Hingorani Mohan, Dixit Sanjay, Maraveyas Anthony
Department of Clinical Oncology, Castle Hill Hospital, Hull and East Yorkshire, NHS Trust, Cottingham, UK.
World J Oncol. 2014 Dec;5(5-6):223-227. doi: 10.14740/wjon843w. Epub 2014 Dec 3.
Pervious randomized studies have demonstrated survival benefit in favor of tyrosine kinase inhibitors (TKIs) compared to cytokines in metastatic clear cell renal cell carcinoma (RCC). However, the role of TKIs for treating brain metastasis from RCC remains unknown. Previous studies have reported possible activity of sunitinib and sorafenib in RCC patients with brain metastasis. We report on patient with metastatic RCC who responded to first-line sunitinib but then progressed with multiple brain metastasis, but with controlled extra-cranial metastatic disease. The patient was treated with whole-brain palliative radiotherapy followed by treatment schedule of pazopanib at standard dose of 800 mg/day which was associated with a response in brain metastasis. Subsequently, she was re-challenged at reduced dose of 600 mg/day and developed further response in metastatic brain lesions. She lived for more than 3 years from initial diagnosis of brain metastasis. This is the first case report of sequential TKI therapy for treating metastatic RCC with brain metastasis and supports the probable use of pazopanib as potent TKI for treating patients with cerebral metastasis.
既往随机研究表明，在转移性透明细胞肾细胞癌（RCC）中，与细胞因子相比，酪氨酸激酶抑制剂（TKIs）具有生存获益。然而，TKIs治疗RCC脑转移的作用仍不明确。既往研究报道了舒尼替尼和索拉非尼在RCC脑转移患者中可能具有活性。我们报告了1例转移性RCC患者，该患者一线使用舒尼替尼有效，但随后出现多发脑转移进展，而颅外转移病灶得到控制。该患者接受了全脑姑息性放疗，随后采用帕唑帕尼800 mg/天的标准剂量治疗方案，脑转移灶出现反应。随后，以600 mg/天的减量再次治疗，转移性脑病灶进一步缓解。自脑转移初始诊断起，她存活了3年多。这是首例关于序贯TKI治疗RCC脑转移的病例报告，支持帕唑帕尼可能作为治疗脑转移患者的有效TKI。
