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Literature review of international mammalian target of rapamycin inhibitor use in the non-surgical management of haemodynamically significant cardiac rhabdomyomas

Published online by Cambridge University Press:  11 June 2020

Aoife Cleary
Affiliation:
Department of Paediatric Cardiology, Evelina London Children’s Hospital, SE1 7EHEngland, UK
Colin J. McMahon*
Affiliation:
Children’s Health Ireland, Crumlin, Dublin 12, Ireland
*
Author for correspondence: Prof. Colin McMahon, MD, MHPE, FACC, Department of Paediatric Cardiology, Children’s Health Ireland, Crumlin, Dublin 12, Ireland. Tel: +3531 4096160; Fax: +35314096181. E-mail: cmcmahon992004@yahoo.com

Abstract

Cardiac rhabdomyomas represent the most common primary paediatric cardiac tumour and typically regresses over time in the majority of patients. Among those who are symptomatic, surgical resection or catheterisation procedures have traditionally proven effective. More recently, those invasive or challenging tumours have been successfully treated with mammalian target of rapamycin inhibitors, typically everolimus and sirolimus. This review outlines the current medical literature of the state-of-the-art medical treatment of these tumours. We specifically focus on dosing regimens, duration of therapy, and side-effect profiles of mammalian target of rapamycin inhibitors among this population. Although the majority of cases responded to mammalian target of rapamycin inhibition, standardised guidelines for dosing and duration of treatment remain to be defined.

Type
Review Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Uzun, O, Wilson, DG, Vujanic, GM, Parsons, JM, De Giovanni, JV. Cardiac tumours in children. Orphanet J Rare Dis 2007; 2: 11.CrossRefGoogle ScholarPubMed
Ebrahimi-Fakhari, D, Mann, LL, Poryo, M, et al.Incidence of tuberous sclerosis and age at first diagnosis: new data and emerging trends from a national, prospective surveillance study. Orphanet J Rare Dis 2018; 13: 117.CrossRefGoogle ScholarPubMed
Black, MD, Kadletz, M, Smallhorn, JF, Freedom, RM.Cardiac rhabdomyomas and obstructive left heart disease: histologically but not functionally benign. Ann Thorac Surg 1998; 65: 13881390.CrossRefGoogle Scholar
Sciacca, P, Giacchi, V, Mattia, C, et al.Rhabdomyomas and tuberous sclerosis complex: our experience in 33 cases. BMC Cardiovasc Disord 2014; 14: 66.CrossRefGoogle ScholarPubMed
Bosi, G, Lintermans, JP, Pellegrino, PA, Svaluto-Moreolo, G, Vliers, A.The natural history of cardiac rhabdomyoma with and without tuberous sclerosis. Acta Paediatr 1996; 85: 928931.CrossRefGoogle ScholarPubMed
Jóźwiak, S, Kotulska, K, Kasprzyk-Obara, J, et al.Clinical and genotype studies of cardiac tumors in 154 patients with tuberous sclerosis complex. Pediatrics 2006; 118: e1146e1151.CrossRefGoogle ScholarPubMed
Ilina, MV, Jaeggi, ET, Lee, KJ.Neonatal rhabdomyoma causing right ventricular inflow obstruction with duct-dependent pulmonary blood flow: successful stenting of PDA. Catheter Cardiovasc Interv 2007; 69: 881885.CrossRefGoogle ScholarPubMed
McMahon, CJ, Ayres, N, Lewin, M.Cardiac rhabdomyoma: a report of alternative strategies to surgical resection. Cardiol Young 2001; 11: 670672.CrossRefGoogle ScholarPubMed
Kotulska, K, Larysz-Brysz, M, Grajkowska, W, et al.Cardiac rhabdomyomas in tuberous sclerosis complex show apoptosis regulation and mTOR pathway abnormalities. Pediatr Dev Pathol 2009; 12: 89–95.CrossRefGoogle Scholar
Bornaun, H, Öztarhan, K, Erener-Ercan, T, et al.Regression of cardiac rhabdomyomas in a neonate after everolimus treatment. Case Rep Pediatr 2016; 2016: 8712962.Google Scholar
Mlczoch, E, Hanslik, A, Luckner, D, Kitzmüller, E, Prayer, D, Michel-Behnke, I.Prenatal diagnosis of giant cardiac rhabdomyoma in tuberous sclerosis complex: a new therapeutic option with everolimus. Ultrasound Obstet Gynecol 2015; 45: 618621.CrossRefGoogle ScholarPubMed
Demir, HA, Ekici, F, Yazal Erdem, A, Emir, S, Tunç, B.Everolimus: a challenging drug in the treatment of multifocal inoperable cardiac rhabdomyoma. Pediatrics 2012; 130: e243e247.CrossRefGoogle ScholarPubMed
Wagner, R, Riede, FT, Seki, H, et al.Oral everolimus for treatment of a giant left ventricular rhabdomyoma in a neonate-rapid tumor regression documented by real time 3D echocardiography. Echocardiography 2015; 32: 18761879.CrossRefGoogle Scholar
Öztunç, F, Atik, SU, Güneş, AO.Everolimus treatment of a newborn with rhabdomyoma causing severe arrhythmia. Cardiol Young 2015; 25: 14111414.CrossRefGoogle ScholarPubMed
Colaneri, M, Quarti, A, Pozzi, M.Everolimus-induced near-resolution of giant cardiac rhabdomyomas and large renal angiomyolipoma in a newborn with tuberous sclerosis complex. Cardiol Young 2016; 26: 10251028.CrossRefGoogle Scholar
Doğan, V, Yeşil, Ş, Kayalı, Ş, et al.Regression of symptomatic multiple cardiac rhabdomyomas associated with tuberous sclerosis complex in a newborn receiving everolimus. J Trop Pediatr 2015; 61: 7477.Google Scholar
Tiberio, D, Franz, DN, Phillips, JR.Regression of a cardiac rhabdomyoma in a patient receiving everolimus. Pediatrics 2011; 127: e1335e1337.CrossRefGoogle Scholar
Hoshal, SG, Samuel, BP, Schneider, JR, Mammen, L, Vettukattil, JJ.Regression of massive cardiac rhabdomyoma on everolimus therapy. Pediatr Int. 2016; 58: 397399.CrossRefGoogle ScholarPubMed
Goyer, I, Dahdah, N, Major, P.Use of mTOR inhibitor everolimus in three neonates for treatment of tumors associated with tuberous sclerosis complex. Pediatr Neurol 2015; 52: 450453.CrossRefGoogle ScholarPubMed
Breathnach, C, Pears, J, Franklin, O, Webb, D, McMahon, CJ.Rapid regression of left ventricular outflow tract rhabdomyoma after sirolimus therapy. Pediatrics 2014; 134: e1199e1202.CrossRefGoogle ScholarPubMed
Ninic, S, Kalaba, M, Jovicic, B, et al.Successful use of sirolimus for refractory atrial ectopic tachycardia in a child with cardiac rhabdomyoma. Ann Noninvasive Electrocardiol 2017; 22: e12435.CrossRefGoogle Scholar
Chang, JS, Chiou, PY, Yao, SH, Chou, IC, Lin, CY. Regression of neonatal cardiac rhabdomyoma in two months through low-dose everolimus therapy: a report of three cases. Pediatr Cardiol 2017; 38: 14781484.CrossRefGoogle Scholar
Choudhry, S, Nguyen, HH, Anwar, S.Rapid resolution of cardiac rhabdomyomas following everolimus therapy. BMJ Case Report 2015; 2015: bcr2015212946.Google ScholarPubMed
Davis, KA, Dodeja, AK, Clark, A, et al.Use of cardiac MRI to assess antitumor efficacy of everolimus in sporadic cardiac rhabdomyoma. Pediatrics 2019; 143: e20182495.CrossRefGoogle ScholarPubMed
Saffari, A, Brösse, I, Wiemer-Kruel, A, et al.Safety and efficacy of mTOR inhibitor treatment in patients with tuberous sclerosis complex under 2 years of age – a multicenter retrospective study. Orphanet J Rare Dis 2019; 14: 96.CrossRefGoogle ScholarPubMed
Patel, C, Abraham, S, Ferdman, D. Rapid regression of prenatally identified intrapericardial giant rhabdomyomas with sirolimus. CASE (Phila). 2018; 2: 258261.CrossRefGoogle Scholar
Martínez-García, A, Michel-Macías, C, Cordero-González, G, et al.Giant left ventricular rhabdomyoma treated successfully with everolimus: case report and review of literature. Cardiol Young 2018; 28: 903909.CrossRefGoogle ScholarPubMed
Weiland, MD, Bonello, K, Hill, KD.Rapid regression of large cardiac rhabdomyomas in neonates after sirolimus therapy. Cardiol Young 2018; 28: 485489.CrossRefGoogle ScholarPubMed
Castro-Monsalve, J, Alvarado-Socarras, JL, Mantilla, KA, Forero, L, Moreno, A, Prada, CE. Cardiac rhabdomyomas in tuberous sclerosis complex. J Pediatr 2018; 192: 264264.e1.CrossRefGoogle Scholar
Lee, SJ, Song, ES, Cho, HJ, Choi, YY, Ma, JS, Cho, YK.Rapid regression of obstructive cardiac rhabdomyoma in a preterm neonate after sirolimus therapy. Biomed Hub 2017; 2: 16.CrossRefGoogle Scholar
Pang, LY, Zou, LP, Huang, LL, et al.Rapamycin in the treatment of cardiac rhabdomyoma associated with tuberous sclerosis complex. Zhonghua Er Ke Za Zhi 2016; 54: 424427.Google ScholarPubMed
Shibata, Y, Maruyama, H, Hayashi, T, et al.Effect and complications of everolimus use for giant cardiac rhabdomyomas with neonatal tuberous sclerosis. AJP Rep 2019; 9: e213e217.Google ScholarPubMed
Garg, A, Gorla, SR, Kardon, RE, Swaminathan, S.Rapid involution of large cardiac rhabdomyomas with everolimus therapy. World J Pediatr Congenit Heart Surg 2019: 2150135118822711.CrossRefGoogle Scholar
Dhulipudi, B, Bhakru, S, Rajan, S, Doraiswamy, V, Koneti, NR.Symptomatic improvement using everolimus in infants with cardiac rhabdomyoma. Ann Pediatr Cardiol 2019; 12: 4548.Google ScholarPubMed
Sánchez-Fructuoso, AI, Ruiz, JC, Pérez-Flores, I, Gómez Alamillo, C, Calvo Romero, N, Arias, M.Comparative analysis of adverse events requiring suspension of mTOR inhibitors: everolimus versus sirolimus. Transplant Proc 2010; 42: 30503052.CrossRefGoogle ScholarPubMed
Tenderich, G, Fuchs, U, Zittermann, A, Muckelbauer, R, Berthold, HK, Koerfer, R.Comparison of sirolimus and everolimus in their effects on blood lipid profiles and haematological parameters in heart transplant recipients. Clin Transplant 2007; 21: 536543.CrossRefGoogle ScholarPubMed
Stelmaszewski, EV, Parente, DB, Farina, A, et al.Everolimus for cardiac rhabdomyomas in children with tuberous sclerosis. The ORACLE study protocol (everOlimus for caRdiac rhAbdomyomas in tuberous sCLErosis): a randomised, multicentre, placebo-controlled, double-blind phase II trial. Cardiol Young 2020; 30: 337345.CrossRefGoogle ScholarPubMed