Spontaneous Regression Of Adrenal Metastasis From Renal Cell Carcinoma After Sunitinib Withdrawal: Case Report And Literature Review
Yang, T. Y., Lin, W. R., & Chiu, A. W. (2018). Spontaneous regression of adrenal metastasis from renal cell carcinoma after sunitinib withdrawal: case report and literature review. BMC urology, 18(1), 105. https://doi.org/10.1186/s12894-018-0420-x
View Original Source →Abstract
BACKGROUND: The spontaneous regression of metastatic renal cell carcinoma is a rare phenomenon, with an estimated incidence of < 1%. We report a case of post-nephrectomy renal cell carcinoma adrenal metastasis, followed by the spontaneous regression of the metastasis after withdrawal of sunitinib. CASE PRESENTATION: The patient was a 55-year-old male with clear cell type renal cell carcinoma who previously underwent a left laparoscopic radical nephrectomy. After 51 months of follow up, a recurrence in the left renal fossa was observed and subsequently excised. Four months after excision, an abdominal Computerized tomography (CT) identified an adrenal metastasis of 1.6 cm. The patient was treated with sunitinib. However, the treatment was discontinued because of gastrointestinal side effects and fatigue. Eleven months after the discontinuation of sunitinib treatment, a progression in the adrenal metastasis growth (5.7 cm) was observed, whereas 16 months after the discontinuation, a regression of the adrenal metastasis growth (3.4 cm) was observed. During subsequent follow-ups, a gradual reduction in the size of the adrenal metastasis (1.8 cm) was observed. After 44 months from the discontinuation of sunitinib treatment, the patient was still alive and followed up in the outpatient department. CONCLUSIONS: Sunitinib is a multi-targeted inhibitor of vascular endothelial growth factor (VEGF) receptors. This compound reduces tumor angiogenesis and has been approved worldwide for the treatment of advanced renal cell carcinoma. To our knowledge, this is the fourth case of the spontaneous regression of metastatic renal cell carcinoma after the discontinuation of sunitinib treatment.
Case Details
Disease Location
Kidney, adrneal gland
Personal Characteristics
55-year-old man. History of hypertension and left renal urolithiasis.
Clinical Characteristics
Presented with chronic testicular pain. An ultrasonography of the abdomen detected a left renal tumor. CT showed a heterogeneous left upper pole renal tumor (5.3 cm in diameter). Laparoscopic radical nephrectomy was performed. Histological evaluation of the tissue revealed a clear cell renal cell carcinoma. Three years after nephrectomy, following a cerebrovascular accident, CT scan detected two nodules in the renal fossa (1.8 and 0.9 cm, respectively). Retroperitoneal exploration confirmed recurrent clear cell carcinoma with microscopically positive surgical margins. Four months after excision, an abdominal CT showed a nodule (1.6 cm) over the right adrenal gland. After 4 years, a repeat CT evaluation confirmed the disease progression of the adrenal metastasis (2.1 cm). The patient was treated with sunitinib (37.5 mg/d) for 4 weeks, but the treatment was discontinued because of gastrointestinal side effects and fatigue. After 3 months, a CT scan showed the progression of the adrenal metastasis (3.8 cm). Eleven months after sunitinib treatment, a CT scan showed an obvious growth of the adrenal metastasis (5.7 cm)
Remission Characteristics
16 months after the treatment, a regression of the metastasis (3.4 cm) was observed. Twenty-two months after sunitinib treatment, a CT scan demonstrated a gradual reduction in the size of the adrenal metastasis (1.8 cm)
Treatment & Mechanisms
Proposed Remission Mechanisms
Gene mutations of the androgen receptor might be a possible mechanism of antiandrogen withdrawal syndrome, which causes the antiandrogens to act as partial agonists. A withdrawal of these antiandrogens can promote disease regression. Option b: immune induced by partial use of sunitinib
Clinical Treatment
Biopsy, sunitinib, nephrectomy, retroperitoneal exploration