Pazopanib-Induced Regression of Brain Metastasis After Whole Brain Palliative Radiotherapy in Metastatic Renal Cell Cancer Progressing on First-Line Sunitinib: A Case Report

Pervious randomized studies have demonstrated survival benefit in favor of tyrosine kinase inhibitors (TKIs) compared to cytokines in metastatic clear cell renal cell carcinoma (RCC). However, the role of TKIs for treating brain metastasis from RCC remains unknown. Previous studies have reported possible activity of sunitinib and sorafenib in RCC patients with brain metastasis. We report on patient with metastatic RCC who responded to first-line sunitinib but then progressed with multiple brain metastasis, but with controlled extra-cranial metastatic disease. The patient was treated with whole-brain palliative radiotherapy followed by treatment schedule of pazopanib at standard dose of 800 mg/day which was associated with a response in brain metastasis. Subsequently, she was re-challenged at reduced dose of 600 mg/day and developed further response in metastatic brain lesions. She lived for more than 3 years from initial diagnosis of brain metastasis. This is the first case report of sequential TKI therapy for treating metastatic RCC with brain metastasis and supports the probable use of pazopanib as potent TKI for treating patients with cerebral metastasis.