July 27, 2020

An expert oncologist presents the case of a 69-year-old woman with advanced renal cell carcinoma, and considers available treatment options for patients with a similar disease setting.

Case Overview:

Initial presentation

  • A 69-year-old woman presents with a 2-month history of fatigue, lower back pain and unintentional weight loss
  • PMH: DM medically controlled
  • PE: flank and lower back discomfort on palpation


Clinical workup

  • Chest/abdominal/pelvic CT showed a right-sided 7.9 cm renal mass; paraaortic lymph node involvement
  • Percutaneous biopsy confirmed clear cell renal cell carcinoma

Treatment and follow-up

  • The patient underwent right total nephrectomy; surgery was well-tolerated
    • Follow-up at 3, 9, 12 months were unremarkable
  • At 24 months the patient developed disease with multifocal disease in her lungs; Stage IV
  • Labs within normal limits
  • ECOG 0; good risk disease by IMDC and MSKCC risk
  • She started treatment on pazopanib; well-tolerated, achieved PR
  • 2 year later the patient suffered progression of disease; with increasing lung nodules, largest (30 mm)
  • Lenvatinib 18 mg PO QD + everolimus 5 mg PO QD was initiated
    • Imaging at week 8 showed a 33% reduction from baseline of the largest lung lesion (20 mm);
    • At week 24 of treatment showed 40% reduction from baseline of largest lung lesion (18 mm); decrease in size of other pulmonary lesions noted
    • At 6 months she continued to have stable disease
    • At 12 months of treatment CT showed 2 new liver nodules