case_images: PMC11401142_01
case_images: Tumor response to mTOR inhibitors. CT scan evaluation during merestinib-based treatment at baseline (a), 2 months (b), and 5 months (c). CT scan evaluation during everolimus in monotherapy at baseline (d) and after 3 months (e).. mTOR: mammalian target of rapamycin.
case_images: 10.1177_17588359241271793-fig1.jpg
case_images: PMC11401142_01_10.1177_17588359241271793-fig1.jpg
case_images: fig1-17588359241271793
case_images: Caucasian patient, with diabetes and no alcohol or tobacco intoxication, was diagnosed with anicteric cholestasis. Computed tomography scan evaluation displayed portal hypertension with ascites associated with a large tumor infiltrating the right liver and lymph node metastasis without distant lesions (Figure 1(a)). He was randomized in the merestinib arm (80 mg daily), an oral kinase inhibitor developed initially to target the MET kinase, but it might also interfere with mTOR activation through MNK1 and MNK2 inhibition.   Two months after initiation of treatment, the tumor was evaluated in stable disease per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST). However, important tumor necrosis was observed with the disappearance of all enhancing lesions in favor of a complete response based on modified RECIST (mRECIST) (Figure 1(b)). Five months after treatment initiation, the tumor was still stable according to the RECIST criteria, and intra-lesional calcifications were observed as well as the disappearance of ascites (Figure 1(c)). ARID1A (c.2282delA; VAF: 27%), and ARID2 (c.2416C>T; VAF: 26%). At progression (Figure 1(d)), given the genomic profiling supporting the activity of the mTOR pathway, the patient was treated with everolimus (10 mg daily), an mTOR inhibitor. Three months after everolimus introduction, the tumor was evaluated in stable disease according to the RECIST criteria with decreased contrast enhancement corresponding to a partial response with mRECIST (Figure 1(e)).