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Li Y, Liu J, Huang J, Wei C, Ge L, Chung M, Zhu B, Guo Z, Zheng T, Li H, Gu Y, Wang W, Li Q, Wang Z. Reduced PTPRS expression promotes epithelial-mesenchymal transition of Schwann cells in NF1-related plexiform neurofibromas. Cancer Lett 2024; 599:217151. [PMID: 39094827 DOI: 10.1016/j.canlet.2024.217151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024]
Abstract
Plexiform neurofibromas (PNFs) are a prevalent and severe phenotype associated with NF1, characterized by a high teratogenic rate and potential for malignant transformation. The growth and recurrence of PNFs are attributed to aberrant proliferation and migration of Nf1-deficient Schwann cells. Protein tyrosine phosphatase receptor S (PTPRS) is believed to modulate cell migration and invasion by inhibiting the EMT process in NF1-derived malignant peripheral nerve sheath tumors. Nevertheless, the specific role of PTPRS in NF1-derived PNFs remains to be elucidated. The study utilized the GEO database and tissue microarray to illustrate a decrease in PTPRS expression in PNF tissues, linked to tumor recurrence. Furthermore, the down- and over-expression of PTPRS in Nf1-deficient Schwann cell lines resulted in the changes of cell migration and EMT processes. Additionally, RTK assay and WB showed that PTPRS knockdown can promote EGFR expression and phosphorylation. The restoration of EMT processes disrupted by alterations in PTPRS levels in Schwann cells can be achieved through EGFR knockdown and EGFR inhibitor. Moreover, high EGFR expression has been significantly correlated with poor prognosis. These findings underscore the potential role of PTPRS as a tumor suppressor in the recurrence of PNF via the regulation of EGFR-mediated EMT processes, suggesting potential targets for future clinical interventions.
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Affiliation(s)
- Yuehua Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jun Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jingxuan Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chengjiang Wei
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Lingling Ge
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Manhon Chung
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Beiyao Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Zizhen Guo
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Tingting Zheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Haibo Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yihui Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Wei Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Zhichao Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China; Neurofibromatosis Type 1 Center and Laboratory for Neurofibromatosis Type 1 Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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Viskochil D, Wysocki M, Learoyd M, Sun P, So K, Evans A, Lai F, Hernàndez HS. Effect of food on selumetinib pharmacokinetics and gastrointestinal tolerability in adolescents with neurofibromatosis type 1-related plexiform neurofibromas. Neurooncol Adv 2024; 6:vdae036. [PMID: 38721358 PMCID: PMC11078060 DOI: 10.1093/noajnl/vdae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Background Selumetinib is approved for the treatment of pediatric patients with neurofibromatosis type 1 (NF1) who have symptomatic, inoperable plexiform neurofibromas (PN) in multiple countries, including the USA (≥ 2 years). Until recently, individuals had to take selumetinib twice daily (BID) in a fasted state. This study evaluated the effect of a low-fat meal on selumetinib PK parameters and gastrointestinal (GI) tolerability in adolescent participants with NF1-PN. Methods Eligible participants aged ≥ 12 to < 18 years took 25 mg/m2 selumetinib BID with a low-fat meal (T1) for 28 days, followed by a 7-day washout, and then administration in a fasted state (T2) for another 28 days. Primary objectives were to evaluate the effect of a low-fat meal on AUC0-12,ss and GI tolerability after multiple selumetinib doses in T1 versus T2. Key secondary objectives were additional PK parameters and adverse events (AEs). Results At primary data cut-off, all 24 participants completed T1, and 23 participants completed T2. There were no significant differences in AUC0-12,ss between T1 and T2. In T1 and T2, 29.2% and 33.3% participants, respectively, reported ≥ 1 GI AE. No GI AEs Grade ≥ 3, or serious AEs, or GI AEs resulting in treatment interruptions, discontinuation, or dose reductions were reported in T1 and T2. Conclusions Dosing selumetinib with a low-fat meal had no clinically relevant impact on selumetinib AUC0-12,ss nor GI tolerability in adolescents with NF1-PN. Trial registration ClinicalTrialsgov ID NCT05101148.
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Affiliation(s)
- David Viskochil
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University Torun, Jurasz University Hospital 1, Bydgoszcz, Poland
| | - Maria Learoyd
- Clinical Pharmacology & Safety Sciences, AstraZeneca, Cambridge, UK
| | - Peng Sun
- Alexion, AstraZeneca Rare Disease Clinical Development, NF and Bone Metabolism Therapeutic Area, Cambridge, UK
| | - Karen So
- Alexion, AstraZeneca Rare Disease Clinical Development, NF and Bone Metabolism Therapeutic Area, Cambridge, UK
| | - Azura Evans
- Alexion, AstraZeneca Rare Disease Clinical Development, NF and Bone Metabolism Therapeutic Area, Cambridge, UK
| | - Francis Lai
- Quantitative Sciences, Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | - Héctor Salvador Hernàndez
- Department of Pediatric Oncology and Hematology, Sant Joan de Déu Barcelona Hospital, Barcelona, Spain
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Armstrong AE, Belzberg AJ, Crawford JR, Hirbe AC, Wang ZJ. Treatment decisions and the use of MEK inhibitors for children with neurofibromatosis type 1-related plexiform neurofibromas. BMC Cancer 2023; 23:553. [PMID: 37328781 PMCID: PMC10273716 DOI: 10.1186/s12885-023-10996-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
Neurofibromatosis type 1 (NF1), the most common tumor predisposition syndrome, occurs when NF1 gene variants result in loss of neurofibromin, a negative regulator of RAS activity. Plexiform neurofibromas (PN) are peripheral nerve sheath tumors that develop in patients with NF1 and are associated with substantial morbidity and for which, until recently, the only treatment was surgical resection. However, surgery carries several risks and a proportion of PN are considered inoperable. Understanding the genetic underpinnings of PN led to the investigation of targeted therapies as medical treatment options, and the MEK1/2 inhibitor selumetinib has shown promising efficacy in pediatric patients with NF1 and symptomatic, inoperable PN. In a phase I/II trial, most children (approximately 70%) achieved reduction in tumor volume accompanied by improvements in patient-reported outcomes (decreased tumor-related pain and improvements in quality of life, strength, and range of motion). Selumetinib is currently the only licensed medical therapy indicated for use in pediatric patients with symptomatic, inoperable NF1-PN, with approval based on the results of this pivotal clinical study. Several other MEK inhibitors (binimetinib, mirdametinib, trametinib) and the tyrosine kinase inhibitor cabozantinib are also being investigated as medical therapies for NF1-PN. Careful consideration of multiple aspects of both disease and treatments is vital to reduce morbidity and improve outcomes in patients with this complex and heterogeneous disease, and clinicians should be fully aware of the risks and benefits of available treatments. There is no single treatment pathway for patients with NF1-PN; surgery, watchful waiting, and/or medical treatment are options. Treatment should be individualized based on recommendations from a multidisciplinary team, considering the size and location of PN, effects on adjacent tissues, and patient and family preferences. This review outlines the treatment strategies currently available for patients with NF1-PN and the evidence supporting the use of MEK inhibitors, and discusses key considerations in clinical decision-making.
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Affiliation(s)
- Amy E Armstrong
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John R Crawford
- CHOC Neuroscience Institute, Children's Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, Division of Child Neurology University of California Irvine, Orange, CA, USA
| | - Angela C Hirbe
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Zhihong J Wang
- Division of Hematology and Oncology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA
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Kotch C, Wagner K, Broad JH, Dombi E, Minturn JE, Phillips P, Smith K, Li Y, Jacobs IN, Elden LM, Fisher MJ, Belasco J. Vinblastine/Methotrexate for Debilitating and Progressive Plexiform Neurofibroma in Children and Young Adults with Neurofibromatosis Type 1: A Phase 2 Study. Cancers (Basel) 2023; 15:cancers15092621. [PMID: 37174087 PMCID: PMC10177272 DOI: 10.3390/cancers15092621] [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: 03/22/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Limited therapies exist for neurofibromatosis type 1 (NF1)-associated plexiform neurofibroma (PN). For this reason, the activity of vinblastine (VBL) and methotrexate (MTX) was evaluated in children and young adults with NF1 and PN. Patients ≤ 25 years of age with progressive and/or inoperable NF1-PN received VBL 6 mg/m2 and MTX 30 mg/m2 weekly for 26 weeks, followed by every 2 weeks for 26 weeks. Objective response rate was the primary endpoint. Of 25 participants enrolled, 23 were evaluable. The median age of participants was 6.6 years (range 0.3-20.7). The most frequent toxicities were neutropenia and elevation of transaminases. On two-dimensional (2D) imaging, 20 participants (87%) had stable tumor, with a median time to progression of 41.5 months (95% confidence interval 16.9, 64.9). Two of eight participants (25%) with airway involvement demonstrated functional improvements including decreased positive pressure requirements and apnea-hypopnea index. A post hoc three-dimensional (3D) analysis of PN volumes was completed on 15 participants with amenable imaging; 7 participants (46%) had progressive disease on or by the end of therapy. VBL/MTX was well-tolerated but did not result in objective volumetric response. Furthermore, 3D volumetric analysis highlighted the lack of sensitivity of 2D imaging for PN response evaluation.
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Affiliation(s)
- Chelsea Kotch
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kristina Wagner
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - J Harris Broad
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Anesthesiology, Valley Medical Center, Renton, WA 98055, USA
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Jane E Minturn
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter Phillips
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Katherine Smith
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yimei Li
- Department of Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ian N Jacobs
- Division of Otolaryngology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Lisa M Elden
- Division of Otolaryngology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Michael J Fisher
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jean Belasco
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Wolkenstein P, Chaix Y, Entz Werle N, Amini-Adle M, Barbarot S, Boileau C, Miled A, Rashid T, Aerts I. French cohort of children and adolescents with neurofibromatosis type 1 and symptomatic inoperable plexiform neurofibromas: CASSIOPEA study. Eur J Med Genet 2023; 66:104734. [PMID: 36868501 DOI: 10.1016/j.ejmg.2023.104734] [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: 11/18/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
Surgery is a treatment option for neurofibromatosis type 1 (NF1)-related plexiform neurofibromas (PN), but complete resection is often not feasible. Real-world studies are warranted to understand disease burden, progression, and need for medical treatment in patients with inoperable PN. CASSIOPEA was a retrospective study of French pediatric patients (aged ≥3 to <18 years) presenting at a national multidisciplinary team (MDT) review with NF1 and ≥1 symptomatic, inoperable PN. Medical records were reviewed from the time of MDT review and over a follow-up period of up to 2 years. Primary objectives were to describe patient characteristics and target PN-associated therapy patterns. A secondary objective was evolution of target PN-related morbidities. Patients with prior, ongoing, or MDT recommendation of mitogen-activated protein kinase kinase (MEK) inhibitor treatment were excluded. Overall, 78 target PN were identified in 76 patients. At MDT review, median age was 8.4 years, with approximately 30% of patients aged 3-6 years. Target PN were primarily internal (77.3%), and 43.2% were progressive. Target PN location was evenly distributed. 34 target PN had documented MDT recommendations; of these, a majority (76.5%) were for non-medication management, including surveillance. At least one follow-up visit was recorded for 74 target PN. Despite initially being considered inoperable, 12.3% of patients underwent surgery for target PN. At MDT review, most (98.7%) target PN were associated with ≥1 morbidity, primarily pain (61.5%) and deformity (24.4%); severe morbidities were identified in 10.3%. Of 74 target PN with follow-up data, 89.2% were associated with ≥1 morbidity, primarily pain (60.8%) and deformity (25.7%). Of 45 target PN associated with pain, pain improved in 26.7%, was stable in 44.4%, and deteriorated in 28.9%. Deformity improved in 15.8% and remained stable in 84.2% of 19 target PN associated with deformity. None deteriorated. In this real-world study in France, NF1-PN disease burden was considerable, and a considerable proportion of patients were very young. Most patients received only supportive care without medication for target PN management. Target PN-related morbidities were frequent, heterogeneous, and generally did not improve during follow-up. These data highlight the importance of effective treatments that target PN progression and improve disease burden.
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Affiliation(s)
- Pierre Wolkenstein
- Department of Dermatology, Henri-Mondor Hospital, APHP, UPEC, Créteil, France.
| | - Yves Chaix
- Children's Hospital, Toulouse-Purpan University Hospital, Toulouse, France
| | - Natacha Entz Werle
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | | | | | - Anissa Miled
- Alexion, AstraZeneca Rare Disease, Paris, France
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Carton C, Evans DG, Blanco I, Friedrich RE, Ferner RE, Farschtschi S, Salvador H, Azizi AA, Mautner V, Röhl C, Peltonen S, Stivaros S, Legius E, Oostenbrink R. ERN GENTURIS tumour surveillance guidelines for individuals with neurofibromatosis type 1. EClinicalMedicine 2023; 56:101818. [PMID: 36684394 PMCID: PMC9845795 DOI: 10.1016/j.eclinm.2022.101818] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder, predisposing development of benign and malignant tumours. Given the oncogenic potential, long-term surveillance is important in patients with NF1. Proposals for NF1 care and its specific manifestations have been developed, but lack integration within routine care. This guideline aims to assimilate available information on NF1 associated tumours (based on evidence and/or expert opinion) to assist healthcare professionals in undertaking tumour surveillance of NF1 individuals. METHODS By comprehensive literature review, performed March 18th 2020, guidelines were developed by a NF1 expert group and patient representatives, conversant with clinical care of the wide NF1 disease spectrum. We used a modified Delphi procedure to overcome issues of variability in recommendations for specific (national) health care settings, and to deal with recommendations based on indirect (scarce) evidence. FINDINGS We defined proposals for personalised and targeted tumour management in NF1, ensuring appropriate care for those in need, whilst reducing unnecessary intervention. We also incorporated the tumour-related psychosocial and quality of life impact of NF1. INTERPRETATION The guideline reflects the current care for NF1 in Europe. They are not meant to be prescriptive and may be adjusted to local available resources at the treating centre, both within and outside EU countries. FUNDING This guideline has been supported by the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS). ERN GENTURIS is funded by the European Union. DGE is supported by the Manchester NIHRBiomedical Research Centre (IS-BRC-1215-20007).
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Affiliation(s)
- Charlotte Carton
- Laboratory for Neurofibromatosis Research, Department of Human Genetics, University of Leuven, KU Leuven, Belgium
| | - D. Gareth Evans
- Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, MAHSC, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ignacio Blanco
- Clinical Genetics Department, Hospital Germans Trias I Pujol, Barcelona, Spain
| | | | - Rosalie E. Ferner
- Neurofibromatosis Centre, Department of Neurology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Hector Salvador
- Sant Joan de Déu, Barcelona Children's Hospital, Barcelona, Spain
| | - Amedeo A. Azizi
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
| | - Victor Mautner
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Sirkku Peltonen
- University of Turku and Turku University Hospital, Turku, Finland
- Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Stavros Stivaros
- Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Eric Legius
- University Hospital Leuven, Department of Human Genetics, University of Leuven, KU Leuven, Belgium
| | - Rianne Oostenbrink
- ENCORE-NF1 Expertise Center, ErasmusMC-Sophia, Rotterdam, the Netherlands
- Corresponding author. Department General Pediatrics, ErasmusMC-Sophia, Room Sp 1549, Dr Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
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Surgical Treatment and Complications of Deep-Seated Nodular Plexiform Neurofibromas Associated with Neurofibromatosis Type 1. J Clin Med 2022; 11:jcm11195695. [PMID: 36233563 PMCID: PMC9571780 DOI: 10.3390/jcm11195695] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Nodular plexiform neurofibromas in individuals with neurofibromatosis type 1 often cause significant symptoms and are treated with surgical excision despite the potential risk of complications. This study aimed to clarify the surgical outcomes of deep-seated nodular plexiform neurofibromas and identify the factors associated with postoperative complications. Methods: We retrospectively reviewed patients with neurofibromatosis type 1 who underwent surgical excision for deep-seated nodular plexiform neurofibromas in our hospital from 2015 to 2021. Enucleation while preserving the nerve fascicles was attempted first, and en bloc resection, ligating the nerve origin in cases in which the parent nerve was entrapped by the tumor, making the tumor difficult to dissect, was performed. Results: In 15 patients, 24 nodular plexiform neurofibromas received surgical excision. Sixteen tumors were enucleated, and eight were en bloc resected. The symptoms of all 10 patients with preoperative symptoms resolved after surgery. Four patients developed new neurological deficits immediately after surgery, two of whom had retained neurological symptoms at the last visit, but these symptoms were mild. Conclusions: The present study demonstrates that surgical treatment of nodular plexiform neurofibromas, even deep-seated neurofibromas, is safe with a low risk of severe complications and improvement in preoperative symptoms.
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8
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Natroshvili T, Peperkamp K, Malyar MA, Wijnberg D, Heine EP, Walbeehm ET. Rare Tumors Causing Median Nerve Compression in Adults-A Narrative Review. Arch Plast Surg 2022; 49:656-662. [PMID: 36159378 PMCID: PMC9507571 DOI: 10.1055/s-0042-1756345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/11/2022] [Indexed: 11/01/2022] Open
Abstract
The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment options. The PubMed, Embase, and Web of Science databases were searched for studies describing median nerve compression due to a tumor in adults, published from the year 2000 and written in English. From 94 studies, information of approximately 100 patients have been obtained. Results The rare tumors causing compression were in 32 patients located at the carpal tunnel, in 21 cases in the palm of the hand, and 28 proximal from the carpal tunnel. In the other cases the compression site extended over a longer trajectory. There were 37 different histological types of lesions. Complete resection of the tumor was possible in 58 cases. A total of 8 patients presented for the second time after receiving initial therapy. During follow-up, three cases of recurrence were reported with a mean follow-up period of 11 months. The most common published cause of median nerve compression is the lipofibromatous hamartoma. Besides the typical sensory and motor symptoms of median nerve compression, a thorough physical examination of the complete upper extremity is necessary to find any swelling or triggering that might raise suspicion of the presence of a tumor.
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Affiliation(s)
- Tinatin Natroshvili
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Kirsten Peperkamp
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Masoud A Malyar
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - David Wijnberg
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Erwin P Heine
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Erik T Walbeehm
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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王 生, 李 艳, 张 杰, 倪 鑫. [Progress in diagnosis and treatment of neurofibromatosis in children]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:477-482. [PMID: 35822370 PMCID: PMC10128489 DOI: 10.13201/j.issn.2096-7993.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Indexed: 06/15/2023]
Abstract
Neurofibromatosis type 1(NF1) is an autosomal dominant genetic disease in which a mutation in the NF1 gene on chromosome 17q11.2 results in inactivation or down-regulation of neurofibromin. This results in a series of neurocutaneous lesions characterized by neurofibromatosis. Patients with plexiform neurofibromas(PN), as one of the main manifestations of NF1, often experience pain, dysfunction, skeletal deformities, changes in appearance and other symptoms. In severe cases, compression of the airways and vital organs occurs, and the PN is at risk of malignancy progression. At present, its treatment is still challenging. Surgery is the primary treatment for PN, but complete resection is often difficult. In recent years, chemotherapy for PN has become a hot topic. This article reviews the research progress in the pathogenesis, diagnosis and treatment of PN in recent years.
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Affiliation(s)
- 生才 王
- 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory for Pediatric Disease of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 艳珍 李
- 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory for Pediatric Disease of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 杰 张
- 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory for Pediatric Disease of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
| | - 鑫 倪
- 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科 国家儿童医学中心 儿童耳鼻咽喉头颈外科疾病北京市重点实验室(北京,100045)Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory for Pediatric Disease of Otolaryngology Head and Neck Surgery, Beijing, 100045, China
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10
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Banthia R, Rose JMO. Letter to the Editor. Urology 2022; 165:e46. [PMID: 35339511 DOI: 10.1016/j.urology.2022.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ravi Banthia
- Senior clinical fellow urology, University Hospital Coventry and Warwickshire NHS trust, Coventry, England, United Kingdom.
| | - Joanne Michelle Oida Rose
- Senior clinical fellow urology, University Hospital Coventry and Warwickshire NHS trust, Coventry, England, United Kingdom
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11
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Collins-Sawaragi YC, Ferner R, Vassallo G, De Agrò G, Eccles S, Cadwgan J, Hargrave D, Hupton E, Eelloo J, Lunt L, Tang V, Burkitt Wright E, Lascelles K. Location, symptoms, and management of plexiform neurofibromas in 127 children with neurofibromatosis 1, attending the National Complex Neurofibromatosis 1 service, 2018-2019. Am J Med Genet A 2022; 188:1723-1727. [PMID: 35178860 DOI: 10.1002/ajmg.a.62691] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022]
Abstract
We report on the location, symptoms, and management of plexiform neurofibroma (PN) in children with Neurofibromatosis Type 1 (NF1) attending the 2 National Complex Neurofibromatosis 1 Services at Guy's and St. Thomas' NHS Foundation Trust, London and St Mary's Hospital, Manchester. Retrospective data collection was performed from patient chart reviews from April 2018 to April 2019. There were 127 NF1 patients with PN, age range 0.8-17.0, mean age was 9.9 years (SD ± 4.2 years). The main location of the PN was craniofacial in 35%, and limb in 19%. Disfigurement was present in 57%, pain in 28%, impairment of function in 23%, and threat to function in 9% of children. Fifty-four percent of patients were managed conservatively, 28% surgically, and 19% are either taking or due to start a mitogen-activated protein kinase kinase (MEK) inhibitor (selumetinib or trametinib), either through a clinical trial or compassionate usage scheme. This national study provides a comprehensive overview of the management of children with PN in an era where new therapies (MEK inhibitors) are becoming more widely available. We anticipate that there will be a shift to more patients receiving MEK inhibitor therapy and combination therapy (surgery and MEK inhibitor) in the future.
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Affiliation(s)
- Yoshua Colyn Collins-Sawaragi
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Rosalie Ferner
- National Complex Neurofibromatosis 1 Service, Department of Neurology, National Neurofibromatosis Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grace Vassallo
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Germana De Agrò
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon Eccles
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Jill Cadwgan
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Darren Hargrave
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK.,Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Eileen Hupton
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Judith Eelloo
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lauren Lunt
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vivian Tang
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Burkitt Wright
- National Complex Neurofibromatosis 1 Service, St Mary's Genomic Centre for Medicine, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Karine Lascelles
- National Complex Neurofibromatosis 1 Service, Guy's and St. Thomas' NHS Foundation Trust and Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK.,National Complex Neurofibromatosis 1 Service, Department of Neurology, National Neurofibromatosis Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Alabduljabbar M, Strianese D, Al-Sheikh O, Alkatan HM, Al-Hussain H, Maktabi AMY, Khandekar R, Abedalthagafi M, Edward DP. The clinico-pathologic profile of primary and recurrent orbital/periorbital plexiform neurofibromas (OPPN). PLoS One 2021; 16:e0258802. [PMID: 34673814 PMCID: PMC8530295 DOI: 10.1371/journal.pone.0258802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
To evaluate and compare the clinical and histopathological profile of primary and recurrent orbital-periorbital plexiform neurofibromas (OPPN) in patients with neurofibromatosis type 1. We retrospectively evaluated 43 primary or recurrent neurofibroma (NF) specimens from 26 patients (2002 to 2018) at the King Khaled Eye Specialist Hospital, Saudi Arabia. Demographics, clinical presentation, and surgical intervention data were collected. Histopathological specimens were studied with hematoxylin-eosin, Alcian blue, and immunohistochemical markers; S-100, CD44, CD117, smooth muscle actin (SMA), neurofilament, and Ki-67. Of the 43 NFs specimens, 20 were primary and 23 recurrent tumors. For primary NF, the ratio of plexiform to the diffuse type was 13:7, however in recurrent tumors was 3:8 after the first recurrence, and 1:5 after multiple recurrences. Of the 17 patients with primary tumors that had paired recurrent tumors, 12/17 (70.6%) primary NFs were plexiform and 5/17 (29.4%) were diffuse. However, when tumors recurred, 13/17 tumors (76.5%) were diffuse and only 4/17 tumors (23.5%) had a plexiform pattern. The odds of a tumor having a diffuse pattern in recurrent NF was significantly higher than the plexiform pattern [OR = 7.8 (95% confidence interval 1.69:36.1) P = 0.008]. Primary plexiform NFs underwent an excision at a significantly younger age than the diffuse type. Recurrent NFs had significantly higher CD44, CD117, and neurofilament labeling (P = 0.02, P = 0.01 and P<0.001 respectively) but had significantly decreased Alcian blue, and S-100 labeling (P = 0.03, and P = 0.02 respectively) compared to primary tumors. SMA and Ki-67 proliferation index were not different between primary and recurrent NFs (P = 0.86, and P = 0.3 respectively). There appears to be a high risk for primary plexiform NFs to develop a diffuse histologic pattern when they recur. Immunohistochemical staining suggests a role of mast cells (CD117) and expression of infiltration makers (CD44) in the transformation of plexiform tumors to the diffuse phenotype.
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Affiliation(s)
| | | | | | - Hind M. Alkatan
- King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | | | | | | | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Deepak P. Edward
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology, Visual Sciences and Pathology, University of Illinois, College of Medicine, Chicago, IL, United States of America
- * E-mail:
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13
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Yang X, Desai K, Agrawal N, Mirchandani K, Chatterjee S, Sarpong E, Sen S. Characteristics, treatment patterns, healthcare resource use, and costs among pediatric patients diagnosed with neurofibromatosis type 1 and plexiform neurofibromas: a retrospective database analysis of a medicaid population. Curr Med Res Opin 2021; 37:1555-1561. [PMID: 34218725 DOI: 10.1080/03007995.2021.1940907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objectives of this study were to describe the characteristics and initial treatment patterns, healthcare resource use (HCRU), and costs of patients newly diagnosed with neurofibromatosis type 1 (NF1)-related plexiform neurofibromas (PN). METHODS This was a retrospective study of individuals enrolled in the IBM MarketScan Multi-State Medicaid database from 1 October 2014 to 31 December 2017. Patients aged ≤18 years at the index date (first diagnosis of NF1 or PN, whichever occurred later) with at least 1 ICD-10-CM diagnosis code for both NF1 and PN were included. All-cause HCRU and the associated direct costs during the follow-up period were calculated per patient per year (PPPY) in 2018 USD. RESULTS A total of 383 patients were included with a mean follow-up of 448 days. Most patients were diagnosed by a specialist (63.5%). During the follow-up period, pain medications were used by 58.5% of patients, 25.1% were treated with chemotherapy, 7.1% received surgery for PN, 1.6% received MEK inhibitors, and 0.8% received radiation. Mean PPPY inpatient, outpatient, ER, pharmacy, and other visits were 1.4, 17.3, 1.6, 13.6, and 25.8, respectively. Mean ± SD (median) total PPPY healthcare costs were $17,275 ± $61,903 ($2889), with total medical costs of $14,628 ± $56,203 ($2334) and pharmacy costs of $2646 ± $13,303 ($26). CONCLUSIONS This study showed that many pediatric patients newly diagnosed with NF1 and PN were initially treated with supportive care only, highlighting a substantial unmet medical need. This study also highlights the considerable economic burden among patients with NF1 and PN.
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Affiliation(s)
- Xiaoqin Yang
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Kaushal Desai
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Eric Sarpong
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Shuvayu Sen
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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14
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Misiloi S, Haydock DA, Cranshaw I, Lauti M. Surgical debulking of a large thoracoabdominal plexiform neurofibroma with pericardial resection. ANZ J Surg 2021; 92:283-285. [PMID: 34151490 DOI: 10.1111/ans.17018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/11/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Soane Misiloi
- Greenlane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand.,Department of General Surgery, Counties Manukau Health, Auckland, New Zealand
| | - David A Haydock
- Greenlane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Isaac Cranshaw
- Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Melanie Lauti
- Department of General Surgery, Counties Manukau Health, Auckland, New Zealand
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15
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Friedrich RE, Tuzcu CT. Surgery for Peripheral Nerve Sheath Tumours of the Buttocks, Legs and Feet in 90 Patients With Neurofibromatosis Type 1. In Vivo 2021; 35:889-905. [PMID: 33622881 DOI: 10.21873/invivo.12329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Neurofibromatosis type 1 (NF1) is an autosomal dominant tumour predisposition syndrome that can cause plexiform neurofibromas (PNFs). This study examines the surgical procedures that have been performed on large PNFs of the lower extremities. PATIENTS AND METHODS Surgical procedures on the lower extremity performed on 90 patients with NF1 with PNFs were evaluated. The topography of the tumours was classified according to dermatomes and functional units. RESULTS A total of 243 surgical interventions on the regions of interest were performed. Neurological complications were rarely noted and usually occurred temporarily. There was no preference for dermatomes affected by PNF. The proportion of patients with malignant peripheral nerve sheath tumours (MPNSTs) in this group was 4/90 (4.4%). CONCLUSION PNFs often require repeated local interventions to achieve the treatment goal. Local tumour recurrences are to be expected even after extensive tumour reduction. Rapid tumour growth combined with new pain sensations can be signs of a MPNST.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Caglayan T Tuzcu
- Department of Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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16
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Copley-Merriman C, Yang X, Juniper M, Amin S, Yoo HK, Sen SS. Natural History and Disease Burden of Neurofibromatosis Type 1 with Plexiform Neurofibromas: A Systematic Literature Review. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2021; 12:55-66. [PMID: 34040477 PMCID: PMC8141405 DOI: 10.2147/ahmt.s303456] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022]
Abstract
Neurofibromatosis type 1 (NF1) is an incurable genetic condition that frequently includes the development of plexiform neurofibromas (PNs) in patients. A systematic literature review was conducted to identify data on the natural history, disease burden, and treatment patterns among patients diagnosed with NF1 and PN, as well as to identify evidence gaps in these areas. MEDLINE and MEDLINE In-Process, Embase, and Cochrane Library Searches were searched using predefined terms. Potential references underwent two phases of screening by two independent researchers. A total of 39 references focusing on populations of patients with both NF1 and PN were included in this review. The wide range of PN-related complications creates a substantial quality-of-life (QOL) burden for patients, including pain, social functioning, physical function impact, stigma, and emotional distress. The severe burden of NF1 with PN on the QOL of patients demonstrates the high unmet need for an effective treatment option that can reduce tumor burden and improve QOL. The heterogeneity of measurement tools used to evaluate QOL and the gap in data evaluating the health economic burden of PN should be the focus of future research.
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17
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Jia J, Zhang H, Zhang H, Liu W, Shu M. Infiltrating Macrophages Induced Stem-cell-like Features Through PI3K/AKT/GSK3β Signaling to Promote Neurofibroma Growth. Arch Med Res 2020; 51:124-134. [PMID: 32111496 DOI: 10.1016/j.arcmed.2019.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/12/2019] [Accepted: 12/31/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inflammation plays an important role in promoting neurofibroma progression, and macrophages are key inflammatory cells in neurofibroma. AIM OF THIS STUDY We attempted to clarify the detailed mechanism of infiltrating macrophages promoting neurofibroma progression. METHODS We performed IHC and Western blot assays to detect the expression levels of OCT3/4, Nanog and SOX2 in tissues and cells. A colony/sphere formation assay was used to analyze cell stemness. MTT, colony formation assay and xenograft tumor model were used to detect cell growth. The transwell system was used to examine macrophage infiltration. RESULTS We demonstrated increased macrophage infiltration in neurofibroma tissues accompanied by increased stem cell-like markers. Moreover, Nf1-mutated SW10 cells possessed a stronger capacity to recruit macrophages, which in turn facilitated neurofibroma growth. Mechanistically, the infiltrating macrophages induced neurofibroma cell stem cell transition by modulating PI3K/AKT/GSK3β signaling, which then enhanced neurofibroma cell viability in vivo and in vitro. CONCLUSION Our results revealed a new mechanism of infiltrating macrophages contributing to neurofibroma progression, and targeting this newly identified signaling may help to treat neurofibroma.
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Affiliation(s)
- Jing Jia
- Department of Plastic, Cosmetic and Maxillofacial Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; The school of electronic and information engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haibao Zhang
- Key laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an, Shaanxi, China
| | - Hongke Zhang
- Department of Plastic, Cosmetic and Maxillofacial Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenbo Liu
- Department of Plastic, Cosmetic and Maxillofacial Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Maoguo Shu
- Department of Plastic, Cosmetic and Maxillofacial Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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18
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Liao CP, Booker RC, Brosseau JP, Chen Z, Mo J, Tchegnon E, Wang Y, Clapp DW, Le LQ. Contributions of inflammation and tumor microenvironment to neurofibroma tumorigenesis. J Clin Invest 2018; 128:2848-2861. [PMID: 29596064 DOI: 10.1172/jci99424] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/27/2018] [Indexed: 12/19/2022] Open
Abstract
Neurofibromatosis type 1 associates with multiple neoplasms, and the Schwann cell tumor neurofibroma is the most prevalent. A hallmark feature of neurofibroma is mast cell infiltration, which is recruited by chemoattractant stem cell factor (SCF) and has been suggested to sustain neurofibroma tumorigenesis. In the present study, we use new, genetically engineered Scf mice to decipher the contributions of tumor-derived SCF and mast cells to neurofibroma development. We demonstrate that mast cell infiltration is dependent on SCF from tumor Schwann cells. However, removal of mast cells by depleting the main SCF source only slightly affects neurofibroma progression. Other inflammation signatures show that all neurofibromas are associated with high levels of macrophages regardless of Scf status. These findings suggest an active inflammation in neurofibromas and partly explain why mast cell removal alone is not sufficient to relieve tumor burden in this experimental neurofibroma model. Furthermore, we show that plexiform neurofibromas are highly associated with injury-prone spinal nerves that are close to flexible vertebras. In summary, our study details the role of inflammation in neurofibromagenesis. Our data indicate that prevention of inflammation and possibly also nerve injury at the observed tumor locations are therapeutic approaches for neurofibroma prophylaxis and that such treatment should be explored.
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Affiliation(s)
- Chung-Ping Liao
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Reid C Booker
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jean-Philippe Brosseau
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zhiguo Chen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Juan Mo
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edem Tchegnon
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yong Wang
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - D Wade Clapp
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lu Q Le
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Neurofibromatosis Clinic.,Simmons Comprehensive Cancer Center, and.,Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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19
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Nonoperative Management May Be a Viable Approach to Plexiform Neurofibroma of the Porta Hepatis in Patients with Neurofibromatosis-1. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2018; 2018:7814763. [PMID: 29849532 PMCID: PMC5925028 DOI: 10.1155/2018/7814763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/12/2018] [Indexed: 12/15/2022]
Abstract
Background Plexiform neurofibroma (PNF) in the porta hepatis (PH) is an unusual manifestation of neurofibromatosis-1 (NF-1). Resection is often recommended given the risk of malignant transformation. We encountered a challenging case in clinical practice which prompted us to report our findings and perform a systematic review on the management of these tumors. Methods We reported the case of a 31-year-old woman with NF-1 and PNF of the PH. PRISMA 2009 guidelines were followed for systematic review. Results Our patient was found to have unresectable disease at exploration. After >5 years of follow-up, she continued to have stable disease on imaging. We identified 12 studies/case reports including 10 adult and 6 pediatric patients with PNF of PH. None of the 7 adult patients with NF-1 and PNF of PH underwent a successful tumor resection. All pediatric patients were managed with surveillance alone. All but one pediatric patient had NF-1. None of the reported cases of PNF of PH had malignant transformation. Conclusion Our findings suggest that PNFs of PH in the setting of NF-1 are often unresectable and may have an indolent course. Surveillance alone may be a reasonable option in some patients; however, further studies are needed.
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20
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The pineapple technique for excision of large plexiform neurofibromas. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Hu K, Ma H, Shen Y, Williams Z, Xu W. Plexiform neurofibroma as a cause of carpal tunnel syndrome in a radial deficiency patient. Br J Neurosurg 2017; 33:281-282. [PMID: 28554231 DOI: 10.1080/02688697.2017.1333572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We reported a rare peripheral nerve case, a patient developed carpal tunnel syndrome with a history of floating thumb in right hand. The median nerve was found expanded and spindle-shaped and a plexiform neurofibroma was diagnosed. Our case sheds light on anatomy and possible etiological association which may help clinical management.
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Affiliation(s)
- Kejia Hu
- a Department of Hand Surgery , Huashan Hospital, Fudan University , Shanghai , China.,b Department of Neurosurgery , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Hao Ma
- a Department of Hand Surgery , Huashan Hospital, Fudan University , Shanghai , China
| | - Yundong Shen
- a Department of Hand Surgery , Huashan Hospital, Fudan University , Shanghai , China.,c Department of Hand and Upper Extremity Surgery , Jing'an District Central Hospital , Shanghai , China
| | - Ziv Williams
- b Department of Neurosurgery , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Wendong Xu
- a Department of Hand Surgery , Huashan Hospital, Fudan University , Shanghai , China.,c Department of Hand and Upper Extremity Surgery , Jing'an District Central Hospital , Shanghai , China
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22
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Gür ÖE, Öztürk MT, Ensari N, Şenen D, Sonbay ND. Plexiform neurofibroma: An uncommon cause of conductive-type hearing loss. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1316174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Özer Erdem Gür
- Department of ENT, Antalya Education and Training Hospital, Antalya, Turkey
| | - M. Türker Öztürk
- Department of ENT, Antalya Education and Training Hospital, Antalya, Turkey
| | - Nuray Ensari
- Department of ENT, Antalya Education and Training Hospital, Antalya, Turkey
| | - Dilek Şenen
- Department of Plastic and Reconstructive Surgery, Antalya Education and Training Hospital, Antalya, Turkey
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23
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Avery RA, Katowitz JA, Fisher MJ, Heidary G, Dombi E, Packer RJ, Widemann BC. Orbital/Periorbital Plexiform Neurofibromas in Children with Neurofibromatosis Type 1: Multidisciplinary Recommendations for Care. Ophthalmology 2016; 124:123-132. [PMID: 27817916 DOI: 10.1016/j.ophtha.2016.09.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/06/2016] [Accepted: 09/16/2016] [Indexed: 12/13/2022] Open
Abstract
TOPIC Children and adults with neurofibromatosis type 1 (NF1), a common autosomal dominant condition, manifest a variety of ophthalmologic conditions. Plexiform neurofibromas (PNs) involving the eyelid, orbit, periorbital, and facial structures (orbital-periorbital plexiform neurofibroma [OPPN]) can result in significant visual loss in children. Equally important, OPPNs can cause significant alteration in physical appearance secondary to proptosis, ptosis, and facial disfigurement, leading to social embarrassment and decreased self-esteem. CLINICAL RELEVANCE Although NF1 is a relatively common disease in which routine ophthalmologic examinations are required, no formal recommendations for clinical care of children with OPPNs exist. Although medical and surgical interventions have been reported, there are no agreed-on criteria for when OPPNs require therapy and which treatment produces the best outcome. METHODS Because a multidisciplinary team of specialists (oculofacial plastics, pediatric ophthalmology, neuro-ophthalmology, medical genetics, and neuro-oncology) direct management decisions, the absence of a uniform outcome measure that represents visual or aesthetic sequelae complicates the design of evidence-based studies and feasible clinical trials. RESULTS In September 2013, a multidisciplinary task force, composed of pediatric practitioners from tertiary care centers experienced in caring for children with OPPN, was convened to address the lack of clinical care guidelines for children with OPPN. CONCLUSIONS This consensus statement provides recommendations for ophthalmologic monitoring, outlines treatment indications and forthcoming biologic therapy, and discusses challenges to performing clinical trials in this complicated condition.
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Affiliation(s)
- Robert A Avery
- The Gilbert Family Neurofibromatosis Institute, Children's National Health System, Washington, DC; Department of Neurology, Children's National Health System, Washington, DC; Department of Ophthalmology, Children's National Health System, Washington, DC; Center for Neuroscience and Behavior, Children's National Health System, Washington, DC; Division of Ophthalmology, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - James A Katowitz
- Division of Ophthalmology, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael J Fisher
- Division of Oncology, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Eva Dombi
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Roger J Packer
- The Gilbert Family Neurofibromatosis Institute, Children's National Health System, Washington, DC; Department of Neurology, Children's National Health System, Washington, DC; The Brain Tumor Institute, Children's National Health System, Washington, DC; Center for Neuroscience and Behavior, Children's National Health System, Washington, DC
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Denadai R, Buzzo CL, Takata JPI, Raposo-Amaral CA, Raposo-Amaral CE. Comprehensive and Global Approach of Soft-Tissue Deformities in Craniofacial Neurofibromatosis Type 1. Ann Plast Surg 2016; 77:190-4. [PMID: 27416559 DOI: 10.1097/sap.0000000000000494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To present a single-institution experience in the comprehensive and global soft-tissue surgical approach of patients with craniofacial neurofibromatosis type 1 (NF-1). METHODS A retrospective analysis of patients with craniofacial NF-1 (n = 20) who underwent craniofacial soft-tissue reconstruction between 1993 and 2014 was conducted. Surgical treatment was individualized according to age, functional and/or aesthetic impairment, neurofibroma types, anatomical location, size, and patient/family and surgical team preferences, regardless of previously published compartmental grading systems. The surgical results were classified based on 2 previously published outcome rating scales (craniofacial symmetry improvement and need for additional surgery). RESULTS All patients underwent en bloc translesional surgical excisions, 12 facial suspension, 3 eyebrow suspension, 2 ear suspension, 9 lateral canthopexy, 5 horizontal shortening of the tarsus of lower eyelid, and 1 horizontal shortening of the tarsus of upper eyelid. The degree of craniofacial symmetry improvement was considered "mostly satisfactory" (75%), and the overall rate of surgical results ranked according to the need for additional surgery was 2.4 ± 0.50, with variations according to the spectrum of soft-tissue involvement. CONCLUSIONS According to the experience and surgical outcomes presented in this study, the soft-tissue surgical approach of the craniofacial NF-1 should be global, comprehensive, and individualized.
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Affiliation(s)
- Rafael Denadai
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
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Jiang W, Mautner VF, Friedrich RE, Kluwe L. Preclinical assessment of the anticancer drug response of plexiform neurofibroma tissue using primary cultures. J Clin Neurol 2015; 11:172-7. [PMID: 25851896 PMCID: PMC4387483 DOI: 10.3988/jcn.2015.11.2.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Individualized drug testing for tumors using a strategy analogous to antibiotic tests for infectious diseases would be highly desirable for personalized and individualized cancer care. METHODS Primary cultures containing tumor and nontumor stromal cells were utilized in a novel strategy to test drug responses with respect to both efficacy and specificity. The strategy tested in this pilot study was implemented using four primary cultures derived from plexiform neurofibromas. Responses to two cytotoxic drugs (nilotinib and imatinib) were measured by following dose-dependent changes in the proportions of tumor and nontumor cells, determined by staining them with cell-type-specific antibodies. The viability of the cultured cells and the cytotoxic effect of the drugs were also measured using proliferation and cytotoxicity assays. RESULTS The total number of cells decreased after the drug treatment, in accordance with the observed reduction in proliferation and increased cytotoxic effect upon incubation with the two anticancer drugs. The proportions of Schwann cells and fibroblasts changed dose-dependently, although the patterns of change varied between the tumor samples (from different sources) and between the two drugs. The highly variable in vitro drug responses probably reflect the large variations in the responses of tumors to therapies between individual patients in vivo. CONCLUSIONS These preliminary results suggest that the concept of assessing in vitro drug responses using primary cultures is feasible, but demands the extensive further development of an application for preclinical drug selection and drug discovery.
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Affiliation(s)
- Wei Jiang
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Victor F Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhard E Friedrich
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lan Kluwe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Weiss B, Widemann BC, Wolters P, Dombi E, Vinks AA, Cantor A, Korf B, Perentesis J, Gutmann DH, Schorry E, Packer R, Fisher MJ. Sirolimus for non-progressive NF1-associated plexiform neurofibromas: an NF clinical trials consortium phase II study. Pediatr Blood Cancer 2014; 61:982-6. [PMID: 24851266 DOI: 10.1002/pbc.24873] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with Neurofibromatosis Type 1 (NF1) have an increased risk of developing tumors of the central and peripheral nervous system, including plexiform neurofibromas (PN), which are benign nerve sheath tumors that are among the most debilitating complications of NF1. There are no standard treatment options for PN other than surgery, which is often difficult due to the extensive growth and invasion of surrounding tissues. Mammalian Target of Rapamycin (mTOR) acts as a master switch of cellular catabolism and anabolism and controls protein translation, angiogenesis, cell motility, and proliferation. The NF1 tumor suppressor, neurofibromin, regulates the mTOR pathway activity. Sirolimus is a macrolide antibiotic that inhibits mTOR activity. PROCEDURE We conducted a 2-stratum phase II clinical trial. In stratum 2, we sought to determine whether the mTOR inhibitor sirolimus in subjects with NF1 results in objective radiographic responses in inoperable PNs in the absence of documented radiographic progression at trial entry. RESULTS No subjects had better than stable disease by the end of six courses. However, the children's self-report responses on health-related quality of life questionnaires indicated a significant improvement in the mean scores of the Emotional and School domains from baseline to 6 months of sirolimus. CONCLUSIONS This study efficiently documented that sirolimus does not cause shrinkage of non-progressive PNs, and thus should not be considered as a treatment option for these tumors. This study also supports the inclusion of patient-reported outcome measures in clinical trials to assess areas of benefit that are not addressed by the medical outcomes.
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Affiliation(s)
- Brian Weiss
- Division of Oncology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | | | - Pamela Wolters
- Department of Pediatric Oncology; National Cancer Institute; Bethesda Maryland
| | - Eva Dombi
- Department of Pediatric Oncology; National Cancer Institute; Bethesda Maryland
| | - Alexander A. Vinks
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Alan Cantor
- Department of Genetics; University of Alabama at Birmingham; Birmingham Albama
| | - Bruce Korf
- Department of Genetics; University of Alabama at Birmingham; Birmingham Albama
| | - John Perentesis
- Division of Oncology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - David H. Gutmann
- Department of Neurology; Washington University in St. Louis; St. Louis Missouri
| | - Elizabeth Schorry
- Department of Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Roger Packer
- Children's National Medical Center; Washington District of Columbia
| | - Michael J. Fisher
- Division of Oncology; Philadelphia Children's Hospital; Philadelphia Pennsylvania
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