Prolonged response to cytoreductive surgery and Sunitinib in an elderly patient with synchronous multiple metastases from renal cell carcinoma
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Data di Pubblicazione:
2011
Citazione:
Prolonged response to cytoreductive surgery and Sunitinib in an elderly patient with synchronous multiple metastases from renal cell carcinoma / M. Maggioni, G. Dormia, S. Di Pierro, F. Bertana, G. Longo, A. Maggioni, C. Locatelli, P. Tombolini. ((Intervento presentato al 21. convegno Annual meeting of the Italian society of uro-oncology tenutosi a Napoli nel 2011.
Abstract:
Renal cell carcinoma (RCC) is a cancer with a relatively low
incidence, accounting for about 2-3% of all cancer cases.
Multitargeted therapy of advanced RCC appears to be a better
option than immunotherapy. Sunitinib is a multitarget tyrosine
kinase inhibitor whose activity has been demonstrated in phase
III and expanded-access studies. In the present paper, we report
the case of an elderly patient with multiple metastases who
attained a prolonged response to sunitinib. A 72-year-old
woman with a Karnofsky performance status of 90, no
significant medical history, and no comorbidities except
hypertension treated with transdermal clonidine (TTS-1) was
referred to our hospital in October 2006 complaining of flank
pain and gross hematuria. At clinical examination, a mass in
the right flank and a 2 cm subcutaneous nodule in the right
breast were detected. Total-body computed tomography (CT)
scan showed a right kidney neoplasm of 15 cm, a mass in the
left adrenal gland, peripancreatic abnormal tissue, small lung
nodules (three bilateral nodules of 1 cm) and extensive hilarmediastinal
lymphadenopathies (maximum diameter 3.8 cm).
At cranial CT evaluation, a sub-centimetric (0.4 cm) thalamic
lesion of uncertain etiology was identified. Bone scintigraphy
was normal. At blood chemistry assay, mild anemia (Hb 11.7
g/dl) was present; LDH and calcium were in the normal range.
Surgical excision of the subcutaneous breast nodule revealed
an adenocarcinoma of metastatic origin. The patient underwent
a right radical nephrectomy and abdominal cytoreductive
surgery, including left adrenalectomy and distal
pancreatectomy. No residual intra-abdominal gross tumor
remained after surgery. Final pathology documented a 15×10×8 cm clear cell RCC, Fuhrman grade 2, pT3cN0M1, with
pancreatic and contralateral adrenal involvement. After surgery,
the patient recovered quickly and was placed on long-term
corticosteroid treatment. Four weeks later (December 2006),
she began subcutaneous interferon-alpha (IFN) 6 MU three
times/weekly; higher doses were not tolerated. In February
2007, treatment was discontinued because of malaise and bone
pain in the left hip. A CT scan of the pelvis revealed bone
involvement of the left ischium. On CT and MRI, the thalamic
lesion was found to have increased to 1 cm, with peripheral
edema. The patient underwent stereotactic radiosurgery
(Cyberknife) of the brain lesion. After cardiological assessment
with ECG and echocardiography, in April 2007, she was placed
on 50 mg sunitinib daily in a six-week cycle according to a 4/6
schedule (four weeks on treatment, two weeks off treatment.
Up to June 2010, the patient was continuing sunitinib treatment
and there was good control of arterial blood pressure with the
three-drug combination, no electrocardiographic or
echocardiographic alterations, normal thyroid function, grade
1 leukopenia and thrombocytopenia, and macrocytosis. The
patient was in good performance status (Karnofsky 80) and
was asymptomatic, but complaining of asthenia, especially
during the four weeks of sunitinib administration, causing mild
impairment of quality of life. The role of surgery in metastatic
RCC is still debatable especially in this new era of targeted
therapy. In conclusion, in the treatment of older people with
targeted therapies, the following recommendations are made:
assessment of the type and severity of co-morbidities; careful
monitoring of cardiac, thyroid and metabolic dysfunctions, and
assessment of the impact of every kind and grade of the
developed toxicities on quality of life.
1 Flanigan RC, Mickisch GH, Sylvester R, Tangel C, Van
Poppel H and Crawford ED: Cytoreductive nephrectomy in
patients with metastatic renal cancer: a combined a
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
M. Maggioni, G. Dormia, S. Di Pierro, F. Bertana, G. Longo, A. Maggioni, C. Locatelli, P. Tombolini
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