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Renal Cell Carcinoma
Center of Excellence
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Nixon Cevallos Reyna
May 20, 2015
METASTASECTOMY IF IS FEASIBLE
Andrew Fintel
Jun 02, 2015
To answer the first question, she should be counseled on the risk of relapse being 20-30% and usually occurring within 3 years. The ASSURE trial has seemed to answer the question of adjuvant systemic therapy at this time. It showed that neither Sorafenib nor sunitinib improved DFS as well as OS, but did increase toxicity.
For the second part, this is a younger, reportedly healthy woman who has a solitary met to the lung. As long as she can tolerate the surgery, metastasectomy should be offered. If not feasible, then RFA would also be an option.
The is some data supporting targeted therapy following metastasectomy in regards to improved PFS "Targeted therapy after complete resection of metastatic lesions in metastatic renal cell carcinoma" (Park et al.) You could make your case that she has proved she can relapse early and that she would need additional treatment. In that case, pazopanib would be my first choice given its superior side effect profile.
Mayer Gorbaty
Jun 20, 2015
Her pathology showed "collecting duct carcinoma" with LN involvement rather than clear cell Ca. Does that change your recommendation concerning adjuvant therapy at the time of her initial presentation?
Tatiana Hadjieva
Jun 22, 2015
She should be offered Stereotactic body radiotherapy /SBRT/
Andrew Fintel
Jun 23, 2015
There is no good consensus on how to approach this patient who at the time of diagnosis had at least a Stage III Collecting Duct Carcinoma (CDC) given her LN involvement. CDCs are rare cancers that don't respond well to typical treatments for Clear Cell RCC and also are very aggressive and carry a poor prognosis overall. Given that is it so rare, there have been no large studies done including CDC. Oudard et al, Journal of Urology May 2007, did a phase II trial using Gem-Cis (given that CDC is similar to urothelial carcinoma in origin) for metastatic CDC showing response rates of 41-49% and OS of 12 months. Retrospective studies using modern Targeted therapy have not proved to be of much benefit.
For this patient who presented with locally advanced CDC who presumably was in good health, adjuvant chemotherapy using a platinum doublet would not be unreasonable given the age of the patient, the stage and the poor prognosis it carries. If it was an earlier stage, say T1 or T2, and no LN involvement, then one would have to discuss with the patient the risk/benefit of using chemo vs no treatment in her rare type of cancer.
Apr 25, 2024
Pending Moderator approval.
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Tony
Nimeh
MD
Nixon Cevallos Reyna
May 20, 2015
Andrew Fintel
Jun 02, 2015
Mayer Gorbaty
Jun 20, 2015
Tatiana Hadjieva
Jun 22, 2015
Andrew Fintel
Jun 23, 2015
Apr 25, 2024
Pending Moderator approval.