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Treatment of voluminous and complicated superficial slow-flow vascular malformations with sirolimus (PERFORMUS): protocol for a multicenter phase 2 trial with a randomized observational-phase design

Annabel Maruani 1, 2, 3 Olivia Boccara 4, 5 Didier Bessis 6 Laurent Guibaud Pierre Vabres 7 Juliette Mazereeuw-Hautier 8 Sébastien Barbarot 9 Christine Chiaverini 10 Sophie Blaise 11 Catherine Droitcourt 12 Stephanie Mallet 13 Ludovic Martin 14 Gérard Lorette 2 Jean-Baptiste Woillard Annie-Pierre Jonville-Bera 1, 15 Rollin Jérôme 16 Yves Gruel 16 Denis Herbreteau 17 Dominique Goga 18 Anne Le Touze 19 Sophie Leducq 2 Valerie Gissot 20, 3 Baptiste Morel 21 Elsa Tavernier 3, 1 Bruno Giraudeau 3, 1
Abstract : Background: Slow-flow superficial vascular malformations (VMs) are rare congenital anomalies that can be responsible for pain and functional impairment. Currently, we have no guidelines for their management, which can involve physical bandages, sclerotherapy, surgery, anti-inflammatory or anti-coagulation drugs or no treatment The natural history is progressive and worsening. Mammalian target of rapamycin (mTOR) is a serine/threonine kinase that acts as a master switch in cell proliferation, apoptosis, metabolism and angio/lymphangiogenesis. Sirolimus directly inhibits the mTOR pathway, thereby inhibiting cell proliferation and angio/lymphangiogenesis. Case reports and series have reported successful use of sirolimus in children with different types of vascular anomalies, with heterogeneous outcomes. Objective: The objective of this trial is to evaluate the efficacy and safety of sirolimus in children with complicated superficial slow-flow VMs. Methods/design: This French multicenter randomized observational-phase, phase 2 trial aims to include 50 pediatric patients 6 to 18 years old who have slow-flow (lymphatic, venous or lymphatico-venous) voluminous complicated superficial VM. Patients will be followed up for 12 months. All patients will start with an observational period (no treatment). Then at a time randomly selected between month 4 and month 8, they will switch to the experimental period (switch time), when they will receive sirolimus until month 12. Each child will undergo MRI 3 times: at baseline, at the switch time, and at month 12. For both periods (observational and treatment), we will calculate the relative change in volume of the VM divided by the study period duration. This relative change weighted by the study period duration will constitute the primary endpoint. VM will be measured by MRI images, which will be centralized and interpreted by the same radiologist who will be blinded to the study period. Hence, each patient will be his/her own control. Secondary outcomes will include assessment of safety and efficacy by viewing standardized digital photographs and according to the physician, the patient or proxy; impact on quality of life; and evolution of biological makers (coagulation factors, vascular endothelial growth factor, tissue factor). Discussion: The main benefit of the study will be to resolve uncertainty concerning the efficacy of sirolimus in reducing the volume of VMs and limiting related complications and the safety of the drug in children with slowflow VMs. This trial design is interesting in these rare conditions because all included patients will have the opportunity to receive the drug and the physician can maintain it after the end of the protocol if is found efficient (which would not be the case in a classical cross-over study).
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Contributeur : Lnc - Université de Bourgogne <>
Soumis le : mardi 5 mars 2019 - 09:02:23
Dernière modification le : mercredi 19 août 2020 - 11:17:51

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Annabel Maruani, Olivia Boccara, Didier Bessis, Laurent Guibaud, Pierre Vabres, et al.. Treatment of voluminous and complicated superficial slow-flow vascular malformations with sirolimus (PERFORMUS): protocol for a multicenter phase 2 trial with a randomized observational-phase design. Trials, BioMed Central, 2018, 19 (1), pp.340. ⟨10.1186/s13063-018-2725-1⟩. ⟨hal-02057029⟩



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