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.