Abstract
BackgroundTo evaluate the efficacy, safety and health economics of sequential everolimus in treating angiomyolipoma (AML) associated with tuberous sclerosis complex (TSC).MethodsIn this prospective cohort study, patients met the inclusion criteria received standard or sequential treatment according to their willingness. All patients received an initial dose of everolimus (10 mg oral, once a day) for 3 months. The standard treatment group maintained 10 mg QD for 12 months, while the sequential treatment group reduced the dose to 5 mg QD from the 4th month. The efficacy, serum everolimus concentration and safety were evaluated at 1, 3, 6, 9 and 12 months after treatment. The primary efficacy endpoint was the proportion of patients with confirmed angiomyolipoma response of at least a 50% reduction in the total volume of target AML relative to baseline.ResultsBetween June 1, 2016 and June 1, 2017, a total of 53 patients were included. Twenty-three patients received standard treatment, 30 patients received sequential treatment. At 1, 3, 6, 9 and 12 months after treatment, the proportion of patients whose total target tumor volume decreased by ≥ 50% from baseline was 39.1% versus 36.7%, 43.5% versus 56.7%, 47.8% versus 50%, 47.8% versus 60% and 47.8% versus 23.3% respectively (P > 0.05 for all). The overall response rate of skin lesions in the two groups was 40.4%, and the response rates of skin lesions at different times were similar for two groups (P > 0.05 for all). Major adverse effects (AEs) included mouth ulceration, hypertriglyceridemia, hypercholesterolemia, menstrual disorders. There was no significant difference between the two groups in the incidence of AEs at 3 months after treatment. The incidence of overall and grade 3/4 AEs at 12 months after treatment were significantly lower in the sequential treatment group. The average direct cost of the two groups in 12 months was $15,466 and $11,120, respectively.ConclusionsCompared to standard treatment, sequential treatment was equally effective, with a lower incidence of adverse events and a lower direct cost, suggesting that it may be an alternative treatment for AML associated with TSC.
Highlights
Angiomyolipoma (AML), a common benign tumor of kidney, can be sporadic or the renal manifestation of tuberous sclerosis complex (TSC)
Everolimus and other mammalian target of rapamyoin inhibitors have been used in the treatment of TSC-related AML and achieved satisfactory results, which have been recommended as first-line treatment by guidelines [3]
At 1, 3, 6, 9 and 12 months after treatment, the proportion of patients whose total target tumor volume decreased by ≥ 50% from baseline was 39.1% versus 36.7%, 43.5% versus 56.7%, 47.8% versus 50%, 47.8% versus 60% and 47.8% versus 23.3% for standard and sequential treatment group respectively, with no statistically significant difference between the two groups (P > 0.05 for all)
Summary
Angiomyolipoma (AML), a common benign tumor of kidney, can be sporadic or the renal manifestation of tuberous sclerosis complex (TSC). TSC is an autosomal dominant syndrome involving multiple organs originating from three embryonic layers. It is mainly caused by inactivation mutations of TSC1 and/or TSC2 genes, and. Compared with sporadic renal AML, TSC-related renal AML is mostly bilateral, prone to severe consequences such as bleeding and renal failure, and is the main cause of death in adult TSC patients [2]. To explore appropriate administration regimens for TSC-AML patients in China, we conducted a prospective cohort study of individualized everolimus therapy in TSC-associated renal AML patients. Safety and health economics of sequential everolimus in treating angiomyolipoma (AML) associated with tuberous sclerosis complex (TSC)
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