TKI in Poor-Risk Advanced Renal Cell Carcinoma
TKI in Poor-Risk Advanced Renal Cell Carcinoma
Case: A 68-Year-Old Man With Poor-Risk RCC
A 68-year-old man presented with a 6-week history of painless intermittent hematuria, fatigue and a 7-lb weight loss.
H & P:
- History of medically controlled hypertension and hypercholesterolemia
- 30 pack/year smoking history, social alcohol use
- Thin, ill-appearing; able to meet activities of daily living but unable to work due to fatigue. He spends more than half the day active on his feet
Labs:
- CBC: Hb 11.4 g/dL, corrected Calcium,11.2 mg/dL, WBC, PLT, LFT all WNL
- BP: 134/92
- Lipid panel: WNL
- U/A: gross hematuria
Imaging:
- CT scan of the chest/abdomen/pelvis showed a left-sided 8.7 (I believe he said 8cm) cm renal mass, para-aortic lymph nodes, and pulmonary metastases
Diagnosis:
- Underwent radical left nephrectomy; found to have Fuhrman grade 4 clear cell carcinoma without sarcomatoid features
- IMDC risk-score: poor
Treatment:
- Initiated treatment with ipilimumab 1mg/kg IV + nivolumab 3mg/kg IV q3w for 4 doses; achieved partial response; received maintenance nivolumab for 6 doses (q4w) followed by disease progression
- Patient was switched to cabozantinib 60mg PO qDay
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