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Background  There is no established treatment after failure of proven therapies for patients with metastatic renal cell carcinoma.    Case presentation  A 66-year-old Japanese man with metastatic renal cell carcinoma became refractory to interferon α and sunitinib therapies. He started treatment with axitinib at 10 mg/day, and the dose was gradually tapered down to 4 mg/day because of intolerable adverse events. His metastatic lesions shrank; however, he could not continue due to the adverse events. He started fourth-line therapy with nivolumab; however, the metastatic lesions increased. Rechallenge with axitinib 4 mg/day was started, and the dose was reduced to 2 mg/day because of adverse events. Subsequently, the adverse events became controllable, and the metastatic lesions were maintained at reduced size.    Conclusion  Therapeutic drug monitoring of axitinib could play an important role in the development of safe and effective therapeutic treatment and individualization of these medications.

journal of medical case reports

Low-dose axitinib rechallenge with positive outcomes in a patient with metastatic renal cell carcinoma refractory to interferon α, sunitinib, axitinib, and nivolumab therapies: a case report