Pilot Study of mTOR Inhibitor Therapy in Peutz-Jeghers Syndrome

Inclusion Criteria:

Yes/No (Response of "no" = patient ineligible)

1. Patients who are 18 years or older with a clinical or genetic diagnosis of Peutz-Jeghers Syndrome.
2. Patient has one or more intestinal polyps ≥ 5mm in maximum diameter by contrast enhanced CT scan that is not clinically indicated for removal or is beyond the reach of a push endoscope.
3. Minimum of two weeks since any major surgery.
4. Patient has had colonoscopy within the past 24 months and did not have high-grade dysplasia or colorectal cancers.
5. WHO performance status £ 2
6. Adequate bone marrow function as shown by: ANC ≥ 1.5 x 109/L, Platelets ≥ 100 x 109/L, Hgb \> 9 g/dL
7. Adequate liver function as shown by: serum bilirubin ≤ 1.5 x upper limit of normal (ULN), and serum transaminases activity ≤ 2.5 x ULN.
8. Patients must be able to provide written informed consent.

Exclusion Criteria:

Yes/No (Response of "yes" = patient ineligible)

1. Prior treatment with any investigational drug within the preceding 4 weeks
2. Chronic treatment with systemic steroids or another immunosuppressive agent
3. Patients should not receive immunization with attenuated live vaccines during study period or within one week of study entry
4. Uncontrolled brain or leptomeningeal metastases, including patients who continue to require glucocorticoids for brain or leptomeningeal metastases
5. Other malignancies within the past 3 years except for adequately treated carcinoma of the cervix or basal or squamous cell carcinomas of the skin.
6. Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study such as:

   1. Unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction ≤ 6 months prior to first study treatment, serious uncontrolled cardiac arrhythmia
   2. Severely impaired lung function
   3. Uncontrolled diabetes as defined by fasting serum glucose \>1.5x ULN
   4. Any active (acute or chronic) or uncontrolled infection/ disorders.
   5. Nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the treatment with the study therapy
   6. Liver disease such as cirrhosis, or severe hepatic impairment (Child-Pugh class C)
   7. A known history of HIV seropositivity
   8. Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of everolimus (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small bowel resection)
   9. Patients with an active, bleeding diathesis or on oral anti-vitamin K medication
7. Women who are pregnant or breast feeding, or women/men able to conceive and unwilling to practice an effective method of birth control throughout the trial and for 8 weeks after the last dose of study drug. (Women of childbearing potential must have a negative pregnancy test). Oral, implantable, or injectable contraceptives may be affected by cytochrome P450 interactions, and are therefore not considered effective for this study.
8. Male patients whose sexual partner(s) are WOCBP who are not willing to use adequate contraception during the study and for 9 weeks after the end of treatment.
9. Patients who have received treatment with an mTor inhibitor in the past 6 months.
10. Patients with a known hypersensitivity to RAD001 (everolimus) or other rapamycins (sirolimus, temsirolimus) or to its excipients

Patients who can not undergo FDG-PET are eligible to participate in this study for the purpose of the primary endpoint. Patient with the following will be excluded from FDG-PET piece of the study.

1. Patients cannot have a serum glucose level greater than 200 mg/dl for FDG-PET imaging
2. Patients who are too claustrophobic to undergo FDG-PET imaging
3. Patients who will require conscious sedation to undergo FDG-PET imaging.