Cortese et al., J Clin Case Rep 2015, 5:12 DOI: 10.4172/2165-7920.1000658 Volume 5 • Issue 12 • 1000658 J Clin Case Rep ISSN: 2165-7920 JCCR, an open access journal Open Access Case Report Long Term Survival of a Patient with Metastatic Renal Cell Carcinoma Treated with Half-Dose Pazopanib: A Case Report Giada Cortese 1 *, Maria Teresa Martino 1 , Elisabetta Gambale 1 , Clara Natoli 2 and Michele De Tursi 3 1 Department of Oncology, Hospital via dei Vestini, Italy 2 Medical Oncology Unit, Department of Medical, Oral and Biotechnological Sciences, University G. d’Annunzio, Italy 3 Department of Medical, Oral and Biotechnological Sciences, University G. d’Annunzio, Italy *Corresponding author: Giada Cortese, Department of Oncology, Hospital via dei Vestini, Italy, Tel: 0871358005; Fax: 0871358476; E-mail: giada_cortese@libero.it Received October 13, 2015; Accepted December 13, 2015; Published December 21, 2015 Citation: Cortese G, Martino MT, Gambale E, Natoli C, De Tursi M (2015) Long Term Survival of a Patient with Metastatic Renal Cell Carcinoma Treated with Half-Dose Pazopanib: A Case Report. J Clin Case Rep 5: 658. doi:10.4172/2165-7920.1000658 Copyright: © 2015 Cortese G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract We describe the case of a 59-year-old woman who underwent a radical left nephrectomy for renal cell cancer in 1993. After 7 years, the disease relapsed as thyroid and pulmonary metastases and she has been initially treated with chemotherapy. At further progression we administered an antiangiogenic drug, Sunitinib for 9 months then we switched to Pazopanib. The patient is still receiving a half-dose of Pazopanib (46 months) and she is showing a long- lasting response with an optimal safety profle. In this patient, Pazopanib demonstrated a signifcant improvement in PFS and tumor response also with half a dose. Nephrectomy, metastasectomy, medical therapy and targeted treatments have been shown able to prolong survival and improve quality of life. This is an example of chronicized disease in a patient who can be defned as a long-term survivor. Keywords: Long-term survivor; Metastatic renal cell cancer; Pazopanib; Quality life; Tyroid Introduction Te incidence of all stages of Renal Cell Carcinoma (RCC) has increased over the past several years, accounting for 2%-3% of all adult malignancies [1]. All stages of RCC patients have a 5-year survival rate of approximately 62%, but untreated metastatic patients (mRCC) have a 5-year survival rate ranging from 0% to 18% [2,3]. Te systemic management of metastatic RCC (mRCC), traditionally resistant to conventional chemotherapy [4,5] has changed rapidly over the past fve years with FDA approval of six targeted agents directed against aberrant VEGF and mTOR pathways. VEGF-pathway antagonists have largely replaced cytokine-based therapies as the frst- line treatment for many patients with clear cell RCC. Materials and Methods A 59 years-old Caucasian woman underwent a lef radical nephrectomy for a renal mass in February 1993. Histology revealed a grade II clear-cell carcinoma without invasion of the capsule or major vessels. No lymph nodes were removed during surgery. Te patient was followed up with 6-monthly abdominal computed tomography (CT) scans and chest X-rays. Afer seven years, due to the appearance of dysphagia and dysphonia, a total body CT scan was performed and multiple thyroid lesions were detected. A total thyroidectomy was done in April 2000 and metastases of mRCC were diagnosed. No specifc oncological therapy was started, and in February 2001 bilateral lung metastases were highlighted by CT scan. A frst line chemotherapy with vinblastine was started; due to hematological G4 toxicity (requiring hospitalization), it was stopped afer two cycles. In September 2001, lung progression disease was documented and a second-line therapy with Fluorodeoxyuridine (FUDR) 0,15 mg/kg/day, 14 days ON and 14 days OFF, was performed for 2 years with stable disease until December 2005. Lung disease progression was highlighted in February 2009 and biological frst-line therapy started with dose-escalation of oral Sunitinib (from 37.5 mg to 50 mg daily, 4 weeks ON/2 weeks OFF). Due to hematological G4 toxicity (pancytopenia requiring hospitalization), Sunitinib therapy was stopped afer 6 month and no further therapy was started for patient’s refusal. In January 2012, due to severe clinical and radiological lung disease progression, the patient was treated with Pazopanib at a reduced dose of 400 mg/day considering previous toxicities. Treatment was well tolerated and in July 2012, afer six months of therapy, partial response to treatment was highlighted, showing number and size reduction of bilateral lung metastases. Tere were neither hematological toxicity nor laboratory abnormalities; the only adverse events were fatigue (G1) and changes in hair color (G1). Patient is still continuing Pazopanib therapy, now achieving a 46 months Progression Free Survival (PFS). Results In patients with mRCC, chemotherapy as monotherapy is not considered efective. In contrast, a systematic review on phase I/II/III studies, published between 2003 and 2012, indicated that chemotherapy can still play a promising role in mRCC when immunotherapy and target therapy have not yielded lasting and satisfactory results [6]. Recent advances in molecular biology have led to the development of several novel agents for the treatment of mRCC. Many targeted agents have been introduced for the treatment of advanced and/or metastatic renal cell carcinoma and have demonstrated a substantial improvement in PFS. Tyrosine kinase inhibitors (TKIs) are able to increase the progression-free survival and/or overall survival as both frst-line and second-line treatments for mRCC. Our case represents the transition between two diferent settings of care: chemotherapy was the past and TKI drugs were the future. In our case report, thyroid was the frst metastatic site during follow- up for CCRC that had been diagnosed 7 years earlier. In the literature there are only 10 cases of CCRC with metastasis to thyroid [7]. Afer chemotherapy, the patient was initially treated with Journal of Clinical Case Reports J o u r n a l o f C li n i c a l C a s e R e p o r t s ISSN: 2165-7920