María Llavero-Valero1, Francisco Guillén-Grima2, Carles Zafon1, Juan C Galofré3. 1. Departments of Endocrinology and NutritionPreventive MedicineClínica Universidad de Navarra, University of Navarra, Pío XII, 36, 31080, Pamplona, SpainIdiSNANavarra's Health Research Institute, Pamplona, SpainDepartment of Health SciencesPublic University of Navarra, Pamplona, SpainDepartment of EndocrinologyHospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain. 2. Departments of Endocrinology and NutritionPreventive MedicineClínica Universidad de Navarra, University of Navarra, Pío XII, 36, 31080, Pamplona, SpainIdiSNANavarra's Health Research Institute, Pamplona, SpainDepartment of Health SciencesPublic University of Navarra, Pamplona, SpainDepartment of EndocrinologyHospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain Departments of Endocrinology and NutritionPreventive MedicineClínica Universidad de Navarra, University of Navarra, Pío XII, 36, 31080, Pamplona, SpainIdiSNANavarra's Health Research Institute, Pamplona, SpainDepartment of Health SciencesPublic University of Navarra, Pamplona, SpainDepartment of EndocrinologyHospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain Departments of Endocrinology and NutritionPreventive MedicineClínica Universidad de Navarra, University of Navarra, Pío XII, 36, 31080, Pamplona, SpainIdiSNANavarra's Health Research Institute, Pamplona, SpainDepartment of Health SciencesPublic University of Navarra, Pamplona, SpainDepartment of EndocrinologyHospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain. 3. Departments of Endocrinology and NutritionPreventive MedicineClínica Universidad de Navarra, University of Navarra, Pío XII, 36, 31080, Pamplona, SpainIdiSNANavarra's Health Research Institute, Pamplona, SpainDepartment of Health SciencesPublic University of Navarra, Pamplona, SpainDepartment of EndocrinologyHospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain Departments of Endocrinology and NutritionPreventive MedicineClínica Universidad de Navarra, University of Navarra, Pío XII, 36, 31080, Pamplona, SpainIdiSNANavarra's Health Research Institute, Pamplona, SpainDepartment of Health SciencesPublic University of Navarra, Pamplona, SpainDepartment of EndocrinologyHospital Vall d'Hebron, and Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain jcgalofre@unav.es.
Abstract
CONTEXT: The natural history of advanced thyroid malignancies is largely unknown. The outcome of patients included in the placebo arm of clinical trials could be reflective of their therapy-free evolution. OBJECTIVE: To analyze the response rate, symptoms and adverse effects of locally advanced or metastatic differentiated (DTC) and medullary thyroid cancer (MTC) in patients treated with placebo in clinical trials. DESIGN: PubMed (MEDLINE) and SCOPUS databases were searched through September 2015 to identify high-quality randomized controlled clinical trials. We included studies that recruited patients with DTC or MTC with a placebo arm. METHODS: We conducted a meta-analysis for each category of response rate, adherence to treatment, and adverse events. An empirical Bayesian random-effect model was used. RESULTS: We identified five clinical trials. DTC and MTC were independently analyzed. In the placebo arm, no complete response was observed; partial response occurred in 1.6% (0.6-3) and 6.4% (3.4-10.3) of DTC and MTC respectively; stable disease was described in 40.5% (34.6-46.9) and 53.9% (44.3-64.4) of DTC and MTC respectively. DTC reached a disease control rate of 42.3% (36.2-48.9) and MTC of 60.2 (50.1-71.4). Treatment discontinuation rate was 3.5% (1.9-5.5) in DTC and 5.7% (3.0-9.4) in MTC. Rate of dose reduction was 7.3% (4.8-10.5) in DTC and 6.2% (3.3-10.0) in MTC. CONCLUSIONS: This meta-analysis provides extensive data on the response rate and adverse effects of locally advanced or metastatic DTC and MTC in patients treated with placebo. These results may be used for comparisons with results from clinical trials without a placebo arm.
CONTEXT: The natural history of advanced thyroid malignancies is largely unknown. The outcome of patients included in the placebo arm of clinical trials could be reflective of their therapy-free evolution. OBJECTIVE: To analyze the response rate, symptoms and adverse effects of locally advanced or metastatic differentiated (DTC) and medullary thyroid cancer (MTC) in patients treated with placebo in clinical trials. DESIGN: PubMed (MEDLINE) and SCOPUS databases were searched through September 2015 to identify high-quality randomized controlled clinical trials. We included studies that recruited patients with DTC or MTC with a placebo arm. METHODS: We conducted a meta-analysis for each category of response rate, adherence to treatment, and adverse events. An empirical Bayesian random-effect model was used. RESULTS: We identified five clinical trials. DTC and MTC were independently analyzed. In the placebo arm, no complete response was observed; partial response occurred in 1.6% (0.6-3) and 6.4% (3.4-10.3) of DTC and MTC respectively; stable disease was described in 40.5% (34.6-46.9) and 53.9% (44.3-64.4) of DTC and MTC respectively. DTC reached a disease control rate of 42.3% (36.2-48.9) and MTC of 60.2 (50.1-71.4). Treatment discontinuation rate was 3.5% (1.9-5.5) in DTC and 5.7% (3.0-9.4) in MTC. Rate of dose reduction was 7.3% (4.8-10.5) in DTC and 6.2% (3.3-10.0) in MTC. CONCLUSIONS: This meta-analysis provides extensive data on the response rate and adverse effects of locally advanced or metastatic DTC and MTC in patients treated with placebo. These results may be used for comparisons with results from clinical trials without a placebo arm.
Authors: Matthew F Peters; Tim Landry; Carmen Pin; Kim Maratea; Cortni Dick; Matthew P Wagoner; Allison L Choy; Herb Barthlow; Deb Snow; Zachary Stevens; Alex Armento; Clay W Scott; Seyoum Ayehunie Journal: Toxicol Sci Date: 2019-03-01 Impact factor: 4.849