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In this module, Brendan D. Curti, MD, offers an overview of systemic therapy in the treatment of renal cell carcinoma (RCC), including the use of high-dose (HD) interleukin 2 (IL-2), immune checkpoint inhibitors (ICI), and combinations of tyrosine kinase inhibitors (TKIs) with ICIs. The role of nephrectomy in patients with metastatic RCC is also discussed.
The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset that can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.
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Case Vignette/Patient History:
A 67-year-old man presented with low back pain. CT imaging showed:
At presentation, metastatic sites included bone (multiple), lung (~ 50 nodules), and multiple lymph nodes, primarily in the chest and hilar area. During his evaluation, he had a pathologic fracture of his right femur requiring urgent surgical stabilization and management. A femoral nail was placed and pathology was submitted from that operation, confirming the clinical suspicion of metastatic clear-cell RCC.
Relevant laboratory tests at the time of presentation showed a normal white blood cell count, but the patient was anemic without any clinical evidence of blood loss. Hemoglobin was 10.4 g/dL, hematocrit was 30.4%, platelets were elevated at a level of 531,000/µL, and the corrected calcium was greater than the upper limit of normal. Using International Metastatic RCC Database Consortium (IMDC) criteria, this patient would be classified as poor risk, and based on that model, his median survival would be estimated at 7.8 months.