Frontline TKI in Intermediate-Risk Renal Cell Carcinoma
December 18, 2019
Frontline TKI in Intermediate-Risk Renal Cell Carcinoma
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
History of ulcerative colitis, controlled hypertension, and controlled hypercholesterolemia
Lower back tender to touch
Labs
CBC: Hgb 12.5 g/dL, HCT, PLT, WBC all WNL
BP: WNL
Lipid panel: WNL
Imaging
Bone CT scan of the chest, abdomen, and pelvis showed a bilateral renal mass, a small lytic lesion in the lumbar vertebrae, several pulmonary nodules, and mediastinal and right hilar lymphadenopathy.
Diagnosis: stage IV clear-cell renal cell carcinoma; intermediate-risk
Treatment
Received cytoreductive nephrectomy
He was started on cabozantinib 60 mg daily
Follow-up
At 3 weeks of therapy patient tolerated treatment well, with mild fatigue and diarrhea, HTN remains controlled; blood in urine and lower back pain resolved; ECOG 0
At 6 weeks of therapy the patient shows PR and reduction in size of the renal masses and lymphadenopathy.