Abstract
IntroductionIn this case series and short review of the literature, we underline the impact of nephrectomy combined with sequential therapy based on cytokines, antiangiogenic factors, and mammalian target of rapamycin inhibitors along with metastasectomy on overall survival and quality of life in patients with metastatic clear cell renal carcinoma.Case presentationIn the first of two cases reported here, a 53-year-old Caucasian man underwent a radical left nephrectomy for renal cell cancer and relapsed with a bone metastasis in his right humerus. He was treated with closed nailing and cytokine-based chemotherapy. For 5 years, the disease was stable and he had great improvement in quality of life. Subsequently, the disease relapsed in his lymph nodes, lung, and thorax soft tissue. He was then treated with antiangiogenic factors and mammalian target of rapamycin inhibitors. The disease progressed until September 2009, when he died of allergic shock during a blood transfusion, 9 years after the initial diagnosis of renal cell cancer.In the second case, a 54-year-old Caucasian man underwent a radical left nephrectomy for renal cell cancer. A year later, the disease progressed to his neck lymph nodes, and cytokine-based chemotherapy was initiated. While he was on cytokines, a solitary pulmonary nodule appeared and he underwent a metastasectomy. Nine months later, magnetic resonance imaging of his brain revealed a focal right occipitoparietal lesion, which was resected. After two years of active surveillance, the disease relapsed as a pulmonary metastasis and he was treated with an antiangiogenic factor. Further progressions presenting as enlarged axillary lymph nodes, chest soft tissue lesions, and thoracic spine bone metastases were sequentially observed. He then received a first-generation mammalian target of rapamycin inhibitor, an antiangiogenic factor, and later a second-generation mammalian target of rapamycin inhibitor and palliative radiotherapy. Ten years after the initial diagnosis of renal cell cancer, his disease is stable and he is on a third antiangiogenic factor and leads an active life.ConclusionsOne multidisciplinary approach to patients with metastatic renal cell cancer combines nephrectomy, metastasectomy, and radiotherapy (when feasible) with medical therapy based on cytokines and targeted treatment employing agents inhibiting angiogenesis, other receptor tyrosine kinases, and mammalian target of rapamycin. This approach could prolong survival and improve quality of life.
Highlights
In this case series and short review of the literature, we underline the impact of nephrectomy combined with sequential therapy based on cytokines, antiangiogenic factors, and mammalian target of rapamycin inhibitors along with metastasectomy on overall survival and quality of life in patients with metastatic clear cell renal carcinoma.Case presentation: In the first of two cases reported here, a 53-year-old Caucasian man underwent a radical left nephrectomy for renal cell cancer and relapsed with a bone metastasis in his right humerus
One multidisciplinary approach to patients with metastatic renal cell cancer combines nephrectomy, metastasectomy, and radiotherapy with medical therapy based on cytokines and targeted treatment employing agents inhibiting angiogenesis, other receptor tyrosine kinases, and mammalian target of rapamycin
Lungs are commonly affected by a single metastasis (30.4%) or multiple metastases (75.6%), whereas bones are affected in 14% of patients with metastatic Renal cell carcinoma (RCC) (mRCC)
Summary
Patients with untreated mRCC have a 5-year survival rate of less than 20%. Several treatment modalities that may prolong survival and improve quality of life are at our disposal. We present two patients whose RCC was treated with nephrectomy, metastasectomies, and sequential systemic therapy and who experienced a very satisfactory quality of life and long-term survival. Sequential medical therapy based on cytokines and on an array of targeted treatment agents such as tyrosine kinase receptor inhibitors, humanized monoclonal antibodies against vascular endothelial growth factor, and mTOR inhibitors may be established as a routine practice in the treatment of mRCC in selected patients. It is conceivable that current guidelines could be amended, leading to an increase in the number of RCC patients who achieve long-term survival and an acceptable quality of life. Abbreviations CT, computed tomography; IFN-α, interferon-alpha; mRCC, metastatic renal cell carcinoma; mTOR, mammalian target of rapamycin; PDGFR, plateletderived growth factor receptor; PFS, progression-free survival; RCC, renal cell carcinoma; RTK, receptor tyrosine kinase; VEGF, vascular endothelial growth factor; VEGFR, vascular endothelial growth factor receptor. All authors read and approved the final manuscript. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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