A 71-Year-Old Woman with Relapsed-Refractory (R/R) Metastatic Clear Cell Renal Cell Carcinoma : Episode 4
Utilizing Lenvatinib Plus Everolimus in the Metastatic Renal Cell Carcinoma Setting
A closer look at lenvatinib plus everolimus in patients with advanced renal cell carcinoma, touching on dose-related toxicities.
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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