Trametinib for refractory chylous effusions and systemic complications in children with Noonan syndrome
TA Nakano, AW Rankin, A Annam… - The Journal of …, 2022 - Elsevier
TA Nakano, AW Rankin, A Annam, AM Kulungowski, LM McCallen, LR Hill, KC Chatfield
The Journal of pediatrics, 2022•ElsevierObjective To evaluate the effect of the RAS-MAPK pathway inhibitor trametinib on medically
refractory chylous effusions in 3 hospitalized patients with Noonan syndrome. Study design
Pharmacologic MEK1/2 inhibition has been used to treat conditions associated with Noonan
syndrome, given that activation of RAS-MAPK pathway variants leads to downstream MEK
activation. We describe our experience with 3 patients with Noonan syndrome (owing to
variants in 3 distinct genes) and refractory chylous effusions treated successfully with MEK …
refractory chylous effusions in 3 hospitalized patients with Noonan syndrome. Study design
Pharmacologic MEK1/2 inhibition has been used to treat conditions associated with Noonan
syndrome, given that activation of RAS-MAPK pathway variants leads to downstream MEK
activation. We describe our experience with 3 patients with Noonan syndrome (owing to
variants in 3 distinct genes) and refractory chylous effusions treated successfully with MEK …
Objective
To evaluate the effect of the RAS-MAPK pathway inhibitor trametinib on medically refractory chylous effusions in 3 hospitalized patients with Noonan syndrome.
Study design
Pharmacologic MEK1/2 inhibition has been used to treat conditions associated with Noonan syndrome, given that activation of RAS-MAPK pathway variants leads to downstream MEK activation. We describe our experience with 3 patients with Noonan syndrome (owing to variants in 3 distinct genes) and refractory chylous effusions treated successfully with MEK inhibition. A monitoring protocol was established to standardize medication dosing and monitoring of outcome measures.
Results
Subjects demonstrated improvement in lymphatic leak with additional findings of improved growth and normalization of cardiac and hematologic measurements. Trametinib was administered safely, with only moderate skin irritation in 1 subject.
Conclusions
Improvements in a variety of quantifiable measurements highlight the potential utility of MEK1/2 inhibition in patients with Noonan syndrome and life-threatening lymphatic disease. Larger, prospective studies are needed to confirm efficacy and assess long-term safety.
Elsevier
