A phase 1 study (46) demonstrated the combination therapy of cixutumumab and temsirolimus (an mTOR inhibitor) resulted in extended disease stability, with 42% patients maintaining stability for over 6 months; however, limitations such as limited overall efficacy, significant toxicities (e.g., grade 4 hyperglycemia and multiorgan failure), and potential patient selection bias have hindered the continued development of these therapies for advanced ACC. This evidence concerns the gene MTOR and adrenal cortex carcinoma.