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Renal Cell Cancer Case Studies

Case Studies: Perspective on the Treatment of Advanced Renal Cell Cancer

Robert J. Motzer, MD, reviews the case of a 49-year old male who is diagnosed with advanced renal cell carcinoma, and discusses the sequencing of therapies available to this patient after progression.

Perspective on the Treatment of Advanced Renal Cell Cancer

A Japanese-American Male With Recurrent RCC

November 2015

  • At the age of 49, a Japanese-American man presented to the ER with abdominal pains
  • CT of the abdomen and pelvis revealed diverticulitis with an incidental left renal mass (4.2 cm × 8.6 cm × 2.8 cm)
  • SH: Marathon runner; nonsmoker; social drinker
  • He underwent sigmoid colon resection; left radical nephrectomy
  • Pathology; sigmoid colon pathology revealed diverticulitis; renal pathology revealed RCC, clear cell type
  • Diagnosis: RCC stage PT2a
  • KPS: 90
  • Fuhrman Grade: 3/4

September 2017

  • Follow-up CT showed residual soft tissue in the left nephrectomy bed, pulmonary lung metastasis, and an expansile lucent osseous lesion in the right pubic ramus
  • Biopsy of one of the osseous lesions confirmed mRCC
  • He began systemic therapy with sunitinib for 20 weeks and achieved stable disease and some shrinkage of the bone lesion
  • KPS: 90
  • MSKCC risk score: Intermediate

July 2018

  • The patient now complains of left pelvic pain
  • Imaging shows marked progression in retroperitoneal mass; new lung metastasis
  • Laboratory values:
    • CBC: WBC - 7; Hgb - 12.6; Platelet - 190; ANC – 5.2;
    • CMP; Creatinine - 1.82 mg/dL; LFTs - WNL; Calcium - 9.2 mg/dL; LDH – WNL
  • MSKCC risk score: Intermediate
  • KPS: 80
  • The patient was treated with palliative radiation therapy to bone metastasis
  • He was then started on treatment with lenvatinib/everolimus
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