Patient Scenario 1: Diagnosis and Risk Stratification of Clear-Cell RCC
Join Wenxin (Vincent) Xu, MD, and his team at Dana-Farber Cancer Institute as they explore strategies for diagnosing and stratifying renal cell carcinoma, reviewing a clinical scenarios and best practices in workup.
Summary:
In this clinical scenario, a 68-year-old woman, SK, presented with fatigue, right upper quadrant discomfort, and an 8-cm right renal mass diagnosed as clear cell renal cell carcinoma (RCC). Following a right total nephrectomy, she opted for active surveillance due to low disease volume. Two years later, a CT scan revealed bilateral pulmonary nodules, confirming advanced clear cell RCC through a biopsy. Despite normal blood work and a Karnofsky score of 90%, systemic therapy was initiated. The first-line approach involved cabozantinib and nivolumab, combining a tyrosine kinase inhibitor with an immunotherapy regimen.
The clinical presentation aligns with common symptoms seen at clinics like Dana-Farber, where patients often exhibit fatigue, pain, weight loss, or other systemic symptoms leading to a renal cell carcinoma diagnosis. Diagnosis and staging involve imaging, commonly starting with a CT scan, and may progress to a biopsy or nephrectomy based on findings. Staging incorporates the TNM system, assessing tumor size, lymph node involvement, and distant metastasis.
The discussion extended to the International mRCC (metastatic RCC) Database Consortium risk criteria, categorizing patients into favorable, unfavorable, or poor risk disease based on factors like performance status, time from diagnosis to systemic therapy, and laboratory results. This risk assessment aids in predicting survival and guides oncologists in selecting appropriate first-line systemic therapy. The initiation of systemic therapy, in this case, cabozantinib and nivolumab, is influenced by the patient’s risk group. Landmark trials categorized patients into risk groups, demonstrating varying benefits from treatments. Identifying the patient’s risk group becomes crucial for prognostication and tailoring effective first-line systemic therapy.
This scenario highlights the complexity of managing clear cell RCC, emphasizing the importance of risk assessment in predicting outcomes and guiding treatment decisions. The integration of targeted therapies and immunotherapies in first-line regimens reflects evolving strategies in managing advanced renal cell carcinoma.
Summary is AI-generated and reviewed by Cancer Network editorial staff.
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