ESMO Preceptorship Programme

Pancreatic Metastasis from RCC mimicking PNET

Siraphong Putraveephong Srinagarind Hospital, Khon Kaen University, Thailand

Metastatic Bladder and Kidney Cancer – Singapore – 4-5 September 2019

ESMO PRECEPTORSHIP PROGRAMME

DISCLOSURE OF INTEREST

◉ No conflicts of interest.

ESMO PRECEPTORSHIP PROGRAMME

Initial Presentation◉ Present with Facial plethora ◉ Polycythemia (Hb 20 / Hct 61) ◉ JAK2 V617F neg

◉ CT (29/10/2008) : Lt.Renal mass 7.1x6.9 cm no LN , no distant metastasis

◉ Lt.Radical Nephrectomy (19/11/2008)◉ Clear cell RCC gr.II

◉ Dx : Clear cell RCC pT2N0M0

64-year-old Male PS 0Comorbid - T2DM- HT- Hypothyroidism

ESMO PRECEPTORSHIP PROGRAMME

1st Line Rx Metastatic RCC◉ September 2011 : LLL Pulmonary nodule 2.1x1.8 cm◉ October 2011 : LLL Lobectomy (13/10/2011)

◉ Metastatic clear cell carcinoma

◉ Dx : Recurrent clear cell RCC with Pulmonary metastasis◉ MSKCC - Favourable risk

◉ January 2012 : start Sunitinib 50 mg/d x 4-wk on/2-wk off◉ Stomatitis gr.2 , HFSR gr.3 —> ↓ Sunitinib 37.5 mg/d◉ January 2012 - September 2017 —> PR

ESMO PRECEPTORSHIP PROGRAMME

Pancreatic Metastasis from RCC◉ May 2017 : Pancreatic mass 1.9x1.5 cm —> MDT : Wait&See◉ October 2017 : Pancreatic mass 3.0x2.1 cm◉ November 2017 : Distal Pancreatectomy (30/11/2017)

◉ Clear cell RCC◉ Complication : Intraabdominal collection , Fistula

ESMO PRECEPTORSHIP PROGRAMME

2nd line Rx Metastatic RCC◉ July 2018 : Liver metastasis at segment 2/3 and 6

◉ PS 1◉ August 2018 : start Axitinib 5mg BID◉ August 2018 - June 2019 : SD

ESMO PRECEPTORSHIP PROGRAMME

CR

ComplicationIntrabdominal collection Fistula

SD> 12 mo.

Lt.Radical

NephrectomyNovember 2008

SunitinibJanuary 2012 -September 2017

AxitinibJuly 2018 -Present

Metastectomy

LLL LobectomyOctober 2011

Distal

PancreatectomyNovember 2017

PR69 mo.

RCC pT2N0M0 RCC rT0N0M1

ESMO Preceptorship Programme

Thank you for your attention !