title: Everolimus treatment of abdominal lymphangioleiomyoma in five women with sporadic lymphangioleiomyomatosis.
abstract: OBJECTIVE
  Lymphangioleiomyomatosis (LAM) is a rare systemic disease of young women arising from mutations in the tuberous sclerosis complex (TSC) genes, TSC1 or TSC2. This disrupts the mammalian target of rapamycin (mTOR) pathway, affecting cellular proliferation and growth. mTOR inhibitors are a promising novel therapy in LAM. The mTOR inhibitor sirolimus is reported to produce resolution of lymphatic abnormalities in LAM, but the efficiacy of the mTOR inhibitor everolimus has not been assessed. We aimed to examine the efficacy of everolimus on lymphatic abnormalities in LAM.
  
  
  METHODS
  Open-label treatment of five patients with sporadic LAM (sLAM) and abdominopelvic and lung involvement at the outpatient LAM clinic of a tertiary city teaching hospital. Clinical data were collected during treatment of the women and included regular clinical reviews, everolimus levels, lung function and computed tomography assessment before and after 6 months of everolimus treatment.
  
  
  METHODS
  Symptoms and level of resolution of lymphangioleiomyomas.
  
  
  RESULTS
  All five women experienced significant shrinkage or complete resolution of the lymphangioleiomyomas during treatment. In one woman, cessation of everolimus resulted in recurrence of symptoms. Adverse events were compatible with the known side-effect profile of everolimus, but overall the drug was well tolerated.
  
  
  CONCLUSIONS
  This is the first report to suggest that everolimus has efficacy in the treatment of lymphangioleiomyoma and chylous ascites in sLAM.
authors.affiliation: St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Mohammadieh
authors.forename: Simon D
authors.initials: SD
authors.lastname: Bowler
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Silverstone
authors.forename: Allan R
authors.initials: AR
authors.lastname: Glanville
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Yates
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002915:Chylous Ascites / Q000188:drug therapy / Q000209:etiology; D004334:Drug Administration Schedule; D000068338:Everolimus; D005260:Female; D006801:Humans; D018192:Lymphangioleiomyomatosis / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus; D020123:Sirolimus