Cáncer renal metastásico, respuesta histopatológica completa posterior a sunitinib

Abstract

Approximately 25% of with renal cell carcinoma have already reached the metastatic phase of disease (mRCC) at the time of diagnosis. Multi-targeted tyrosine kinase inhibitors have revolutionised the treatment of mRCC, replacing cytokine therapy. Sunitinib, a tyrosine kinase inhibitor has shown to be effective in terms of progression free survival and overall survival, with complete response rates of around 3%. A case is presented of a complete histological response after sunitinib in mRCC.

A 65 year-old hypertensive man, who in 2013 began with a considerable loss of weight, pain in the right hypochondrium, and an increase in ipsilateral abdominal volume. The computed tomography found a tumour of 24 × 13.8 × 10 cm in the right kidney, with 98 HU enhancement and a peri-hilar lymph node conglomerate. The thorax showed a single heterogeneous image with a hyperdense centre in the apical segment of the left lung. The percutaneous renal biopsy reported a Fuhrman grade I renal cell carcinoma. Sunitinib was started at 50 mg orally every 24 hours for 4 weeks, resting for 2 weeks, for 3 cycles. At the end of the treatment the tomography showed a tumour of 10.2 × 8.1 × 5.1 cm hyperdense in the centre, peripheral calcifications, diffuse enhancement, and the thorax with no lesions. A right radical nephrectomy was performed, with the histopathology reporting an inflammatory infiltrate, necrosis, and with no evidence of a tumour.

The combination of surgery and systemic therapy is currently the best treatment option for many patients with advanced disease.

The treatment of mRCC has been revolutionised from the era of blanket therapy, with up to 30% - 40% partial responses, and a complete response in isolated cases. Neoadjuvant therapy has been shown to decrease tumour size and enables surgery to be performed in selected patients.