POSSIBILITIES OF THE SECOND LINE OF THERAPY FOR METASTATIC RENAL CELL CARCINOMA. CLINICAL CASE

In 2020, there were about 19,3 million new cancers and 10,0 million cancer deaths worldwide, according to GLOBOCAN. Renal cell carcinoma is one of the ten most commonly diagnosed cancers in the world. Anti-angiogenic drugs targeting VEGF (bevacizumab) and its receptors (sunitinib, sorafenib, pazopanib, and axitinib) are standard therapies. Cabosantinib is an oral small molecule tyrosine kinase inhibitor including MET, VEGF receptors (VEGFR) and AXL. A randomized phase III study METEOR evaluated the efficacy of cabozantinib versus everolimus in patients with renal cell carcinoma that progressed after anti-VEGFR therapy with targeted drugs. A clinical case of a 32-year-old patient with metastatic renal cell carcinoma is presented. The patient underwent cytoreductive nephrectomy. Renal cell carcinoma, sarcomatoid subtype, was morphologically established. Against the background of the first line of targeted therapy with sunitinib, the progression of the disease was registered after three months ― multiple metastases to the lungs, peritoneal carcinomatosis, ascites, hydrothorax. The patient is undergoing the second line of therapy ― cabozantinib, after three courses a partial response was recorded. The given clinical observation demonstrates a patient with one of the most unfavorable variants of renal cell carcinoma ― sarcomatoid subtype. The three courses of the second line of targeted therapy with cabozantinib provided a partial response and, which is important, improved the patient’s quality of life.