Case Overview: Newly Diagnosed mRCC

Daniel George, MD:This is a case of a 52-year-old gentleman who initially presented with some back pain in his left flank. In workup, a large left renal mass was found. He was also noted to have a couple of small lytic lesions in his lumbar spine. But, based upon this presentation, he is highly suspicious for renal cell carcinoma. He underwent a cytoreductive nephrectomy, which revealed grade 3 clear-cell carcinoma. Following his surgery, he recovered and was restaged.

At that time, the lytic lesions were shown to have grown and he had new lung nodules. So, the patient underwent radiation therapy to his lytic lesions in his lumbar spine, and then was immediately started on cabozantinib, 60 mg a day. He initially tolerated the 60-mg dose of cabozantinib quite well. However, after about 6 weeks on therapy, he started developing increased nausea, vomiting, and diarrhea. Based upon these symptoms, his dose was reduced to 40 mg a day. He tolerated this well. At 3 months’ time, he was restaged. At this point, his back pain was gone and his lung nodules had significantly decreased, suggesting a partial response to therapy.

Transcript edited for clarity.

Case Scenario: A 52-year old male with mRCC

February 2018

• A 52-year old Caucasian man presented to his physician complaining of severe left-sided back pain
• Laboratory findings: mild anemia, otherwise WNL
• CT scan of the abdomen and pelvis showed a large left renal mass, several small lytic lesions in the lumbar and thoracic vertebrae, and a small pulmonary nodule
• The patient underwent cytoreductive nephrectomy
• Diagnosis; stage IV clear-cell renal cell carcinoma; good-risk
• He received radiation therapy to his spinal lesions and was then started on cabozantinib 60 mg daily
• The patient reported moderate nausea and vomiting and diarrhea after 6 weeks on therapy; he continues to do well with improved tolerance after dose adjustment to 40 mg
• Imaging at 3 months showed a significant decrease in size of the pulmonary nodule