A 71-Year-Old Woman with Relapsed-Refractory (R/R) Metastatic Clear Cell Renal Cell Carcinoma : Episode 3
Data-Informed Discussion of Tivozanib in Patients with Metastatic Renal Cell Carcinoma
Thoughtful discussion of study data supporting the use of tivozanib in patients with metastatic renal cell carcinoma, in the relapsed/refractory setting.
Case Overview: A 71-Year-Old Woman with R/R Metastatic Clear Cell RCC
Initial Clinical Presentation and Diagnosis:
- SW is a 71 y/o woman who visited her oncologist for annual follow up.
- Hx: Diagnosed in 2018 with metastatic renal cell carcinoma (mRCC) with metastases in her adrenal gland; post-left nephrectomy and adrenalectomy
- Patient was observed based on low-volume and indolent behavior of disease and patient preference.
- PMH: T2DM (well managed with medication)
- SMH: Does not smoke and occasionally drinks alcohol
Disease Progression, Clinical Workup, and Treatments:
- SW was initiated on systemic therapy of pembrolizumab + axitinib; stable disease on follow up
- Moderate diarrhea and fatigue were reported by SW
- 14 months later, the patient reported increased back pain, weight loss, and new onset of persistent rib pain
- Imaging confirmed disease progression – growth of paratracheal LN, new mediastinal nodal involvement, and new lytic osseous lesions
- Patient was then initiated on cabozantinib 60 mg QD
- 6 months later, further disease progression is documented
- Shared decision was made to initiate treatment with tivozanib 1.34 mg QD x 21 days, followed by 7 days off (28-day cycle) until disease progression or undesirable toxicity
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