Targeted therapy for capillary-venous malformations

Sporadic venous malformations are genetic conditions primarily caused by somatic gain-of-function mutation of PIK3CA or TEK,an endothelial transmembrane receptor signaling through PIK3CA.Venous malformations are associated with pain,bleedings,thrombosis,pulmonary embolism,esthetic deformities and,in severe cases,life-threatening situations.No authorized medical treatment exists for patients with venous malformations.Here,we created a genetic mouse model of PIK3CA-related capillary venous malformations that replicates patient phenotypes.We showed that these malformations only partially signal through AKT proteins.We compared the efficacy of different drugs,including rapamycin,a mTORC1 inhibitor,miransertib,an AKT inhibitor and alpelisib,a PI3Kαinhibitor at improving the lesions seen in the mouse model.We demonstrated the effectiveness of alpelisib in preventing vascular malformations’occurrence,improving the already established ones,and prolonging survival.Considering these findings,we were authorized to treat 25 patients with alpelisib,including 7 children displaying PIK3CA(n=16)or TEK(n=9)-related capillary venous malformations resistant to usual therapies including sirolimus,debulking surgical procedures or percutaneous sclerotherapies.We assessed the volume of vascular malformations using magnetic resonance imaging(MRI)for each patient.Alpelisib demonstrated improvement in all 25 patients.Vascular malformations previously considered intractable were reduced and clinical symptoms were attenuated.MRI showed a decrease of 33.4%and 27.8%in the median volume of PIK3CA and TEK malformations respectively,over 6 months on alpelisib.In conclusion,this study supports PI3Kαinhibition as a promising therapeutic strategy in patients with PIK3CA or TEK-related capillary venous malformations.

Pharmacogenetics implementation in the clinics:information and guidelines for germline variants

The aim of this work was to supply an overview of the germline Pharmacogenetics that can be already implemented in the oncology clinical practice.An explanation of the three pillars considered necessary for determining which genetic polymorphisms should be used has been provided.These are PharmGKB single nucleotide polymorphism(SNP)-Drug Clinical Annotations with levels of evidence 1 or 2;the genetic information provided in the drug labels by the drug regulatory main agencies(Food and Drug Administration and European Medicines Agency,mainly);and the guidelines elaborated by international expert consortia(mainly Clinical Pharmacogenetics Implementation Consortium and Dutch Pharmacogenetics Working Group).A summary of the relevant SNPs and the recommendations on how to apply their results has also been compiled.