Pazopanib as salvage therapy in metastatic renal cell carcinoma with hypercalcemic crisis and renal insufficiency: a case report and literature review

A hypercalcemic crisis in renal cell carcinoma (RCC) is an extremely rare and life-threatening condition for advanced RCC patients. It is considered nearly intractable for treatment and a poor-risk category by Memorial Sloan Kettering Cancer Center (MSKCC) criteria. In our case, best supportive care was regularly administered according to the related guidelines and consensuses but with little high-quality, prospective clinical trial data to support the therapeutic strategy. Indeed, determining the individual etiological treatment for a given patient can be challenging. Here, we present a typical case with hypercalcemic crisis, reduced renal function (chronic kidney disease, CKD4), and poor performance status. The patient, who was treated with pazopanib of an individual lower dose of 200 mg daily as salvage therapy, had significantly improved quality of life (QOL) and prolonged progression-free survival (PFS) and overall survival (OS). These are the first results of their kind to be reported of a clinical benefit being generally observed with single doses of 800 mg. How to individually control the primary disease and concurrently relieve the symptoms in clinic to improve QOL and prolong the patient’s PFS and OS is worthy of exploration.