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After completing this case study, the reader should be able to:

  • Evaluate first-line pharmacotherapeutic options for patients with metastatic kidney cancer.

  • Formulate a monitoring plan for a patient receiving treatment for metastatic kidney cancer based on patient-specific factors and the prescribed regimen.

  • Recommend alternative pharmacotherapeutic treatment options for patients with relapsed or progressive metastatic kidney cancer.

  • Provide appropriate and detailed educational information to patients about the targeted therapies for metastatic kidney cancer.


Chief Complaint

“What treatment options do I have for my kidney cancer?”


Morgan Shepherd is a 65-year-old woman who presented 3.5 months ago to her primary care physician with complaints of back pain, cough, and weight loss. She did not respond to an initial course of antibiotics for assumed pyelonephritis and developed gross hematuria a few days later. She was subsequently referred to a urologist, who detected a mass on renal ultrasound. CT scan of chest, abdomen, and pelvis revealed a 7-cm left upper-pole kidney tumor, and several bilateral lung nodules. She was referred to a nearby cancer center for further evaluation. A core needle biopsy of the kidney mass revealed neoplastic cells, but the sample was too small and heterogeneous to definitively determine a specific histology. In order to relieve worsening symptoms and further elucidate a specific histopathology of the mass, she underwent radical nephrectomy of her left kidney. Pathologic examination revealed kidney cancer with a clear cell histologic etiology.

Now, 6 weeks later, the patient has recovered from surgery with resolution of back pain and hematuria. She presents to the outpatient oncology clinic for an appointment with the medical oncologist. A postsurgical CT scan reveals persistent lung metastases (unchanged in number or size). She is interested in pursuing systemic treatment of her metastatic renal carcinoma and would like to discuss available treatment options.


  • Hypertension

  • Dyslipidemia


Her mother died at age 75 due to complications related to MI, and her father died at age 73 due to PE. She has one brother, age 58, who is alive and living with asthma, but who is otherwise healthy. She has no family history of cancer.


Mrs Shepherd has been happily married for over 40 years. She has one grown son, age 33, who is alive and healthy. The patient reports an extensive smoking history (25 pack-years), but quit 5 years ago. She is overweight (BM1 29.3 kg/m2).


  • Hydrochlorothiazide 25 mg PO once daily

  • Enalapril 5 mg PO once daily

  • Atorvastatin ...

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