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This report of three patients with malignant PEComa responding to oral sirolimus was the first evidence that these tumours, which share TSC1/TSC2 loss with tuberous sclerosis, depend on the mTOR pathway.
Case series of three patients with metastatic malignant PEComa treated with sirolimus, all showing radiological responses, with molecular analysis of tumour tissue demonstrating loss of TSC2 and activation of mTORC1 signalling.
mTOR inhibition became the therapeutic strategy for PEComa, culminating in the AMPECT trial and approval of nab-sirolimus.