Pazopanib as salvage therapy in metastatic renal cell carcinoma with hypercalcemic crisis and renal insufficiency: a case report and literature review

The number of newly diagnosed renal cell carcinoma (RCC) cases is about 338,000 every year, making it the 12th most common cancer in incidence rate in the world. Furthermore, about 40% of patients with locoregional RCC experience recurrence and develop metastasis after surgery (1,2). Up to 20–30% of metastatic RCC (mRCC) patients present with hypercalcemia and renal function failure, but only 1.6% patients experience crisis (3,4). Some systemic symptoms resulting from metastatic disease, such as fever, weight loss, anemia, local bone pain, and pulmonary symptoms have been associated with a poor prognosis. In current therapy, gaining control of the disease and improving the quality of life (QOL) of unresectable mRCC patients is still challenging. Pazopanib is an oral multiple receptor tyrosine kinase inhibitor approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) as a first-line therapy for clear cell carcinoma for mRCC patients (5). Based on clinical evidence, few studies have reported on salvage therapy in mRCC with hypercalcemic crisis and renal insufficiency. Here, we share the experience of an mRCC case with concurrent hypercalcemic crisis and renal insufficiency who responded to individual salvage therapy of only 200 mg daily oral pazopanib