Modern Challenges in Precision Oncology: A Case Presentation of Immuno and Targeted Therapy When Treating Mrcc

Introduction Widespread metastatic renal cell carcinoma (mRCC) can no longer be treated with cytoreductive nephrectomy; instead, targeted therapies such as immune checkpoint inhibitors (ICI) like nivolumab and ipilimumab, and tyrosine kinase inhibitors (TKI), including cabozantinib, are commonly used [1]. While these drugs offer significant benefits in cancer treatment, they also pose their own risk of adverse events. This case highlights the challenges of advanced cancer treatments and the quality versus quantity of life debate. Case Presentation A 75-year-old female with a history of clear cell renal carcinoma and metastases in the brain and lungs was receiving nivolumab and ipilimumab as a first-line treatment. After the second cycle of immunotherapy, the patient was diagnosed with immunotherapy-induced pneumonitis. Treatment with dexamethasone was believed to have relieved symptoms, but after continuing immunotherapy, dyspnea recurred. As a result, palliative treatment with cabozantinib was started. Unfortunately, 5 months after it was prescribed, the patient developed sensitivity in her palms and soles, along with skin peeling and exudation. Therefore, the dose of 60 mg was reduced to 40 mg. A year later, due to pulmonary aspergillosis, treatment with cabozantinib was discontinued for 7 months. 2 months after the rechallenge of cabozantinib, hypothyroidism and hand-foot syndrome relapse led to the suspension of this medication once again. After symptoms were controlled, treatment with TKI was resumed and is continued to this day. Discussion The standard starting dose of cabozantinib in mRCC is 60 mg. However, recent studies show that the best tolerated dose for most patients with mRCC is 40 mg. Additional research is necessary to understand and optimize treatment strategies for individual patient responses. [2]. Nivolumab-ipilimumab combination therapy can cause severe immune-related adverse events like pneumonitis, colitis, and hepatitis, as well as endocrinopathies and neurological complications, necessitating early detection and aggressive management for patient safety [3, 4]. Conclusions Cancer treatments such as targeted therapy and immunotherapy can cause a variety of adverse effects such as immune-related adverse events and treatment toxicity. It is vital to monitor patients for any complications and to adjust treatment accordingly.