Digoxin for the Reinduction of Radioiodine Uptake in Metastatic or Locally Advanced Non-medullary Thyroid Carcinoma

NCT05507775 | Completed

• 1 other identifier: 2022-500477-14-00
• Study Type: interventional
• Target: 8
• Locations: 1 country
• Sites: 1

Brief Summary

Non-medullary thyroid carcinoma has a good prognosis in most patients. However, a small subset of patients nevertheless develop metastatic or locally advanced and unresectable disease which in some cases also becomes radioiodine refractory. In these patients treatment options are very limited. Earlier cell line and animal studies have shown that digoxin can reinduce radioiodine uptake in non-medullary thyroid cancer. This study serves as a proof of principle study to assess the possibility of digoxin to reinduce radioiodine uptake in adult humans with metastatic or locally advanced non-medullary radioiodine refractory thyroid carcinoma.

Conditions

Non-Medullary Thyroid Carcinoma

Keywords

Thyroid cancer; Digoxin; Autophagy; Redifferentiation; Radio-iodine refractory

Outcome Measures

Primary Outcomes (1)

• Reinduction of radioiodine uptake in target lesion

  At baseline and after 3 weeks of digoxin treatment, a scintigraphy scan will be conducted. Reinduction of radioiodine uptake is defined as enough uptake that a treatment with high-dose radioactive iodine is possible.

  3 weeks

Secondary Outcomes (2)

• Beneficial effects of high-dose radioactive iodine treatment after reinduction

  6 months

• Safety of digoxin treatment

  3 weeks

Study Arms (1)

Treatment with digoxin

EXPERIMENTAL

This arm will consist of 10 patients with radioiodine refractory non-medullary thyroid carcinoma. All participants will be treated according to the same protocol.

Drug: Digoxin tablet

Interventions

Digoxin tablet DRUG

Participants will be treated with digoxin tablets for 3 weeks. On the first they, participants will start with a starting dosage of 3x0.25mg with 6 hours between each administration. Thereafter they will continue with a dosage of 1x0.25mg. Participants aged \>70 years or with body weight \<55kg will initiate a starting dosage of 3x0.125mg with 6 hours between each administration. Thereafter they will continue with a dosage of 1x0.125mg. After one week the blood concentration of digoxin will be measured. According to this blood concentration, the dose of digoxin will be adjusted.

Treatment with digoxin

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Non-medullary thyroid carcinoma
• Having undergone total thyroidectomy and at least 1 treatment with \[131\]sodium iodine (NaI)
• Presence of local or metastatic disease, radiologically proven. A minimum of 1 target lesion (at least 1cm for soft tissue and 1.5cm for lymph nodes) must be present.
• Radioiodine refractory disease; at least one lesion without therapeutic relevant uptake at previous post-therapeutic scintigraphy and/or negative diagnostic \[123\]NaI-scan.
• The target lesion must not be eligible for local treatments.
• Hematologic lab values should be at least: absolute neutrophil count \>1.4x10\^9/liter, hemoglobin\>5.5mmol/liter, thrombocytes \>99x10\^9/liter

You may not qualify if:

• Creatinine clearance \<50ml/min and/or active kidney disease
• Cardiac arrhythmias
• Electrolyte disorder
• Concomitant drugs that interfere with digoxin metabolism such as P-glycoprotein inductors or inducers, including but not limited to penicillamine, sulfasalazin, tipranavir, amiodarona, diltiazem, itraconazole, ketoconazole, kinidin, lapatinib, propafenon, vemurafenib, verapamil, azithromycin, clarithromycin, erythromycin, roxithromycin, chloroquin, ciclosporin, anti hepatitis C drugs, anti-HIV drugs, hydroxychloroquine.
• Pregnancy, lactating or breast-feeding women.
• Having undergone a procedure with iodine contrast agent within the last 3 months.
• Prior therapy with radioactive iodine \<6 months prior to participation.
• External beam radiation therapy \<4 weeks prior to participation.
• Having undergone chemotherapy or targeted therapy \<4 weeks prior to participation.
• Eastern Cooperative Oncology Group (ECOG) score \>2.
• Use of other investigational drugs within 4 weeks preceding the first dose of digoxin treatment.
• Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to digoxin.
• Uncontrolled intercurrent illness that would limit compliance with the study requirements.
• Unwillingness or inability to comply with study and follow-up procedures.
• Other active malignancies other than basal cell carcinoma. Malignancies that have been in complete remission over 2 years are not considered active malignancies.

Sponsors & Collaborators

• Radboud University Medical Center: lead

Study Sites (1)

Radboud University Medical Center

Nijmegen, Netherlands

Location

MeSH Terms

Conditions

Thyroid Cancer, Papillary; Thyroid Neoplasms

Interventions

Digoxin

Condition Hierarchy (Ancestors)

Adenocarcinoma, Papillary; Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Endocrine Gland Neoplasms; Neoplasms by Site; Head and Neck Neoplasms; Endocrine System Diseases; Thyroid Diseases

Intervention Hierarchy (Ancestors)

Digitalis Glycosides; Cardenolides; Cardiac Glycosides; Cardanolides; Steroids; Fused-Ring Compounds; Polycyclic Compounds; Glycosides; Carbohydrates

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: 10 participants with radioiodine refractory metastatic or locally advanced non-medullary thyroid carcinoma will enroll in this study. All participants will be treated according to the same protocol.

Study Record Dates

• First Submitted: August 17, 2022
• First Posted: August 19, 2022
• Study Start: December 6, 2022
• Primary Completion: June 21, 2023
• Study Completion: January 1, 2024
• Last Updated: April 11, 2024

Record last verified: 2024-04

Data Sharing

• IPD Sharing: Will not share

Locations

NL (1)