Patient C is a 68-year-old white man who was diagnosed with metastatic RCC, clear cell type in July 2008 discovered as part of an evaluation for new onset atrial fibrillation. He had a 7.1 × 9.7 cm left renal mass, enlarged retroperitoneal and mediastinal lymph nodes and multiple lung nodules. Mediastinal lymph node was positive for metastatic RCC on biopsy. He underwent debulking nephrectomy in August 2008 and then had a trial of high-dose IL-2 (600,000 IU/kg) which failed with progressive disease. He began sunitinib 50 mg daily for 4 weeks of a 6 week cycle, and had initially stable disease, but progressed after 36 weeks. He then began everolimus 10 mg daily but developed symptomatic mTOR-inhibitor-associated pneumonitis which resolved with steroids and discontinuation of everolimus. He then began bevacizumab 10 mg/m2 given every 2 weeks and had an initial minor response then prolonged stable disease. He remains on therapy at 24 weeks to date. He continues to be very active, golfing regularly and traveling.
Patient D is a 58-year-old white female who was diagnosed with a T2, N0, M0 right sided RCC of clear cell histology in 2001. She underwent radical nephrectomy and was followed by her urologist who found a small enlarging left adrenal mass and numerous pulmonary nodules concerning for metastatic disease in 2005. Metastatic disease was confirmed via biopsy of a lung lesion and the patient was started on high-dose IL-2 (600,000 IU/kg). After 8 weeks, she had disease progression on CT scan in both the lung and adrenal gland. She was then treated with sunitinib 50 mg daily for 4 weeks of a 6 week cycle, in the context of a clinical trial. She required a dose reduction because of pancytopenia. Imaging after 30 weeks showed stable pulmonary disease and improvement of the adrenal lesion and retroperitoneal lymphadenopathy. She remained on sunitinib with stable disease until September 2007 when CT scan showed disease progression in aortocaval lymph nodes. Her treatment was then changed to sorafenib 400 mg BID. She achieved 54 weeks of stable disease until July 2008 when her disease progressed on CT scan. The patient was then put on temsirolimus 25 mg IV weekly until October of 2008 when, once again, she had disease progression on CT scan. She was placed on bevacizumab 10 mg/m2 every 2 weeks and completed 48 weeks of treatment. She then progressed on bevacizumab at all sites and began 6th-line treatment with pazopanib 800 mg daily. She continues to be active and well.