Suggest Treatment For Renal Cell Carcinoma

Posted on Mon, 24 Jul 2017

Question: Hello, in July 2015 I was diagnosed with clear cell renal cell carcinoma which had spread to my right humerus. In August 2015 I had the tumor in my humerus removed and a prosthesis inserted. I was then placed on Sutent 50mg to reduce the size of the tumor on my left kidney. A nephrectomy was scheduled for 6 weeks from commencement of the medication. After 3 days on Sutent my Nephrectomy was fast tracked as I was unable to urinate as the tumor was being massacred by the sutent and had shrunk 2cm in 3 days. It was originally 10cm. I have since been on Sutent for a period of 17 months until February this year, due to the severe side effects. I have remained clear of any reappearance of the disease during this period and since I ceased my medication. My CBC last week showed my blood levels were back to normal. Obviously my Oncologist who I have not seen for 4 months now would rather I recommence treatment on a different chemo drug ie Votrient. However I would prefer to give my body a break, keeping in mind I was told Sutent only works for about 2 years, so my body is better prepared should reoccurance happen. My question is what risk am I at, considering I have been clear for nearly 2 years, I am back to my pre illness body weight, my blood is returning to normal and I feel great. Thankyou XXXXXXX

Answered by Dr. Deepak Sundriyal (12 minutes later)

Brief Answer:
Hello. You require reevaluation

Detailed Answer:
Hello dear. I have gone through the details. So you were on sutent and completed 17 mths of treatment and then stopped due to side effects. Obvuously sutent is a toxic drug and because you stopped it, a reevaluation is mandatory to look for relapse of disease prior going to votrient. Votrient is a good drug which is easily tolerable with fewer side effects.
In a metastatic setting, there is always a risk of disease coming back. But since you had low volume disease, you woll enjoy a good quantity and quality of life.
Upcoming is immunotherapy which can be utilized later.
Thanks and regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Deepak Sundriyal (33 minutes later)

I am having continual reavaluation by ct scans every 3 months and blood tests every 6 weeks. What do you mean by low volume disease? Also I asked advice of continuing a break from chemotherapy to build up my immune system which you did not answer.

Answered by Dr. Deepak Sundriyal (12 minutes later)

Brief Answer:
Hello. You have limited metastasis to bones

Detailed Answer:
Hello dear. A low volume disease means you have limited metastasis to bones only and hence good prognosis. Continuation of break from drug is only tailored as per patients need if there are too much intolerance to drug. otherwise we like to give continuous therapy. If you have got a ct scan and bone scan recently within 1 month, then no need for a repeat scan. You can go to votrient straight away.
Thanks and regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Deepak Sundriyal (26 hours later)

So doctor if I went back on to Sutent should another tumour appear, would it be as effective as the first time I was taking the medication. Could you also explain why you consider it necessary for me to go back on to chemotherapy, when I have been in remission for nearly 2 years ?

Answered by Dr. Deepak Sundriyal (1 hour later)

Brief Answer:
Hello. Yes it will be effective

Detailed Answer:
Hello dear. So sutent will be effective, there is no doubt. However, votrient can be chosen depending upon its safety profile. The reason for you in remission is the drug sutent which you were having. If you stop drug, tumor will come back. There is no concept of drug free holiday in renal cancer, hence you must continue it.
thanks and regards

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Above answer was peer-reviewed by : Dr. Nagamani Ng