E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Advanced or metastatic papillary or follicular Thyroid Carcinoma |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10001205 |
E.1.2 | Term | Adenocarcinoma thyroid |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To demonstrate an improvement in progression free survival (PFS) with ZACTIMA™ (ZD6474) 300 mg as compared to Placebo in subjects with advanced or metastatic papillary or follicular Thyroid Carcinoma failing or unsuitable for Radioiodine therapy |
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E.2.2 | Secondary objectives of the trial |
1. To demonstrate an improvement in Disease Control Rate (DCR) [Complete Response (CR) + Partial Response (PR) + Stable disease (SD) at 6 months] with ZACTIMA™ (ZD6474) 300 mg as compared to placebo according to the RECIST (Therasse et al, 2000). 2. To quantify the improvement in Objective Response Rate (ORR) (CR+PR) with ZACTIMA™ (ZD6474) 300 mg as compared to placebo according to the RECIST. 3. To demonstrate an improvement in the Overall Survival (OS) with ZACTIMA™ (ZD6474) as compared to placebo. 4. To determine the safety and tolerability of ZACTIMA™ (ZD6474) 300 mg in subjects with advanced or metastatic papillary or follicular Thyroid Carcinoma failing or unsuitable for Radioiodine therapy.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Provision of written informed consent prior to any study-related procedures. 2. Female or male aged 18 years and over. 3. Previously confirmed histological diagnosis of advanced or metastatic papillary or follicular thyroid carcinoma, without anaplastic component. Tumor sample available for centralized exploratory analysis. 4. Presence of one or more measurable lesions at least 1 cm in the longest diameter by spiral CT scan or 2 cm with conventional techniques. 5. Life expectancy of 12 weeks or longer. 6. WHO Performance status 0-2. 7. Able to swallow study medication. 8. Progressive disease following RAI131 or patient unsuitable for RAI131 after surgery. 9. Serum TSH<0.5mU/L. 10. Negative pregnancy test for female subjects of childbearing potential.
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E.4 | Principal exclusion criteria |
1. Brain metastases or spinal cord compression, unless treated at least 4 weeks before first dose and stable without steroid treatment for 10 days. 2. Major surgery within 4 weeks before randomization. 3. Prior chemotherapy within the last 4 weeks prior to randomization. 4. RAI131 therapy within 3 months in patients with radioiodine uptake. 5. Radiation therapy within the last 4 weeks prior to randomization (with the exception of palliative radiotherapy). 6. Serum bilirubin >1.5 x the upper limit of reference range (ULRR). 7. Serum creatinine >1.5 x ULRR or creatinine clearance <50 ml/minute (calculated by Cockcroft-Gault formula). 8. Potassium <4.0 mmol/L despite supplementation; or above the CTCAE grade 1 upper limit. 9. Magnesium below the normal range despite supplementation or above the CTCAE grade 1 upper limit. 10. Serum calcium above the CTCAE grade 1 upper limit. 11. In cases where the serum calcium is below the normal range, 2 options would be available: - the calcium adjusted for albumin is to be obtained and substituted for the measured serum value. Exclusion is to then be based on the adjusted for albumin values falling below the normal limit. - Determine the ionized calcium levels. Exclusion is then to be based if these ionized calcium levels are out of normal range despite supplementation. 12. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), or alkaline phosphatase (ALP) greater than 2.5 × ULRR, or greater than 5.0 × ULRR if judged by the investigator to be related to liver metastases. 13. Clinically significant cardiovascular event (eg myocardial infarction), superior vena cava [SVC] syndrome, New York Heart Association [NYHA] classification of heart failure >II within 3 months before entry, or presence of cardiac disease that in the opinion of the Investigator increases the risk of ventricular arrhythmia. 14. History of arrhythmia (multifocal premature ventricular contractions [PVCs], bigeminy, trigeminy, ventricular tachycardia or uncontrolled atrial fibrillation), which is symptomatic or requires treatment (CTCAE grade 3), , or asymptomatic sustained ventricular tachycardia. Subjects with atrial fibrillation controlled by medication are permitted. 15. Congenital long QT syndrome or 1st degree relative with unexplained sudden death under 40 years of age. 16. QT prolongation with other medications that required discontinuation of that medication. 17. Presence of left bundle branch block (LBBB). 18. QTc with Bazett’s correction unmeasurable or >480 msec on screening ECG (Note: If a subject has QTc interval >480 msec on screening ECG, the screen ECG may be repeated 2 times [at least 24 hours apart]. The average QTc from the three screening ECGs must be <480 msec in order for the subject to be eligible for the study). Patients who are receiving a drug that has a risk of QTc prolongation (see Appendix E for list of medications) are excluded if QTc is ≥ 460 msec. 19. Hypertension not controlled by medical therapy (systolic BP greater than 160 millimeter of mercury [mmHg] or diastolic blood pressure greater than 100 mmHg). 20. Any concomitant medications that may cause QTc prolongation or induce Torsades de Pointes (see Appendix E for the lists of medications in Table 1 & Table 2) or induce CYP3A4 function. 21. Currently active diarrhea that may affect the ability of the patient to absorb the ZACTIMA or tolerate diarrhea. 22. Previous or current malignancies of other histologies within the last 5 years, with the exception of in situ carcinoma of the cervix, and adequately treated basal cell or squamous cell carcinoma of the skin. 23. Any unresolved chronic toxicity greater than CTCAE grade 1 from previous anticancer therapy. 24. Participation in a clinical study and/or receipt of an investigational drug during the last 30 days (participation in the survival follow-up period of a study is not an exclusion). 25. Evidence of severe or uncontrolled systemic disease (hepatitis B or HIV infection) or any concurrent condition which in the Investigator’s opinion makes it undesirable for the patient to participate in the trial or which would jeopardize compliance with the protocol. 26. Previous exposure to ZACTIMA (ZD6474) or any previous treatment with signal transduction inhibitors targeting VEGF. 27. Currently pregnant or breast feeding. 28. Involvement in the planning and conduct of the study (applies to both AstraZeneca staff or staff at the investigational site). 29. Previous randomization or treatment in the present study.
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E.5 End points |
E.5.1 | Primary end point(s) |
Progression Free Survival |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | Information not present in EudraCT |
E.7.1.2 | Bioequivalence study | Information not present in EudraCT |
E.7.1.3 | Other | Information not present in EudraCT |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 13 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |