| Abstrakt: |
Clear cell renal cell carcinoma is described in the medical literature as a pathology with a high rate of distant metastases, even in patients initially presenting with localized disease at the time of diagnosis. We present the case of a 75-year-old woman who presented in June 2016 to the oncology department with a diagnosis of chromophobe cell renal cell carcinoma, previously treated with radical nephrectomy in 2006, and a pulmonary metastasis that was surgically removed in May 2016, with histopathological and immunohistochemical aspect of clear cell renal cell carcinoma. As the resection margins of the metastasectomy were negative, a decision was initially made to perform periodic imaging follow-up. In June 2017, a new pulmonary nodule was identified on a CT scan, leading to a second surgical intervention with complete excision, histopathologically confirmed as a new metastatic lesion. We maintained the same therapeutical approach until November 2021 when a new pulmonary nodule was detected on a CT scan. Resection followed by histopathological examination established the same diagnosis, but this time with positive macroscopic and microscopic resection margins. The patient met the criteria for the intermediate-risk group and began the treatment with axitinib and avelumab in July 2022. The treatment was poorly tolerated, with the patient experiencing severe bilateral visual impairment, with ophthalmologic examination establishing the diagnosis of keratoconjunctivitis sicca. The treatment was temporarily discontinued, with partial improvement of the symptoms, but which worsened upon treatment resumption. Subsequent imaging evaluations revealed disease progression involving the pancreas, bones and liver. The patient refused a new biopsy of the lesions and, therefore, a decision was made to initiate the second-line therapy with cabozantinib in May 2023, which has been continued to the present day, with good clinical tolerance and with improvement in visual disturbances. This case highlights the success of metastasectomies in providing a six-year interval between the appearance of the first metastatic lesions and the initiation of systemic therapy. It also underscores the development of a rare but debilitating adverse reaction. [ABSTRACT FROM AUTHOR] |
