Protocol Number: 01-C-0222
Patients with NF1 have a reduced amount of the protein neurofibromin. Neurofibromin is thought to help control the activity of another protein, called ras, which regulates cell growth. Too little neurofibrin, therefore, may allow for uncontrolled cell growth and tumor formation. R115777 interferes with the function of the ras and other proteins. In test tube and animal studies, R115777 has blocked the growth of cancer cells. This study will examine whether the drug is effective against plexiform tumors. Patients with NF1 and progressive plexiform neurofibromas between 3 and 25 years of age may be eligible for this study. Patients whose tumors can be successfully removed surgically may not participate in this study. Candidates will have a medical history and physical and eye examinations, blood and urine tests, and magnetic resonance imaging (MRI). Photographs will be taken of tumors visible on the body surface. Study participants will be randomly assigned to receive either R115777 or placebo (an inactive substance). They will take R115777 or placebo tablets every 12 hours for 21 days, followed by a 7-day rest period. This constitutes one 28-day treatment cycle. Treatment will continue as long as the tumors remain stable or shrink and side effects are tolerable. The treatment will be switched (for example, from placebo to R115777) or stopped if the tumors grow and will be stopped if side effects are unacceptable. Patients (or their parents) will be asked to keep a record of side effects. For the first 3 months of treatment, patients will have a physical examination and blood tests every other week. Blood tests will also be done before cycles 3, 6, 9 and 12 to measure protein levels and the level of a substance called nerve growth factor. MRI scans will be done periodically throughout treatment to measure the size of the tumors. Cells will be collected from inside the cheek before the first treatment dose and at one point in time after at least 14 days of treatment on each study phase (R115777 or placebo). A tissue biopsy (surgical removal of a small tumor tissue sample) will be requested before treatment begins and again at least 2 weeks after treatment starts, if tumor nodules are easily accessible for biopsy. Tumor samples may also be obtained from tissue removed from patients who must undergo surgery for medical management of their disease. The tissue samples will be analyzed for changes in the NF1 and ras genes and in the ras protein. Patients (or their parents) will also be asked periodically throughout the course of treatment to fill out questionnaires assessing quality of life.
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