Is the Same Tyrosine Kinase Inhibitor Still Effective After Development of Brain Metastases? A Case Report

Česká verzia

Authors: J. Obertova; M. Mego; P. Palacka; J. Rajec; M. Chovanec ; J. Mardiak
Authors place of work: II. onkologická klinika LF UK a Národný onkologický ústav, Bratislava
Published in the journal: Klin Onkol 2013; 26(4): 286-290
Category: Case Report

Summary

There is a new era of treatment options since introduction of new biological targeted therapies (tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin (mTOR) inhibitors) in renal cell cancer. However, in patients who developed brain metastases, there is still treatment dilemma about an optimal therapeutic scenario, particularly in the subgroup of patients without disease progression outside the central nervous system. The objective of this case report is to present that it is possible to continue the same targeted therapy after development of brain metastasis after application of local whole brain irradiation with meaningful overall survival.

Key words:
renal cell cancer – brain metastases – targeted therapy – sunitinib

Zdroje

1. Motzer RJ, Bacik J, Murphy BA et al. Interferon‑alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002; 20(1): 289– 296.

2. Cancer.gov [homepage on the Internet]. National Cancer Institute Common Terminology Criteria for adverse events, version 4.0. U.S. Department of health and human services. Published: May 28, 2009. Available from: http:/ / ctep.cancer.gov/ protocolDevelopment/ electronic_applications/ ctc.htm#ctc_40.

3. Schouten LJ, Rutten J, Huveneers HA et al. Incidence of brain metastasis in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 2002; 94(10): 2698– 2705.

4. Remon J, Lianes P, Martínez S. Brain metastases from renal cell carcinoma. Should we change the current standard? Cancer Treat Rev 2012; 38(4): 249– 257.

5. Wrónsky M, Maor MH, Davis BJ et al. External radiation of brain metastases from renal carcinoma: A retropective study of 119 patients from the M. D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys 1997; 37(4): 753– 759.

6. Sheehan JP, Sun MH, Kondziolka D et al. Radiosurgery in patients with renal cell carcinoma metastasis to the brain: Long‑term outcomes and prognostic factors influencing survival and local tumor control. J Neurosurg 2003; 98(2): 342– 349.

7. Helgason HH, Mallo HA, Droogendijk H et al. Brain metastases in patients with renal cell cancer receiving new targeted treatment. J Clin Oncol 2008; 26(1): 152– 154.

8. Larkin JM, Hess V, Pickering LM et al. Symptomatic brain metastases from renal cell carcinoma during treatment with sunitinib or sorafenib. J Clin Oncol 2010; 28 (Suppl 15):abstr. e15023.

9. Patyna S, Peng G. Distribution of sunitinib and its active metabolite in brain and spinal cord tissue following oral or intravenous administration in rodents and monkeys. Eur J Cancer 2006; 4: 21– 22.

10. Koutras AK, Krikelis D, Alexandrou N et al. Brain metastasis in renal cell cancer responding to sunitinib. Anticancer Res 2007; 27(6C): 4255– 4257.

11. Zeng H, Li X, Yao J et al. Multifocal brain metastases in clear cell renal cell carcinoma with complete response to sunitinib. Urol Int 2009; 83(4): 482– 485.

12. Gore ME, Hariharan S, Porta C et al. Sunitinib in metastatic renal cell carcinoma patients with brain metastases. Cancer 2011; 117(3): 501– 509.

13. Batchelor TT, Sorensen AG, di Tomaso E et al. AZD2171, a pan- VEGF receptor tyrosine kinase inhibitor, normalizes tumor vasculature and alleviates edema in glioblastoma patients. Cancer Cell 2007; 11(1): 83– 95.

14. Kelly PJ, Weiss SE, Sher DJ et al. Sunitinib- Induced pseudoprogression after whole- brain radiotherapy for metastatic renal cell carcinoma. J Clin Oncol 2010; 28(25): e433– e435.