News - Sunitinib Offers Favourable Outcomes for Patients With Refractory Thyroid Cancers - a Summary from the UK

News - Sunitinib Offers Favourable Outcomes for Patients With Refractory Thyroid Cancers: Presented at WCTC

Sunitinib Offers Favourable Outcomes for Patients With Refractory Thyroid Cancers: Presented at WCTC

By Cameron Johnston

TORONTO -- August 11, 2009 -- Patients with thyroid cancers who are refractory to radioactive iodine therapy, and/or have progressed following surgical resection of the thyroid seem to show favourable responses when treated with sunitinib, according to a study presented here at the World Congress on Thyroid Cancer (WCTC).

Ezra Cohen, MD, University of Chicago, Chicago, Illinois, presented the preliminary results of a phase 2 study at an oral presentation on August 8.

The study results included only patients with differentiated cancers; the results from a second cohort of patients with medullary carcinomas were not presented.

Patients in the study had either papillary (n = 18), follicular (n = 8), Hurthle cell (n = 10), or insular (n = 2) thyroid cancer.

Of the 38 who were enrolled, 37 had been treated with radioactive iodine, 35 had had prior surgery, 15 had had external beam radiation therapy (EBRT), and 6 had had systemic chemotherapy. Many had a combination of therapies.

All patients had shown signs of progressive disease within the previous 6 months before being enrolled in the study. Thirty-one patients had distant metastases at the time of enrolment.

Patients were treated with sunitinib 50 mg/day on a 4-week-on/2-week-off cycle.

Overall, 26 patients (68%) had stable disease and 7 (18%) had a partial response. Progression-free survival was 57% and 34% at 1 and 2 years respectively. Overall survival was 76% and 70% at 1 and 2 years respectively.

Treatment response was determined according to modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria as well as by the patient's decrease in thyroglobulin levels.

Adverse events were very common in this study group, although according to Dr. Cohen, they were not unexpected and were comparable to what had been seen in other studies when sunitinib was used to treat renal cell carcinoma.

A total of 5 patients discontinued the study due to adverse events, which included fatigue (79%), diarrhoea (56%), and hand-foot syndrome (53%). There were also 3 toxic deaths, which were felt to be related to the sunitinib (1 case of sepsis, 1 of liver failure, and 1 of left ventricular failure).

Half of the patients (19/38) had to undergo dose reductions as a result of the aggressive toxicity profile.

Nonetheless, Dr. Cohen said sunitinib is an active agent, showing an 87% response rate among patients whose thyroid carcinomas were refractory to virtually all other available treatments.

[Presentation title: Sunitinib in Patients With Radioactive Iodine Refractory and Progressive Differentiated Thyroid Cancer: A Phase 2 Study. Abstract O51]

Phase 2 study of sunitinib in refractory thyroid cancer. - This is my clinical trial

Phase 2 study of sunitinib in refractory thyroid cancer. - ASCO

New drug coming for thyroid cancer??? from XL 184 | The Haystack

June 21st, 2010

BMS Bails on Exelixis

Exelixis has lost a second big pharma partner for its most advanced compound in development. Bristol-Myers Squibb is giving back the rights to XL184, a MET inhibitor in several Phase II and III trials in cancer, less than two years after buying into the program for $195 million. GlaxoSmithKline had already given up rights to the drug in October 2008.
As part of the termination agreement, BMS will shell out $17 million, a figure that would have covered its financial contribution to the drug’s development over the next three months. The South San Francisco-based biotech said in a conference call this morning that despite the loss of about $20 million in expected revenues this year from the collaboration, it will still end the year with a higher cash balance than in 2009.
However, that healthier balance sheet has more to do with cost-cutting than milestone payments from partners. In March, the company underwent a major restructuring in order to help support the development of the drug candidate, cutting 40% of staff, or 270 jobs. The move was meant to save the company $90 million through 2011, and help fund the development of XL 184, arguably the most critical compound in the Exelixis pipeline.
XL184 blocks three protein kinases, MET, VEGFR2, and RET, and is being studied to treat thyroid cancer, glioblastoma, and a variety of other cancers. If an ongoing Phase III trial in thyroid cancer yields positive results, Exelixis expects to ask FDA for approval in 2011. The biotech also plans a Phase III in glioblastoma towards the end of this year.
“We could not agree with BMS on the prioritization of XL184, the speed, the scope of the program,” George Scangos said this morning.
So what’s next for Exelixis and XL 184? The biotech firm is clearly on the lookout for partner number three. Scangos told analysts he expected even more suitors at the company’s doorstep, as the data for the compound is more robust than when it was negotiating with BMS in 2008.
XL 184 was being watched as one of several drugs in development that block MET, a protein implicated in cancer metastasis. ArQule is developing ARQ197, which recently offered up solid Phase II data in lung cancer. Pfizer’s Crizotinib, which blocks MET and ALK, is also in Phase III trials in lung cancer. GlaxoSmithKline, Exelixis’ previous partner for XL 184, continues to develop XL880, which blocks MET and VEGFR2.

Understanding Chemo Brain from Cancer.Net

Understanding Chemo Brain | Cancer.Net

Understanding Chemo Brain

Cancer survivors commonly use the term “chemo brain” to describe difficulty thinking clearly after cancer treatment, even months or years later. Doctors may refer to such concentration and memory problems as cognitive changes or cognitive dysfunction. The chemo brain phenomenon is not well understood, but the frustrating symptoms are experienced by many patients who have received cancer treatment.

Symptoms

Symptoms or signs of chemo brain include:

• Inability to focus or concentrate
  
• Mental “fog” or disorientation
  
• Forgetfulness
  
• Difficulty finding the “right word”
  
• Losing track of the rest of a planned sentence
  
• Difficulty comprehending what people are saying
  
• Difficulty completing tasks and multi-tasking
  
• Difficulty balancing a checkbook
  
• Difficulty with spatial orientation
  
• Fatigue
  
• Mood swings
  
• Insomnia

The severity of the symptoms can vary depending on the person’s age, stress level, and history of depression or anxiety.

Causes

Despite the name, it’s not clear whether chemotherapy causes the symptoms of chemo brain. Some people who do not receive chemotherapy report similar symptoms. Other potential causes could include other cancer treatments, such as hormone therapy, immunotherapy, or radiation therapy; complications of cancer treatment, such as anemia, infection, or sleep problems; emotional responses, such as anxiety or depression; or medications taken for symptoms, such as pain. Of course, these same mental problems often occur with normal aging.

There are no definitive screening tests available to assess a patient’s risk for chemo brain. However, researchers are studying the subject to determine ways to treat and prevent it.

Strategies to help with the effects of chemo brain

The following is a list of strategies that may help enhance your quality of life and keep you mentally sharp:

• Keep a log or checklist containing daily reminders. Put it in a convenient location, where you can look at it frequently throughout your day. If necessary, keep a duplicate copy at work.
  
• Take on one task at a time, and avoid distractions.
  
• Carry around a small pad, making it easy to write down reminders.
  
• Place a calendar in an easy-to-see location, and mark upcoming events and appointments.
  
• Place post-it notes around the house and workplace to remind you of important tasks.
  
• Use word play, such as rhyming, to help your memory.
  
• Get plenty of rest.
  
• Try yoga or meditation to relax and regain some mental clarity.
  
• Have someone accompany you to your doctors’ visits. Don’t be afraid to ask questions, even if you feel like you are repeating yourself. Keep a journal of your visits, and write down important facts that you discuss with your doctor. If it is too overwhelming, have the person who goes with you take notes and review them with you after the visit.
  
• Talk with your employer if you are having problems at work. Discuss potential ways your employer could support you, such as modifying workload and deadlines. Read more about going back to work after cancer.
  
• Prepare for the next day by setting out the things you will need the night before.
  
• Color code or label certain cabinets or drawers where you store things around your home.
  
• Put things—such as car keys—back in their designated place after you use them, so that they will be easy to find the next time you need them.
  
• Create an environment that is free of clutter.
  
• Keep important phone numbers easily displayed next to your phone, and carry a small address book in case you forget someone’s number while you are out.

In addition, don’t be afraid to ask your family and friends for help. If you need additional assistance to cope with the symptoms of chemo brain, talk with your doctor or other health care team members about counselingand other resources.

More Information

Emotional and Physical Matters

Cognitive Problems

Additional resources

CancerCare: Doctor, Can We Talk About Chemobrain?

Mayo Clinic: Chemobrain