Perspective on the Treatment of Advanced Renal Cell Cancer

August 20, 2018

Perspective on the Treatment of Advanced Renal Cell Cancer


A Japanese-American Male With Recurrent RCC

November 2015

  • At the age of 49, a Japanese-American man presented to the ER with abdominal pains
  • CT of the abdomen and pelvis revealed diverticulitis with an incidental left renal mass (4.2 cm × 8.6 cm × 2.8 cm)
  • SH: Marathon runner; nonsmoker; social drinker
  • He underwent sigmoid colon resection; left radical nephrectomy
  • Pathology; sigmoid colon pathology revealed diverticulitis; renal pathology revealed RCC, clear cell type
  • Diagnosis: RCC stage PT2a
  • KPS: 90
  • Fuhrman Grade: 3/4

September 2017

  • Follow-up CT showed residual soft tissue in the left nephrectomy bed, pulmonary lung metastasis, and an expansile lucent osseous lesion in the right pubic ramus
  • Biopsy of one of the osseous lesions confirmed mRCC
  • He began systemic therapy with sunitinib for 20 weeks and achieved stable disease and some shrinkage of the bone lesion
  • KPS: 90
  • MSKCC risk score: Intermediate

July 2018

  • The patient now complains of left pelvic pain
  • Imaging shows marked progression in retroperitoneal mass; new lung metastasis
  • Laboratory values:
    • CBC: WBC - 7; Hgb - 12.6; Platelet - 190; ANC — 5.2;
    • CMP; Creatinine - 1.82 mg/dL; LFTs - WNL; Calcium - 9.2 mg/dL; LDH — WNL
  • MSKCC risk score: Intermediate
  • KPS: 80
  • The patient was treated with palliative radiation therapy to bone metastasis
  • He was then started on treatment with lenvatinib/everolimus