Cabozantinib shows promise as first line treatment for differentiated thyroid cancer
In Penn-led trial, 97 percent of patients saw their tumors shrink
UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE
A kinase inhibitor called cabozantinib could be a viable therapy option for patients with metastatic, radioactive iodine-resistant thyroid cancer. In a trial initiated and led by the Abramson Cancer Center and the Perelman School of Medicine at the University of Pennsylvania, tumors shrunk in 34 out of 35 patients who took the drug, and more than half of those patients saw the tumor size decrease by more than 30 percent.
Researchers will present their findings at the 2018 Multidisciplinary Head and Neck Cancers Symposium in Scottsdale, Arizona this Friday.
Most cases of differentiated thyroid cancer are treated with radioactive iodine therapy. Since the thyroid absorbs nearly all of the iodinein the human body, radioactive iodine given to a patient will concentrate in thyroid cancer cells, killing them with little effect on the rest of the body. The treatment can be curative, but about 15 percent of these patients have cancers that are resistant to the therapy. There are currently two approved treatments in these cases, both of which are kinase inhibitors - drugs that block enzymes that are crucial to a cancer cell's ability to function. However, responses to these treatments are not durable. Once patients progress, they need additional therapeutic options.
"Our trial shows that cabozantinib is an active agent for patients with RAI-refractory thyroid cancer and may be able to significantly improve the care of patients who are at this advanced stage of their disease," said the study's lead author Marcia S. Brose, MD PhD, an associate professor of Otorhinolaryngology: Head and Neck Surgery and director of the Center for Rare Cancers and Personalized Therapy at Penn.
As part of a phase II trial, Brose and her team gave the drug as a first line therapy to 35 patients with metastatic, radioactive iodine-resistant thyroid cancer starting in March of 2014. Thirty-four experienced tumor shrinkage, and 19 of the 35 (54 percent) achieved a partial response - defined as a shrinkage greater than 30 percent. The median time on the study was 35 weeks (range 3-197), and 16 patients are currently still enrolled. "These results indicate cabozantinib may offer an additional treatment option to these patients that will shrink tumors and provide an additional progression-free period for our patients," Brose said.
Twenty-three of the 35 patients (66 percent) required dose interruptions and dose adjustments during the trial. The most common toxicities attributable to cabozantinib included hyperglycemia, which presented in 28 patients (80 percent). Twenty-seven patients experienced diarrhea (77 percent), 26 had fatigue (74 percent), and 25 had weight loss (71 percent). Five patients experienced grade 3-5 hypertension (14 percent), 3 had grade 3-5 increase lipase (9 percent), 2 had grade 3-5 weight loss (6 percent), 2 had grade 3-5 pulmonary embolism (6 percent), and 2 had hyponatremia (6 percent).
Brose says the data show the need for a larger, multi-center study, plans for which are already underway.
The study was supported by Exelixis, which manufactures cabozantinib.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $7.8 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $405 million awarded in the 2017 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751.
Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine, and Princeton House Behavioral Health, a leading provider of highly skilled and compassionate behavioral healthcare.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2017, Penn Medicine provided more than $500 million to benefit our community.