Evaluation of Efficacy, Safety of Vandetanib in Patients With Differentiated Thyroid Cancer (VERIFY)

A Randomized, Double-Blind, Placebo-Controlled, Multi-Centre Phase III Study to Assess the Efficacy and Safety of Vandetanib (CAPRELSA™; SAR390530 (Formerly AstraZeneca ZD6474)) 300 mg in Patients With Differentiated Thyroid Cancer That Is Either Locally Advanced or Metastatic Who Are Refractory or Unsuitable for Radioiodine (RAI) Therapy

Primary Objective:

To determine the efficacy (as assessed by progression-free survival [PFS]) of vandetanib when compared to placebo in participants with differentiated thyroid cancer that is either locally advanced or metastatic who are refractory or unsuitable for radioiodine therapy.

Secondary Objectives:

• To determine the efficacy of vandetanib when compared to placebo in this participant population as assessed by efficacy variables including duration of response (DOR), objective response rate (ORR), change in tumour size (TS) and overall survival (OS).
• To evaluate the pharmacokinetics (PK) of vandetanib in this participant population and potentially investigate any influence of participant demography and pathophysiology on vandetanib PK.
• To demonstrate an improvement in time to worsening of pain (TWP) in participants treated with vandetanib when compared to placebo in this participant population.
• To evaluate the safety and tolerability of vandetanib treatment in this participant population.

Study Overview

• Status: Completed
• Conditions: Differentiated Thyroid Cancer
• Intervention / Treatment: Drug: Placebo; Drug: Vandetanib (SAR390530)

Detailed Description

Participants who received vandetanib as randomized treatment were allowed, upon re-consent, to continue on open-label vandetanib if in the opinion of the Investigator the participant received benefit. Placebo participants who experienced disease progression within 60 days of unblinding were offered the option of treatment with open-label vandetanib if, in the Investigator's opinion, such treatment was of clinical benefit to the participant. Approximately 2 years; duration depends on individual participant response.

• Study Type: Interventional
• Enrollment (Actual): 238
• Phase: Phase 3

Contacts and Locations

Study Locations

• Brazil
  • Porto Alegre, Brazil
    • Research Site
  • Ribeirão Preto, Brazil
    • Research Site
  • Rio de Janeiro, Brazil
    • Research Site
  • São José do Rio Preto, Brazil
    • Research Site
  • São Paulo, Brazil
    • Research Site
• China
  • Beijing, China
    • Research Site
  • Changchun, China
    • Research Site
  • Chengdu, China
    • Research Site
  • Huangzhou, China
    • Research Site
  • Shanghai, China
    • Research Site
  • Tianjin, China
    • Research Site
  • Wuhan, China
    • Research Site
• Czechia
  • Olomouc, Czechia
    • Research Site
  • Praha, Czechia
    • Research Site
• Denmark
  • Odense, Denmark
    • Research Site
• France
  • Angers Cedex 01, France
    • Research Site
  • Bordeaux Cedex, France
    • Research Site
  • Caen Cedex 5, France
    • Research Site
  • Paris Cedex 13, France
    • Research Site
  • Villejuif Cedex, France
    • Research Site
• Italy
  • Catania, Italy
    • Research Site
  • Milano, Italy
    • Research Site
  • Napoli, Italy
    • Research Site
  • Pisa, Italy
    • Research Site
  • Roma, Italy
    • Research Site
  • Siena, Italy
    • Research Site
• Japan
  • Bunkyo-ku, Japan
    • Research Site
  • Fukuoka-shi, Japan
    • Research Site
  • Fukushima-shi, Japan
    • Research Site
  • Kashiwa-shi, Japan
    • Research Site
  • Kobe-shi, Japan
    • Research Site
  • Koto-ku, Japan
    • Research Site
  • Matsumoto-shi, Japan
    • Research Site
  • Nagasaki-shi, Japan
    • Research Site
  • Nagoya-shi, Japan
    • Research Site
  • Niigata-shi, Japan
    • Research Site
  • Osaka-shi, Japan
    • Research Site
  • Shinjuku-ku, Japan
    • Research Site
  • Yokohama-shi, Japan
    • Research Site
• Poland
  • Gliwice, Poland
    • Research Site
  • Kielce, Poland
    • Research Site
  • Warszawa, Poland
    • Research Site
  • Zgierz, Poland
    • Research Site
• Russian Federation
  • Barnaul, Russian Federation
    • Research Site
  • Obninsk, Russian Federation
    • Research Site
• Spain
  • Barcelona, Spain
    • Research Site
  • Gerona, Spain
    • Research Site
  • Hospitalet de Llobregat(Barcel, Spain
    • Research Site
  • Madrid, Spain
    • Research Site
• Sweden
  • Lund, Sweden
    • Research Site
  • Stockholm, Sweden
    • Research Site
• United States
  • Arkansas
    • Little Rock, Arkansas, United States, 72205
      • Research Site
  • California
    • Torrance, California, United States, 90502
      • Research Site
  • Kentucky
    • Lexington, Kentucky, United States, 40536-0293
      • Research Site
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Research Site
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • Research Site
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Washington University
  • Nebraska
    • Omaha, Nebraska, United States, 68198-4100
      • Research Site
  • New York
    • New York, New York, United States, 10065
      • Research Site
  • Oregon
    • Portland, Oregon, United States, 97239
      • Research Site
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19014
      • Research Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Provision of informed consent to participate in the study as well as provision of informed consent to provide a sample of a previously obtained archival tumor biopsy.
• Female or male aged 18 years and older with previously confirmed histological diagnosis of locally advanced or metastatic differentiated (excluding minimally invasive follicular) thyroid cancer not amenable to surgical resection, external beam radiotherapy or local therapy.
• Measurable disease defined as at least one lesion, not irradiated within 12 weeks of the date of randomization, that can be accurately measured at baseline.
• Participants must have experienced progression within 14 months and be RAI-refractory/resistant or unsuitable for RAI.
• Thyroid-stimulating hormone (TSH) suppression below 0.5 mU/L is required.
• World Health Organization (WHO) or Eastern Cooperative Oncology Group (ECOG) Performance status 0-2.
• Negative pregnancy test (urine or serum) for female participants of childbearing potential.

Exclusion Criteria:

• Inadequate organ function as defined by: (1) Alanine aminotransferase (ALT), aspartate aminotransferase (AST), or alkaline phosphatase (ALP) greater than 2.5*upper limit of normal (ULN), or greater than 5.0*ULN if judged by the Investigator to be related to liver metastases. (2) Serum bilirubin greater than 1.5*ULN. This criterion does not apply to participants with known Gilbert's Disease. (3) Creatinine clearance <50 mL/min (calculated by Cockcroft-Gault formula).
• Risk of prolonged interval between Q and T (QT) on an electrocardiogram (ECG) corrected for heart rate (QTc) as defined by: (1) Current therapy with any medication known to be associated with Torsades de pointes or potent inducers of cytochrome CYP3A4. (2) History of QT prolongation. (3) Congenital long QT syndrome. (4) QT interval corrected for heart rate by the Bazett's method (QTcB) correction unmeasurable or greater than 480 ms on screening ECG.
• Previous therapy with approved or investigational tyrosine kinase or anti- vascular endothelial growth factor (VEGF) receptor inhibitors or targeted therapies (e.g. multi-targeted kinase inhibitors such as sorafenib, AMG-706, sunitinib, pazopanib, lenvatinib).
• RAI therapy within 12 weeks prior to first dose of study drug, and radiation therapy other than RAI, including external beam, if not completed prior to randomization.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Vandetanib/ Vandetanib; Participants received Vandetanib 300 mg tablet, orally once daily until disease progression or death, in randomized treatment period (up to maximum of 40 months). Participants who completed the randomized treatment period, were offered the opportunity to continue the same vandetanib treatment in the open label period, if in the investigator's opinion, they received benefit and if the participant agreed and provided their informed consent to continue the open-label period for up to additional 31 months.	Drug: Vandetanib (SAR390530); Pharmaceutical form: tablet Route of administration: oral; Other Names: CAPRELSA
Placebo Comparator: Placebo/ Vandetanib; Participants received placebo matched to Vandetanib tablet, orally once daily until disease progression or death, in randomized treatment period (up to maximum of 40 months). Participants who completed the randomized treatment period, and experienced disease progression were offered the option of treatment in open-label period with vandetanib, if in the investigator's opinion, they received benefit and if the participant agreed and provided their informed consent to begin open-label vandetanib treatment i.e., 300 mg tablet, orally once daily for up to 31 months.	Drug: Placebo; Pharmaceutical form: tablet Route of administration: oral; Drug: Vandetanib (SAR390530); Pharmaceutical form: tablet Route of administration: oral; Other Names: CAPRELSA

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-Free Survival (PFS)	The PFS was defined as the time (in months) from randomization until the date of first documented disease progression or death (from any cause), whichever came first. Disease progression as per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) was defined as: at least a 20% increase and absolute increase of 5 mm in the sum of the longest diameter (LD) of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. Analysis was performed by Kaplan-Meier method.	Randomization until disease progression or death, assessed every 12 weeks (up to 22 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival (OS)	OS was defined as the time from the date of randomization until death due to any cause. In the absence of observation of death, survival time was censored to last date the participant is known to be alive or at the cut-off date, whichever comes first. Analysis was performed by Kaplan-Meier method.	From randomization to the date of death due to any cause (maximum duration: up to 42 months)
Randomized Treatment Period: Percent Change From Baseline in Tumor Size (TS) at Week 36	Tumor size was the sum of the longest diameters of the target lesions. Target lesions were measurable tumor lesions. Baseline was defined as the last evaluable assessment prior to starting treatment.	Baseline, Week 36
Percentage of Participants With Objective Response	Objective Response was defined as the percentage (%) of participants with complete response or partial response. Per RECIST 1.1 criteria, complete response was defined as the disappearance of all target lesions since Baseline. Any pathological lymph nodes selected as target lesions must have a reduction in short axis to less than (<)10 millimeters (mm). Partial response was defined as at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the Baseline sum of diameters. Progressive Disease was defined as at least at least a 20% increase and absolute increase of 5 mm in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.	From randomization to the date of first documented tumor progression, or death due to any cause, whichever comes first (maximum duration: up to 42 months)
Time to Worsening of Pain (TWP) Using Numeric Rating Scale (NRS) of Worst Pain	Time to worsening of pain was defined as the time interval from the date of randomization to the date of first assessment of worsening of pain with no evidence of improvement within the next 14 days. Participants rate their worst pain intensity during the past seven days using an 11-point NRS scale, where 0 represents "no pain" and 10 represents "pain as bad as you can imagine." Higher scores indicated greater pain severity. TWP analysis was performed using Kaplan-Meier method.	From randomization to the date of first assessment of worsening of pain (maximum duration: up to 42 months)
Duration of Response (DOR)	Duration of response was defined as the time from the date of first documented response until the date of documented progression or death. If participants did not progress following a response, then their DOR used the PFS censoring time. Per RECIST 1.1, progressive disease was defined as at least a 20% increase and absolute increase of 5 mm in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. DOR analysis was performed using Kaplan-Meier method.	From the date of first response to the date of first documented tumor progression or death due to any cause whichever comes first (maximum duration: up to 42 months)
Randomized Treatment Period: PK Parameters: Maximum Plasma Concentration (Cmax)		Post-dose on Week 1 to Week 48

Collaborators and Investigators

• Sponsor: Genzyme, a Sanofi Company
• Investigators: Study Director: Clinical Sciences & Operations, Sanofi

Study record dates

Study Major Dates

• Study Start (Actual): September 17, 2013
• Primary Completion (Actual): August 30, 2015
• Study Completion (Actual): January 22, 2022

Study Registration Dates

• First Submitted: June 11, 2013
• First Submitted That Met QC Criteria: June 11, 2013
• First Posted (Estimated): June 13, 2013

Study Record Updates

• Last Update Posted (Actual): July 23, 2024
• Last Update Submitted That Met QC Criteria: June 26, 2024
• Last Verified: June 1, 2024

More Information

Terms related to this study

• Keywords: vandetanib, AZD 6474, Differentiated Thyroid Cancer
• Additional Relevant MeSH Terms: Neoplasms; Neoplasms by Site; Endocrine System Diseases; Endocrine Gland Neoplasms; Head and Neck Neoplasms; Thyroid Diseases; Thyroid Neoplasms
• Other Study ID Numbers: D4203C00011; 2013-000422-58 (EudraCT Number); LPS14813 (Other Identifier: Sanofi)