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Giraud JS, Bièche I, Pasmant É, Tlemsani C. NF1 alterations in cancers: therapeutic implications in precision medicine. Expert Opin Investig Drugs 2023; 32:941-957. [PMID: 37747491 DOI: 10.1080/13543784.2023.2263836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/24/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION NF1 is a tumor suppressor gene encoding neurofibromin, an inhibitor of the RAS/MAPK and PI3K-AKT-mTOR signaling pathways. NF1 germline pathogenic variants cause the tumor predisposition syndrome neurofibromatosis type 1. Targeted therapies (MEK inhibitors) have been approved for benign nerve sheath tumors in neurofibromatosis type 1 patients. NF1 somatic alterations are present in ~5% of all human sporadic cancers. In melanomas, acute myeloid leukemias and lung adenocarcinomas, the NF1 somatic alteration frequency is higher (~15%). However, to date, the therapeutic impact of NF1 somatic alterations is poorly investigated. AREAS COVERED This review presents a comprehensive overview of targeted therapies and immunotherapies currently developed and evaluated in vitro and in vivo for NF1-altered cancer treatment. A PubMed database literature review was performed to select relevant original articles. Active clinical trials were researched in ClinicalTrials.gov database in August 2022. TCGA and HGMD® databases were consulted. EXPERT OPINION This review highlights the need to better understand the molecular mechanisms of NF1-altered tumors and the development of innovative strategies to effectively target NF1-loss in human cancers. One of the current major challenges in cancer management is the targeting of tumor suppressor genes such as NF1 gene. Currently, most studies are focusing on inhibitors of the RAS/MAPK and PI3K-AKT-mTOR pathways and immunotherapies.
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Affiliation(s)
- Jean-Stéphane Giraud
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
| | - Ivan Bièche
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Genetic Department, Curie Institute, Paris, France
| | - Éric Pasmant
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Genetic Department, Hôpital Cochin, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Camille Tlemsani
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Oncology Department, Hôpital Cochin, AP-HP.Centre-Université Paris Cité, Paris, France
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Li Y, Blakeley J, Ly I, Berman Y, Lau J, Wolkenstein P, Bergqvist C, Jia W, Milner TE, Katta N, Durkin AJ, Kennedy GT, Rowland R, Romo CG, Fleming J, Kelly KM. Current and Emerging Imaging Techniques for Neurofibromatosis Type 1-Associated Cutaneous Neurofibromas. J Invest Dermatol 2023:S0022-202X(23)01988-7. [PMID: 37330718 DOI: 10.1016/j.jid.2023.03.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
A consistent set of measurement techniques must be applied to reliably and reproducibly evaluate the efficacy of treatments for cutaneous neurofibromas (cNFs) in people with neurofibromatosis type 1 (NF1). cNFs are neurocutaneous tumors that are the most common tumor in people with NF1 and represent an area of unmet clinical need. This review presents the available data regarding approaches in use or development to identify, measure, and track cNFs, including calipers, digital imaging, and high-frequency ultrasound sonography. We also describe emerging technologies such as spatial frequency domain imaging and the application of imaging modalities such as optical coherence tomography that may enable the detection of early cNFs and prevention of tumor-associated morbidity.
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Affiliation(s)
- Yingjoy Li
- Department of Dermatology, School of Medicine, University of California, Irvine, California, USA
| | - Jaishri Blakeley
- Comprehensive Neurofibromatosis Center, Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ina Ly
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yemima Berman
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, Australia
| | - Jonathan Lau
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, Australia; Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Pierre Wolkenstein
- Faculty of Medicine and Health, Université Paris-Est Créteil Val de Marne, Créteil, France; Department of Dermatology, National Referral Center for Neurofibromatoses, Henri-Mondor Hospital, Assistance Publique-Hôpital Paris (AP-HP), Créteil, France
| | - Christina Bergqvist
- Department of Dermatology, National Referral Center for Neurofibromatoses, Henri-Mondor Hospital, Assistance Publique-Hôpital Paris (AP-HP), Créteil, France
| | - Wangcun Jia
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, USA
| | - Thomas E Milner
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, USA; Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Nitesh Katta
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, USA
| | - Anthony J Durkin
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, USA; Department of Biomedical Engineering, University of California, Irvine, California, USA
| | - Gordon T Kennedy
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, USA
| | - Rebecca Rowland
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, USA
| | - Carlos G Romo
- Comprehensive Neurofibromatosis Center, Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jane Fleming
- Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, Australia
| | - Kristen M Kelly
- Department of Dermatology, School of Medicine, University of California, Irvine, California, USA; Beckman Laser Institute & Medical Clinic, University of California, Irvine, California, USA.
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Ly I, Romo C, Gottesman S, Kelly KM, Kornacki D, York Z, Lee SY, Rhodes SD, Staedtke V, Steensma MR, Blakeley JO, Wolkenstein P. Target Product Profile for Cutaneous Neurofibromas: Clinical Trials to Prevent, Arrest, or Regress Cutaneous Neurofibromas. J Invest Dermatol 2023:S0022-202X(23)01961-9. [PMID: 37294242 DOI: 10.1016/j.jid.2023.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 06/10/2023]
Abstract
Cutaneous neurofibromas (cNFs) are benign tumors of the skin that affect >95% of adults with neurofibromatosis type 1. Despite their benign histology, cNFs can significantly impact QOL due to disfigurement, pain, and pruritus. There are no approved therapies for cNFs. Existing treatments are limited to surgery or laser-based treatments that have had mixed success and cannot be readily applied to a large number of tumors. We review cNF treatment options that are currently available and under investigation, discuss the regulatory considerations specific to cNFs, and propose strategies to improve cNF clinical trial design and standardize clinical trial endpoints.
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Affiliation(s)
- Ina Ly
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Carlos Romo
- Neurofibromatosis Therapeutic Acceleration Program (NTAP), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sally Gottesman
- Neurofibromatosis Therapeutic Acceleration Program (NTAP), Baltimore, Maryland, USA; Children's Tumor Foundation, New York, New York, USA
| | - Kristen M Kelly
- Department of Dermatology, School of Medicine, University of California, Irvine, Irvine, California, USA
| | | | | | - Sang Y Lee
- Neurofibromatosis Therapeutic Acceleration Program (NTAP), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Steven D Rhodes
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Verena Staedtke
- Neurofibromatosis Therapeutic Acceleration Program (NTAP), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew R Steensma
- Helen Devos Children's Hospital, Spectrum Health System, Grand Rapids, Michigan, USA
| | - Jaishri O Blakeley
- Neurofibromatosis Therapeutic Acceleration Program (NTAP), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pierre Wolkenstein
- Department of Dermatology, Henri Mondor Hospital, University Paris East Créteil, Créteil, France
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Poplausky D, Young JN, Tai H, Rivera-Oyola R, Gulati N, Brown RM. Dermatologic Manifestations of Neurofibromatosis Type 1 and Emerging Treatments. Cancers (Basel) 2023; 15:2770. [PMID: 37345107 DOI: 10.3390/cancers15102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/23/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant tumor predisposition syndrome that increases one's risk for both benign and malignant tumors. NF1 affects every organ in the body, but the most distinctive symptoms that are often the most bothersome to patients are the cutaneous manifestations, which can be unsightly, cause pain or pruritus, and have limited therapeutic options. In an effort to increase awareness of lesser-known dermatologic associations and to promote multidisciplinary care, we conducted a narrative review to shed light on dermatologic associations of NF1 as well as emerging treatment options. Topics covered include cutaneous neurofibromas, plexiform neurofibromas, diffuse neurofibromas, distinct nodular lesions, malignant peripheral nerve sheath tumors, glomus tumors, juvenile xanthogranulomas, skin cancer, and cutaneous T-cell lymphoma.
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Affiliation(s)
- Dina Poplausky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jade N Young
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hansen Tai
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ryan Rivera-Oyola
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca M Brown
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Saleh M, Dib A, Beaini S, Saad C, Faraj S, El Joueid Y, Kotob Y, Saoudi L, Emmanuel N. Neurofibromatosis type 1 system-based manifestations and treatments: a review. Neurol Sci 2023; 44:1931-1947. [PMID: 36826455 DOI: 10.1007/s10072-023-06680-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) is a genetic disorder caused by a mutation in the NF1 gene. This disease presents with various system-based manifestations, including cardiac, musculoskeletal, and neuronal issues, which have been well-studied in previous research and have prompted the development of current and emerging treatments. These treatments, mainly medications targeting specific manifestations of NF1, aim to mitigate the negative impacts of the disease on patients' lives. NF1 is associated with an increased risk of malignancy and a significant decrease in life expectancy. In this paper, we review the current and emerging treatments for NF1 in relation to its system-based manifestations. METHODS We conducted an extensive literature search using specific keywords through databases such as PubMed, Scopus, and Cochrane. The articles we found were compiled and subjected to strict inclusion and exclusion criteria. RESULTS Pharmacological advances have led to the development of products that hold promise as future treatments for NF1. Given the diverse manifestations that can affect multiple organ systems in patients with NF1, it is important to consider a variety of treatment options to achieve optimal results. However, one of the major challenges in diagnosing and treating NF1 is that patients present asymptomatically, making it necessary to rely on clinical features for diagnosis. CONCLUSION In conclusion, NF1 is a complex disease with varying manifestations and a growing field of pharmacologic treatments. The information presented in this article synthesizes current knowledge and available therapies for NF1.
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Affiliation(s)
- Mustafa Saleh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - AlFadel Dib
- Faculty of Medicine & Medical Sciences, University of Balamand, Koura, Lebanon
| | - Sarah Beaini
- Faculty of Medicine, Université Saint Joseph de Beirut, Damascus Street, Lebanon
| | - Charbel Saad
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Sary Faraj
- Department of Anatomy, Cell Biology, and Physiological Cell Sciences, AUB- FM and MC, Beirut, Lebanon
| | - Youssef El Joueid
- Department of Medicine, School of Health Sciences, University of Georgia, Tbilisi, Georgia
| | - Yasmine Kotob
- Faculty of Medicine, Université Saint Joseph de Beirut, Damascus Street, Lebanon
| | - Lara Saoudi
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Nancy Emmanuel
- Department of Dermatology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil.
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[Treatment and progress of cutaneous neurofibroma]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1064-1071. [PMID: 36111466 PMCID: PMC9626300 DOI: 10.7507/1002-1892.202205072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To summarize current widely-used therapies for cutaneous neurofibroma (cNF) and related research progress. METHODS Based on extensive investigation of domestic and foreign research, the existing treatment of cNF, including the indications, effectiveness and trials of targeted drugs were reviewed. RESULTS cNF is a hallmark feature of neurofibromatosis type 1 and has a dramatic negative impact on patient appearance and quality of life. At present, there is no standard management of cNF. Invasive treatment is a commonly-used treatment. Surgical removal gives excellent cosmetic results, but it is difficult for multiple tumors; CO2 laser ablation, laser photocoagulation, electro-drying, and radiofrequency ablation are effective in treating lots of cNF at one time. Although fast and effective, these therapies can lead to depigmentation, hyperpigmentation, or extensive scarring. There is no targeted drug approval for cNF, and a series of studies have been carried out on the Ras-MEK pathway, Ras-mTOR pathway, receptor tyrosine kinase, et al. CONCLUSION The treatment of cNF has developed rapidly in recent years and has broad prospects, but the individualization and precision of the treatment still needs further clinical research.
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7
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Roman Souza G, Abdalla A, Mahadevan D. Clinical Trials Targeting Neurofibromatoses-associated Tumors: A Systematic Review. Neurooncol Adv 2022; 4:vdac005. [PMID: 35291225 PMCID: PMC8919406 DOI: 10.1093/noajnl/vdac005] [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] [Indexed: 11/13/2022] Open
Abstract
Background There is a paucity of literature that comprehensively analyzes previous and current clinical trials targeting neurofibromatoses-related tumors. This article aims to provide readers with drug development efforts targeting these tumors by analyzing translational and clinical findings. Methods This systematic review was written according to the PRISMA guidelines. Inclusion criteria were clinical trials involving patients with neurofibromatosis type 1, type 2, or schwannomatosis that were treated with therapies targeting neurofibromatoses-associated tumors and that were registered on clinicaltrials.gov. In addition, a search was performed in PubMed, Web of Science, Google Scholar, and Embase European for articles fully describing these clinical trials. Results A total of 265 clinical trials were registered and screened for eligibility. Ninety-two were included in this systematic review involving approximately 4636 participants. The number of therapies analyzed was more than 50. Drugs under investigation mainly act on the MAPK/ERK and PI3K/AKT/mTOR pathways, tumor microenvironment, or aberrantly over-expressed cell surface receptors. Selumetinib was the most effective medication for treating a neurofibromatosis type 1-associated tumor with approximately 68%–71% partial response for inoperable or progressive plexiform neurofibromas in children 2 years of age and older and bevacizumab for a neurofibromatosis type 2-related tumor with approximately 36%–41% partial response for vestibular schwannomas in patients 12 years of age and older. Conclusions This systematic review presents the results of previous clinical investigations and those under development for neurofibromatoses-associated tumors. Clinicians may use this information to strategize patients to appropriate clinical trials.
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Affiliation(s)
- Gabriel Roman Souza
- Institute for Drug Development, Division of Hematology and Medical Oncology, Mays Cancer Center, University of Texas Health San Antonio MD Anderson Cancer Center, Texas, United States of America
| | - Ahmed Abdalla
- Institute for Drug Development, Division of Hematology and Medical Oncology, Mays Cancer Center, University of Texas Health San Antonio MD Anderson Cancer Center, Texas, United States of America
| | - Daruka Mahadevan
- Institute for Drug Development, Division of Hematology and Medical Oncology, Mays Cancer Center, University of Texas Health San Antonio MD Anderson Cancer Center, Texas, United States of America
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8
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Abstract
Neurofibromatosis type 1 (NF1) is one of the most common neurocutaneous genetic disorders, presenting with different cutaneous features such as café-au-lait macules, intertriginous skin freckling, and neurofibromas. Although most of the disease manifestations are benign, patients are at risk for a variety of malignancies, including malignant transformation of plexiform neurofibromas. Numerous studies have investigated the mechanisms by which these characteristic neurofibromas develop, with progress made toward unraveling the various players involved in their complex pathogenesis. In this review, we summarize the current understanding of the cells that give rise to NF1 neoplasms as well as the molecular mechanisms and cellular changes that confer tumorigenic potential. We also discuss the role of the tumor microenvironment and the key aspects of its various cell types that contribute to NF1-associated tumorigenesis. An increased understanding of these intrinsic and extrinsic components is critical for developing novel therapeutic approaches for affected patients.
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Affiliation(s)
- Ashley Bui
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chunhui Jiang
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Renee M McKay
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Laura J Klesse
- Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Comprehensive Neurofibromatosis Clinic, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lu Q Le
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Comprehensive Neurofibromatosis Clinic, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Hamon Center for Regenerative Science and Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Rabab’h O, Gharaibeh A, Al-Ramadan A, Ismail M, Shah J. Pharmacological Approaches in Neurofibromatosis Type 1-Associated Nervous System Tumors. Cancers (Basel) 2021; 13:cancers13153880. [PMID: 34359780 PMCID: PMC8345673 DOI: 10.3390/cancers13153880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Neurofibromatosis type 1 (NF1) is a common cancer predisposition genetic disease that is associated with significant morbidity and mortality. In this literature review, we discuss the major pathways in the nervous system that are affected by NF1, tumors that are associated with NF1, drugs that target these pathways, and genetic models of NF1. We also summarize the latest updates from clinical trials that are evaluating pharmacological agents to treat these tumors and discuss the efforts that are being made to cure the disease in the future Abstract Neurofibromatosis type 1 is an autosomal dominant genetic disease and a common tumor predisposition syndrome that affects 1 in 3000 to 4000 patients in the USA. Although studies have been conducted to better understand and manage this disease, the underlying pathogenesis of neurofibromatosis type 1 has not been completely elucidated, and this disease is still associated with significant morbidity and mortality. Treatment options are limited to surgery with chemotherapy for tumors in cases of malignant transformation. In this review, we summarize the advances in the development of targeted pharmacological interventions for neurofibromatosis type 1 and related conditions.
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Affiliation(s)
- Omar Rabab’h
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
| | - Abeer Gharaibeh
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
- Insight Institute of Neurosurgery & Neuroscience, Flint, MI 48507, USA
- Insight Surgical Hospital, Warren, MI 48091, USA
| | - Ali Al-Ramadan
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
| | - Manar Ismail
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
| | - Jawad Shah
- Insight Research Institute, Flint, MI 48507, USA; (O.R.); (A.G.); (A.A.-R.); (M.I.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
- Insight Institute of Neurosurgery & Neuroscience, Flint, MI 48507, USA
- Insight Surgical Hospital, Warren, MI 48091, USA
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI 48824, USA
- Correspondence:
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Thalheimer RD, Merker VL, Ly KI, Champlain A, Sawaya J, Askenazi NL, Herr HP, Da JLW, Jordan JT, Muzikansky A, Pearce EM, Sakamoto FH, Blakeley JO, Anderson RR, Plotkin SR. Validating Techniques for Measurement of Cutaneous Neurofibromas: Recommendations for Clinical Trials. Neurology 2021; 97:S32-S41. [PMID: 34230197 DOI: 10.1212/wnl.0000000000012428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the reliability and variability of digital calipers, 3D photography, and high-frequency ultrasound (HFUS) for measurement of cutaneous neurofibromas (cNF) in patients with neurofibromatosis type 1 (NF1). BACKGROUND cNF affect virtually all patients with NF1 and are a major source of morbidity. Reliable techniques for measuring cNF are needed to develop therapies for these tumors. METHODS Adults with NF1 were recruited. For each participant, 6 cNF were assessed independently by 3 different examiners at 5 different time points using digital calipers, 3D photography, and HFUS. The intraclass correlation coefficient (ICC) was used to assess intrarater and interrater reliability of linear and volumetric measurements for each technique, with ICC values >0.90 defined as excellent reliability. The coefficient of variation (CV) was used to estimate the minimal detectable difference (MDD) for each technique. RESULTS Fifty-seven cNF across 10 participants were evaluated. The ICC for image acquisition and measurement was >0.97 within and across examiners for HFUS and 3D photography. ICC for digital calipers was 0.62-0.88. CV varied by measurement tool, linear vs volumetric measurement, and tumor size. CONCLUSIONS HFUS and 3D photography demonstrate excellent reliability whereas digital calipers have good to excellent reliability in measuring cNF. The MDD for each technique was used to create tables of proposed thresholds for investigators to use as guides for clinical trials focused on cNF size. These criteria should be updated as the performance of these end points is evaluated.
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Affiliation(s)
- Raquel D Thalheimer
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vanessa L Merker
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - K Ina Ly
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Champlain
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Sawaya
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Naomi L Askenazi
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hamilton P Herr
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer L W Da
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin T Jordan
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alona Muzikansky
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth Morehouse Pearce
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fernanda H Sakamoto
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jaishri O Blakeley
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - R Rox Anderson
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Scott R Plotkin
- From the Department of Neurology and Cancer Center (R.T., V.L.M., I.L., N.L.A., H.P.H., J.L.W.D., J.T.J., S.R.P.), Wellman Center for Photomedicine (A.C., J.S., E.M.P., F.H.S., R.R.A.), and Biostatistics Center (A.M.), Massachusetts General Hospital, and Department of Dermatology (A.C., J.S., E.M.P., F.H.S., R.R.A.), Harvard Medical School, Boston; and Department of Neurology, Neurosurgery, and Oncology (J.B.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Dhaenens BAE, Ferner RE, Evans DG, Heimann G, Potratz C, van de Ketterij E, Kaindl AM, Hissink G, Carton C, Bakker A, Nievo M, Legius E, Oostenbrink R. Lessons learned from drug trials in neurofibromatosis: A systematic review. Eur J Med Genet 2021; 64:104281. [PMID: 34237445 DOI: 10.1016/j.ejmg.2021.104281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/24/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Abstract
Neurofibromatosis (NF) is the umbrella term for neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SWN). EU-PEARL aims to create a framework for platform trials in NF. The aim of this systematic review is to create an overview of recent clinical drug trials in NF, to identify learning points to guide development of the framework. We searched Embase, Medline and Cochrane register of trials on October 1, 2020 for publications of clinical drug trials in NF patients. We excluded publications published before 2010, systematic reviews, secondary analyses and studies with <10 patients. Data was extracted on manifestations studied, study design, phase, number of participating centres and population size. Full-text review resulted in 42 articles: 31 for NF1, 11 for NF2, none for SWN. Most NF1 trials focused on plexiform neurofibromas (32%). Trials in NF2 solely studied vestibular schwannomas. In NF1, single-arm trials (58%) were most common, and the majority was phase II (74%). For NF2 most trials were single-arm (55%) and exclusively phase II. For both diseases, trials were predominantly single-country and included five centres or less. Study population sizes were small, with the majority including ≤50 patients (74%). In conclusion, NF research is dominated by studies on a limited number out of the wide range of manifestations. We need more trials for cutaneous manifestations and high-grade gliomas in NF1, manifestations other than vestibular schwannoma in NF2 and trials for SWN. Drug development in NF may profit from innovative trials on multiple interventions and increased international collaboration.
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Affiliation(s)
- Britt A E Dhaenens
- Department of General Paediatrics, Sophia's Children's Hospital, Rotterdam, the Netherlands; ENCORE, Erasmus MC Rotterdam, the Netherlands
| | - Rosalie E Ferner
- Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust London, UK
| | - D Gareth Evans
- Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Guenter Heimann
- Biostatistics & Pharmacometrics, Novartis Pharma AG, Basel, Switzerland
| | - Cornelia Potratz
- Department of Paediatric Neurology, Charité Universitätsmedizin Berlin, Germany
| | | | - Angela M Kaindl
- Department of Paediatric Neurology, Charité Universitätsmedizin Berlin, Germany; Institute of Cell- and Neurobiology, Charité Universitätsmedizin Berlin, Germany; Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Charité Universitätsmedizin Berlin, Germany
| | - Geesje Hissink
- Department of General Paediatrics, Sophia's Children's Hospital, Rotterdam, the Netherlands
| | | | | | | | - Eric Legius
- Department of Clinical Genetics, UZ Leuven, Belgium; Full Member of the European Reference Network on Genetic Tumour Risk Syndromes, (ERN GENTURIS)-Project ID No 739547, UK
| | - Rianne Oostenbrink
- Department of General Paediatrics, Sophia's Children's Hospital, Rotterdam, the Netherlands; ENCORE, Erasmus MC Rotterdam, the Netherlands; Full Member of the European Reference Network on Genetic Tumour Risk Syndromes, (ERN GENTURIS)-Project ID No 739547, UK.
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12
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Strowd RE. Available Therapies for Patients with Neurofibromatosis-Related Nervous System Tumors. Curr Treat Options Oncol 2020; 21:81. [DOI: 10.1007/s11864-020-00779-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Mateos ME, López-Laso E, Vicente J, Ortega R, Vázquez F, Pérez-Navero JL. Response to everolimus of a progressive plexiform neurofibroma in Neurofibromatosis type 1. Pediatr Int 2020; 62:857-859. [PMID: 32027426 DOI: 10.1111/ped.14183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/18/2019] [Accepted: 02/03/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Maria Elena Mateos
- Pediatric Oncology Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Reina Sofia University Hospital, Córdoba, Spain
| | - Eduardo López-Laso
- Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Reina Sofia University Hospital, Córdoba, Spain.,Neuropediatric Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain
| | - Josefina Vicente
- Pediatric Radiology Unit, Department of Radiology, Reina Sofia University Hospital, Córdoba, Spain
| | - Rosa Ortega
- Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Reina Sofia University Hospital, Córdoba, Spain.,Department of Pathology, Reina Sofia University Hospital, Córdoba, Spain
| | - Fernando Vázquez
- Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Reina Sofia University Hospital, Córdoba, Spain.,Department of Pediatric Surgery, Reina Sofia University Hospital, Córdoba, Spain
| | - Juan Luis Pérez-Navero
- Pediatric Oncology Unit, Department of Pediatrics, Reina Sofia University Hospital, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Reina Sofia University Hospital, Córdoba, Spain
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14
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Brosseau JP, Liao CP, Le LQ. Translating current basic research into future therapies for neurofibromatosis type 1. Br J Cancer 2020; 123:178-186. [PMID: 32439933 PMCID: PMC7374719 DOI: 10.1038/s41416-020-0903-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/25/2020] [Accepted: 05/01/2020] [Indexed: 12/12/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a hereditary tumour syndrome that predisposes to benign and malignant tumours originating from neural crest cells. Biallelic inactivation of the tumour-suppressor gene NF1 in glial cells in the skin, along a nerve plexus or in the brain results in the development of benign tumours: cutaneous neurofibroma, plexiform neurofibroma and glioma, respectively. Despite more than 40 years of research, only one medication was recently approved for treatment of plexiform neurofibroma and no drugs have been specifically approved for the management of other tumours. Work carried out over the past several years indicates that inhibiting different cellular signalling pathways (such as Hippo, Janus kinase/signal transducer and activator of transcription, mitogen-activated protein kinase and those mediated by sex hormones) in tumour cells or targeting cells in the microenvironment (nerve cells, macrophages, mast cells and T cells) might benefit NF1 patients. In this review, we outline previous strategies aimed at targeting these signalling pathways or cells in the microenvironment, agents that are currently in clinical trials, and the latest advances in basic research that could culminate in the development of novel therapeutics for patients with NF1.
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Affiliation(s)
- Jean-Philippe Brosseau
- Department of Dermatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-9069, USA.
- Department of Biochemistry and Functional Genomics, University of Sherbrooke, Sherbrooke, QC, J1E 4K8, Canada.
| | - Chung-Ping Liao
- Department of Dermatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-9069, USA
| | - Lu Q Le
- Department of Dermatology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-9069, USA.
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-9069, USA.
- UTSW Comprehensive Neurofibromatosis Clinic, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-9069, USA.
- Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390-9069, USA.
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