ONCAlert | Upfront Therapy for mRCC
Renal Cell Cancer Case Studies

Case Studies: Therapeutic Approach for Metastatic Renal Cell Carcinoma

In this case-based interview, Neeraj Agarwal, MD, reviews the case of a 73-year-old female patient with rapidly progressing metastatic renal cell carcinoma and provides his expert perspective on the therapeutic approach for this type of patient.

Therapeutic Approach for Metastatic Renal Cell Carcinoma

Case Scenario: A 73-year old female with rapidly progressing mRCC

March 2017

  • A 73-year old woman with clear cell RCC, hyperlipidemia, and type 2 diabetes, which are both managed medically
  • Her baseline patient and disease characteristics were:
    • ECOG PS 0, KPS 90
    • pT3bNxM0 (AJCC stage 3)
    • 5-cm left kidney tumor mass with extension into the left renal vein
  • She underwent radical nephrectomy within 1 month following diagnosis

December 2017

  • The patient reported loss of appetite and weight loss
  • CT imaging showed multiple liver lesions, 2 small nodules in the right lung upper lobe, and mediastinal lymphadenopathy
  • Laboratory findings notable for Ca2+ 14.8 mg/dL
  • PD-L1 expression, <1%
  • Remarks: RCC disease progression; IMDC risk stratification, intermediate
  • The patient was started on cabozantinib, 60 mg daily
  • After 4 weeks on therapy she developed grade 2 diarrhea and her dose was reduced to 40 mg
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