Everolimus treatment for adults with vascular malformations who cannot have effective surgery

An Open-Label, Single-Arm Exploratory Clinical Study of Everolimus for the Treatment of Vascular Malformations

This study will try daily oral everolimus in adults with vascular malformations who are not good candidates for surgery to see if it shrinks lesions and improves symptoms.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 10 (estimated)
• Ages: 18 Years to 65 Years
• Sex: All
• Sponsor: Xuanwu Hospital, Beijing (other)
• Drugs / interventions: radiation
• Locations: 1 site (Beijing)
• Trial ID: NCT07037238 on ClinicalTrials.gov

What this trial studies

This is an open-label, single-arm Phase 2 trial enrolling 10 adults aged 18–65 with MRI-confirmed vascular malformations judged unsuitable for effective surgical treatment. Participants will take oral everolimus 10 mg once daily in continuous 28-day cycles until progression, unacceptable toxicity, or other stopping criteria. The primary efficacy measure is change in target lesion volume by MRI, with scheduled imaging at baseline, after cycles 3, 6, and 12, then every six cycles and at end of treatment; safety, microbleeding, iron deposition, hemorrhage risk, clinical signs, symptom scores, and quality of life will also be tracked. Blood samples for biomarkers and standard labs will be collected centrally to monitor organ function and safety throughout treatment.

Who should consider this trial

Good fit: Adults aged 18–65 with MRI-confirmed vascular malformations who are judged by investigators to be unsuitable for effective surgical treatment and who meet organ-function and laboratory criteria are eligible.

Not a fit: Patients who are candidates for effective surgical correction, who have serious organ dysfunction, recent major surgery, or contraindications to mTOR inhibitors are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, everolimus could reduce lesion size and bleeding risk and improve symptoms and quality of life, offering a non-surgical therapy option for patients who cannot undergo effective surgery.

How similar studies have performed: mTOR inhibitors such as sirolimus have shown benefit in other vascular anomaly studies, but everolimus monotherapy for these lesions is less well-studied, so this trial is exploratory.

Eligibility criteria

Inclusion Criteria

* Patients aged ≥18 and ≤65 years;
* No gender restrictions;
* Diagnosed with vascular malformation by MRI;
* No major surgery within the past 3 months;
* Able to swallow and retain oral medication, with no significant gastrointestinal abnormalities that may affect drug absorption, such as malabsorption syndrome, intestinal obstruction, or extensive gastrointestinal resection;
* Able to provide peripheral blood samples for biomarker testing at a central laboratory;
* Patients must have adequate organ and bone marrow function, and must not have received blood transfusions or any supportive treatments (e.g., cytokines or erythropoietin) to increase white blood cells, platelets, or hemoglobin levels within 7 days before screening tests:Absolute neutrophil count ≥1.0×10⁹/L;Hemoglobin ≥90 g/L; Platelets ≥100×10⁹/L;Total bilirubin ≤1.5× upper limit of normal (ULN), or ≤3.0× ULN for patients with Gilbert's syndrome;AST and ALT ≤2.5× ULN;Albumin ≥3 g/dL; Serum creatinine \<1.5× ULN or creatinine clearance ≥50 mL/min;Urine protein \<2+; if ≥2+, then 24-hour urine protein must be ≤1 g;Coagulation: International normalized ratio (INR) and activated partial thromboplastin time (APTT) ≤1.5× ULN.
* Patients must voluntarily sign the written informed consent form and be able to complete follow-up;
* For patients of childbearing potential: they must agree to use highly effective contraceptive methods, such as combined hormonal contraception, progestogen-only hormonal contraception associated with ovulation inhibition, intrauterine devices (IUDs), intrauterine hormonal systems (IUS), bilateral tubal occlusion, or partner vasectomy, or to practice sexual abstinence during the treatment period and for at least 90 days after the last dose. Male patients must agree to refrain from sperm donation for at least 90 days after the last dose.

Exclusion Criteria:

* Diagnosed with Hereditary Hemorrhagic Telangiectasia (HHT), Arteriovenous Malformation (AVM), or PTEN Hamartoma Tumor Syndrome (PHTS);
* Patients who have previously received any of the following treatments after birth: participation in other interventional clinical trials targeting cerebral cavernous malformations (CM);
* Presence of malignant tumors currently or within the past three years, except for curatively treated non-melanoma skin basal cell carcinoma, ductal carcinoma in situ of the breast, or cervical carcinoma in situ;
* Unable to undergo MRI scans and/or have contraindications for MRI (e.g., interference from prosthetics, orthodontic devices, etc., affecting target lesion volume analysis on MRI);
* Modified Rankin Scale (mRS) score of 5, respiratory failure, or currently experiencing severe bleeding requiring life-support treatment;
* Severe renal failure (e.g., creatinine clearance \\\[CrCl\] \< 30 mL/min, or significantly elevated serum creatinine not correctable by other means), recent history (within past 3 months) of renal failure or end-stage renal disease without effective treatment, or currently undergoing dialysis;
* Severe hepatic failure, including but not limited to: Child-Pugh Class C or higher, recent (within 3 months) uncontrolled symptoms related to hepatic failure such as ascites, jaundice, coagulopathy, or hepatic encephalopathy, or patients requiring liver transplantation;
* Currently using other immunosuppressants or patients with immunodeficiency;
* Patients requiring use of medications that interfere with or inhibit CYP3A4 enzyme activity, or medications such as cisapride or metoclopramide;
* Patients with dysphagia, active gastrointestinal disorders, malabsorption syndrome, or other conditions that may affect the absorption of the investigational drug;
* Interstitial pneumonitis, including clinically significant radiation pneumonitis;
* Severe asthma;
* Uncontrolled diabetes mellitus;
* Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirements;
* First-degree relatives with a history of sudden cardiac death before the age of 50. First-degree relatives are defined as those with a direct bloodline, such as parents and children, grandparents and grandchildren, or maternal grandparents and maternal grandchildren;
* Active bacterial, fungal, or viral infections, including active hepatitis B (HBsAg positive with HBV DNA \> 1000 IU/mL or meeting local diagnostic criteria for active HBV infection), hepatitis C (HCV RNA positive), or HIV infection (HIV positive);
* Pregnant or breastfeeding women. Any patient who becomes pregnant during the trial must withdraw from the study;
* Known hypersensitivity to everolimus, other rapamycin derivatives, or any of the excipients in this product. Observed allergic reactions to everolimus or related compounds include but are not limited to: hypersensitivity, dyspnea, flushing, chest pain, or angioedema (e.g., airway or tongue swelling with or without respiratory compromise);
* Other factors, as determined by the investigator, that may lead to early study termination, such as presence of other severe diseases (including psychiatric disorders) requiring concomitant treatment, significantly abnormal lab values, or social/family issues that may affect patient safety or data collection.

Where this trial is running

Beijing

• the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University — Beijing, China (RECRUITING)

Study contacts

• Study coordinator: Tao Hong, MD

Conditions: Vascular Malformations, Vascular malformations, mTOR Inhibitors, Pharmacological Treatment