Natural History and Biology of Dermal Neurofibromas in Neurofibromatosis Type 1
This protocol results from a funded 2005 Bench-to-Bedside Award and explores the genetic
basis of disease severity in neurofibromatosis type 1 (NF1) and the evaluation of three
methods to measure disease progression of dermal neurofibromas. NF1 is a common multisystem
genetic disorder associated with the development of benign and malignant tumors, primarily
of the nervous system. NF1 is 100% penetrant and features variable expressivity and
essentially no phenotype/genotype correlation. No standard treatment other than surgery
exists for most NF1-associated tumors. Many aspects of the natural history of NF1-associated
tumors are not fully characterized and require investigation to assess the effects of
potential new treatments, in future clinical trials. The development of medical treatments
for NF1-associated tumors is an important goal given their morbidity and the lack of
non-surgical treatment options. The ability to predict the ultimate severity of disease
would have a significant impact on the management and treatment of individuals with NF1.
Sorafenib (BAY 43-9006) is a novel, orally bioavailable agent that targets downstream
effectors in the Ras signaling pathway (a key dysregulated pathway in NF1). It has thus a
strong scientific rationale for evaluation in NF1 related tumors. Dermal neurofibromas occur
in nearly every individual with NF1, and are a significant cosmetic problem and a major
cause of morbidity. This protocol will 1) quantify the growth of dermal neurofibromas in NF1
with 3 different imaging modalities 2) use an innovative gene expression method to identify
genetic modifiers of dermal neurofibroma burden, and 3) evaluate dermal neurofibromas and
normal skin for the presence of targets of sorafenib. Successful validation of reliable
quantitative imaging methods of dermal neurofibroma growth is a logical prerequisite to
subsequent clinical trials with medical treatments, which will evaluate the effect of new
agents on the growth rate of dermal neurofibromas. Identification of genetic modifiers may
permit prediction of ultimate tumor burden. Evaluation of targets of new agents in dermal
neurofibromas will allow for more rationale drug development for NF1. Given the paucity of
protocols for adults with NF1 and dermal neurofibromas, this study will likely generate
great interest among affected individuals and have rapid accrual.
Observational
N/A
Douglas R Stewart, M.D.
Principal Investigator
National Cancer Institute (NCI)
United States: Federal Government
060134
NCT00314119
April 2006
Name | Location |
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National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda, Maryland 20892 |
University of Alabama | Birmingham, Alabama |