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Everolimus

In Patients with Subependymal Giant Cell Astrocytoma Associated with Tuberous Sclerosis Complex

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Abstract

Everolimus is an orally administered inhibitor of the mammalian target of rapamycin (mTOR).

Everolimus (starting dosage 3.0 mg/m2) was associated with a significant reduction in the volume of the largest subependymal giant cell astrocytoma (SEGA) in 28 patients aged ≥3 years with tuberous sclerosis complex (TSC) in a phase II trial (C2485). At 6 months, 32% of patients treated with everolimus had a ≥50% reduction in the volume of their largest SEGA lesion (assessed via an independent central radiology review); 75% had a ≥30% reduction. No patients developed new lesions. During the extension phase of this trial (median duration 34 months), the reduction in SEGA volume was maintained, with no everolimus recipient requiring surgery or other therapy for SEGA or hydrocephalus.

In a phase III trial (EXIST-1) in 117 patients with SEGA associated with TSC, 35% of everolimus recipients (starting dosage 4.5mg/m2) versus none of the placebo recipients (p< 0.0001) had an overall response (a reduction in the sum of all target SEGA volumes of ≥50% relative to baseline, nonworsening of non-target SEGA lesions, no new SEGA lesions, and no new/worsening hydrocephalus).

Everolimus was generally well tolerated in patients with SEGA associated with TSC; most drug-related adverse reactions were mild to moderate in severity.

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Acknowledgments and Disclosures

The manuscript was reviewed by: D.N. Franz: Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; J. Hauptman: Department of Neurosurgery, Geffen School of Medicine at UCLA, Los Angeles, CA, USA; S. Sparagana: Division of Neurology, Texas Scottish Rite Hospital for Children, Dallas, TX, USA.

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on this article. Changes resulting from comments received were made by the author on the basis of scientific and editorial merit.

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    Monique P. Curran

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Curran, M.P. Everolimus. Pediatr Drugs 14, 51–60 (2012). https://doi.org/10.2165/11207730-000000000-00000

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