Long-term response with everolimus for metastatic renal cell carcinoma refractory to sunitinib-sorafenib sequence

We presented a 39-year-old male who developed progressive cancer disease 4 years after nephrectomy due to clear cell carcinoma. He was diagnosed with locally reccurence and metastases to the liver, spleen and abdominal muscles. The patient was treated with sunitinib and then after disease progression – with sorafenib. We observed 18 months of cancer control (TKI-TKI). After second progression everolimus was administered. Third line everolimus therapy helped to achieve durable stable disease with PFS 46 months till now (May 2015). The patient remains in very good performance status with minimal toxicity from the regimen. This case illustrates a long term survival for patients with metastatic renal cell carcinoma, a malignancy with historically poor prognosis. The use of three sequential targeted therapies (TKI – TKI – mTORi) helped to achieve over 5 years or disease control, with rarely seen long-term response to third line treatment (mTORi) – where stabilization is good enough. We discussed therapeutic strategies in metastatic renal cell carcinoma according to the literature and therapeutic possibilities in Poland.