A molecular case report
A 61-y-old male presented with gross hematuria. Imaging revealed a left renal mass and he underwent radical nephrectomy one month later, which revealed a 5.8 cm T1b clear cell renal cell carcinoma, Fuhrman grade 4. Distant metastatic workup was negative. Surveillance imaging at 5 mo after presentation revealed peritoneal nodules and mediastinal lymphadenopathy. Biopsy of an omental nodule was consistent with metastatic renal cell carcinoma. He began treatment with the VEGF-R TKI pazopanib at 6 mo, but received limited exposure due to significant transaminitis requiring dose interruption and reduction. Follow-up imaging at 7 mo revealed tumor progression. He began second line systemic therapy with the mTOR inhibitor everolimus at 8 mo, but follow-up imaging at 10 mo revealed progressive disease. The patient was aware of a publication regarding the potential utility of the Src inhibitor dasatinib in RCC. He elected third line treatment with dasatinib which he began at 11 mo. CT scan after 6 weeks showed progressive disease with enlargement of pre-existing tumors and development of liver metastases. Despite subsequent treatment with the VEGF-R TKI sunitinib, the patient developed worsening symptomatic progression of metastatic disease, and died approximately one year and one month after his diagnosis.