Renal cell carcinoma: complete pathological response in a patient with gastric metastasis of renal cell carcinoma

Abstract

A 75-year-old-man, with a 2-month history of abdominal pain, underwent a standard diagnostic workup that included a CT scan that showed a large right renal mass and subcentimeter nodes in the right and left lung lobes. In December 2003, the patient underwent right nephrectomy with adrenalectomy and a diagnosis of renal cell carcinoma (pT3N0M0 stage) was made. No further treatment was proposed and patient was followed up regularly. In October 2006, the annual gastrointestinal endoscopy showed asymptomatic multilobulated and polypoid masses in the gastric fundus and gastric body that corresponded to metastasis of the renal carcinoma that had been resected three years ago. Surgical treatment was refused and oral treatment with sunitinib (50 mg/day consecutively for 4 weeks followed by 2 weeks off) was initiated. Patient completed one cycle and development of acute toxicity (grade 3 asthenia, anorexia and mucositis) led to treatment interruption. After recovering from acute toxicity, the patient was proposed to reinitiate treatment with dose reduction, but he refused any medical treatment. At the follow-up visit, three months later, the gastrointestinal endoscopy showed four unspecific 2 mm nodules without malignant evidence. The whole-body CT did not reveal any other abnormality except for the known lung nodes. PET scan six months after treatment confirmed complete gastric response.

Renal Cell Cancer Diagnosed at Endoscopy

“…The upper part of the stomach is most common site where metastases deposit in the stomach as seen in our case [9]. Renal cell carcinoma spreading to the stomach has been reported previously [10–12]. But they have all been in those who were known to have RCC already unlike our case.…”

Renal cell cancer metastases to esophagus and stomach successfully treated with radiotherapy and pazopanib

“…When a complete endoscopic resection is not technically viable but lesions are nonbleeding and measure 2 cm or less [16], the upfront and cautious initiation of any of the currently approved molecularly targeted agents for RCC would be an option as reported in two cases treated with sunitinib and everolimus [17,18], although assuming a probably higher risk for gastrointestinal bleeding. In contrast, as was shown with our patient, these agents should not be initiated before the proper hemostatic control of gastrointestinal metastases when lesions are large or bleed profusely.…”

Pharmacodynamic Study Using FLT PET/CT in Patients with Renal Cell Cancer and Other Solid Malignancies Treated with Sunitinib Malate

“…(10) Reports in the literature of CRs in mRCC patients treated with sunitinib have remained consistently low. (15–17) In contrast to sunitinib, single-agent bevacizumab appears to produce a relatively modest ORR and PFS of 10 to 13% and 4.8 to 8.5 months, respectively. (18, 19) Overall, all patients eventually progress on anti-angiogenic therapy.…”