Patient-reported Symptoms of Tenosynovial Giant Cell Tumors.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: CONFLICTS OF INTEREST G. Maclaine and X. Ye are employees of Daiichi Sankyo Development Ltd, which provided financial support for this research. S. Tong and P. Lin are employees of Plexxikon Inc, which provided financial support for this research. J.H. Healey is a paid consultant of Daiichi Sankyo Development Ltd. H. Hsu is a paid consultant of Plexxikon Inc. S. Anthony is a paid member of the Paradigm Medical Evidence Team and a paid consultant of Zymeworks Biopharmaceuticals. W. Taq is a paid consultant of Plexxikon and Daiichi Sankyo Development Ltd. The institutions of S. Bukata, D. Von Hoff, and V. Keedy received funding from Plexxikon for conducting the study for this work. D. Von Hoff is a paid consultant of Five Prime Therapeutics. H. Gelhorn, K. McQuarrie, C. Vernon, J. Hanlon, W. Lenderking, and R. Speck participated in this project as employees of Evidera, a company which performs work for hire for multiple pharmaceutical and device companies in outcomes research. K. McQuarrie is currently employed by Janssen. A. Wagner, A. Singh, C. Becerra, J. Hanlon, and R. Lackman have no conflicts of interest related to this work to report. 8. Onco Targets Ther. 2022 Jan 13;15:53-66. doi: 10.2147/OTT.S345878. eCollection 2022. Pexidartinib in the Management of Advanced Tenosynovial Giant Cell Tumor: Focus on Patient Selection and Special Considerations. Vaynrub A(1), Healey JH(2), Tap W(3), Vaynrub M(2). Author information: (1)Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. (2)Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. (3)Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Tenosynovial giant cell tumor (TGCT) is a neoplasm of the joint synovium that can have severe impacts on joint mobility, function, and quality of life. Traditionally, treatment modalities included partial or complete surgical synovectomy, radiotherapy (typically as an adjunct to surgery), and watchful monitoring (no medical or surgical intervention). However, these approaches have been met with varying degrees of success and high recurrence rates, as well as onerous complications and clinical sequelae. Pexidartinib, a colony-stimulating factor 1 receptor (CSF1R) inhibitor, presents a promising molecular approach that targets a neoplastic driver of TGCT. While the introduction of pexidartinib allows clinicians to avoid the significant morbidity associated with traditional treatment options, there are also defined risks associated with pexidartinib treatment. Therefore, patient selection is critical in optimizing treatment modalities in TGCT. The purpose of this literature review is to identify the TGCT patient population that would derive maximal benefit with minimal risk from pexidartinib, and to determine the specific indications and contraindications for selecting pexidartinib over other therapeutic approaches. Specifically, this paper compares the efficacy and safety profile of pexidartinib across clinical and preclinical studies to that of surgery, radiotherapy, and watchful monitoring. Rates of improvement in joint mobility, pain, and recurrence-free survival across studies of pexidartinib have been encouraging. The most common adverse events are mild (hypopigmentation of the hair) or reversible (transient aminotransferase elevation). Severe or permanent adverse events (notably cholestatic hepatotoxicity) are rare. While the optimal treatment strategy remains highly dependent on a patient's clinical circumstances and treatment goals, pexidartinib has surfaced as a promising therapeutic in cases where the morbidity of surgery or radiotherapy outweighs the benefits. © 2022 Vaynrub et al. DOI: 10.2147/OTT.S345878 PMCID: PMC8763255