Management of selumetinib-associated toxicity in children with neurofibromatosis type 1 and plexiform neurofibromas
- Authors: Dinikina Y.V.1, Dekhtyareva N.S.1
-
Affiliations:
- Almazov National Medical Research Center, Ministry of Health of Russia
- Issue: Vol 2, No 1 (2025)
- Pages: 30-43
- Section: REVIEWS
- Published: 07.04.2025
- URL: https://stio.abvpress.ru/jour/article/view/51
- DOI: https://doi.org/10.17650/3034-2473-2025-2-1-30-43
- ID: 51
Cite item
Full Text
Abstract
According to the statistics of major studies, neurofibromatosis is one of the most common genetic diseases associated with tumor syndrome with incidence rate of 1 case per 3000–6000 people. The most common benign neoplasms typical for neurofibromatosis type 1 are plexiform and cutaneous neurofibromas which amount to up to 95 % of all NF1-associated benign tumors.
Selumetinib is a selective mitogen-activated protein kinase types 1 and 2 inhibitor which showed promising results in the treatment of inoperable symptomatic plexiform neurofibromas. Objective response rate for selumetinib was 68 %. In 2021, selumetinib was registered in the Russian Federation and included into the State Register of Medicinal Remedies. It is important to consider that development of clinically significant adverse events during this therapy can cause drug discontinuation, reduce patients’ adherence to therapy and as a result negatively affect the overall treatment effectiveness.
The article presents a review of adverse events of selumetinib, their prevention and treatment options based on the current international guidelines.
About the authors
Yu. V. Dinikina
Almazov National Medical Research Center, Ministry of Health of Russia
Author for correspondence.
Email: dinikina_yuv@almazovcentre.ru
ORCID iD: 0000-0002-2003-0982
Yulia Valerevna Dinikina
2 Akkuratova St., Saint Petersburg 197341
Russian FederationN. S. Dekhtyareva
Almazov National Medical Research Center, Ministry of Health of Russia
ORCID iD: 0000-0001-6547-0925
2 Akkuratova St., Saint Petersburg 197341
Russian FederationReferences
- Boyd K.P., Korf B.R., Theos A. Neurofibromatosis type 1. J Am Acad Dermatol 2009;61(1):1–14. doi: 10.1016/j.jaad.2008.12.051
- Choi J., An S., Lim S.Y. Current concepts of neurofibromatosis type 1: pathophysiology and treatment. Arch Craniofac Surg 2022;23(1):6–16. doi: 10.7181/acfs.2022.00633
- Peduto C., Zanobio M., Nigro V. et al. Neurofibromatosis type 1: pediatric aspects and review of genotype-phenotype correlations. Cancers (Basel) 2023;15(4):1217. doi: 10.3390/cancers15041217
- DeBella K., Szudek J., Friedman J.M. Use of the national institutes of health criteria for diagnosis of neurofibromatosis 1 in children. Pediatrics 2000;105(3 Pt 1):608–14. doi: 10.1542/peds.105.3.608
- Xiong R., Lei J., Wang L. et al. Efficient analysis of adverse drug events and toxicological mechanisms of newly marketed drugs by integrating pharmacovigilance and network toxicology: selumetinib as an example. Front Pharmacol 2024;15:1432759. doi: 10.3389/fphar.2024.1432759
- Longo J.F., Weber S.M., Turner-Ivey B.P., Carroll S.L. Recent advances in the diagnosis and pathogenesis of neurofibromatosis type 1 (NF1)-associated peripheral nervous system neoplasms. Adv Anat Pathol 2018;25(5):353–68. doi: 10.1097/PAP.0000000000000197
- Bergoug M., Doudeau M., Godin F. et al. Neurofibromin structure, functions and regulation. Cells 2020;9(11):2365. doi: 10.3390/cells9112365
- Laycock-van Spyk S., Thomas N., Cooper D.N., Upadhyaya M. Neurofibromatosis type 1-associated tumours: their somatic mutational spectrum and pathogenesis. Hum Genomics 2011;5(6):623–90. doi: 10.1186/1479-7364-5-6-623
- Resolution of the Expert council on the problems of diagnosis and treatment of patients with plexiform neurofibromas. Rossiyskiy zhurnal detskoy gematologii i onkologii = Russian Journal of Pediatric Hematology аnd Oncology 2021;8(2):144–52. (In Russ.). doi: 10.21682/2311-1267-2021-8-2-144-152
- Collins-Sawaragi Y.C., Ferner R., Vassallo G. et al. 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(6):1723–7. doi: 10.1002/ajmg.a.62691
- Mustafin R.N. Prospects for the treatment of neurofibromatosis type 1: a review. Sovremennaya onkologiya = Journal of Modern Oncology 2022;24(2):209–15. (In Russ.). doi: 10.26442/18151434.2022.2.201431
- Suppiah S., Mansouri S., Mamatjan Y. et al. Multiplatform molecular profiling uncovers two subgroups of malignant peripheral nerve sheath tumors with distinct therapeutic vulnerabilities. Nat Commun 2023;14(1):2696. doi: 10.1038/s41467-023-38432-6
- Pivovarova A.M., Dorofeeva M.Yu., Zabrodina A.R. et al. Pharmacotherapy of plexiform neurofibromas in patients with neurofibromatosis type 1. Possible adverse events and their management. Russkiy zhurnal detskoy nevrologii = Russian Journal of Child Neurology 2024;19(2):8–19. (In Russ.). doi: 10.17650/2073-8803-2024-19-2-8-19
- Tamura R. Current understanding of neurofibromatosis type 1, 2, and schwannomatosis. Int J Mol Sci 2021;22(11):5850. doi: 10.3390/ijms22115850
- Gross A.M., Wolters P., Baldwin A. et al. SPRINT: phase II study of the MEK 1/2 inhibitor selumetinib (AZD6244, ARRY-142886) in children with neurofibromatosis type 1 (NF1) and inoperable plexiform neurofibromas (PN). Pediatr Oncol 2018;36(15):10503. doi: 10.1200/JCO.2018.36.15_suppl.10503
- Gross A.M., Wolters P.L., Dombi E. et al. Selumetinib in children with inoperable plexiform neurofibromas. N Engl J Med 2020;382(15):1430–42. doi: 10.1056/NEJMoa1912735.
- Campagne O., Yeo K.K., Fangusaro J., Stewart C.F. Clinical pharmacokinetics and pharmacodynamics of selumetinib. Clin Pharmacokinet 2021;60(3):283–303. doi: 10.1007/s40262-020-00967-y
- Dombi E., Baldwin A., Marcus L.J. et al. Activity of selumetinib in neurofibromatosis type 1-related plexiform neurofibromas. N Engl J Med 2016;375(26):2550–60. doi: 10.1056/NEJMoa1605943
- Luu M., Boone S.L., Patel J. et al. Higher severity grade of erlotinibinduced rash is associated with lower skin phototype. Clin Exp Dermatol 2011;36(7):733–8. doi: 10.1111/j.1365-2230.2011.04117
- Borgia P., Piccolo G., Santangelo A. et al. Dermatologic effects of selumetinib in pediatric patients with neurofibromatosis type 1: clinical challenges and therapeutic management. J Clin Med 2024;13(6):1792. doi: 10.3390/jcm13061792
- Boull C.L., Gardeen S., Abdali T. et al. Cutaneous reactions in children treated with MEK inhibitors, BRAF inhibitors, or combination therapy: a multicenter study. J Am Acad Dermatol 2020;84(6):1554–61. doi: 10.1016/j.jaad.2020.07.044
- Akilli Öztürk Ö., Pakula H., Chmielowiec J. et al. Gab1 and Mapk signaling are essential in the hair cycle and hair follicle stem cell quiescence. Cell Rep 2015;13(3):561–72. doi: 10.1016/j.celrep.2015.09.015
- Palmeiro A.G., Silva L., Pimentel B. et al. MEK inhibitor-induced paronychia in a paediatric population: a tertiary centre experience. Australas J Dermatol 2023;64(3):e245–51. doi: 10.1111/ajd.14079
- Abdel-Rahman O., ElHalawani H., Ahmed H. Risk of selected cardiovascular toxicities in patients with cancer treated with MEK inhibitors: a comparative systematic review and meta-analysis. J Glob Oncol 2015;1(2):73–82. doi: 10.1200/JGO.2015.000802
- Australian product information. Koselugo® (selumetinib sulfate) capsules. Alexion Pharmaceuticals, Inc. PM-2020-05290-1-4 FINAL. 2024.
- Glen C., Tan Y.Y., Waterston A. et al. Mechanistic and clinical overview cardiovascular toxicity of BRAF and MEK inhibitors: JACC: CardioOncology state-of-the-art review. JACC CardioOncol 2022;4(1):1–18. doi: 10.1016/j.jaccao.2022.01.096
- Avery R.A., Trimboli-Heidler C., Kilburn L.B. Separation of outer retinal layers secondary to selumetinib. J AAPOS 2016;20(3):268–71. doi: 10.1016/j.jaapos.2016.01.012
- Azizi A.A., Hargrave D., Passos J. et al. Consensus recommendations on management of selumetinib-associated adverse events in pediatric patients with neurofibromatosis type 1 and plexiform neurofibromas. Neurooncol Pract 2024;11(5):515–31. doi: 10.1093/nop/npae038
- Jeng-Miller K.W., Miller M.A., Heier J.S. Ocular effects of MEK inhibitor therapy: literature review, clinical presentation, and best practices for mitigation. Oncologist 2024;29(5):e616–21. doi: 10.1093/oncolo/oyae014
- Hummel L., Ameri M., Alqahtani S. et al. Incidence of ophthalmological complications in NF-1 patients treated with MEK inhibitors. Curr Oncol 2024;31(5):2644–9. doi: 10.3390/curroncol31050199
- Coltin H., Perreault S., Larouche V. et al. Selumetinib for symptomatic, inoperable plexiform neurofibromas in children with neurofibromatosis type 1: a national real-world case series. Pediatr Blood Cancer 2022;69(8):e29633. doi: 10.1002/pbc.29633
- Yang Y., Liu Y.H., Sun X. et al. Risk of peripheral edema in cancer patients treated with MEK inhibitors: a systematic review and metaanalysis of clinical trials. Curr Med Res Opin 2017;33(9):1663–75. doi: 10.1080/03007995.2017.1349657
- General characteristics of the drug Koselugo® (capsules, 10 mg, 25 mg). Registration certificate LP-No.(005053)-(RG-RU) dated 09/25/2024. (In Russ.).
- Kang E., Yoon H.M., Lee B.H. Neurofibromatosis type I: points to be considered by general pediatricians. Clin Exp Pediatr 2021;64(4):149–56. doi: 10.3345/cep.2020.00871
- Freites-Martinez A., Santana N., Arias-Santiago S., Viera A. Using the Common Terminology Criteria for Adverse Events (CTCAE – version 5.0) to evaluate the severity of adverse events of anticancer therapies. Actas Dermosifiliogr (Engl Ed) 2021;112(1):90–2. doi: 10.1016/j.ad.2019.05.009
- Kim H., Yoon H.M., Kim E.K. et al. Safety and efficacy of selumetinib in pediatric and adult patients with neurofibromatosis type 1 and plexiform neurofibroma. Neuro Oncol 2024;26(12): 2352–63. doi: 10.1093/neuonc/noae121
- Yoshida Y., Tozawa K., Koto R. et al. Patient characteristics, treatment patterns, healthcare resource utilization, and costs among patients diagnosed with neurofibromatosis type 1 with and without plexiform neurofibromas in Japan. Curr Med Res Opin 2024;40(4): 723–31. doi: 10.1080/03007995.2024.2322698
Supplementary files


