Pelvic lymphangioleiomyomatosis treated successfully with everolimus: Two case reports with literature review

• Published in: Medicine (Baltimore) Vol. 96; no. 10; p. e4562
• Main Authors: Wahid, Sharjil, Chiang, Ping Chia, Luo, Hao Lun, Huang, Shun-Chen, Tsai, Eing-Mei, Chiang, Po Hui
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.03.2017
• Subjects: Adult; Antineoplastic Agents - therapeutic use; Clinical Case Report; Everolimus - therapeutic use; Female; Humans; Lymphangioleiomyomatosis - drug therapy; Lymphangioleiomyomatosis - pathology; Middle Aged; Pelvic Neoplasms - drug therapy; Pelvic Neoplasms - pathology; Pelvis - pathology
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000004562

Lymphangioleiomyomatosis (LAM) is a rare disease affecting young women caused by abnormal proliferation of smooth muscle-like cells (LAM cells) in the lungs and extrapulmonary sites (extrapulmonary LAM). The objective of this case series is to demonstrate marked regression in 2 cases of retroperitoneal LAM after treatment with everolimus, an mTOR inhibitor. We enrolled 2 cases with large volume, extrapulmonary pelvic LAM, and evaluated them with contrast-enhanced abdominal computed tomographic (CT) scans at presentation and serially during treatment with everolimus. Results were objectively quantified using the Response Evaluation Criteria in Solid Tumors, RECIST, Version 1.1. After 12 to 18 months of treatment with everolimus, both patients showed substantial reduction in the volume of their tumors. The first had about 50% regression of the pelvic LAM and renal angiomyolipoma (AML). The second patient had extensive abdomino-pelvic LAM which after treatment showed complete remission. Both patients have not demonstrated disease progression after nearly 4 and 2 years of follow-up, respectively. This case series demonstrates the enormous value of mTOR inhibitors (specifically everolimus) in the management of extrapulmonary pelvic LAM, of which there is no effective treatment currently available.