Annals of Oncology Advance Access originally published online on July 8, 2008
Annals of Oncology 2008 19(9):1655-1656; doi:10.1093/annonc/mdn408
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letters to the editor |
Sunitinib in the treatment of tubulocystic carcinoma of the kidney. A case report
Collecting (Bellini) duct carcinoma (CDC) of the kidney is a rare variant of kidney carcinoma. It is associated with aggressive course and poor prognosis. CDC represents 1%–3% of renal malignancies and affects more often young males, with median age of 43 years [1]. It is often already metastasized at the time of diagnosis. It has been suggested that tubulocystic carcinoma (TC) represent a low-grade CDC, with very limited clinical and pathological information available in literature. Recently, it was shown that molecular profile of TC was similar to papillary renal cell carcinoma (RCC) [2]. Since the histology of CDC is similar to that of transitional cell carcinoma (TCC), there is analogy in the treatment approach as well. Gemcitabine with cisplatin/carboplatin has substantial activity in CDC [3]. Several drugs including docetaxel have some activity in TCC; however, there is no established salvage therapy [4].Sunitinib is a multikinase inhibitor with activity in several tumors including RCC [5]. Trials conducted with sunitinib in RCC enrolled conventional-type (clear-cell) tumors. However, recently, it was shown that sunitinib exhibit activity in metastatic papillary and chromophobe RCC as well as in urothelial carcinoma [6, 7]. Herein, we present, for the first time, a case report of a patient with TC of the kidney treated with sunitinib in third-line setting.
A 44-year-old man with no significant past medical history presented himself with a 3-month history of shortness of the breath. Physical examination revealed left-sided pleural effusion and pleural fluid examination showed bloody fluid with malignant cells. Staging computerized tomography (CT) scans revealed right renal mass, retroperitoneal and mediastinal lymphadenopathy. Additionally, left-sided pleural effusion with pleural involvement was confirmed. Talc pleurodesis and subsequently a right-sided radical nephrectomy was carried out. Histologic examination showed TC of right kidney. Patient was referred to our institution for further disease management. He was treated with six cycles of gemcitabine and cisplatin chemotherapy. CT scans after third treatment cycle showed disease stabilization. However, patient experienced disease progression after the sixth cycle in all affected area. On the basis of the similarities between CDC and TCC, he was treated with three cycles of docetaxel monotherapy. However, he experienced further progression of lymphadenopathy with appearance of new right pleural effusion. This progression was accompanied by fatique, mild shortness of breath and decrement of Karnofski performance status (PS) from 90% to 60%. The patient started the treatment with sunitinib malate, 50 mg/day for 4 weeks with 2 weeks rest. After 1 week of therapy, he reported rapid improvement of fatique and dyspnea. Karnofski PS increases to 90% as well. In the second week of rest period, he again experienced worsening of symptoms with rapid improvement after restarting therapy. After second cycle of therapy, CT scan revealed regression of lymphadenopathy, pleural mass and effusion (Figure 1). On the basis of disease progression during the rest period, the treatment schedule was changed to 37.5 mg of sunitinib malate/day continuously. Tolerance of the treatment was generally good, without clinically significant toxicity. After, 5 months from the start of sunitinib therapy, patient is fully ambulatory, with only mild symptoms of the disease.
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On the basis of this experience, we indicate that sunitinib malate could be one of the new treatment approaches in this rare disease. However, further research in this area is warranted.
1 Department of Medical Oncology, Comenius University, School of Medicine, Bratislava, Slovakia
2 Department of Medical Oncology, National Cancer Institute, Bratislava, Slovakia
3 Department of Pathology, Slovak Medical University, Bratislava, Slovakia
4 Department of Pathology, Charles University Hospital, Plzen, Czech Republic
* E-mail: misomego{at}gmail.com
References
1. Milowsky MI, Rosmarin A, Tickoo SK, et al. Active chemotherapy for collecting duct carcinoma of the kidney: a case report and review of the literature. Cancer (2002) 94:111–116.[CrossRef][Web of Science][Medline]
2. Yang XJ, Zhou M, Hes O, et al. Tubulocystic carcinoma of the kidney: clinicopathologic and molecular characterization. Am J Surg Pathol (2008) 32:177–187.[Web of Science][Medline]
3. Oudard S, Banu E, Vieillefond A, et al. Prospective multicenter phase II study of gemcitabine plus platinum salt for metastatic collecting duct carcinoma: results of a GETUG (Groupe d'Etudes des Tumeurs Uro-Génitales) study. J Urol (2007) 177:1698–1702.[CrossRef][Web of Science][Medline]
4. de Wit R, Kruit WH, Stoter G, et al. Docetaxel (Taxotere): an active agent in metastatic urothelial cancer: results of a phase II study in non-chemotherapy-pretreated patients. Br J Cancer (1998) 78:1342–2345.[Web of Science][Medline]
5. Motzer RJ, Bukowski RM. Targeted therapy for metastatic renal cell carcinoma. J Clin Oncol (2006) 24:5601–5608.
6. Choueiri TK, Plantade A, Elson P, et al. Efficacy of sunitinib and sorafenib in metastatic papillary and chromophobe renal cell carcinoma. J Clin Oncol (2008) 26:127–131.
7. Gallagher DJ, Milowsky MI, Gerst SR, et al. Phase II study of sunitinib in patients (pts) with relapsed or refractory urothelial carcinoma (UC). J Clin Oncol (2007) 25:5080S.
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