Efficacy of cabozantinib in the 1st line therapy of progressing multiple primary metachronous renal cell carcinomas: clinical observation

In 2023 in Russia, renal cell carcinoma (RCC) was the 7th most common cancer among men and the 12th among women. According to the data of the national cancer register, in approximately 18 % of patients, RCC is diagnosed at a late stage and with distant metastases. Another large group (between 20 and 40 %) are patients who underwent radical surgical treatment at a localized stage but whose disease progressed into metastatic stage. Frequency of bilateral tumor lesions in both kidneys is 2 to 6 % of all RCC cases. In the presented rare clinical observation of a patient with bilateral metachronous metastatic RCC, late metachronous tumor in the contralateral kidney 13 years after diagnosis of the primary tumor, different histological types of the tumors (clear cell and non-clear cell papillary RCC), efficacy of cabozantinib therapy in combination with immunotherapeutic drug nivolumab and as monotherapy is demonstrated. Objective response to treatment was achieved. The patient had intolerable immune-related toxicity – grade III adrenal gland failure – which required nivolumab cessation. Continued therapy with cabozantinib demonstrated satisfactory tolerability with controlled adverse events. Overall duration of response (disease control) to cabozantinib therapy is currently 24 months.