Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer
Involvement of adrenal gland in kidney cancer represents a unique site of metastasis with a distinct clinical course. The cases are typically resistant to immune therapy and need local therapy management. A case series of patients with adrenal metastases was reviewed to highlight the nuances of clin...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Codon Publications
2020-10-01
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| Series: | Journal of Kidney Cancer and VHL |
| Subjects: | |
| Online Access: | https://jkcvhl.com/index.php/jkcvhl/article/view/132 |
| _version_ | 1829472392806662144 |
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| author | Ulka Vaishampayan, MD Harsh Shah Mohammad F Asad Dongping Shi Brenda Dickow Stacey Suisham Jason Domina Michael L. Cher Julie Samantray Hussein D. Aoun |
| author_facet | Ulka Vaishampayan, MD Harsh Shah Mohammad F Asad Dongping Shi Brenda Dickow Stacey Suisham Jason Domina Michael L. Cher Julie Samantray Hussein D. Aoun |
| author_sort | Ulka Vaishampayan, MD |
| collection | DOAJ |
| description | Involvement of adrenal gland in kidney cancer represents a unique site of metastasis with a distinct clinical course. The cases are typically resistant to immune therapy and need local therapy management. A case series of patients with adrenal metastases was reviewed to highlight the nuances of clinical course and therapy. We reviewed renal cancer carcinoma (RCC) cases with adrenal metastases at Karmanos Cancer Center, Detroit MI. Medical records were reviewed to collect relevant case information. Next-generation sequencing, tumor mutation burden testing, and programmed death ligand bio-markers were evaluated in five cases. Twelve cases were reviewed; all were males with a median age of 49.5 years. Three patients presented with adrenal metastases only and were treated with local therapy. Three received interleukin-2 (IL-2). One patient relapsed with bilateral adrenal lesions after 11 years of remission, post-IL-2 therapy. Five cases received immune checkpoint inhibitor (ICI) and one received antivascular therapy. ICI therapy was followed by ablation of residual adrenal metastases in three patients. Genomic profiling was available in five cases. All were BAP1 and PD-L1 negative.Patho-genic mutations in PBRM1, SETD2, and VHL were noted. All patients with residual adrenal metastases responded to antivascular therapies or to local ablation. One patient died 17 years after diagnosis and 11 patients are alive at a median follow-up of 9.5 years. Adrenal metastases in RCC have a distinct clinical course. They can represent a sanctuary site of relapse/residual disease following treatment with immune therapy. Management with local therapy can induce durable remissions. Systemic management with antivascular therapies also demonstrated favorable responses. Further investigation should focus on the unique clinical course and optimal management of adrenal metastases in kidney cancer. |
| first_indexed | 2024-12-14T02:12:13Z |
| format | Article |
| id | doaj.art-69096690f8394109a60adc2a36f28738 |
| institution | Directory Open Access Journal |
| issn | 2203-5826 |
| language | English |
| last_indexed | 2024-12-14T02:12:13Z |
| publishDate | 2020-10-01 |
| publisher | Codon Publications |
| record_format | Article |
| series | Journal of Kidney Cancer and VHL |
| spelling | doaj.art-69096690f8394109a60adc2a36f287382022-12-21T23:20:44ZengCodon PublicationsJournal of Kidney Cancer and VHL2203-58262020-10-017410.15586/jkcvhl.v7i4.132Adrenal Metastases as Sanctuary Sites in Advanced Renal CancerUlka Vaishampayan, MD0Harsh Shah1Mohammad F Asad2Dongping Shi3Brenda Dickow4Stacey Suisham5Jason Domina6Michael L. Cher7Julie Samantray8Hussein D. Aoun 9University of MichiganWayne State University/Karmanos Cancer InstituteWayne State University/Karmanos Cancer InstituteWayne State University/Karmanos Cancer InstituteWayne State University/Karmanos Cancer InstituteKarmnos Cancer Center/Wayne State University, Detroit MI, USAWayne State University/Karmanos Cancer InstituteDetroit Medical CenterWayne State University/Karmanos Cancer InstituteWayne State University/Karmanos Cancer InstituteInvolvement of adrenal gland in kidney cancer represents a unique site of metastasis with a distinct clinical course. The cases are typically resistant to immune therapy and need local therapy management. A case series of patients with adrenal metastases was reviewed to highlight the nuances of clinical course and therapy. We reviewed renal cancer carcinoma (RCC) cases with adrenal metastases at Karmanos Cancer Center, Detroit MI. Medical records were reviewed to collect relevant case information. Next-generation sequencing, tumor mutation burden testing, and programmed death ligand bio-markers were evaluated in five cases. Twelve cases were reviewed; all were males with a median age of 49.5 years. Three patients presented with adrenal metastases only and were treated with local therapy. Three received interleukin-2 (IL-2). One patient relapsed with bilateral adrenal lesions after 11 years of remission, post-IL-2 therapy. Five cases received immune checkpoint inhibitor (ICI) and one received antivascular therapy. ICI therapy was followed by ablation of residual adrenal metastases in three patients. Genomic profiling was available in five cases. All were BAP1 and PD-L1 negative.Patho-genic mutations in PBRM1, SETD2, and VHL were noted. All patients with residual adrenal metastases responded to antivascular therapies or to local ablation. One patient died 17 years after diagnosis and 11 patients are alive at a median follow-up of 9.5 years. Adrenal metastases in RCC have a distinct clinical course. They can represent a sanctuary site of relapse/residual disease following treatment with immune therapy. Management with local therapy can induce durable remissions. Systemic management with antivascular therapies also demonstrated favorable responses. Further investigation should focus on the unique clinical course and optimal management of adrenal metastases in kidney cancer.https://jkcvhl.com/index.php/jkcvhl/article/view/132kidney cancerimmunotherapyclear cellmetastases |
| spellingShingle | Ulka Vaishampayan, MD Harsh Shah Mohammad F Asad Dongping Shi Brenda Dickow Stacey Suisham Jason Domina Michael L. Cher Julie Samantray Hussein D. Aoun Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer Journal of Kidney Cancer and VHL kidney cancer immunotherapy clear cell metastases |
| title | Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer |
| title_full | Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer |
| title_fullStr | Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer |
| title_full_unstemmed | Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer |
| title_short | Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer |
| title_sort | adrenal metastases as sanctuary sites in advanced renal cancer |
| topic | kidney cancer immunotherapy clear cell metastases |
| url | https://jkcvhl.com/index.php/jkcvhl/article/view/132 |
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