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- Title
Treating renal cell carcinoma in a young adult: challenges and approaches. Case report.
- Authors
Mateianu, Elena Adriana; Dragomir, Adelina Silvana; Radu, Andreea Mihaela; Komporaly, Isabela Anda; Seliuc, Claudia Paraschiva; Baiulescu, Maria Alexandra; Mihăilă, Raluca Ioana; Kajanto, Lidia Anca; Stănculeanu, Dana Lucia
- Abstract
Objective. We present the case of a challenging me tastatic renal cell carcinoma (RCC) in a young adult, with less common histological pattern and three lines of treatment (targeted therapy and immunotherapy). Case presen tation. A 31yearold patient presented to the on cology department in January 2018 with the diagno sis of RCC with clear cells and predominant papillary features, for which he underwent radical nephrectomy (2014) and surgical resection of a retroperitoneal recurrence (2017). The followup computed tomography (CT) scans revealed pulmonary, hepatic and retroperitoneal metastases. The patient met the criteria for the lowrisk group, according to MSKCC Prognostic Model, and began sunitinib treatment, with positive evolution, requiring dose escalation. After two years of progressionfree survival (PFS), his performance status (PS) started to decline and the CT scan revealed disease progression. The treatment was changed to nivolumab, which caused an initial pseudoprogression of the metastases. Immunotherapy was not well tolerated, as he developed serious immunerelated adverse events (hypophysitis) and his PS deteriorated furthermore. Secondary PFS was only 6 months, as CT confirmed progressive disease (iRECIST criteria): increase of the known neoplastic lesions, as well as new metastases. Therefore, thirdline therapy with cabozantinib was initiated since November 2020. The patient had a favorable evolution, with an augmentation of PS and of the quality of life. Despite mild gastrointestinal adverse effects, which led to dose reduction, cabozantinib was well tolerated. Conclusions. RCC is a possible diagnosis even in younger patients and may represent a challenging disease due to its resistance to various tyrosinekinase inhibitors and immune checkpoint inhibitors. The histopathological feature of papillary morphology has also a negative impact on prognosis and can be taken into consideration while choosing therapy sequencing.
- Subjects
RENAL cell carcinoma; YOUNG adults; IMMUNE checkpoint inhibitors; COMPUTED tomography; DRUG side effects; DIAGNOSIS
- Publication
Oncolog-Hematolog, 2021, Issue 55, p41
- ISSN
2066-8716
- Publication type
Article