TKI in Poor-Risk Advanced Renal Cell Carcinoma

February 7, 2020

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