Interpreting Genomic Data to Identify Sequencing Options
This is a 54 year old Caucasian male, who presented to his PCP with left flank pain and intermittent hematuria. He has a h/o hypertension, but is otherwise in good health. CT scan on 1/2009 showed multiple bilateral pulmonary nodules in addition to a mass in the left abdomen near the left kidney. Bone scan was negative. He also had an MRI of the abdomen which showed an enlarged left renal vein with tumor thrombus in the peripheral portion of the left renal vein. A 10 cm heterogenous lower pole left renal mass was seen. He had a left nephrectomy for a 12 cm; grade III clear cell carcinoma. The tumor extended into the renal pelvis and invaded into the renal vein; no detectable lymph nodes. He was started on sunitinib at that time and continued until 2/2012 when a CT scan showed that he had increasing hilar disease and lesions in his lungs that are worsening. He was also having hemopysis and a bronchoscopy was done at that time. The biopsy showed metastatic renal cell and he was switched to Affinitor. In 7/2012 CT chest was worse and he changed to pazopanib. One year later, 7/2013, CT showed in the lungs and he then changed to temsirolimus. In 7/2014, he developed an acute renal injury with creatinine increasing up to 5.4 and temsirolimus was stopped until renal function improved and then it was reintroduced as he continued to show improvement in disease and was otherwise tolerating well. CT scan in December 2014 showed that he had further progression of his disease.
He is awaiting placement on MedImmune phase I PDL1 study, but there are several slots ahead of him.
What other treatment options are available based on previous therapies and genomic sequencing results?
(The attached image shows genomic alterations on Foundation One NGS testing of lung metastasis in 2012)
Additional Info
Disclosure statements are available on the authors' profiles:
Discuss This item Follow
No comments yet, be the first to start the discussion!
May 18, 2024
Pending Moderator approval.