Clinicians weigh RCC immunotherapy choices by risk, metastasis site, and histology, citing durable outcomes with nivo-ipi and favoring TKIs after early progression.
|Videos|December 18, 2019
Frontline TKI in Intermediate-Risk Renal Cell Carcinoma
Frontline TKI in Intermediate-Risk Renal Cell Carcinoma
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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.
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Related to this article
FDA approves belzutifan plus lenvatinib for advanced clear cell RCC after PD-1/PD-L1 therapy, based on PFS and response rate benefit vs cabozantinib.
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