Cabozantinib as the causative agent of high-grade fever in a patient with a background of metastatic clear cell renal cell carcinoma: a case report

H M N Chen,P M Manders,M Morris

doi:10.1186/s13256-020-02560-0

H M N Chen, P M Manders + Show 1 more

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https://doi.org/10.1186/s13256-020-02560-0

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Abstract

BackgroundFever, as an adverse event, is well documented in a wide array of drugs including multiple tyrosine kinase inhibitors however, it is not a previously well described consequence of the novel multi-targeted tyrosine kinase inhibitor, cabozantinib.Case presentationIn this paper we document the first detailed review of high-grade fevers in a 54 year old male (Caucasian) with a background of metastatic clear cell renal cell carcinoma recently commenced on cabozantinib. After detailed investigation, we exclude infection and other common causes of fever as the causative agent and further, definitively resolve the recurrent fever by ceasing cabozantinib and starting a short course of oral corticosteroids.ConclusionsWe have demonstrated that cabozantinib should always be considered in the aetiology of high-grade fever in relevant patients. Further, we demonstrate that temporary cessation of cabozantinib and a course of short-term steroids can induce resolution of fever and allow for recommencement of cabozantinib safely thereafter.

Highlights

Treatment of metastatic renal cell carcinoma is rapidly evolving with the introduction of new targeted therapies and ongoing investigation into combination therapies using immunotherapy backbones [1].Vascular endothelial growth factor (VEGF) is a potent angiogenic stimulus supporting the growth of renal cell carcinoma (RCC) [2]
We describe a case of refractory, high-grade fever with rigors in a patient recently commencing cabozantinib in the absence of any more plausible causative agent after detailed investigation
Clinical findings, timeline and diagnostic assessment A 54 year old male (Caucasian) was commenced on 4th line cabozantinib 40 mg daily in Dec 2019 for Metastatic Renal Cell Carcinoma following disease progression after 8 cycles of 3rd line pembrolizumab and denosumab which was given as per the KEYPAD trial [7]. He was originally diagnosed with de-novo metastatic RCC in April 2015 with a right sided renal lesion and multiple pulmonary metastases present on baseline imaging

Summary

Conclusions

We have demonstrated that cabozantinib should always be considered in the aetiology of high-grade fever in relevant patients. We demonstrate that temporary cessation of cabozantinib and a course of shortterm steroids can induce resolution of fever and allow for recommencement of cabozantinib safely thereafter

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