Choosing Second-Line Therapy for Metastatic Kidney Cancer: Case 1

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Choosing Second-Line Therapy for Metastatic Kidney Cancer

Case Scenario 1: A 50-year old male with relapse of metastatic RCC

January 2014

  • A 48-year old Caucasian man presented to his physician complaining of right upper quadrant discomfort and back pain
  • CT scan of the abdomen and pelvis showed a large right renal mass with retroperitoneal adenopathy, largest node measuring 2.5 cm on right axis; metastatic lesion to T9, lytic
  • The patient underwent cytoreductive nephrectomy, retroperitoneal node biopsy
  • He was diagnosed with stage IV renal cell carcinoma, clear-cell histology, with metastases to bone and contralateral adrenal gland
  • After radiation therapy to T8, he was then started on pazopanib 800 mg
  • The first follow up scan showed a decrease in size of the adrenal lymph node
  • The patient reported moderate diarrhea and mild fatigue which was controlled with antidiarrheal medication and rest
  • He continues to do well with improved tolerance after dose adjustment to 600 mg

April 2016

  • Imaging shows slow but steady progression in the adrenal lesion
  • The patient complains of increasing back pain. He reports nausea and
  • Pazopanib was discontinued and the patient was started on cabozantinib 60 mg
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