Vol 20, No 2 (2024)
Case report
Published online: 2023-06-30
Spectacular clinical benefit achieved by multidisciplinary management of a kidney cancer patient
Oncol Clin Pract 2024;20(2):136-143.
Abstract
The present study is a case report of a patient with a diagnosis of renal cell carcinoma with poor prospects, in whom long-term tumor control at the level of deep cytoreduction was achieved through aggressive multidisciplinary management using surgery, stereotactic radiotherapy, and sequential systemic therapy with immunotherapy based on a checkpoint inhibitor with anti-PDL1 activity combined with anti-angiogenic treatment, and by a non-selective tyrosine kinase inhibitor.
Keywords: renal cell carcinomamultidisciplinary treatmentmolecularly targeted drugsimmune checkpoint inhibitors
References
- Narodowy Instytut Onkologii. Nowotwory złośliwe w Polsce w 2020 roku. https://onkologia.org.pl/sites/default/files/publications/2023-01/nowotwory_2020.pdf (15.05.2023).
- Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007; 356(2): 115–124.
- Sternberg CN, Davis ID, Mardiak J, et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol. 2010; 28(6): 1061–1068.
- Escudier B, Porta C, Bono P, et al. Patient preference between pazopanib (Paz) and sunitinib (Sun): Results of a randomized double-blind, placebo-controlled, cross-over study in patients with metastatic renal cell carcinoma (mRCC)—PISCES study, NCT 01064310. J Clin Oncol. 2012; 30(15_suppl): CRA4502–CRA4502.
- Motzer RJ, Hutson TE, Cella D, et al. Pazopanib versus sunitinib in metastatic renal-cell carcinoma. N Engl J Med. 2013; 369(8): 722–731.
- Haas NB, Manola J, Uzzo RG, et al. Adjuvant sunitinib or sorafenib for high-risk, non-metastatic renal-cell carcinoma (ECOG-ACRIN E2805): a double-blind, placebo-controlled, randomised, phase 3 trial. Lancet. 2016; 387(10032): 2008–2016.
- Ravaud A, Motzer RJ, Pandha HS, et al. S-TRAC Investigators. Adjuvant sunitinib in high-risk renal-cell carcinoma after nephrectomy. N Engl J Med. 2016; 375(23): 2246–2254.
- Haas NB, Manola J, Dutcher JP, et al. Adjuvant treatment for high-risk clear cell renal cancer: updated results of a high-risk subset of the ASSURE randomized trial. JAMA Oncol. 2017; 3(9): 1249–1252.
- Motzer RJ, Haas NB, Donskov F, et al. PROTECT investigators. Randomized phase III trial of adjuvant pazopanib versus placebo after nephrectomy in patients with localized or locally advanced renal cell carcinoma. J Clin Oncol. 2017; 35(35): 3916–3923.
- Motzer RJ, Russo P, Haas N, et al. PROTECT study investigators. Adjuvant pazopanib versus placebo after nephrectomy in patients with localized or locally advanced renal cell carcinoma: final overall survival analysis of the phase 3 PROTECT trial. Eur Urol. 2021; 79(3): 334–338.
- Gross-Goupil M, Kwon TG, Eto M, et al. Axitinib versus placebo as an adjuvant treatment of renal cell carcinoma: results from the phase III, randomized ATLAS trial. Ann Oncol. 2018; 29(12): 2371–2378.
- Oza B, Eisen T, Frangou E, et al. Adjuvant sorafenib for renal cell carcinoma at intermediate or high risk of relapse: results from the SORCE randomized phase III intergroup trial. J Clin Oncol. 2020; 38(34): 4064–4075.
- Choueiri TK, Tomczak P, Park SeH, et al. KEYNOTE-564 Investigators. Adjuvant pembrolizumab after nephrectomy in renal-cell carcinoma. N Engl J Med. 2021; 385(8): 683–694.
- Pal SK, Uzzo R, Karam JA, et al. Adjuvant atezolizumab versus placebo for patients with renal cell carcinoma at increased risk of recurrence following resection (IMmotion010): a multicentre, randomised, double-blind, phase 3 trial. Lancet. 2022; 400(10358): 1103–1116.
- Motzer RJ, Russo P, Grünwald V, et al. Adjuvant nivolumab plus ipilimumab versus placebo for localised renal cell carcinoma after nephrectomy (CheckMate 914): a double-blind, randomised, phase 3 trial. Lancet. 2023; 401(10379): 821–832.
- ESMO. Renal Cell Carcinoma: ESMO Clinical Practice Guidelines. https://www.esmo.org/guidelines/guidelines-by-topic/genitourinary-cancers/renal-cell-carcinoma. (15.05.2023).
- EAU Guidelines on Renal Cell Carcinoma. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Renal-Cell-Carcinoma-2023.pdf (15.05.2023).
- NCCN. Kidney Cancer. https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf (15.05.2023).
- Powles T, Plimack ER, Soulières D, et al. Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): extended follow-up from a randomised, open-label, phase 3 trial. Lancet Oncol. 2020; 21(12): 1563–1573.
- Motzer RJ, Penkov K, Haanen J, et al. Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019; 380(12): 1103–1115.
- Choueiri TK, Powles T, Burotto M, et al. CheckMate 9ER Investigators. Nivolumab plus Cabozantinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2021; 384(9): 829–841.
- Motzer R, Alekseev B, Rha SY, et al. CLEAR Trial Investigators. Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. N Engl J Med. 2021; 384(14): 1289–1300.
- Motzer RJ, Escudier B, George S, et al. Nivolumab versus everolimus in patients with advanced renal cell carcinoma: Updated results with long-term follow-up of the randomized, open-label, phase 3 CheckMate 025 trial. Cancer. 2020; 126(18): 4156–4167.
- Albiges L, Tannir NM, Burotto M, et al. Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended 4-year follow-up of the phase III CheckMate 214 trial. ESMO Open. 2020; 5(6): e001079.
- Rini BI, Escudier B, Tomczak P, et al. Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3 trial. Lancet. 2011; 378(9807): 1931–1939.
- Bracarda S. Abstract 589. ASCO GU 2018 Congress.
- Chung BI, Malkowicz SB, Nguyen TB, et al. Expression of the proto-oncogene Axl in renal cell carcinoma. DNA Cell Biol. 2003; 22(8): 533–540.
- Zhou L, Liu XD, Sun M, et al. Targeting MET and AXL overcomes resistance to sunitinib therapy in renal cell carcinoma. Oncogene. 2016; 35(21): 2687–2697.
- Obwieszczenie Ministra Zdrowia z dnia 20 lutego 2023 r. w sprawie wykazu leków, środków spożywczych specjalnego przeznaczenia żywieniowego oraz wyrobów medycznych na 1 marca 2023 r. https://www.gov.pl/web/zdrowie/obwieszczenie-ministra-zdrowia-z-dnia-20-lutego-2023-r-w-sprawie-wykazu-lekow-srodkow-spozywczych-specjalnego-przeznaczenia-zywieniowego-na-1-marca-2023-r (15.05.2023).