Intolerance to Sunitinib Treatment in Hemodialysis Patients With Metastatic Renal Cell Carcinoma
An 80-year-old female patient underwent left radical nephrectomy after a diagnosis of stage II clear cell carcinoma of the left kidney (pT2N0M0) in 2002. The patient was put on a hemodialysis program (three times per week) 6 years after nephrectomy. Her medical history included essential hypertension, which had been controlled with amlodipine (5 mg/d), for 10 years. In February 2009, she complained of pelvic and lower extremity pain. Abdominopelvic magnetic resonance imaging (MRI) revealed a lytic lesion with dimensions of 7 cm×6 cm at the sacrum. Systemic screening did not reveal any additional metastatic site. Histopathologic evaluation of the lesion showed clear cell RCC metastasis. Although radiotherapy was delivered to the sacrum, the patient was referred to our department for further evaluation because the lytic lesion became enlarged 8 months after radiotherapy. The prognostic risk category was intermediate, as defined by the MSKCC risk model, with a Karnofsky performance status of 90%, a serum hemoglobin level of 10.6 mg/mL, a serum-corrected calcium level of 9.4 mg/mL, and an LDH level of 216 U/L. Twenty-five milligrams of sunitinib was prescribed daily, commencing in March 2010. On the 15th day of treatment, acute pulmonary edema developed as a result of uncontrolled hypertension. Sunitinib could not be continued, but 15 days later, MRI showed that the disease was stable. She refused further oncologic treatment and 10 months after sunitinib withdrawal, she has not developed any new metastatic lesion or progressive disease in the sacrum.