Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reports
Abstract Background Renal cell carcinoma represents 3–5% of adult malignant tumors. Metastases are found in 30–40% of patients and brain metastases occurred in more than 10% of them. Despite significant progress in medical treatment, patients with brain metastases still have a limited survival. Cabo...
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s13256-018-1875-9 |
| _version_ | 1819173989659967488 |
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| author | Sylvie Négrier Guillaume Moriceau Valéry Attignon Véronique Haddad Daniel Pissaloux Nicole Guerin Christian Carrie |
| author_facet | Sylvie Négrier Guillaume Moriceau Valéry Attignon Véronique Haddad Daniel Pissaloux Nicole Guerin Christian Carrie |
| author_sort | Sylvie Négrier |
| collection | DOAJ |
| description | Abstract Background Renal cell carcinoma represents 3–5% of adult malignant tumors. Metastases are found in 30–40% of patients and brain metastases occurred in more than 10% of them. Despite significant progress in medical treatment, patients with brain metastases still have a limited survival. Cabozantinib, a tyrosine kinase inhibitor directed against vascular endothelial growth factor receptors, was recently registered for the treatment of metastatic renal cell carcinoma. Almost no data are, however, available on patients with brain metastases. Case presentation Case 1 is a 51-year-old man of North African origin; Case 2 is a 55-year-old European man. Case 1 and Case 2 had metastases of renal carcinoma at initial diagnosis and were treated with vascular endothelial growth factor receptors tyrosine kinase inhibitors. Case 1 had clear cell renal carcinoma and underwent nephrectomy; he then received several lines of tyrosine kinase inhibitor directed against vascular endothelial growth factor receptors and the mTor complex. During the second treatment a brain metastasis was diagnosed and treated with radiosurgery with rapid efficacy. Two years later he received nivolumab, an antibody directed against the programmed death-1 and programmed death-ligand 1 complex, but disease progression was observed with the reappearance of the brain metastasis together with neurologic symptoms. Cabozantinib was administered and induced a rapid clinical improvement as well as tumor regression in all sites including his brain. Sequencing of his tumor evidenced a mutation of the MET gene. Case 2 had a papillary renal carcinoma with brain metastases at time of diagnosis. After radiation of the brain tumors, a vascular endothelial growth factor receptor tyrosine kinase inhibitor was administered for 3 years. The disease was under control in all sites except in his brain; several new brain metastases requiring new radiation treatments developed. The disease finally progressed at all metastatic sites including his brain and he had several neurological symptoms. Cabozantinib was administered and rapidly induced a clinical improvement; a further computed tomography scan and brain magnetic resonance imaging showed significant tumor regressions. No MET gene mutation or amplification was observed in the tumor analysis. Conclusions These case reports indicate that cabozantinib was able, first, to reach brain tumors and second, to induce significant regressions in renal carcinoma brain metastases that were resistant to radiation as well as to previous systemic vascular endothelial growth factor receptor tyrosine kinase inhibitors. |
| first_indexed | 2024-12-22T20:31:50Z |
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| id | doaj.art-0ba2696f240f48dfae464963e164a253 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-22T20:31:50Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
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| series | Journal of Medical Case Reports |
| spelling | doaj.art-0ba2696f240f48dfae464963e164a2532022-12-21T18:13:34ZengBMCJournal of Medical Case Reports1752-19472018-11-011211610.1186/s13256-018-1875-9Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reportsSylvie Négrier0Guillaume Moriceau1Valéry Attignon2Véronique Haddad3Daniel Pissaloux4Nicole Guerin5Christian Carrie6Univ Lyon, Université Claude Bernard Lyon 1Department of Medical Oncology, Centre Léon BérardDepartment of Translational Research and Innovation, Centre Léon BérardDepartment of Bio-Pathology, Centre Léon BérardDepartment of Bio-Pathology, Centre Léon BérardDepartment of Radiology, Centre Léon BérardDepartment of Radiation Therapy, Centre Léon BérardAbstract Background Renal cell carcinoma represents 3–5% of adult malignant tumors. Metastases are found in 30–40% of patients and brain metastases occurred in more than 10% of them. Despite significant progress in medical treatment, patients with brain metastases still have a limited survival. Cabozantinib, a tyrosine kinase inhibitor directed against vascular endothelial growth factor receptors, was recently registered for the treatment of metastatic renal cell carcinoma. Almost no data are, however, available on patients with brain metastases. Case presentation Case 1 is a 51-year-old man of North African origin; Case 2 is a 55-year-old European man. Case 1 and Case 2 had metastases of renal carcinoma at initial diagnosis and were treated with vascular endothelial growth factor receptors tyrosine kinase inhibitors. Case 1 had clear cell renal carcinoma and underwent nephrectomy; he then received several lines of tyrosine kinase inhibitor directed against vascular endothelial growth factor receptors and the mTor complex. During the second treatment a brain metastasis was diagnosed and treated with radiosurgery with rapid efficacy. Two years later he received nivolumab, an antibody directed against the programmed death-1 and programmed death-ligand 1 complex, but disease progression was observed with the reappearance of the brain metastasis together with neurologic symptoms. Cabozantinib was administered and induced a rapid clinical improvement as well as tumor regression in all sites including his brain. Sequencing of his tumor evidenced a mutation of the MET gene. Case 2 had a papillary renal carcinoma with brain metastases at time of diagnosis. After radiation of the brain tumors, a vascular endothelial growth factor receptor tyrosine kinase inhibitor was administered for 3 years. The disease was under control in all sites except in his brain; several new brain metastases requiring new radiation treatments developed. The disease finally progressed at all metastatic sites including his brain and he had several neurological symptoms. Cabozantinib was administered and rapidly induced a clinical improvement; a further computed tomography scan and brain magnetic resonance imaging showed significant tumor regressions. No MET gene mutation or amplification was observed in the tumor analysis. Conclusions These case reports indicate that cabozantinib was able, first, to reach brain tumors and second, to induce significant regressions in renal carcinoma brain metastases that were resistant to radiation as well as to previous systemic vascular endothelial growth factor receptor tyrosine kinase inhibitors.http://link.springer.com/article/10.1186/s13256-018-1875-9Renal cell carcinomaBrain metastasesCabozantinibTyrosine kinase inhibitorVEGFr inhibitors |
| spellingShingle | Sylvie Négrier Guillaume Moriceau Valéry Attignon Véronique Haddad Daniel Pissaloux Nicole Guerin Christian Carrie Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reports Journal of Medical Case Reports Renal cell carcinoma Brain metastases Cabozantinib Tyrosine kinase inhibitor VEGFr inhibitors |
| title | Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reports |
| title_full | Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reports |
| title_fullStr | Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reports |
| title_full_unstemmed | Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reports |
| title_short | Activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma: two case reports |
| title_sort | activity of cabozantinib in radioresistant brain metastases from renal cell carcinoma two case reports |
| topic | Renal cell carcinoma Brain metastases Cabozantinib Tyrosine kinase inhibitor VEGFr inhibitors |
| url | http://link.springer.com/article/10.1186/s13256-018-1875-9 |
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