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van Riel L, Kets CM, van Hest LP, Menko FH, Boerrigter BG, Franken SM, Wolthuis RMF, Dubbink HJ, Zondervan PJ, van Moorselaar RJA, Houweling AC, van de Beek I. Metastatic disease after removal of a renal cell carcinoma smaller than 3 cm in a patient with Birt-Hogg-Dubé syndrome, a case report. Fam Cancer 2024:10.1007/s10689-024-00408-w. [PMID: 38900222 DOI: 10.1007/s10689-024-00408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Affiliation(s)
- L van Riel
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
- Department of Human Genetics, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - C M Kets
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L P van Hest
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - F H Menko
- Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - B G Boerrigter
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S M Franken
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - R M F Wolthuis
- Department of Human Genetics, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H J Dubbink
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - P J Zondervan
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - A C Houweling
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - I van de Beek
- Department of Clinical Genetics, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Krens SD, Mulder SF, van Erp NP. Lost in third space: altered tyrosine-kinase inhibitor pharmacokinetics in a patient with malignant ascites. Cancer Chemother Pharmacol 2021; 89:271-274. [PMID: 34853912 DOI: 10.1007/s00280-021-04377-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pazopanib and sunitinib are oral tyrosine kinase inhibitors (TKI) approved for the treatment of renal cell carcinoma. For both oncolytics, a clear target trough concentration level in plasma has been defined above which improved clinical efficacy can be expected. However, many factors can alter TKI exposure, including disease characteristics. CASE A 79-year old male with metastatic papillary renal cell carcinoma and malignant ascites was treated with pazopanib. Initially, treatment with pazopanib at adequate trough concentrations resulted in regression of ascites. After a 6-month puncture-free interval, paracenteses were again required and the plasma trough concentration of pazopanib had decreased to 5 mg/L without any dose adjustments. Despite a dose increase, pazopanib levels remained subtherapeutic and could not prevent new paracenteses. Pazopanib concentrations in the drained ascites fluid were comparable to plasma concentrations and remained high also after treatment discontinuation. This observation suggests that the ascites compartment may act as a third space in which pazopanib accumulates. During subsequent treatment with sunitinib, a similar distribution over ascites fluid was observed. CONCLUSION Presence of ascites or pleural effusion in patients treated with TKIs may lead to subtherapeutic plasma exposure, which may hamper treatment efficacy. Measuring TKIs plasma concentrations regularly during treatment is essential to identify patients with subtherapeutic exposure.
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Affiliation(s)
- Stefanie D Krens
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Sasja F Mulder
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Nielka P van Erp
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Soputro NA, Kapoor J, Zargar H, Dias BH. Malignant ascites following radical nephrectomy for cystic renal cell carcinoma. BMJ Case Rep 2021; 14:14/7/e243103. [PMID: 34257120 PMCID: PMC8278893 DOI: 10.1136/bcr-2021-243103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 69-year-old man with a history of laparoscopic radical nephrectomy for papillary renal cell carcinoma presented with a 1-week history of generalised abdominal pain, distension and loss of appetite. Clinical examination and CT imaging demonstrated ascites associated with peritoneal nodules, raising the possibility of metastatic disease. Immunochemistry staining from ascites fluid cytology confirmed renal cell carcinoma. Following multidisciplinary discussions, the patient was commenced on a small-molecule tyrosine kinase inhibitor.
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Affiliation(s)
- Nicolas Adrianto Soputro
- Department of Surgery, Western Health, Footscray, Victoria, Australia .,Urology, Western Health, Footscray, Victoria, Australia
| | - Jada Kapoor
- Urology, Western Health, Footscray, Victoria, Australia
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Kumar N, Lata K, Tripathy S, Shamim SA, Ray MD. Renal Cell Carcinoma Mimicking with Peritoneal Carcinomatosis and Krukenberg Tumor: Diagnosis Seen on Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography. Indian J Nucl Med 2021; 36:207-209. [PMID: 34385798 PMCID: PMC8320827 DOI: 10.4103/ijnm.ijnm_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/04/2022] Open
Abstract
Krukenberg tumor (KT) is a rare clinical entity with a mysterious origin. It originates most commonly from adenocarcinoma of the stomach. We present an interestingly rare case of this entity in renal cell carcinoma, revealed by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) scan. Ovarian cancers with diffuse peritoneal metastasis were considered the differential diagnosis of the disease, based on PET/CT. The potential efficacy of this functional imaging for KT is still in the exploratory phase, but its applications in diagnosis, disease prognostication, therapeutic response monitoring, and follow-up recurrence detection are superior than other imaging modalities.
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Affiliation(s)
- Navin Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanak Lata
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarthak Tripathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mukur Dipi Ray
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
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