Vincristine-induced peripheral neuropathy (VIPN) is a debilitating side-effect of vincristine. It remains a challenge to predict which patients will suffer from VIPN. Pharmacogenomics may explain an individuals’ susceptibility to side-effects. In this systematic review and meta-analysis, we describe the influence of pharmacogenomic parameters on the development of VIPN in children with cancer. PubMed, Embase and Web of Science were searched. In total, 1597 records were identified and 21 studies were included. A random-effects meta-analysis was performed for the influence of CYP3A5 expression on the development of VIPN. Single-nucleotide polymorphisms (SNPs) in transporter-, metabolism-, cytoskeleton-, and hereditary neuropathy-associated genes and SNPs in genes previously unrelated to vincristine or neuropathy were associated with VIPN. CYP3A5 expression status was not significantly associated with VIPN. The comparison and interpretation of the results of the included studies was limited due to heterogeneity in the study population, treatment protocol and assessment methods and definitions of VIPN. Independent replication is essential to validate the clinical significance of the reported associations. Future research should aim for prospective VIPN assessment in both a discovery and a replication cohort. Ultimately, the goal would be to screen patients upfront to determine optimal vincristine dosage with regards to efficacy and risk of VIPN.

Monotherapy with PI3K/AKT/mTOR inhibitors resulted in a pooled CBR of 32% and ORR of 3% in ovarian cancer patients.• Exclusion of stable disease for a period below 6 months as a beneficial outcome measure reduced the pooled CBR to 7%.• Drug-related grade 3 and 4 toxicities occurred in 36% (range 0-80%) of the patients.• Current PI3K/AKT/mTOR biomarkers insufficiently predict therapy response indicating the need for improved biomarker assays.• Combined treatments regimes targeting two signaling pathways may provide favorable outcomes over single agent therapy.