Amygdala Metastases in 61 Year Old Male With Longstanding History of Metastatic Renal Cell Carcinoma

He has now had Gamma Knife radiosurgery to the single left uncus metastases. Open biopsy of the left femoral lesion is positive for renal cell carcinoma. Restaging CT scans showing mild progression of the right hilar adenopathy and multiple bone metastases with possible encroachment on the cord at T8. A lesion at L2 also shows extension into the spinal canal. He has no neurological symptoms. The plan was to start axitinib prior to receiving these recent results.

Does this change your initial treatment strategy?

Either axitinib or everolimus are potential options at this point. However, axitinib is a multiple tyrosine kinase inhibitor, which includes inhibiting VEGF and thus may cause impaired wound healing. Since he has had recent hip surgery and may potentially need additional surgery for the new spinal met, everolimus, which does not have the wound healing issues, may be the better choice. I would also recommend sending tissue for molecular profiling for future treatment considerations.