Key result
The combination of gemcitabine and sirolimus led to marked tumor regression in two patients with TSC-mutated sarcomas who had previously progressed on nab-sirolimus and gemcitabine-based therapies.
Why the study?
Patients with TSC-mutated sarcomas have no standard-of-care treatment options after failure of the only FDA-approved agent, nab-sirolimus.
Does the combination of gemcitabine and sirolimus improve tumor response in patients with TSC-mutated sarcomas progressing on nab-sirolimus?
Case Report (n=2)
No
Does the combination of gemcitabine and sirolimus improve tumor response in patients with TSC-mutated sarcomas progressing on nab-sirolimus?
The combination of gemcitabine and sirolimus may represent a valid therapeutic option for patients with TSC-mutated sarcomas who have progressed on nab-sirolimus.
Case reports of nab-sirolimus responses in TSC-mutated sarcomas remain hypothesis-generating; prospective trials needed before practice change.
TSC-mutated sarcomas are rare molecular and histologic types of sarcoma. Due to the presence of their specific oncogenic driver mutation, these sarcomas are particularly sensitive to mTOR inhibitors. Recently, nab-sirolimus, an albumin-bound mTOR inhibitor, was approved by the Food and Drug Administration (FDA) for PEComas, which harbor a TSC mutation, and this drug remains the only FDA-approved systemic treatment for these tumors. We report on two cases of patients with TSC-mutated sarcomas who experienced significant responses to the combination of gemcitabine and sirolimus, after progression on prior gemcitabine-based chemotherapy and single agent mTOR inhibition with nab-sirolimus. Preclinical and clinical data support rationale for a synergistic effect of the combination. This combination may represent a valid therapeutic option after failure of nab-sirolimus in these patients, with no standard-of-care treatment options.
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Nassif et al. (2023) conducted a case report in TSC-mutated sarcomas (n=2). Gemcitabine and sirolimus was evaluated on Tumor response. The combination of gemcitabine and sirolimus led to marked tumor regression in two patients with TSC-mutated sarcomas who had previously progressed on nab-sirolimus and gemcitabine-based therapies.
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