Long-term Response of Sequential Treatment With Interferon, Sunitinib, Sorafenib and Everolimus in Metastatic Renal Cell Carcinoma; a Case Report

Son yıllarda vasküler büyüme faktörleri, reseptörleri ve memeli rapamisin yolağına karşı geliştirilen hedefe yönelikmoleküller metastatik böbrek hücreli karsinoma tedavisinde önemli bir yer tutmaktadır. Biz de; interferon alfa 2b,sunitinib, sorefenib ve everolimus ile uzun süreli sağkalım sağlanmış bir metastatik böbrek tümör vakası sunduk. 48yaş erkek hastaya Nisan 2007de metastatik böbrek tümörü tanısı konuldu ve yaklaşık 50 ay boyunca tedavi edildi.Hastada tirozin kinaz inhibitörleri (TKI) ile 44 ay genel sağkalım sağlandı (sırasıyla 5 ay sunitinib, 24 ay sorafenibve 15 ay everolimus). Metastatik böbrek tümörü sıklıkla kür edilemeyen, dekadlar boyunca kötü prognozlu olupaz sayıda tedavi seçeneği mevcuttur. Randomize kontrollü çalışmalarda ise daha önceden hem tedavi almış hemdetedavi almamış metastatik böbrek kanserlerinde hedefe yönelik ajanların etkinliği gösterilmişti. Metastatik böbrektümörünün TKI ve mTOR inhibitörleri ile tedavisi ardı sıra kullanılmadığı taktirde 12 aydan az sağkalım sağlarkenbizim vakamızda sırası ile kullanımda 44 aylık ilave bir sağkalım elde edildi.

Metastatik Böbrek Hücreli Karsinomda Ardışık İnterferon, Sunitinib, Sorafenib ve Everolimus tedavilerine Uzun Dönemli Cevap; Vaka Sunumu

In recent years, targeted therapies directed against vascular endothelial growth factor (VEGF) and its receptor(VEGFR), and mammalian target of rapamycin (mTOR) pathways have replaced immunotherapy in the treatment ofmetastatic renal cell carcinoma (mRCC). We reported a case who treated with mRCC and had long term survival withinterferon alpha 2b, sunitinib, sorafenib, and everolimus sequentially. On April 2007, a 48 year-old man diagnosed withRCC. To date, the patient has received 50 months of treatment. The patients had 44 months of overall survival withtyrosine kinase inhibitors (TKIs), 5 months with sunitinib, 24 months with sorafenib and 15 months for everolimusrespectively. Metastatic RCC is commonly incurable and, for decades, patients with this disease had a poor prognosisdue to few treatment choices. Randomized controlled trials have demonstrated the clinical benefits of targeted agentsin mRCC, for both previously treated and treatment-naïve patients. Metastatic RCC treatment with TKIs and mTORinhibitors usually provide less than 12 months without sequentially design but in this case we had had 44 months ofoverall survival.

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