo neo-adjuvant treatment with dabrafenib/trametinib. After 6 weeks of BRAF/MEK inhibitors, participants will undergo an evaluation of resectability. If the tumor is resectable, patients undergo tumor resection. If not resectable, neo-adjuvant treatment continues for another 6 weeks followed by a new evaluation. All resected patients receive adjuvant dabrafenib/trametinib up to a total treatment duration of 52 weeks. If resection is not possible, patients will continue on dabrafenib/trametinib.

Outcomes

Primary Outcome Measures

primary endpoint of the study will be R0 resection rate (efficacy).
primary endpoint of the study will be R0 resection rate (efficacy).

Secondary Outcome Measures

Neo-adjuvant and adjuvant treatment related toxicity of dabrafenib/trametinib (according to CTCAE v. 5.0)
Neo-adjuvant and adjuvant treatment related toxicity of dabrafenib/trametinib (according to CTCAE v. 5.0) during 1 year of treatment with braf/mek-inhibition
30-day postoperative surgical complications
30-day postoperative surgical complications (within 30 days after surgery)
Histopathological response after neo-adjuvant treatment
Histopathological response after neo-adjuvant treatment: complete response (<10% tumor cells), partial response (between more than 10% and up to 50% tumor cells), or no response (still more than 50% tumor cells)
Locoregional-free survival
Locoregional-free survival
Distant metastasis-free survival
Distant metastasis-free survival
Overall survival
Overall survival

Full Information

First Posted
June 29, 2023
Last Updated
October 5, 2023
Sponsor
Leiden University Medical Center
Collaborators
Novartis
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1. Study Identification

Unique Protocol Identification Number
NCT06079333
Brief Title
NEO- and Adjuvant Targeted Therapy in Braf-mutated Anaplastic Cancer of the Thyroid (NEO-ATACT Study)
Acronym
NEO-ATACT
Official Title
NEO- and Adjuvant Targeted Therapy in Braf-mutated Anaplastic Cancer of the Thyroid (NEO-ATACT Study)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 1, 2023 (Actual)
Primary Completion Date
January 1, 2027 (Anticipated)
Study Completion Date
January 1, 2028 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Leiden University Medical Center
Collaborators
Novartis

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Anaplastic thyroid cancer (ATC) is an almost invariable lethal cancer in humans. Most patients present with a rapid progressive mass in the neck with progressive complaints like dyspnoea, dysphagia or pain. The risk of suffocation is the main reason for rapid surgical intervention, but we know from literature that an oncological resection with clear margins is seldomly achieved. Some patients deteriorate that fast after surgery that radiation therapy and/or chemotherapy is not feasible anymore. Patients with BRAF-mutated ATC already have shown to benefit from targeted BRAF/MEK inhibition. This study aims to increase the number of patients that undergo a successful R0 tumor resection after neo-adjuvant BRAF/MEK inhibitor treatment.
Detailed Description
Unmet need ATC is a very serious condition and is, apart from a few exclusive cases, always lethal. Many patients suffer uncontrollable loco-regional disease with even so uncontrollable complaints of airway obstruction, oesophagus obstruction, pain and neck movement impairment. One of the only shown beneficial treatment is complete surgical resection with clear surgical margins combined with radiotherapy and systemic treatment. However, in less than 10-15% of the patients the pathologist reports clear surgical margins. Thereby it is noticeable that surgery often results in serious morbidity, due to an esophagectomy, laryngectomy or trachea resection all accompanied by an extensive reconstruction. All of these come with serious morbidity and seldomly lead to clear margins and better outcome. Proposed solution A single center, phase II study for the evaluation of safety and efficacy of neo-adjuvant and adjuvant dabrafenib/trametinib treatment in BRAF mutated ATC patients. By introducing neo-adjuvant treatment the hypothesis is that better selection is done for patients who are eligible for complete surgery and that surgery results more often in clear surgical margins after neo-adjuvant treatment. Second benefit of treating patients with combined loco-regional and systemic agents before surgery is that micro/macrometastases (being there in at least 30% of the patients at diagnosis) are already being treated directly after diagnosis. Lastly, adjuvant treatment with dabrafenib/trametinib will hopefully result in reduction of local and distant recurrences after surgery.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anaplastic Thyroid Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
prospective, non-randomized, single center, open-label phase II study
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
neo-adjuvant and adjuvant braf/mek-inhibition
Arm Type
Experimental
Arm Description
Participants will undergo neo-adjuvant treatment with dabrafenib/trametinib. After 6 weeks of BRAF/MEK inhibitors, participants will undergo an evaluation of resectability. If the tumor is resectable, patients undergo tumor resection. If not resectable, neo-adjuvant treatment continues for another 6 weeks followed by a new evaluation. All resected patients receive adjuvant dabrafenib/trametinib up to a total treatment duration of 52 weeks. If resection is not possible, patients will continue on dabrafenib/trametinib.
Intervention Type
Drug
Intervention Name(s)
dabrafenib/trametinib
Intervention Description
braf/mek-inhibition
Primary Outcome Measure Information:
Title
primary endpoint of the study will be R0 resection rate (efficacy).
Description
primary endpoint of the study will be R0 resection rate (efficacy).
Time Frame
after 6-12 weeks braf/mek-inhibition
Secondary Outcome Measure Information:
Title
Neo-adjuvant and adjuvant treatment related toxicity of dabrafenib/trametinib (according to CTCAE v. 5.0)
Description
Neo-adjuvant and adjuvant treatment related toxicity of dabrafenib/trametinib (according to CTCAE v. 5.0) during 1 year of treatment with braf/mek-inhibition
Time Frame
during 1 year of treatment with braf/mek-inhibition
Title
30-day postoperative surgical complications
Description
30-day postoperative surgical complications (within 30 days after surgery)
Time Frame
within 30 days after surgery
Title
Histopathological response after neo-adjuvant treatment
Description
Histopathological response after neo-adjuvant treatment: complete response (<10% tumor cells), partial response (between more than 10% and up to 50% tumor cells), or no response (still more than 50% tumor cells)
Time Frame
6-12 weeks neo-adjuvant braf/mek-inhibition
Title
Locoregional-free survival
Description
Locoregional-free survival
Time Frame
at 2 years
Title
Distant metastasis-free survival
Description
Distant metastasis-free survival
Time Frame
at 2 years
Title
Overall survival
Description
Overall survival
Time Frame
at 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Informed consent. Age over 18 years old. World Health Organization (WHO) Performance Status 0 or I. Histologically confirmed ATC (centrally reviewed). Confirmed presence of BRAFV600E/K mutation in primary tumor tissue. No distant metastases (M0). Free or secured airway. Able to swallow pills. Patients must have undergone complete disease staging including: PET-CT scan and CT-neck/thorax/abdomen. No prior anticancer systemic treatment (including chemotherapy, immunotherapy, oncolytic viral therapy, other systemic therapies). No prior radiotherapy to site of interest. Screening laboratory values must meet the following criteria: WBC ≥ 2.0x109/L, Neutrophils ≥ 1.0x109/L, Platelets ≥ 100 x109/L, Hemoglobin ≥ 6.5 mmol/L, AST ≤ 2.5 x ULN, ALT ≤ 2.5 x ULN, Total bilirubin ≤ 1.5 X ULN, INR and PTT in normal range, LDH < 2xULN. Serum creatinine ≤ 1.5 × ULN; or calculated creatinine clearance ≥ 50 mL/min by Cockcroft-Gault formula; or estimated glomerular filtration rate > 50 mL/min/1.73m2. Absence of additional severe and/or uncontrolled concurrent disease. Exclusion Criteria: No informed consent. History of cancer within 2 years from diagnosis of ATC (exception: basal cell skin cancer, in situ carcinoma). Poorly differentiated transformation of previous differentiated thyroid cancer. Presence of distant metastases. Underlying medical conditions that, in the Investigator's opinion, will make the administration of study treatment hazardous or obscure the interpretation of toxicity determination or adverse events History of congestive heart failure, active cardiac conditions, including unstable coronary syndromes, significant arrhythmias and severe valvular disease must be evaluated for risks of undergoing general anesthesia. Pregnancy or nursing.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ellen Kapiteijn, MD, PhD
Phone
0031-71-5263486
Email
h.w.kapiteijn@lumc.nl
First Name & Middle Initial & Last Name or Official Title & Degree
Saskia Luelmo, MD
Phone
0031-71-5263464
Email
S.A.C.Luelmo@lumc.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ellen Kapiteijn, MD, PhD
Organizational Affiliation
Leiden University Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Ellen Kapiteijn
City
Leiden
State/Province
Zuid-Holland
ZIP/Postal Code
2300RC
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ellen Kapiteijn, MD, PhD
Phone
+31715263486
Email
h.w.kapiteijn@lumc.nl

12. IPD Sharing Statement

Plan to Share IPD
No

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NEO- and Adjuvant Targeted Therapy in Braf-mutated Anaplastic Cancer of the Thyroid (NEO-ATACT Study)

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