Metastasized Renal Cell Cancer in Remission With Sunitinib

Sunitinib, a multityrosine kinase inhibitor approved in 2006, has been shown to significantly prolong progression-free survival and overall survival in patients with metastatic renal cell cancer (mRCC). But while some patients with metastasized RCC have reportedly achieved complete remission with sunitinib, clinical and pathologic remission has seldom been described in reports, say researchers from Jinan University in China. They discuss a patient whose colonic metastasis of RCC resolved with microwave ablation and sunitinib.

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The patient, who was diagnosed with right RCC, underwent a right radical nephrectomy. A pathologic report indicated clear-cell carcinoma of the kidney. Three years later, the patient presented with recurrent upper abdominal pain. An ultrasound scan revealed cholecystitis and gall bladder stones, and she was referred for treatment to the researchers’ hospital. During exploratory laparotomy, surgeons found a hepatic flexure colonic mass “firmly adhering” to the surrounding tissue; the mass perforated the intestine and could not be radically resected. The surgeons performed an ileostomy. The patient was started on sunitinib at 50 mg/d, on a schedule of 4 weeks of therapy followed by 2 weeks off therapy. During a follow-up, they found that the cancer had spread to the liver. Metastasectomy was not possible, so the patient’s doctors chose microwave ablation. The researchers noted that there is currently little experience with microwave ablation in treatment of liver metastasis of RCC.

A follow-up computerized tomography (CT) scan showed that the treatment was shrinking the mass in the colon. Positron emission tomography-CT imaging showed no local signs of relapse. Three years after the microwave ablation, the patient underwent ileostomy reversal, hysterectomy, right hemicolectomy, and partial ileostomy; all pathologic results were benign.

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In about 25% of patients, RCC metastasizes postoperatively—usually to the lungs and liver, the researchers say. Colonic metastases are rare. On the basis of the patient’s clinical features, imaging data, and pathology results, the researchers concluded that sunitinib, with microwave ablation, can prevent unresectable hepatic metastases of RCC from evolving, and sunitinib alone can achieve clinical and pathologic remission of colonic metastases of RCC.

Source:
Peng B, Gong J. Urol Case Rep. 2017;12:78-80.
doi: 10.1016/j.eucr.2016.11.024.