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Deng F, Evans DG, Smith MJ. Comparison of the frequency of loss-of-function LZTR1 variants between Schwannomatosis patients and the general population. Hum Mutat 2022; 43:919-927. [PMID: 35391499 PMCID: PMC9324957 DOI: 10.1002/humu.24376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022]
Abstract
Schwannomatosis is a rare tumour predisposition syndrome that causes multiple schwannomas. Germline loss-of-function LZTR1 variants were only recently identified as disease-causing, so relatively few variants have been identified in patients. In addition, many loss-of-function variants exist in gnomAD in people who do not have clinical symptoms of schwannomatosis. These factors, and the incomplete penetrance seen in this condition, hinder definitive interpretation of the clinical significance of novel loss-of-function variants identified in schwannomatosis patients. We collated published loss-of-function LZTR1 variants identified in schwannomatosis patients and classified them according to current ACMG/AMP/ACGS guidelines. Subsequently, pathogenic/likely pathogenic schwannomatosis-associated loss-of-function variants were compared with loss-of-function LZTR1 variants reported in gnomAD data. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Fanxuan Deng
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D Gareth Evans
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Miriam J Smith
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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2
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Radtke HB, Bergner AL, Goetsch AL, McGowan C, Panzer K, Cannon A. Genetic Counseling for Neurofibromatosis 1, Neurofibromatosis 2, and Schwannomatosis—Practice Resource of the National Society of Genetic Counselors. J Genet Couns 2020; 29:692-714. [DOI: 10.1002/jgc4.1303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Heather B. Radtke
- Department of Pediatrics Medical College of Wisconsin Milwaukee Wisconsin USA
- Children’s Tumor Foundation New York New York USA
| | - Amanda L. Bergner
- Department of Genetics and Development Columbia University New York New York USA
| | - Allison L. Goetsch
- Division of Genetics Birth Defects and Metabolism, Ann and Robert H. Lurie Children’s Hospital of Chicago Chicago Illinois USA
- Department of Pediatrics Northwestern University Chicago Illinois USA
| | - Caroline McGowan
- Division of Genetics and Genomics Boston Children’s Hospital Boston Massachusetts USA
| | - Karin Panzer
- Department of Pediatrics University of Iowa Hospitals and Clinics Iowa City Iowa USA
| | - Ashley Cannon
- Department of Genetics University of Alabama at Birmingham Birmingham Alabama USA
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3
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Kersigo J, Gu L, Xu L, Pan N, Vijayakuma S, Jones T, Shibata SB, Fritzsch B, Hansen MR. Effects of Neurod1 Expression on Mouse and Human Schwannoma Cells. Laryngoscope 2020; 131:E259-E270. [PMID: 32438526 DOI: 10.1002/lary.28671] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The objective was to explore the effect of the proneuronal transcription factor neurogenic differentiation 1 (Neurod1, ND1) on Schwann cells (SC) and schwannoma cell proliferation. METHODS Using a variety of transgenic mouse lines, we investigated how expression of Neurod1 effects medulloblastoma (MB) growth, schwannoma tumor progression, vestibular function, and SC cell proliferation. Primary human vestibular schwannoma (VS) cell cultures were transduced with adenoviral vectors expressing Neurod1. Cell proliferation was assessed by 5-ethynyl-2'-deoxyuridine (EdU) uptake. STUDY DESIGN Basic science investigation. RESULTS Expression of Neurod1 reduced the growth of slow-growing but not fast-growing MB models. Gene transfer of Neurod1 in human schwannoma cultures significantly reduced cell proliferation in dose-dependent way. Deletion of the neurofibromatosis type 2 (Nf2) tumor-suppressor gene via Cre expression in SCs led to increased intraganglionic SC proliferation and mildly reduced vestibular sensory-evoked potentials (VsEP) responses compared to age-matched wild-type littermates. The effect of Neurod1-induced expression on intraganglionic SC proliferation in animals lacking Nf2 was mild and highly variable. Sciatic nerve axotomy significantly increased SC proliferation in wild-type and Nf2-null animals, and expression of Neurod1 reduced the proliferative capacity of both wild-type and Nf2-null SCs following nerve injury. CONCLUSION Expression of Neurod1 reduces slow-growing MB progression and reduces human SC proliferation in primary VS cultures. In a genetic mouse model of schwannomas, we find some effects of Neurod1 expression; however, the high variability indicates that more tightly regulated Neurod1 expression levels that mimic our in vitro data are needed to fully validate Neurod1 effects on schwannoma progression. LEVEL OF EVIDENCE NA Laryngoscope, 131:E259-E270, 2021.
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Affiliation(s)
- Jennifer Kersigo
- Department of Biology, University of Lowa, Lowa City, Lowa, U.S.A
| | - Lintao Gu
- Department of Otolaryngology, University of Lowa, Lowa City, Lowa, U.S.A.,Decibel Pharmaceutical, Boston, Massachusetts, U.S.A
| | - Linjing Xu
- Department of Otolaryngology, University of Lowa, Lowa City, Lowa, U.S.A
| | - Ning Pan
- Department of Biology, University of Lowa, Lowa City, Lowa, U.S.A.,Department of Special Education & Communication Disorders, University of Nebraska, Lincoln, Nebraska, U.S.A
| | - Sarath Vijayakuma
- Department of Otolaryngology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Timothy Jones
- Department of Otolaryngology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Seiji B Shibata
- Department of Otolaryngology, University of Lowa, Lowa City, Lowa, U.S.A
| | - Bernd Fritzsch
- Department of Biology, University of Lowa, Lowa City, Lowa, U.S.A.,Department of Otolaryngology, University of Lowa, Lowa City, Lowa, U.S.A
| | - Marlan R Hansen
- Department of Otolaryngology, University of Lowa, Lowa City, Lowa, U.S.A
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Clinical Management of Children and Adolescents with Neurofibromatosis Type 1 Like Phenotypes and Complex Behavioural Manifestations: A Multidisciplinary and Dimensional Approach. Case Rep Psychiatry 2020; 2019:4764031. [PMID: 32089936 PMCID: PMC7011498 DOI: 10.1155/2019/4764031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction. Cognitive and behavioural problems associated with Neurofibromatosis type 1 (NF1) are common sources of distress and the reasons behind seeking help. Here we describe patients with NF1 or NF1-like phenotypes referred to a Tier 3 Child and Adolescent Psychiatry Department and highlight the benefits of a multidisciplinary assessment.
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Chignon-Sicard B, Hofman V, Chevallier D, Cucchi JM, Ilié M, Dadone-Montaudié B, Paul F, Carpentier X, Quintens H, Bence-Gauchiez C, Caselles D, Rossant J, Durand M, Bertolotti R. Age-related schwannomatosis with potential exosome-mediated contribution to prostate hyperplasia: a case report and mini-review. Ther Adv Urol 2019; 11:1756287219875578. [PMID: 31632463 PMCID: PMC6767708 DOI: 10.1177/1756287219875578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022] Open
Abstract
A 72-year-old Caucasian man incurring a prostate hypertrophy presented with a
right forearm nodule, the growth of which appeared to parallel the rise in his
blood prostate-specific antigen (PSA) level. Echographic examination was
consistent with a median-nerve schwannoma, and was confirmed upon magnetic
resonance imaging (MRI). Excision of the nodule was readily performed without
significant neural damage, and its schwannoma nature was confirmed upon
immunohistochemistry analysis. Importantly, blood PSA dropped abruptly from ≈13
to ≈5 ng/ml within 2 months postschwannoma resection, a swift drastic reduction
unachievable with oral dutasteride alone. However, 6 weeks later, a new nodule
became apparent on the back of the left knee and was identified as a second
schwannoma, thereby suggesting that its growth could have been stimulated by the
resection of the first schwannoma, as previously described for vestibular
schwannomas. The second schwannoma was in fact two: the bigger one was in the
common fibular nerve and the smaller one in the tibial nerve. Both echography
and MRI results were confirmed upon surgical resection of the bigger knee
schwannoma. Although the third schwannoma has not yet been resected and formally
characterized, we face a schwannomatosis case with an unexpected potential
exosome-mediated stimulating effect on PSA secretion (PSA immunohistochemistry
was negative on both schwannomas). On the other hand, preliminary genomic
analysis showed a deficient balance for chromosome 22, the very chromosome
carrying the three main genes involved in schwannomatosis. This age-related
schwannomatosis case is thus discussed in light of the following: age-related
DNA repair deficiency culminating in loss of chromosome/heterozygosity; CpG
methylation/demethylation-based epigenetic aging; age-related functional decline
of the immune system responsible for inefficient elimination of abnormal cells
and subsequent tumorigenic cell turn-over; exosome-mediated pathologic
intercellular communications; and prostate-invading brain neural progenitors as
pathologic peripheral nervous system (PNS) cells.
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Affiliation(s)
- Bérengère Chignon-Sicard
- Department of Plastic and Reconstructive Surgery, Pasteur 2 University Hospital, Côte d'Azur University, Nice, France
| | - Véronique Hofman
- Laboratory of Clinical and Experimental Pathology, Pasteur 2 University Hospital, Côte d'Azur University, Nice, France
| | - Daniel Chevallier
- Department of Urology and Kidney Transplantation, Pasteur 2 University Hospital, Côte d'Azur University, 06001 Nice Cedex 1, France
| | | | - Marius Ilié
- Laboratory of Clinical and Experimental Pathology, Pasteur 2 University Hospital, Côte d'Azur University, Nice, France
| | | | - Florence Paul
- Private Medical Imaging Center "777", Saint-Laurent du Var, France
| | | | | | | | | | | | - Matthieu Durand
- Department of Urology and Kidney Transplantation, Pasteur 2 University Hospital, Côte d'Azur University, Nice, France
| | - Roger Bertolotti
- Gene Therapy and Regulation, Faculty of Medicine, Côte d'Azur University, Nice, France
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Chick G, Victor J, Hollevoet N. Six cases of sporadic schwannomatosis: Topographic distribution and outcomes of peripheral nerve tumors. HAND SURGERY & REHABILITATION 2017; 36:378-383. [PMID: 28781128 DOI: 10.1016/j.hansur.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
Abstract
The diagnosis of schwannomatosis is often overestimated and is based on the existence of multiple peripheral nerve tumors composed exclusively of schwannomas, in the absence of clinical signs of neurofibromatosis type 2 (NF2). Sporadic forms are much more frequent than familial forms. The objective of this study was to describe the distribution of peripheral nerve tumors and investigate the outcomes of schwannomas in the context of sporadic schwannomatosis. We conducted a retrospective study of patients who fulfilled clinical diagnostic criteria for sporadic schwannomatosis. Six patients were reviewed with a mean follow-up of 38.5months (27-60months). Patients' demographic, clinical, radiographic, and pathologic data were extracted. All patients underwent slit-lamp examination, enhanced brain magnetic resonance imaging (MRI) and a spinal MRI. Enucleation that preserved nerve continuity was performed in symptomatic patients. On average, patients were 36years of age at the time of diagnosis with no sex predominance. The topographic distribution of the peripheral nerve tumors was always unilateral and most frequently targeted the upper limb. In four cases, the tumors involved the same peripheral nerve exclusively. The average number of nerve tumors observed per patient was 4.7 (2-8). The outcome after enucleation was marked by the systematic appearance of new tumors. After enucleation, no recurrence or malignant transformation was observed at the final follow-up. There was no transition to a NF2 configuration. The absence of neurofibroma and NF2 criteria makes schwannomatosis a diagnosis of exclusion. While a good prognosis can be expected following enucleation, two risks related to neurofibromatosis type 3 (NF3) are worth monitoring: the transition to NF2, particularly in young patients, and the appearance of new tumors.
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Affiliation(s)
- G Chick
- Department of Hand Surgery and Peripheral Nerve Surgery, hôpital de la Tour, 1, avenue J.D. Maillard, 1217 Meyrin, Geneva, Switzerland.
| | - J Victor
- Ghent University Hospital, Department of Orthopaedic Surgery and Traumatology, De Pintelaan 185, 9000 Gent, Belgium.
| | - N Hollevoet
- Ghent University Hospital, Department of Orthopaedic Surgery and Traumatology, De Pintelaan 185, 9000 Gent, Belgium.
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Neuropathies in the setting of Neurofibromatosis tumor syndromes: Complexities and opportunities. Exp Neurol 2017; 299:334-344. [PMID: 28587874 DOI: 10.1016/j.expneurol.2017.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/03/2017] [Accepted: 06/02/2017] [Indexed: 12/11/2022]
Abstract
The term 'Neurofibromatosis' (NF) comprises a group of rare diseases with related clinical presentations but distinct genetic conditions. All currently known types - NF1, NF2 and Schwannomatosis - predispose afflicted individuals to the development of glial cell-derived (gliogenic) tumors. Furthermore, the occurrence of neuropathic symptoms, which add to the overall neurologic disability of patients, has been described in all disease entities. We show that neuropathic symptoms are a common and clinically important, yet infrequently studied feature in the NF spectrum. However, the clinical relevance and respective underlying pathogenesis, varies greatly among the different NF types. In this review, we summarize and interpret the latest basic research findings, as well as clinical observations, in respect of Neurofibromatosis-associated neuropathies.
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Abstract
Neurofibromatosis type 2 (NF2) is a rare autosomal dominant disorder (incidence 1:33 000-40 000) characterized by formation of central nervous system tumors, due to mutation in the NF2 gene on chromosome 22q12. Vestibular schwannomas are the hallmark lesion, affecting 95% of individuals and typically occur bilaterally. Schwannomas commonly occur on other nerves intracranially and in the spinal compartment, along with meningiomas, ependymomas, and gliomas. Although histologically benign, tumors are associated with significant morbidity due to multiple problems including hearing and vision loss, gait abnormalities, paralysis, pain, and seizures. Risk of early mortality from brainstem compression and other complications is significant. Severity of disease is higher when NF2 presents during childhood. Children have a more variable presentation, which can be associated with significant delays in recognition of the condition. Careful examination of the skin and eyes can identify important clinical signs of NF2 during childhood, allowing timely initiation of disease-specific surveillance and treatment. Monitoring for complications comprises clinical evaluation, along with functional testing including audiology and serial neuroimaging, which together inform decisions regarding treatment. Evidence for disease-specific medical treatment options is increasing, nevertheless most patients will benefit from multimodal treatment including surgery during their lifetime. Patient enrolment in international natural history and treatment trials offers the best opportunity to accelerate our understanding of the complications and optimal treatment of NF2, with a view to improving outcomes for all affected individuals.
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Affiliation(s)
- Simone Ardern-Holmes
- 1 TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Gemma Fisher
- 2 Sydney Children's Hospital, New South Wales, Australia
| | - Kathryn North
- 3 Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
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9
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Farschtschi S, Gelderblom M, Buschbaum S, Bostock H, Grafe P, Mautner VF. Muscle action potential scans and ultrasound imaging in neurofibromatosis type 2. Muscle Nerve 2016; 55:350-358. [PMID: 27422240 DOI: 10.1002/mus.25256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The neuropathy in patients with neurofibromatosis type 2 (NF2) is difficult to quantify and follow up. In this study we compared 3 methods that may help assess motor axon pathology in NF2 patients. METHODS Nerve conduction studies in median nerves were supplemented by deriving motor unit number estimates (MUNEs) from compound muscle action potential (CMAP) scans and by high-resolution ultrasound (US) peripheral nerve imaging. RESULTS CMAP amplitudes and nerve conduction velocity were normal in the vast majority of affected individuals, but CMAP scan MUNE revealed denervation and reinnervation in many peripheral nerves. In addition, nerve US imaging enabled monitoring of the size and number of schwannoma-like fascicular enlargements in median nerve trunks. CONCLUSION In contrast to conventional nerve conduction studies, CMAP scan MUNE in combination with US nerve imaging can quantify the NF2-associated neuropathy and may help to monitor disease progression and drug treatments. Muscle Nerve 55: 350-358, 2017.
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Affiliation(s)
- Said Farschtschi
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Sabriena Buschbaum
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
| | - Hugh Bostock
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Peter Grafe
- Physiological Genomics, Institute of Physiology, Ludwig-Maximilians University Munich, Pettenkoferstrasse 12, 80336, Munich, Germany
| | - Victor F Mautner
- Department of Neurology, University Medical Centre Hamburg-Eppendorf Hospital, Hamburg, Germany
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Ostrow KL, Bergner AL, Blakeley J, Evans DG, Ferner R, Friedman JM, Harris GJ, Jordan JT, Korf B, Langmead S, Leschziner G, Mautner V, Merker VL, Papi L, Plotkin SR, Slopis JM, Smith MJ, Stemmer-Rachamimov A, Yohay K, Belzberg AJ. Creation of an international registry to support discovery in schwannomatosis. Am J Med Genet A 2016; 173:407-413. [PMID: 27759912 DOI: 10.1002/ajmg.a.38024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022]
Abstract
Schwannomatosis is a tumor suppressor syndrome that causes multiple tumors along peripheral nerves. Formal diagnostic criteria were first published in 2005. Variability in clinical presentation and a relative lack of awareness of the syndrome have contributed to difficulty recognizing affected individuals and accurately describing the natural history of the disorder. Many critical questions such as the mutations underlying schwannomatosis, genotype-phenotype correlations, inheritance patterns, pathologic diagnosis of schwannomatosis-associated schwannomas, tumor burden in schwannomatosis, the incidence of malignancy, and the effectiveness of current, or new treatments remain unanswered. A well-curated registry of schwannomatosis patients is needed to facilitate research in field. An international consortium of clinicians and scientists across multiple disciplines with expertise in schwannomatosis was established and charged with the task of designing and populating a schwannomatosis patient registry. The International Schwannomatosis Registry (ISR) was built around key data points that allow confirmation of the diagnosis and identification of potential research subjects to advance research to further the knowledge base for schwannomatosis. A registry with 389 participants enrolled to date has been established. Twenty-three additional subjects are pending review. A formal process has been established for scientific investigators to propose research projects, identify eligible subjects, and seek collaborators from ISR sites. Research collaborations have been created using the information collected by the registry and are currently being conducted. The ISR is a platform from which multiple research endeavors can be launched, facilitating connections between affected individuals interested in participating in research and researchers actively investigating a variety of aspects of schwannomatosis. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- K L Ostrow
- Johns Hopkins University, Baltimore, Maryland
| | - A L Bergner
- Johns Hopkins University, Baltimore, Maryland
| | - J Blakeley
- Johns Hopkins University, Baltimore, Maryland
| | - D G Evans
- University of Manchester, Manchester, England
| | - R Ferner
- Guy's Hospital in London, London, England
| | - J M Friedman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - G J Harris
- Massachusetts General Hospital, Boston, Massachusetts
| | - J T Jordan
- Massachusetts General Hospital, Boston, Massachusetts
| | - B Korf
- University of Alabama at Birmingham, Birmingham, Alabama
| | - S Langmead
- Johns Hopkins University, Baltimore, Maryland
| | | | - V Mautner
- University of Hamburg, Hamburg, Germany
| | - V L Merker
- Massachusetts General Hospital, Boston, Massachusetts
| | - L Papi
- University of Florence, Florence, Italy
| | - S R Plotkin
- Massachusetts General Hospital, Boston, Massachusetts
| | - J M Slopis
- MD Anderson Cancer Center, Houston, Texas
| | - M J Smith
- University of Manchester, Manchester, England
| | | | - K Yohay
- Weill Cornell Medical College, New York City, New York
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11
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Augenbeteiligung bei Neurofibromatose. Ophthalmologe 2016; 113:443-52. [DOI: 10.1007/s00347-016-0237-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Farschtschi S, Kollmann P, Dalchow C, Stein A, Mautner VF. Reduced dosage of bevacizumab in treatment of vestibular schwannomas in patients with neurofibromatosis type 2. Eur Arch Otorhinolaryngol 2015; 272:3857-60. [PMID: 25794543 DOI: 10.1007/s00405-015-3604-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/09/2015] [Indexed: 12/18/2022]
Abstract
Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome associated with vestibular schwannomas and other benign tumors of the central nervous system. Bevacizumab is used for treatment of progressive vestibular schwannomas, with the intent to reduce tumor size or preserve/improve hearing. Prolonged treatment can cause side effects such as hypertension and proteinuria, which can be cause for discontinuation of therapy. We report on 3 patients who were treated with bevacizumab for 66-76 months, with dose reductions that minimized side effects while sustaining the clinical effect of the antiangiogenic therapy. After dose reduction from 5 mg/kg bi- or tri-weekly to 2.5 mg bi- or tri-weekly, all patients appeared clinically stable and radiographic and audiologic follow-up showed sustained response. In conclusion, in some NF2 patients, dose reduction of bevacizumab seems to be an effective option for managing side effects.
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Affiliation(s)
- Said Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Philipp Kollmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Dalchow
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alexander Stein
- Department of Internal Medicine II and Clinic (Oncology Center), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Toelle SP, Poretti A, Weber P, Seute T, Bromberg JEC, Scheer I, Boltshauser E. Cerebellar Hypoplasia and Dysmorphia in Neurofibromatosis Type 1. THE CEREBELLUM 2015; 14:642-9. [DOI: 10.1007/s12311-015-0658-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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