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Sarin KY, Bradshaw M, O'Mara C, Shahryari J, Kincaid J, Kempers S, Tu JH, Dhawan S, DuBois J, Wilson D, Horwath P, de Souza MP, Powala C, Kochendoerfer GG, Plotkin SR, Webster GF, Le LQ. Effect of NFX-179 MEK inhibitor on cutaneous neurofibromas in persons with neurofibromatosis type 1. SCIENCE ADVANCES 2024; 10:eadk4946. [PMID: 38691597 PMCID: PMC11062565 DOI: 10.1126/sciadv.adk4946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/28/2024] [Indexed: 05/03/2024]
Abstract
This phase 2a trial investigated the efficacy of NFX-179 Topical Gel, a metabolically labile MEK inhibitor, in the treatment of cutaneous neurofibromas (cNFs) in neurofibromatosis type 1. Forty-eight participants were randomized to four treatment arms: NFX-179 Topical Gel 0.05%, 0.15%, and 0.5% or vehicle applied once daily to five target cNFs for 28 days. Treatment with NFX-179 Topical Gel resulted in a dose-dependent reduction in p-ERK levels in cNFs at day 28, with a 47% decrease in the 0.5% NFX-179 group compared to the vehicle (P = 0.0001). No local or systemic toxicities were observed during the treatment period, and systemic concentrations of NFX-179 remained below 1 ng/ml. In addition, 20% of cNFs treated with 0.5% NFX-179 Topical Gel showed a ≥50% reduction in volume compared to 6% in the vehicle group by ruler measurement with calculated volume (P = 0.021). Thus, NFX-179 Topical Gel demonstrated significant inhibition of MEK in cNF with excellent safety and potential therapeutic benefit.
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Affiliation(s)
- Kavita Y. Sarin
- Department of Dermatology, Stanford University Medical Center, Stanford, CA, USA
| | | | | | | | | | | | - John H. Tu
- Skin Search of Rochester, Inc., Rochester, NY, USA
| | - Sunil Dhawan
- Center for Dermatology Clinical Research Inc., Fremont, CA, USA
| | | | - David Wilson
- The Education and Research Foundation Inc., Lynchburg, VA, USA
| | | | | | | | | | | | | | - Lu Q. Le
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, VA, USA
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2
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Ortonne N. How to score the impact of treatment on cutaneous neurofibromas in clinical trials. Br J Dermatol 2024; 190:147-148. [PMID: 38084905 DOI: 10.1093/bjd/ljad492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 01/25/2024]
Abstract
Most patients with neurofibromatosis 1 (NF1) develop a variable number of cutaneous neurofibromas (cNFs) which have a major impact on patients’ quality of life0. A major problem is how to score the response to therapy in clinical practice and trials. A measurement instrument recognized by all experts in the field is required to be able to judge the efficacy of treatments and the benefits perceived by the patients. Fertitta and colleagues propose a system for assessing cNFs severity and impact with a list of items validated by a consensus of experts and patients.This qualitative approach has the advantage of integrating multiple parameters of interest, based in part on a “patient-centric” approach.
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Affiliation(s)
- Nicolas Ortonne
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital
- Université Paris Est Créteil
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, Créteil, France
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3
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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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4
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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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Brough D, Amos H, Turley K, Murkin J. Trends in Subcutaneous Tumour Height and Impact on Measurement Accuracy. Cancer Inform 2023; 22:11769351231165181. [PMID: 37113645 PMCID: PMC10126793 DOI: 10.1177/11769351231165181] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/05/2023] [Indexed: 04/29/2023] Open
Abstract
Tumour volume is typically calculated using only length and width measurements, using width as a proxy for height in a 1:1 ratio. When tracking tumour growth over time, important morphological information and measurement accuracy is lost by ignoring height, which we show is a unique variable. Lengths, widths, and heights of 9522 subcutaneous tumours in mice were measured using 3D and thermal imaging. The average height:width ratio was found to be 1:3 proving that using width as a proxy for height overestimates tumour volume. Comparing volumes calculated with and without tumour height to the true volumes of excised tumours indeed showed that using the volume formula including height produced volumes 36X more accurate (based off of percentage difference). Monitoring the height:width relationship (prominence) across tumour growth curves indicated that prominence varied, and that height could change independent of width. Twelve cell lines were investigated individually; the scale of tumour prominence was cell line-dependent with relatively less prominent tumours (MC38, BL2, LL/2) and more prominent tumours (RENCA, HCT116) detected. Prominence trends across the growth cycle were also dependent on cell line; prominence was correlated with tumour growth in some cell lines (4T1, CT26, LNCaP), but not others (MC38, TC-1, LL/2). When pooled, invasive cell lines produced tumours that were significantly less prominent at volumes >1200 mm3 compared to non-invasive cell lines (P < .001). Modelling was used to show the impact of the increased accuracy gained by including height in volume calculations on several efficacy study outcomes. Variations in measurement accuracy contribute to experimental variation and irreproducibility of data, therefore we strongly advise researchers to measure height to improve accuracy in tumour studies.
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Affiliation(s)
- Daniel Brough
- Daniel Brough, BioVolume Ltd, Witney Business & Innovation Centre, Windrush Industrial Park, Burford Road, Witney OX29 7DX, UK.
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Gross AM, Plotkin SR, Widemann BC. Neurofibromatosis Clinical Trials-REiNS Collaboration 2020 Recommendations: Looking Back and Moving Ahead. Neurology 2021; 97:S1-S3. [PMID: 34230201 DOI: 10.1212/wnl.0000000000012429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andrea M Gross
- From the Pediatric Oncology Branch (A.M.G., B.C.W.), Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston.
| | - Scott R Plotkin
- From the Pediatric Oncology Branch (A.M.G., B.C.W.), Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
| | - Brigitte C Widemann
- From the Pediatric Oncology Branch (A.M.G., B.C.W.), Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD; and Department of Neurology and Cancer Center (S.R.P.), Massachusetts General Hospital, Boston
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