Background:
- Medullary thyroid cancer (MTC) represents 5% of thyroid cancers and presents as a
hereditary (25% of cases) or sporadic (75% of cases) neuroendocrine malignancy.
- MTC arises from the parafollicular C-cells of the thyroid.
- Germline mutations in the rearranged during transfection (RET) proto-oncogene occur in
virtually all of hereditary MTC cases, and somatic RET mutations occur in 50% of
sporadic cases.
- Drugs targeting RET kinase such as vandetanib and cabozantinib have shown efficacy in
the treatment of advanced or metastatic MTC, however, more effective RET inhibitors are
needed for previously untreated patients as well as patients who have become refractory
to other molecular targeted therapeutics (MTTs).
- Ponatinib, a drug that is Food and Drug Administration (FDA) approved as a therapy for
chronic myelogenous leukemia
(CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL), is a
potent inhibitor of RET kinase.
Primary Objective:
-To determine the objective overall response rate (complete response [CR] + partial response
[PR] by Response Evaluation Criteria in Solid Tumors (RECIST) to ponatinib in the treatment
of patients with advanced or metastatic MTC previously treated with cabozantinib and
vandetanib who: 1) have tumors with RET mutations and 2) have tumors without RET mutations.
Eligibility:
- Patients must have histologically confirmed, unresectable, locally advanced or
metastatic MTC, with measurable disease by RECIST criteria.
- Patients must have disease amenable to biopsy and be willing to undergo biopsy for
molecular analysis, and also have adequate archival material from their thyroidectomy or
from a tumor biopsy obtained prior to beginning any systemic therapy.
- Patients must have failed or been intolerant to prior treatment with both cabozantinib
and vandetanib.
- The last dose of prior systemic therapy must be more than 28 days prior to the first
dose of ponatinib
- Radiation therapy is permitted if the last treatment was received more than 28 days
prior to the first dose of ponatinib.
Design:
- Open label phase II trial with 2 treatment groups:
- RET mutation positive MTC, previously treated with vandetanib and cabozantinib
- RET mutation negative MTC, previously treated with vandetanib and cabozantinib
- Patients will receive ponatinib 30 mg orally daily until disease progression or until
the development of intolerable side effects.
- Tumor response will be assessed by RECIST 1.1 criteria at 8 weeks and then every 12
weeks thereafter. After one year on study, tumor response will be assessed every 16
weeks.
- Patients will have a biopsy of their MTC for molecular analysis prior to initiating
treatment with ponatinib. Patients will also have a biopsy of their MTC at the time of
tumor progression, should that occur.
Phase:
Phase 2
Details
Lead Sponsor:
National Institutes of Health Clinical Center (CC)