ONCAlert | 2018 ASCO Annual Meeting
Renal Cell Cancer Case Studies

Case Studies: Metastatic RCC, Progressing on Multiple Therapies

In this case-based interview, Nizar M. Tannir, MD, FACP, discusses treatment of a patient with metastatic renal cell carcinoma progressing through multiple lines of therapy.

Metastatic RCC, Progressing on Multiple Therapies: Case 1

Case Presentation

 

February 2016

  • 70-year old female, presented to her physician with symptoms of nausea, fatigue, and weight loss
  • Abdominal CT showed a 9-cm left renal tumor and a small solitary spot on the liver
  • She was referred to urology and underwent left radical nephrectomy with removal of the liver lesion
  • Post-surgical imaging showed multiple liver lesions
  • She was then referred to medical oncology and was started on sunitinib 50 mg daily on a 4/2 schedule; stable disease was achieved within 6 weeks
  • Moderate fatigue, diarrhea, and increasing severity of hand–foot syndrome were managed with treatment interruption and then dose reduction to

 

June 2016

  • Four months later the patient reported increasing fatigue, nausea, and weight loss
  • Abdominal CT showed progression of her liver metastasis
  • She was then switched from sunitinib to nivolumab
  • The patient reported that her symptoms had improved
  • Imaging at 8 weeks showed a response in the liver
  • She was maintained on nivolumab without any toxicity

 

February 2017

  • Eight months later, the patient complained of fatigue, abdominal discomfort, and weight loss; she subsequently developed back pain
  • CT scan of abdomen and chest showed new liver lesions and progression of previously identified lesions
  • MRI of the spine showed multiple metastatic lesions of the thoracic and lumbar vertebrae, with no evidence of cord compression
  • She sought a second-opinion at an academic center
  • She was subsequently switched to cabozantinib 60 mg
  • Her symptoms subsided within 4 weeks
  • CT and MRI imaging at 8 weeks showed response with improvement of both liver and spine metastases.
  • She was maintained on cabozantinib for approximately 4 months and developed diarrhea and hand-foot skin reaction
  • Her dose of cabozantinib was reduced to 40 mg daily on which she was maintained for 13 months until she developed disease progression
  • At this time the patient is being considered for enrollment into a clinical trial
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