Everolimus plus long-acting release pasireotide (pasireotide-LAR) has promising efficacy compared to a single agent for the treatment of radioiodine-refractory differentiated thyroid cancer and medullary thyroid carcinoma (MTC), according to the results of a randomized phase 2 clinical trial that was published in Cancers.
The aim of the trial was to assess the clinical efficacy and establish the most promising regimen and optimal combination sequence of the 2 treatments. A total of 42 patients, the median age of 65 years with progressive differentiated thyroid cancer or MTC were enrolled. Patients could either be untreated or treated with only 1 systemic agent.
Patients were divided into 3 groups. Those in the first group were treated with 10 mg of everolimus once a day. Those in the second group were given 60 mg of pasireotide-LAR as an intramuscular injection every 4 weeks. Finally, those in the third group received a combination of the 2 treatments. In case of disease progression, patients in the first or second groups switched to the combination therapy and continued with it until a further progression.
Read more about the treatment of MTC
The results showed that there was no objective response based on the Response Evaluation Criteria in Solid Tumors criteria in patients in any of the 3 groups. The 1-year progression-free survival was 8.3 months and 49.9% for patients treated with everolimus only. It was 1.8 months and 36.4% for those treated with pasireotide-LAR only, and finally, it was 8.1 months and 25% for those treated with the combination therapy.
The median and 1-year progression-free survival to the second progression were 26.3 months and 78.4% for patients in the first group, 17.5 months and 70% for patients in the second group, and 8.1 months and 25% for those in the third group.
The researcher reported that “the most frequent adverse events were anemia, stomatitis, fatigue, hyperglycemia, and hypercholesterolemia.”
“The delayed combination of everolimus and pasireotide-LAR following progression on single agent everolimus appeared intriguing as a combination strategy,” they concluded.
Bauman JE, Chen Z, Zhang C, et al. A multicenter randomized phase II study of single agent efficacy and optimal combination sequence of everolimus and pasireotide LAR in advanced thyroid cancer. Cancers. 2022;14(11):2639. doi:10.3390/cancers14112639
Pasireotide & everolimus in adult patients with radioiodine-refractory differentiated & medullary thyroid cancer. US National Library of Medicine. Updated February 17, 2021. Accessed June 17, 2022.