分子標的薬治療後の転移巣摘除術により長期寛解を得た転移性腎癌の1例

Abstract

We report a case of metastatic renal cell carcinoma (RCC) treated with cytoreductive nephrectomy, cytokine therapy, and molecular targeted therapy followed by metastasectomy. A 47-year-old man was diagnosed as having bilateral RCC with metastases to the lung, liver, left adrenal gland, and lymph nodes in the mediastinum. He initially received right radical nephrectomy, left partial nephrectomy, and left adrenalectomy. The pathological diagnosis was clear cell RCC, which was found in all excised specimens. After the initial surgery, cytokine therapy was started but it did not generate a response in the evaluation at 3 months. He then received sorafenib for 2.5 years and the treatment produced a 75% response rate with only one metastasis remaining. The following sequential therapy with everolimus and sunitinib did not reduce the size of the lung metastasis. For a long time, the metastasis was limited only to the lung and its size did not become larger and there were no new lesions in any organs. Then, lung metastasectomy was performed. From the time of surgery in January 2010 until November 2012, he has had no recurrence of the disease. In some selected cases, sequential therapy with targeted agents followed by metastatectomy may result in a favorable clinical outcome for patients with metastatic RCC.