I'm sorry about your wife. Cancer hits home for me, it's a terrible disease that nobody should have to go through. As a physician in training however, I can as

I'm sorry about your wife. Cancer hits home for me, it's a terrible disease that nobody should have to go through. As a physician in training however, I can assure you that some of us indeed know about mTOR and VEGF inhibitors, the signaling pathways, and what we could potentially use them for. We learn about it in school. If anything, this story is more of a commentary on how mandatory genetic testing may be more helpful in the treatment of rare diseases. Castleman's is a broad definition for what is going on. Some patients benefit from Anti-IL6 therapy, but maybe some, like Dr. Fajgenbaum, benefit from mTOR inhibitors like sirolimus. That makes me feel like each Castleman's patient may have a different underlying cause for the same severe symptoms. As far as I know, physicians use certain medications for off label use. VEGF is of interest to me and my research, so I know how we've used the VEGF inhibitor Avastin (bevacizumab), originally approved for colon cancer, for macular degeneration. More and more uses are becoming known for many drugs. As a side note, this patient's use of sirolimus to treat Castleman's is still akin to using a blunt device on the signaling pathway that mTOR is a part of. It still hasn't truly gotten him any closer to figuring out the cause of his Castleman's disease.