The goal of this study is to evaluate the effectiveness of trametinib treatment in patients with Hyperthropic cardiomyopathy and a genetic mutation in the RAS/MAPK pathway.
Introduction RASopathies are a group of genetic diseases caused by mutations in the mitogen-activated kinase (RAS-MAPK) pathway. These mutations affect many processes and are the cause of numerous genetic syndromes (including Noonan syndrome) in the course of which severe hypertrophic cardiomyopathy (HCM) develops. MEK kinase inhibitors are used to treat cancers with mutations in the RAS-MAPK pathway in adults. So far, single cases of HCM treatment in patients with RASopathies have been described, with rapid improvement in both laboratory and echocardiographic parameters and regression of myocardial hypertrophy. Due to the described effectiveness, it is reasonable to verify these effects in a well-designed randomized study on a large group of patients. Objective To evaluate the effectiveness of trametinib treatment in patients with HCM and a genetic mutation in the RAS/MAPK pathway. Methodology Randomized, open-label study. The study will include patients aged 0 to 18 with: * mutation in the RAS/MAPK pathway confirmed by genetic tests * HCM diagnosed by echocardiography In the first phase of the study (3 months), patients will be randomly assigned to one of two groups: * the intervention group will receive trametinib and standard treatment (beta-blocker and disopyramide) * the control group will receive only standard treatment. Once this phase is complete, patients will be assessed. If higher effectiveness is demonstrated in the intervention group, in the second phase of the study, patients in the intervention group will continue their current treatment and patients in the control group will receive trametinib treatment. Each group will receive trametinib for 12 months. Importance of the study The study results will provide grounds for routine introduction of MEK kinase inhibitors for the treatment of patients with HCM due to RASopathy. If effectiveness is demonstrated, this group will gain a simple, non-invasive and causal treatment option.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
40
Trametynib orally once daily in 0,025mg/kg dose
Disopiramide and Beta blockers orally
Department of Paediatrics, The Medical University of Warsaw, Poland
Warsaw, Poland
RECRUITINGEffectiveness of the trametynib treatment on cardiac hyperthropy
Reduction of cardiac hypertrophy and/or LVOTO at 6 and 12 months of treatment and at 3 months of follow-up after treatment discontinuation using echocardiographic examination.
Time frame: 1 year
Effectiveness of the trametynib treatment on laboratory enzymes levels
Decrease in cardiac enzyme levels (NT-pro-BNP and high-sensitivity troponin I) determined in the 6th and 12th month of treatment and in the 3rd month of observation after its discontinuation.
Time frame: 1 year
MEK kinase activity
Assessment of MEK kinase activity before treatment and after 6 months of its duration, in the patients' blood samples
Time frame: 6 months
Effectivness of the trametynib treatment assessed in the cardia magnetic resonance
reduction of cardiac hypertrophy in magnetic resonance imaging in the age group of 7-18 years not requiring general anesthesia (comparison of results before inclusion in the study, after 12 months of trametinib treatment and after the end of follow-up after its discontinuation)
Time frame: 1 year
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