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Case 1: First-line Treatment in Metastatic RCC

Question 1

• A 65-year-old male patient with de novo metastatic RCC (mRCC) presents for his first consultation. He has biopsy-proven

clear cell RCC with sarcomatoid features. CT and bone scan demonstrate an 8×8 cm left renal mass; 2 pulmonary nodules

(both <2 cm); one lytic bone metastasis on the sternum; one lytic bone metastasis on the pelvis

Proposed action New information Question*

If you were thinking of… And then you find… The new info makes the proposed action…

• Karnofsky performance status

(KPS) is 90%
Recommending cytoreductive • Hemoglobin is 100 g/L -2 -1 0 +1 +2

nephrectomy • Platelet count is 500 (high)
• Calcium, LDH, and neutrophil are

within normal limits

*The new information makes the proposed action:

-2 very inappropriate; -1 inappropriate; 0 neither more nor less appropriate;
+1 more appropriate; +2 very appropriate.

CT, computed tomography; LDH, lactic dehydrogenase; RCC, renal cell carcinoma

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