Patient Profile Presentation: A 72-Year-Old Man Presenting with Hematuria

Shawnta Anakwah, MD: The last case is a 72-year-old man who presented with hematuria. A CT scan showed an 8.5-cm left-sided renal mass with suspicious mediastinal lymphadenopathy. His past medical history consisted of hypertension; well-controlled, diet-controlled diabetes; and psoriasis, which did not require any medical therapy. He was on blood pressure medicines and an aspirin.

The decision was made to pursue a radical nephrectomy. He underwent surgery, and he was found to have a T3 clear cell renal cell carcinoma. He did have 2 of 10 lymph nodes involved. He did not have any rhabdoid features, but he did have 20% sarcomatoid features. The mediastinal lymph node was biopsied, and it was confirmed to be metastatic clear cell RCC [renal cell carcinoma]. From his labs on presentation, he had a slightly elevated white blood cell count of 12,000 per mm3, hemoglobin of 12.4 g/dL, platelet count of 210 per mm3, and normal calcium, and his other labs were unremarkable. He was deemed to have intermediate-risk clear cell RCC because of his metastatic disease within 1 year of nephrectomy and his leukocytosis.

The patient was started on cabozantinib with nivolumab, 480 mg, every 4 weeks. At his 3-month scan, he was found to have a partial response in his mediastinal lymph nodes. But by his 6-month scan, he had a complete response [CR] with normalization of his target mediastinal lymph nodes. At 12 months, the patient still has an ongoing CR. He did have some toxicities. His blood pressure was elevated, so he was able to tolerate the addition of a calcium channel blocker. He developed a grade 1 skin rash, which was treated with topical steroid cream.

Arnab Basu, MD: Great. There’s a good outcome for this gentleman.

Shawnta Anakwah, MD: Yes.

Transcript edited for clarity.