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Adding a MEK inhibitor to boost iodine uptake before ablation did not improve complete remission rates, cooling the 'redifferentiation for everyone' idea.
ASTRA, trial NCT01843062 sponsored by AstraZeneca and reported in 2019, found that adding the MEK inhibitor selumetinib to boost iodine uptake before adjuvant radioiodine in high-risk differentiated thyroid cancer did not improve complete remission rates, cooling the idea of redifferentiation for everyone. It randomised 401 patients to selumetinib or placebo with radioiodine and found no difference in complete remission at eighteen months. OnCo links it to thyroid cancer, radioiodine therapy, kinase inhibitors, the MAPK pathway and the pairing of MAPK inhibitor redifferentiation followed by radioiodine. Redifferentiation remains reserved for selected radioiodine-refractory patients, where small series show MEK or BRAF and MEK inhibitors restore uptake in about half, and whether that selected use can be proved in a randomised trial is the open question.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
401 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Complete remission at 18 monthsprimary | Selumetinib + RAI | - | 40% | - | - | link |
| Placebo + RAI | - | 38.5% |
Shares Small-molecule kinase inhibitors and the tag failure.
Shares Small-molecule kinase inhibitors and the tag failure.
Shares Small-molecule kinase inhibitors and the tag failure.
Shares Small-molecule kinase inhibitors and the tag failure.
Shares Small-molecule kinase inhibitors and the tag failure.
Shares MAPK inhibitor redifferentiation → radioiodine, Radioiodine therapy and whole-body iodine scanning, Thyroid cancer.
Shares Radioiodine therapy and whole-body iodine scanning, Thyroid cancer.
Shares Radioiodine therapy and whole-body iodine scanning, Thyroid cancer.