Medical Oncologia Resident Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
Background: Clear cell renal cell carcinoma (CCRCC) represents 75% of kidney cancers. Around 20% of patients with localized CCRCC relapse after nephrectomy. Patients with oligometastatic recurrence benefit from local treatment. Cytokine immunotherapy, tyrosine kinases inhibitors and, more recently, immunotherapy with checkpoint inhibitors were major changes in the treatment of metastatic CCRCC.
Methods: Case report
Results: A 63-year-old man, with no personal or family history, underwent a radical left nephrectomy for CCRCC in 2003. In 2007 he had surgery for new mediastinal lymph node metastases and started interferon, posteriorly discontinued due to toxic hepatitis. In February 2012 he relapsed with pleural metastasis and started sunitinib, suspended after 3 cycles for a nephrotic syndrome. At this time, he underwent pleural metastasectomy. After one-year, multiple lung lesions appeared. He started pazopanib, which was discontinued 2 months later because of renal toxicity and hypertension. On progression, he took everolimus for 2 years, suspended due to hypersensitivity pneumonitis. In 2016, the disease progressed with pulmonary, pleural, and symptomatic bone metastases. Nivolumab was started and radiotherapy of the bone lesion was performed. He completed forty-eight nivolumab administrations with partial response and no toxicities. In 2019 two brain metastases were diagnosed. He underwent surgical excision of the largest lesion and radiosurgery to the smallest lesion. In November 2021 he presented pulmonary progression and nivolumab has been reintroduced to date. Since then, he underwent cerebral surgery, due to suspicion of unconfirmed cerebral tumour recurrence, and palliative radiotherapy for a lung lesion. At the last evaluation, in December 2022, the patient maintained a good performance status and stable disease.
Conclusions: This case illustrates the importance of multimodal treatment and the successive therapeutic opportunities coinciding with the paradigm shift in the systemic treatment of kidney cancer in the past 20 years with a positive impact on survival.