Progression on Everolimus
This is a 63 year-old white male who was initially diagnosed with clear cell renal cell carcinoma of the left kidney in 1997 who is s/p nephrectomy. He was doing well until he developed 5 brain metastases in October 2010. He then underwent Gamma Knife and had no other areas of recurrence. In 2012, he then had a left orchiectomy for a left testicular RCC recurrence. Three months later he developed bone mets and was then started on pazopanib titrated to a dose of 800mg PO daily. Unfortunately, he developed pulmonary metastases 6 months later as well as a single brain met for which he had Gamma Knife and was started on oxcarbazepine for seizure prevention. Pazopanib was stopped and he was then switched to everolimus. After 3 months he showed progression of his lung mets. He has tolerated everolimus well with only mild diarrhea.
There are issues/interactions with liver metabolism between oxcarbazepine and everolimus, and concerns as to whether he was getting adequate doses of everolimus.
Question: Would you continue with everolimus and try to switch his seizure medicine vs change to temsirolimus which would prevent 1st pass clearance by the liver vs change to a different class of drug?
George Yaghmour
Jul 15, 2015
May 19, 2024
Pending Moderator approval.