This is a case of a 70-year-old male who actually went to the emergency department with complaints of abdominal pain. In the work-up he underwent a CT computed tomography scan for this, and the CT scan was notable for a right renal mass with associated lymphadenopathy. There was a concern for a lytic lesion in his spine. He subsequently underwent a CT of the chest, which showed enumerable sub-centimeter pulmonary nodules with associated hilar lymphadenopathy. He was referred to urology where they elected to undergo a biopsy of the abdominal lymphadenopathy, which revealed clear cell renal cell carcinoma without any features. His past medical history was notable for ulcerative colitis as well as hypertension. And laboratory tests were notable for essentially normal chemistry with a CBC [complete blood count] showing a mild anemia at 12.5 g/dL with no thrombocytosis or neutrophilia.
This is obviously a common situation. Patient presents with new diagnosis of renal cell carcinoma. And we always have to ask what’s the best way to treat these patients. And I think with the advent of the data regarding targeted therapy combination with immunotherapy in the modern era, really looking at risk stratification is going to be important. And so the one I often use is the IMDC [International Metastatic Renal Cell Carcinoma Database Consortium] risk stratification, which takes into account clinical factors of the patient that were developed in the era of TKIs [tyrosine kinase inhibitors] but really are showing to have an important role in the era of immunotherapy. This is going to involve looking at the patient, the performance status, as well as lab values, and looking at the CBC, looking for neutrophilia, thrombocytosis, anemia, looking for elevated calcium, and really trying to get a sense for that patient and obviously whether they need therapy or not.
So in this patient who’s presenting with metastatic disease, if you’re going to pursue therapy, I would say he has intermediate-risk disease by the IMDC criteria.
Transcript edited for clarity.
Case: A 70-Year-Old Man with Intermediate-Risk RCC
A 70-year-old Caucasian man presented to ER complaining of blood in his urine and abdominal pain.
H & P
Labs
Imaging
Treatment
Follow-up
Long-Term Data Prompt Shifting Approaches to Frontline RCC Therapy
October 8th 2024During a Case-Based Roundtable® event, Chandler Park, MD, moderated a discussion on how recent trial data and sites of metastasis affect treatment of favorable-risk metastatic clear cell renal cell carcinoma in the second article of a 2-part series.
Read More
Enhancing Precision in Immunotherapy: CD8 PET-Avidity in RCC
March 1st 2024In this episode of Emerging Experts, Peter Zang, MD, highlights research on baseline CD8 lymph node avidity with 89-Zr-crefmirlimab for the treatment of patients with metastatic renal cell carcinoma and response to immunotherapy.
Listen
GU Oncology Peers Explore Early Therapy Approaches in Low-Volume mRCC
September 19th 2024During a Case-Based Roundtable® event, Chandler Park, MD, moderated a discussion on treating patients with indolent or low-volume favorable-risk metastatic clear cell renal cell carcinoma in the first article of a 2-part series.
Read More
Beyond the First-Line: Economides on Advancing Therapies in RCC
February 1st 2024In our 4th episode of Emerging Experts, Minas P. Economides, MD, unveils the challenges and opportunities for renal cell carcinoma treatment, focusing on the lack of therapies available in the second-line setting.
Listen