Michalaki Vasiliki, Gennatas Constantine
Oncology Clinic, Second Department of Surgery, Areteion Hospital, University of Athens, 76 V, Sofias av, 115 28, Athens, Greece.
J Med Case Rep. 2012 Apr 23;6:115. doi: 10.1186/1752-1947-6-115.
Chromophobe renal cell carcinoma is universally accepted as a distinct subtype of renal cell carcinoma. There are conflicting reports on prognosis, and few data on response to treatment exist. Currently, we do not have any effective treatment for the metastatic disease apart from surgical procedures. Current strategies are based on results obtained in the context of clear cell-type renal cell carcinoma. Separate trials for rare histologies seem unfeasible and are unlikely to be performed. For these cases, clinical observations are an important part for advancing therapeutic insight. In recent years, novel tyrosine kinase inhibitors have been shown to have significant clinical benefit in advanced renal cell carcinoma.
We present the case of a 43-year-old Caucasian man with advanced chromophobe renal cell carcinoma treated with the tyrosine kinase inhibitor sunitinib and subsequently with sorafenib and the mammalian target of the rapamycin inhibitor everolimus, achieving a prolonged response and significant clinical benefit. We report an unexpectedly high efficacy of everolimus as a third-line treatment in a patient with metastatic chromophobe renal cell carcinoma.
Up to now, no published data from randomized clinical studies have addressed the question of efficacy of everolimus as a third-line treatment after failure of tyrosine kinase inhibitors. To the best of our knowledge, this case is the first report of chromophobe renal cell carcinoma treated successfully with sequential tyrosine kinase and mammalian target of rapamycin inhibitor therapy. Notably, the time on treatment with sunitinib exceeded four years. The case presented here implies that everolimus could be a viable option for patients with metastatic chromophobe renal cell carcinoma.
嫌色性肾细胞癌被公认为肾细胞癌的一种独特亚型。关于其预后的报道存在矛盾，且关于治疗反应的数据很少。目前，除了外科手术外，我们对转移性疾病没有任何有效的治疗方法。当前的策略是基于在透明细胞型肾细胞癌背景下获得的结果。针对罕见组织学类型进行单独试验似乎不可行，也不太可能进行。对于这些病例，临床观察是增进治疗认识的重要部分。近年来，新型酪氨酸激酶抑制剂已显示在晚期肾细胞癌中具有显著的临床益处。
我们报告一例43岁白种男性，患有晚期嫌色性肾细胞癌，先后接受酪氨酸激酶抑制剂舒尼替尼、索拉非尼以及雷帕霉素靶蛋白抑制剂依维莫司治疗，获得了长期缓解并取得显著临床益处。我们报告了依维莫司作为转移性嫌色性肾细胞癌患者三线治疗药物时出人意料的高疗效。
到目前为止，尚无随机临床研究的已发表数据涉及酪氨酸激酶抑制剂治疗失败后依维莫司作为三线治疗药物的疗效问题。据我们所知，本病例是首例关于序贯使用酪氨酸激酶和雷帕霉素靶蛋白抑制剂成功治疗嫌色性肾细胞癌的报告。值得注意的是，舒尼替尼的治疗时间超过了四年。此处报告的病例表明依维莫司可能是转移性嫌色性肾细胞癌患者的一个可行选择。
