1. Update on Neoadjuvant and Adjuvant BRAF Inhibitors in Papillary Craniopharyngioma: A Systematic Review.
- Author
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Cossu, Giulia, Ramsay, Daniele S. C., Daniel, Roy T., El Cadhi, Ahmed, Kerherve, Luc, Morlaix, Edouard, Houidi, Sayda A., Millot-Piccoli, Clément, Chapon, Renan, Le Van, Tuan, Cao, Catherine, Farah, Walid, Lleu, Maxime, Baland, Olivier, Beaurain, Jacques, Petit, Jean Michel, Lemogne, Brivaël, Messerer, Mahmoud, and Berhouma, Moncef
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THERAPEUTIC use of antineoplastic agents , *PROTEIN kinase inhibitors , *MEDICAL information storage & retrieval systems , *PAPILLARY carcinoma , *DESCRIPTIVE statistics , *ADJUVANT chemotherapy , *SYSTEMATIC reviews , *MEDLINE , *COMBINED modality therapy , *CRANIOPHARYNGIOMA , *QUALITY of life , *GENETIC mutation , *HEALTH care teams - Abstract
Simple Summary: Recent research uncovered the BRAF mutation in papillary craniopharyngiomas, leading to new targeted treatments that may reduce the need for invasive procedures. A systematic review of 20 studies with 37 patients, treated mostly in the U.S., found that 18 patients received these drugs after surgery or radiation (adjuvant treatment), while 19 received them before surgery (neoadjuvant treatment). The common combination of a BRAF inhibitor with a MEK inhibitor significantly shrank tumours, with reductions of 70% to 100% in many cases, and up to 91% for those treated before surgery. Some patients required no further treatment afterward. However, questions remain about the optimal use of these drugs, including timing, combinations, and managing side effects. Despite these challenges, targeted therapies are promising in improving outcomes and quality of life for patients with this brain tumour, with future studies expected to refine their use. Background/Objectives: The recent discovery of BRAF mutation in papillary craniopharyngiomas opened new avenues for targeted therapies to control tumour growth, decreasing the need for invasive treatments and relative complications. The aim of this systematic review was to summarize the recent scientific data dealing with the use of targeted therapies in papillary craniopharyngiomas, as adjuvant and neoadjuvant treatments. Methods: The PRISMA guidelines were followed with searches performed in Scopus, MEDLINE, and Embase, following a dedicated PICO approach. Results: We included 21 pertinent studies encompassing 53 patients: 26 patients received BRAF inhibitors (BRAFi) as adjuvant treatment, while 25 received them as neoadjuvant treatment. In the adjuvant setting, BRAFi were used to treat recurrent tumours after surgery or adjuvant radiation therapy. The most common regimen combined dabrafenib (BRAFi) with trametinib (MEK1 and 2 inhibitor) in 81% of cases. The mean treatment length was 8.8 months (range 1.6 to 28 months) and 32% were continuing BRAFi. A reduction of tumour volume variable from 24% to 100% was observed at cerebral MRI during treatment and volumetric reduction ≥80% was described in 64% of cases. Once the treatment was stopped, adjuvant treatments were performed to stabilize patients in remission in 11 cases (65%) or when a progression was detected in three cases (12%). In four cases no further therapies were administered (16%). Mean follow-up after the end of targeted therapy was 17.1 months. As neoadjuvant regimen, 36% of patients were treated with dabrafenib and trametinib with a near complete radiological response in all the cases with a mean treatment of 5.7 months. The neoadjuvant use of verumafenib (BRAFi) and cometinib (MEK1 inhibitor) induced a near complete response in 15 patients (94%), with a median volumetric reduction between 85% and 91%. Ten patients did not receive further treatments. Side effects varied among studies. The optimal timing, sequencing, and duration of treatment of these new therapies should be established. Moreover, questions remain about the choice of specific BRAF/MEK inhibitors, the optimal protocol of treatment, and the strategies for managing adverse events. Conclusions: Treatment is shifting to a wider multidisciplinary management, where a key role is played by targeted therapies, to improve outcomes and quality of life for patients with BRAF-mutated craniopharyngiomas. Future, larger comparative trials will optimize their protocol of use and integration into multimodal strategies of treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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