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Pioglitazone in Thyroid Cancers

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT01655719
Recruitment Status : Completed
First Posted : August 2, 2012
Results First Posted : October 26, 2017
Last Update Posted : October 26, 2017
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Ronald J. Koenig, MD PhD, University of Michigan

Brief Summary:
Through this trial the investigators hope to learn if a drug, Actos (pioglitazone), is useful in treating a certain kind of metastatic thyroid cancer. Actos is approved by the FDA to treat diabetes. It has not been approved by the FDA to treat cancer, so its use in this study is considered experimental.

Condition or disease Intervention/treatment Phase
Thyroid Cancers That Contain the PAX8-PPARgamma Fusion Gene Drug: Pioglitazone Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 2 Study of Pioglitazone in Thyroid Cancers That Contain the PAX8-PPARgamma Fusion Gene
Actual Study Start Date : April 2012
Actual Primary Completion Date : March 31, 2017
Actual Study Completion Date : March 31, 2017

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Pioglitazone Treatment

If eligible, subjects can participate in 1 or both parts of this study as follows:

Part 1: In the initial main portion of the study subjects will receive 24 -28 weeks of therapy with pioglitazone at the dosage approved for the control of diabetes. Response will be evaluated per RECIST. Safety measure are outlined in the protocol including weekly weigh ins, calls, labs, exams, etc.

Part 2: A secondary protocol is then available to subjects who complete the main initial study with less than complete response per RECIST. They can undergo a radioiodine scan to see if the treatment with pioglitazone has sensitized their disease to radioiodine. If it has - they can pursue the radioiodine treatment.

Drug: Pioglitazone
Other Name: Actos

Primary Outcome Measures :
  1. Tumor Response (Change) [ Time Frame: Baseline and 24 weeks ]
    Response is measured by change in Tumor size (cm)

Secondary Outcome Measures :
  1. Change in Serum Thyroglobulin [ Time Frame: Baseline and 24 weeks ]
    Determine if pioglitazone decreases serum thyroglobulin in patients with follicular-patterned thyroid carcinomas that contain the PAX8-PPARgamma fusion gene.

  2. Toxicity [ Time Frame: 24 weeks ]
    Toxicities experienced by patients with PAX8-PPARgamma fusion gene-positive follicular-patterned thyroid carcinomas treated with pioglitazone are indicated by presence of Serious Adverse Events (that show relatedness).

Other Outcome Measures:
  1. Biomarkers [ Time Frame: 24 weeks ]
    Define predictive markers of response or insensitivity to pioglitazone. Unstained tumor tissue slides from archival paraffin blocks, fresh biopsy specimens from measurable metastases, and blood samples (serum and peripheral blood cells) will be collected on enrolled patients who consented for the optional correlative studies. These will be used to identify factors that predict efficacy of pioglitazone. Analyses may include measures of expression of specific RNAs and proteins, and DNA sequence analysis.

  2. Sensitization to Radioiodine Therapy [ Time Frame: 24 weeks ]
    Determine if pioglitazone induces a clinically significant level of radioiodine uptake in the residual thyroid carcinoma, and if so, whether there is a therapeutic response to radioiodine. This will be addressed in a separate follow-up protocol available to subjects completing this study.

  3. Lipid Accumulation in Tumor [ Time Frame: 24 weeks ]
    Determine (by MRI) if pioglitazone induces lipid accumulation in follicular-patterned thyroid carcinomas that contain the PAX8-PPARgamma fusion gene.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients must have histologically confirmed thyroid carcinoma with the PAX8-PPARgamma translocation (translocation testing will be performed on archived tissue during the screening period).

    Refractory to radioactive iodine (RAI) as defined by: the tumor does not concentrate RAI; or the patient has had RAI within the last 16 months and has had progression despite that RAI; or the last RAI treatment was >16 months ago and the patient progressed after at least two RAI treatments; or the patient has received RAI treatments with a cumulative RAI dose of ≥22.2 GBq (600 mCi)

    Not a candidate for surgery or RAI therapy with curative intent.

    Lesions that would be treated by external beam radiation therapy (EBRT) based on standard of care can be so treated, but then cannot be used as target lesions.

  2. Measurable disease by RECIST 1.1 criteria.
  3. Documented disease progression by RECIST 1.1 in the past 14 months.
  4. Availability of histological material (primary tumor or metastases) for review of the diagnosis and demonstration of PAX8-PPARgamma fusion gene.
  5. Adequate TSH suppression (<0.5 mIU/L)
  6. Prior chemotherapy or surgery must have been completed at least 28 days prior to registration, and all toxicities must have resolved.
  7. Prior radioactive iodine must have been completed at least 6 months prior to registration, or there must be documented disease progression since such therapy if it was within 6 months. Sites that have received EBRT must have disease progression post-EBRT to be used as sites of measurable disease.
  8. Life expectancy of greater than 6 months.
  9. ECOG performance status 2 or less.
  10. Patients must have normal organ function as defined below:

    AST(SGOT)/ALT(SGPT) less than 2.5 X institutional upper limit of normal (within 1 month of study Day 1)

  11. Patients must be able to consume oral medications.
  12. Women of childbearing potential must have a negative pregnancy test at baseline prior to receiving any study drug and must practice effective contraception while on study. (Pregnant or lactating patients are excluded).
  13. All patients must sign an informed consent prior to enrollment.

Exclusion Criteria:

  1. Patients may not be receiving any other investigational agents.
  2. Patients with known untreated brain metastases.
  3. History of allergic reactions attributed to compounds of similar chemical or biologic composition to pioglitazone.
  4. Diagnosis of diabetes mellitus or current therapy with any drugs used to treat diabetes mellitus, including but not limited to insulin, sulfonylureas, metformin, rosiglitazone (Avandia), and pioglitazone (Actos) within 14 days of study Day 1
  5. Therapy with rosiglitazone (Avandia) or pioglitazone (Actos) at any time since the diagnosis of thyroid cancer.
  6. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, congestive heart failure, unstable angina pectoris, or cardiac arrhythmias.
  7. Pregnant women are excluded from this study because pioglitazone is a U.S. Food and Drug Administration Pregnancy Category C drug. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with pioglitazone, breastfeeding should be discontinued if the mother is treated with pioglitazone.
  8. No concurrent radiotherapy or chemotherapy may be given to the patient during the administration of the study drug.
  9. Patients with uncontrolled malabsorption syndromes.
  10. Patients with a history of congestive heart failure of any New York Heart Association class.
  11. Any medical or psychiatric illness which, in the opinion of the principal investigator, would compromise the patient's ability to tolerate this treatment regimen.
  12. Use of rifampin (strong CYP2C8 inducer) within 14 days of study Day 1.
  13. Other current malignancy than the disease under study.
  14. Grade 2 or worse edema within 14 days of study Day 1, per CTCAE v4.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01655719

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United States, Colorado
University of Colorado
Aurora, Colorado, United States, 80045
United States, Michigan
University of Michigan
Ann Arbor, Michigan, United States, 48109
United States, Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
United States, Texas
University of Texas MD Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
University of Michigan
National Cancer Institute (NCI)
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Principal Investigator: Ronald J Koenig, MD, PhD University of Michigan
  Study Documents (Full-Text)

Documents provided by Ronald J. Koenig, MD PhD, University of Michigan:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Ronald J. Koenig, MD PhD, Professor, University of Michigan
ClinicalTrials.gov Identifier: NCT01655719    
Other Study ID Numbers: 2011.097
R01CA166033 ( U.S. NIH Grant/Contract )
First Posted: August 2, 2012    Key Record Dates
Results First Posted: October 26, 2017
Last Update Posted: October 26, 2017
Last Verified: September 2017

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Thyroid Neoplasms
Thyroid Diseases
Endocrine System Diseases
Endocrine Gland Neoplasms
Neoplasms by Site
Head and Neck Neoplasms
Hypoglycemic Agents
Physiological Effects of Drugs