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Presurgical therapy with axitinib for advanced renal cell carcinoma: a case report.

Koie T, Ohyama C, Okamoto A, Yamamoto H, Imai A, Hatakeyama S, Yoneyama T, Hashimoto Y - BMC Res Notes (2013)

Bottom Line: No serious adverse events were reported during this treatment.Pathological examination indicated a pT3aN0M0, Furman grade 3, clear cell renal cell carcinoma with necrosis, hyaline degeneration, and hemosiderosis.The patient was asymptomatic and disease-free at 1 year post-diagnosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan. coyama@cc.hirosaki-u.ac.jp.

ABSTRACT

Background: Targeted therapy with tyrosine kinase inhibitors has been shown to reduce tumor volumes and prolong the survival of patients with metastatic renal cell carcinoma. Tyrosine kinase inhibitors, particularly sunitinib, have recently been used in neoadjuvant and presurgical settings. Axitinib is a promising second-line therapy option for advanced or metastatic renal cell carcinoma. Herein, we report a patient with advanced renal cell carcinoma who received presurgical treatment with axitinib.

Case presentation: A 73-year-old man was transported by ambulance to a community hospital with chief complaints of high fever and a gait disorder. Computed tomography screening revealed a hypervascular tumor (size, 9 × 8.5 cm) in the lower pole of the left kidney. Upon admission to our hospital, his general condition was poor and his performance status was judged as 3, based on the Eastern Cooperative Oncology Group performance status criteria. After biopsy for the renal tumor, he received 5 mg of axitinib twice daily for 3 months. No serious adverse events were reported during this treatment. The tumor diameter shrank by 56%. Left radical nephrectomy was performed, and there were no intraoperative or postoperative complications. Pathological examination indicated a pT3aN0M0, Furman grade 3, clear cell renal cell carcinoma with necrosis, hyaline degeneration, and hemosiderosis. The patient was asymptomatic and disease-free at 1 year post-diagnosis.

Conclusion: This case study demonstrate that presurgical therapy with axitinib is feasible and might have several potential advantages for patients with advanced renal cell carcinoma.

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Related in: MedlinePlus

Hematoxylin-eosin stained section. The pathological findings indicate clear cell renal cell carcinoma with necrosis, hyaline degeneration, and hemosiderosis (magnification: ×200).
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Figure 4: Hematoxylin-eosin stained section. The pathological findings indicate clear cell renal cell carcinoma with necrosis, hyaline degeneration, and hemosiderosis (magnification: ×200).

Mentions: Upon admission to our hospital, the patient’s general condition was poor and his performance status (PS) was judged as 3, based on the Eastern Cooperative Oncology Group performance status criteria. Laboratory evaluations revealed the following findings: hemoglobin, 6.8 g/dL; adjusted calcium, 12.7 mg/dL (normal range, 8.7-10.3 g/dL); and alkaline phosphatase, 1670 U/L (normal range: 115-359 U/L). The patient underwent renal biopsy and was diagnosed with clear cell carcinoma of the left kidney. He received 5 mg of axitinib twice daily for 3 months, because we thought that immediate radical surgery was not safe because of his poor performance status and laboratory data paraneoplastic syndrome. Fortunately, no serious adverse events were reported during this treatment. The patient convalesced during the administration of axitinib, and all laboratory data were restored to within normal limits after axitinib treatment. An abdominal CT after the axitinib therapy showed that the tumor diameter shrank by 56% (Figure 2A, B). At that time, we were convinced that his renal tumor could be removed safely. Left radical nephrectomy was performed. The operation time was 95 min, and the estimated blood loss was 50 mL. No intraoperative or postoperative complications including wound healing delay or hemorrhage resulted from surgery. Macroscopic examination revealed a solid, yellowish-white tumor measuring 4 × 2.5 cm in size, with necrosis in the lower pole of the resected kidney (Figure 3). Pathological examination indicated pT3aN0M0, Furman grade 3, clear cell RCC with necrosis, hyaline degeneration, and hemosiderosis (Figure 4). Fifty percent of tumor tissue was necrosis, and it was central necrosis. The patient was asymptomatic and disease-free at 1 year post-diagnosis.


Presurgical therapy with axitinib for advanced renal cell carcinoma: a case report.

Koie T, Ohyama C, Okamoto A, Yamamoto H, Imai A, Hatakeyama S, Yoneyama T, Hashimoto Y - BMC Res Notes (2013)

Hematoxylin-eosin stained section. The pathological findings indicate clear cell renal cell carcinoma with necrosis, hyaline degeneration, and hemosiderosis (magnification: ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222084&req=5

Figure 4: Hematoxylin-eosin stained section. The pathological findings indicate clear cell renal cell carcinoma with necrosis, hyaline degeneration, and hemosiderosis (magnification: ×200).
Mentions: Upon admission to our hospital, the patient’s general condition was poor and his performance status (PS) was judged as 3, based on the Eastern Cooperative Oncology Group performance status criteria. Laboratory evaluations revealed the following findings: hemoglobin, 6.8 g/dL; adjusted calcium, 12.7 mg/dL (normal range, 8.7-10.3 g/dL); and alkaline phosphatase, 1670 U/L (normal range: 115-359 U/L). The patient underwent renal biopsy and was diagnosed with clear cell carcinoma of the left kidney. He received 5 mg of axitinib twice daily for 3 months, because we thought that immediate radical surgery was not safe because of his poor performance status and laboratory data paraneoplastic syndrome. Fortunately, no serious adverse events were reported during this treatment. The patient convalesced during the administration of axitinib, and all laboratory data were restored to within normal limits after axitinib treatment. An abdominal CT after the axitinib therapy showed that the tumor diameter shrank by 56% (Figure 2A, B). At that time, we were convinced that his renal tumor could be removed safely. Left radical nephrectomy was performed. The operation time was 95 min, and the estimated blood loss was 50 mL. No intraoperative or postoperative complications including wound healing delay or hemorrhage resulted from surgery. Macroscopic examination revealed a solid, yellowish-white tumor measuring 4 × 2.5 cm in size, with necrosis in the lower pole of the resected kidney (Figure 3). Pathological examination indicated pT3aN0M0, Furman grade 3, clear cell RCC with necrosis, hyaline degeneration, and hemosiderosis (Figure 4). Fifty percent of tumor tissue was necrosis, and it was central necrosis. The patient was asymptomatic and disease-free at 1 year post-diagnosis.

Bottom Line: No serious adverse events were reported during this treatment.Pathological examination indicated a pT3aN0M0, Furman grade 3, clear cell renal cell carcinoma with necrosis, hyaline degeneration, and hemosiderosis.The patient was asymptomatic and disease-free at 1 year post-diagnosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan. coyama@cc.hirosaki-u.ac.jp.

ABSTRACT

Background: Targeted therapy with tyrosine kinase inhibitors has been shown to reduce tumor volumes and prolong the survival of patients with metastatic renal cell carcinoma. Tyrosine kinase inhibitors, particularly sunitinib, have recently been used in neoadjuvant and presurgical settings. Axitinib is a promising second-line therapy option for advanced or metastatic renal cell carcinoma. Herein, we report a patient with advanced renal cell carcinoma who received presurgical treatment with axitinib.

Case presentation: A 73-year-old man was transported by ambulance to a community hospital with chief complaints of high fever and a gait disorder. Computed tomography screening revealed a hypervascular tumor (size, 9 × 8.5 cm) in the lower pole of the left kidney. Upon admission to our hospital, his general condition was poor and his performance status was judged as 3, based on the Eastern Cooperative Oncology Group performance status criteria. After biopsy for the renal tumor, he received 5 mg of axitinib twice daily for 3 months. No serious adverse events were reported during this treatment. The tumor diameter shrank by 56%. Left radical nephrectomy was performed, and there were no intraoperative or postoperative complications. Pathological examination indicated a pT3aN0M0, Furman grade 3, clear cell renal cell carcinoma with necrosis, hyaline degeneration, and hemosiderosis. The patient was asymptomatic and disease-free at 1 year post-diagnosis.

Conclusion: This case study demonstrate that presurgical therapy with axitinib is feasible and might have several potential advantages for patients with advanced renal cell carcinoma.

Show MeSH
Related in: MedlinePlus