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CASE REPORT
TARGETED AGENTS AND RESPONSES IN TREATMENT OF RCC IN PATIENT CW
THERAPY LINE
DATE
AGENT
CLASS
RESPONSE
1st
May 2012
Sunitinib
TKI
Progression
2nd
Mar 2013
Everolimus
m-TOR inhibitor
Progression
3rd
Nov 2013
Pazopanib
TKI
Not tolerated
4th
Oct 2014
Sorafenib
TKI
Not tolerated
5th
Nov 2014
Bevacizumab
VEGF inhibitor
Progression
6th
Nov 2014
Temsirolimus
m-TOR inhibitor
Progression
7th
Dec 2015
Nivolumab
PD-1 inhibitor
Objective response
TKI = tyrosine kinase inhibitor
m-TOR = mammalian target of rapamycin inhibitor
VEGF = vascular endothelial growth factor PD-1 = programmed cell death protein 1
TABLE I
Summary of chemotherapy and immunotherapy agents in our patient with her associated response.
In terms of response, the ongoing regression of our patient’s tumors on imaging over a four-month period, as well as her vastly improved functional status, suggest that the immunotherapeutic of her highly refractory disease and advanced morbidity.
CONCLUSION
Immunotherapy has proven to be a groundbreaking new modality in the treatment of cancer over the past decade, and randomized NSCLC, and RCC. This case illustrates the remarkable response that PD-1 inhibitors can have in patients who have failed multiple lines of targeted, systemic therapy and raises optimism that such treatment options can be effective in a wider patient population than previously demonstrated.
CONTRIBUTING AUTHORS
■ NICOLE C. FINELLI, DO is an Internal Medicine Resident at Christiana Care Health System in Newark, Del.
■ SARIM A. BAIG, MD is a Radiology Resident at Christiana Care Health System in Newark, Del.
■ GREGORY A. MASTERS, MD is a Medical Oncologist at the Helen F. Graham Cancer Center and Research Institute at Christiana Care Health System in Newark, Del. He is the principal investigator of the Delaware/ Christiana National Cancer Institute Community Oncology Research Program.
REFERENCES:
1. Atkins MB, Choueiri TK. Epidemiology, pathology, and pathogenesis of renal cell carcinoma. UpToDate. Available at: http://www.uptodate. com/contents/epidemiology-pathology-and-pathogenesis-of-renal-cell- carcinoma.
2. Motzer RJ, Escudier B, McDermott DF, et al. Nivolumab versus Everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015; 373:1803-1813.
Del Med J | January 2017 | Vol. 89 | No. 1
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