Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Case Report Volume 3 Issue 2

Everolimus Efficacy in the Treatment of Neurofibromatosis Type 1

Pereira AM1, Pereira AK2, Grant K1 and Maurice C1,3*

1Faculty of Medicine, University of Toronto, Toronto, Canada
2Faculty of Medicine, Saba University, Saba, Dutch Caribbean
3Pencer Brain Tumor Centre, Princess Margaret Hospital Cancer Centre, Toronto, Canada

*Corresponding Author: Maurice C, Faculty of Medicine, University of Toronto and Pencer Brain Tumor Centre, Princess Margaret Hospital Cancer Centre, Toronto, Canada.

Received: December 12, 2019; Published: January 07, 2020

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Abstract

  Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder induced by a mutation in the NF1 tumor suppressor gene resulting in devastating physical and emotional repercussions, potentially life threatening. The recognized therapeutic options for neurofibromas are surgery or radiotherapy; however, when these options have been exhausted, pharmacologic agents interfering specifically with the mTOR pathway can be utilized. Everolimus is an oral inhibitor of mTOR complex 1 (mTORC1) with an intrinsic anti-tumor effect recognized in various cancer subtypes. The FDA and Health Canada have approved everolimus for the treatment of advanced renal cell carcinoma, neuroendocrine pancreatic tumors and subependymal giant cell tumors (SEGA) associated with tuberous sclerosis. However, there is limited clinical data reporting the efficacy of everolimus in the treatment of neurofibromas. The manuscript presents the case of a 60-year-old male diagnosed with progressive cervical spine neurofibroma refractory to standard surgical and radiation treatment. Everolimus was administered due to the imminent risk of tetraplegia. This decision acted in the patient’s favor. We faced the dilemma of observing the patient, progressing through his natural evolution, currently considered has the good practice and the standard of care, despite the risk of a potentially irreversible unfortunate condition. This manuscript discusses the situation we will face in a near future, when several therapeutic molecules will emerge from clinical trials and we will only rely on our judgment to determine the best clinical practice.

Keywords: Neurofibromatosis Type1; Quadriplegia; Mtor Pathway; Everolimus; Neurofibroma; Spinal Stenosis; Peripheral Nerve Sheath Tumor

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References

  1. JR Leonard, RE Ferner, N Thomas, DH Gutmann. “Cervical Cord Compression from Plexiform Neurofibromas in Neurofibromatosis 1”. Journal of Neurology, Neurosurgery, and Psychiatry 78.12 (2007): 1404-1406. 
  2. M Güler, T Aydin, E Poyraz. “Neurofibromatosis 1 with Invasive Spinal Cord Compression (Case Report)”. African Journal of Pharmacy and Pharmacology 7.24 (2013): 1615-1618. 
  3. A Cérange, J Zeller, S Rostaing-Rigattieri, P Brugières, JD Degos, J Revuz, P Wolkenstein. “Neurological Complications of Neurofibromatosis Type 1 in Adulthood”. Brain 122.3 (1999): 473-481. 
  4. F Wu, L Zhang, Z Liu, Y Sun, F Li, S Wang, F Wei. “Cervical Neurofibromatosis with Tetraplegia: Management by Cervical Suspensory Traction”. Spine 37.14 (2012): E858. 
  5. S Garg, H Hosalkar, JP Dormans. “Quadriplegia in a 10 Year-Old Boy Due to Multiple Cervical Neurofibromas”. Spine 28.17 (2003): E339. 
  6. FB Sarica, M Cekinmez, K Tufan, B Erdoğan, O Sen, MN Altinörs. “A Rare Case of Massive NF1 with Invasion of Entire Spinal Axis by Neurofibromas: Case Report”. Turkish Neurosurgery 18.1 (2008): 99-106.
  7. PJ Houghton. “Everolimus”. Clinical Cancer Research: An Official Journal of the American Association for Cancer Research 16.5 (2010): 1368-1372. 
  8. M Showkat, MA Beigh, KI Andrabi. “MTOR Signaling in Protein Translation Regulation: Implications in Cancer Genesis and Therapeutic Interventions”. Molecular Biology International (2014). 
  9. JC Yao, MH Shah, T Ito, et al. “Everolimus for Advanced Pancreatic Neuroendocrine Tumors”. New England Journal of Medicine 364.6 (2011): 514-523. 
  10. S Buti, A Leonetti, A Dallatomasina, M Bersanelli. “Everolimus in the Management of Metastatic Renal Cell Carcinoma: An Evidence-Based Review of Its Place in Therapy”. Core Evidence 11 (2016): 23-36. 
  11. DN Franz, E Belousova, S Sparangana, E Bebin, M Frost, R Kuperman, et al. “Everolimus for Subependymal Giant Cell Astrocytoma in Patients with Tuberous Sclerosis Complex: 2-Year Open-Label Extension of the Randomised EXIST-1 Study”. The Lancet Oncology 15.13 (2014): 1513-1520. 
  12. JK Capal and DN Franz. “Profile of Everolimus in the Treatment of Tuberous Sclerosis Complex: An Evidence-Based Review of Its Place in Therapy”. Neuropsychiatric Disease and Treatment 12 (2016): 2165-2172. 
  13. D Osorio, A Filatov, M Hagiwara., et al. “Tr-13 effects Of Everolimus On Meningioma Growth In Patients With Neurofibromatosis Type 2”. Neuro-Oncology 17.3 (2015): 39. 
  14. B Korf. “MEK Inhibitor PD-0325901 Trial in Adolescents and Adults with NF1 (MEK Inhibitor)”. U.S. National Library of Medicine. WI176190. (2017). 
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Citation

Citation: Maurice C., et al. “Everolimus Efficacy in the Treatment of Neurofibromatosis Type 1". Relationship Between Both Values”.Acta Scientific Neurology 3.2 (2020): 15-17.




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