Patient case: 70-year-old male with melanoma; genetic feature: NF1 truncation

Clinical trial: Lapatinib Study for Children and Adults With Neurofibromatosis Type 2 (NF2) and NF2-Related Tumors

Summary: The purpose of this study is to determine if Lapatinib has any effect on tumors found in patients with Neurofibromatosis Type 2 (NF2). NF2 is a condition that mainly affects the skin and nervous system. It causes non-cancerous tumors (which are known as neuromas) to grow on the nerves around a person's body. Some signs of NF2 include a gradual loss of hearing and tumors growing on the skin, the brain and the spinal cord which can lead to complications.
  Lapatinib is an oral drug that is approved by Food and Drug Administration (FDA) for other types of tumors, it is not approved by the FDA for treatment of NF2 related tumors. The investigators know a lot about how well it is tolerated, but the investigators do not know if it is effective in treating your condition, therefore it is considered to be an investigational medication. This study will test whether Lapatinib may shrink tumors commonly found in patients with NF2 or stop them from growing. This will help us to decide if Lapatinib should be used to treat NF2 patients in future. Lapatinib is a drug that has been used for over 10 years to treat various forms of cancer. It has not been studied for the treatment of tumors in NF2 patients.

Detailed description: In this trial, we propose to assess the objective response rates to Lapatinib in patients with NF2-related tumors. Lapatinib is a commercially available inhibitor of ErbB2 and EGF. Data suggests that abnormal signaling via EGFR and ErbB2 is a major contributor to tumor growth and progression in both sporadic and NF2-related VS and that inhibition of this signaling pathway can result in decreased tumor growth.
  Demonstrating that Lapatinib produces an objective response to reduce tumor volume or stabilize disease will provide additional treatment options for NF patients with multiple tumor growth. For patients with VS we expect to see ≥ 10 dB improvement in PTA and/or improvement in SDS, compared to the audiogram at initiation of treatment. Currently there are no available treatment options for NF2 patients with multiple tumors. Depending on tumor cell type, lapatinib has cytostatic or cytotoxic antitumor effects, and in a recent study assessing the biological effects of Lapatinib on the associated molecular pathways and tumor growth in patients with solid tumors, a correlation was seen between tumor response and pre-treatment levels of (phosphor)-ErbB2 and (phosphor)-ERK1/2.

Eligibility: Inclusion Criteria:
  1. Patients must be at least 4 years of age.
  2. Patients must meet diagnostic criteria for NF2 and at least one volumetrically measured NF2-related brain or spinal tumor with radiographic evidence of progression over the past 12 months, designated as the primary target OR volumetrically measurable VS with ipsilateral progressive hearing loss over the past 12 months, designated as the primary target tumor.
  3. Significant hearing loss criteria for enrollment.
  4. Karnofsky (PS) OR Lansky 50-100% (>16 years of age)
  5. Absolute neutrophil count ≥ 1,000/mm3 g/dL
  6. Hemoglobin ≥ 8 g/dL
  7. Creatinine ≤ 1.5 times upper limit of normal (ULN) OR corrected glomerular filtration rate ≥ 70 ml/min
  8. Bilirubin ≤ 1.5 times ULN
  9. ALT ≤ 2.5 times ULN
  10. Fully recovered from acute toxic effects of any prior chemotherapy, biological modifiers or radiotherapy.
  11. Steroids are allowed for progressive symptoms but patient must be on a stable dose for at least 1 week prior to study entry.
  12. Any neurologic deficits must be stable for ≥ 1 week.
  13. Patients with the potential for pregnancy or impregnating their partner must agree to follow acceptable birth control methods to avoid conception. Women of childbearing potential must have a negative pregnancy test. The anti-proliferative activity of this experimental drug may be harmful to the developing fetus.
  14. Normal cardiac left ventricular ejection fraction (LVEF) by transthoracic echocardiogram.
  15. Able to provide written informed consent (or consent by parent/legal guardian for minors)
  Exclusion Criteria:
  1. Patients with serious concurrent infection or medical illness.
  2. Neurological deficits that are rapidly progressing.
  3. Patients who are pregnant or breast-feeding.
  4. Anti-tumor therapy within 4 weeks prior to enrollment.
  5. Radiation therapy within 2 months prior to enrollment.
  6. Prior therapy with agents targeting EGFR or ErbB2.
  7. Any surgery within 4 weeks prior to enrollment.
  8. Significant gastrointestinal disorder(s)
  9. Known cardiac disease
  10. Patients with a concurrent or prior malignancy are ineligible unless they are patients with curatively treated carcinoma-in-situ or basal cell carcinoma of the skin. Patients who have been free of disease (any prior malignancy) for more than five years are eligible for this study.
  11. Patients cannot have received cytochrome P450-inducing anticonvulsants (EIADs; e.g., phenytoin, carbamazepine, phenobarbital, primidone, oxcarbazepine) or similar agents (e.g., rifampin) or P450-inhibiting agents (Ketoconazole, Itraconazole, Clarithromycin, Atazanavir, Indinavir, Nefazodone, Nelfinavir, Ritonavir, Saquinavir, Telithromycin, Voriconazole)

Relevance to patient case: not relevant