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Metastatic Renal Cancer Clinical Case

Metastatic Renal Cancer Clinical Case. Dr. J. Cambronero Hospital Infanta Leonor Madrid - SPAIN. Metastatic Renal Cancer Clinical Case. Dr. J. Cambronero Hospital Infanta Leonor Madrid - SPAIN. Clinical Case. Woman, 35 years old. No medical history.

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Metastatic Renal Cancer Clinical Case

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  1. Metastatic Renal CancerClinical Case Dr. J. Cambronero Hospital Infanta Leonor Madrid - SPAIN

  2. Metastatic Renal CancerClinical Case Dr. J. Cambronero Hospital Infanta Leonor Madrid - SPAIN

  3. Clinical Case • Woman, 35 years old. • No medical history. • Clinic: left laterocervical lymphnode. • Phisical exam: bilateral cervical and supraclavicular lymphnodes (4 cm). • Analitics: normal. LDH: 449.

  4. Clinical Case

  5. Clinical Case

  6. TAC • Bilateral cervical and supraclavical, mediastinic, retrocrural and retroperitoneal lymphnodes. • Left renal tumor of 5x6 cm. Pathology • Supraclavicular lymphnode Biopsy: • Renal carcinoma metastase.

  7. 1º Question • After to know the case, Which is your therapeutic action?: • Radical nephrectomy. • Sunitinib and posterior evaluation of surgery. • Citokine treatment. • Wait and reserve teatment if progression.

  8. What do we make? • Sunitinib 50 mg / day (4 on-2 off cycles). • Radical Nephrectomy delayed untill know outcome.

  9. 2º Question • After 3º cycle of Sunitinib (6 weeks per cycle) there was good tolerability, with reduction in LDH and anemia. Little reduction in size of cervical linphnodes and stability in the others but with change to hipodensity.

  10. 2º Question

  11. 2º Question • Do you know that a negative radiological outcome can be considered like a positive general outcome? • YES • NO

  12. What do we think? • YES. • Radiologic findings. • Clinical findings. • Analitic findings.

  13. 3º Question • After a partial therapeutic outcome, Which is your treatment offer? • Cytorreductive surgery and onchological treatment after. • Continue treatment with sunitinib. • Start Second line treatments. • Stop treatment and vigilante.

  14. What do we make? • Sunitinib cycles maintenance.

  15. 4º Question • We detect progression with hepatic metastasis after 6 cicles of Sunitinib.

  16. 4º Question • Which is your therapeutic action?: • Everolimus. • Sorafenib. • Tensirolimus. • Discontinuation of Sunitinib and support.

  17. What do we make? • Everolimus 10 mg / day.

  18. 5º Question • After treatment with Everolimus we have new important hepatic pregression in 2 months.

  19. 5º Question • Which is your action?: • Symptomatic treatment. • Sorafenib • Bevacizumab + IFN • Pazopanib.

  20. What do we make? • Sorafenib 400 mg / 12 h. (3ª line)

  21. Final • New progression: • 4ª line: • Interferon alfa2a 9 M IU (3 times per week) • Bevacizumab 10 mg / Kg. • New progression: • Lymphedema, ascitis, sepsis • Die (15 months from diagnostic).

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