Authors: Check DL, Check JH, Poretta T.
Cardiovascular complications of hemodialysis leading to shortened life spans, has led to the modern trend of recommending conservative laparoscopic surgery rather than bilateral nephrectomy for multifocal bilateral renal carcinoma. However, following repeated surgery for lesions reaching >3cm, eventually leads to renal failure, and hemodialysis will still be needed. By suppressing the immunomodulatory protein, called the progesterone induced blocking factor (PIBF), the progesterone receptor modulator mifepristone has been found to inhibit further metastatic spread of a variety of advanced cancers, leading to improved longevity and quality of life. To test a hypothesis that treatment with mifepristone can prevent growth of smaller multifocal renal cell carcinoma lesions to the point of requiring more surgery, after initial renal sparing surgery, a 58 year old man with multifocal renal cell carcinoma was prescribed 200mg daily oral mifepristone following laparoscopic removal of a large lesion in the right kidney, but not removing 3 smaller lesions in the left kidney. After 10 years of mifepristone treatment, the 3 left kidney lesions remained stable, and no new lesions appeared. Unfortunately, his diabetes caused renal failure, and bilateral nephrectomy was performed, followed by short term hemodialysis. Related to his lack of progression of his cancer, he was approved for kidney transplant. He is alive and well 17 years from original diagnosis, with no evidence of metastases from his renal cell carcinoma. Hopefully, this case will create an interest in a clinical trial of mifepristone, plus renal sparing surgery for multifocal kidney cancer to help determine if this man’s apparent response to mifepristone was the exception or the rule.
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