Pimicotinib MANEUVER Data and Treatment Around Joint Replacement

Dale R. Shepard, MD, PhD, of Cleveland Clinic, reviews the phase 3 MANEUVER trial of pimicotinib, an investigational once-daily colony-stimulating factor 1 receptor (CSF1R) inhibitor under US Food and Drug Administration review for tenosynovial giant cell tumor (TGCT), with R. Lor Randall, MD, FACS, of UC Davis Health, and Alexander B. Christ, MD, of UCLA Health. In patients with symptomatic, unresectable disease, the overall response rate at week 25 was 54% vs 3% with placebo, with improvements in stiffness, pain, physical function, and range of motion that continued over time and held across joints. Dr Shepard reports no pexidartinib-like liver toxicity and says side effects appear early without building over time. He expects dosing, once daily vs twice weekly for vimseltinib, could become a differentiator for patients. Dr Christ welcomes a third option and describes using these drugs before and after joint replacement to calm inflammation and possibly improve implant survival.