A 58-Year-Old Man With Advanced Renal Cell Carcinoma

September 22, 2020

Robert Alter, MD, of John Theurer Cancer Center, describes the rationale for treating a 58-year-old male with advanced renal cell carcinoma with the combination of lenvatinib and everolimus following progression on first-line therapy.


Case: A 58-Year-Old Man With Advanced Renal Cell Carcinoma

  • August 2018: A 58-year-old man complained of fatigue and anorexia; after appropriate workup the patient was diagnosed with clear cell renal cell carcinoma
    • He underwent left total nephrectomy
  • March 2019: He developed metastatic disease to the lungs bilaterally (30 x 35 mm), mediastinum and soft tissue metastatic deposits
    • MSKCC risk status: intermediate
    • ECOG 1
    • He was started on pembrolizumab 200 mg IV every 21 days + axitinib 5 mg PO q2Days
  • September 2019: He developed progressive disease (45 x 50 mm); pulmonary lymph nodes increased in size and new mediastinal and hilar lymphadenopathy was noted
    • He was started on lenvatinib 18 mg PO qDay + everolimus 5 mg PO qDay
  • October 2019: Due to grade 1 diarrhea, reduced dose of lenvatinib to 14 mg PO qDay + everolimus 5 mg PO qDay
  • December 2019: Lesions reduced to 20 x 20 mm from September 2019; achieved partial response
  • January 2020: He remained on therapy with lenvatinib + everolimus